Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence

Rouleau, Geneviève; Richard, Lauralie; Côté, José; Gagnon, Marie‐Pierre; Pelletier, Jérôme

doi:10.1097/jnc.0000000000000103

Cited by 32 publications

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References 27 publications

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“…To gain insight into HIV nursing practice and the challenges nurses face when providing antiretroviral therapy–related care, a qualitative study [ 16 ] was conducted, identifying 3 challenges. The first was performing nursing roles at the interface of social and biomedical boundaries: nurses sometimes felt unequipped to perform their social role.…”

Section: Methodsmentioning

confidence: 99%

“…On the basis of the needs identified by nurses providing HIV care in a qualitative study [ 16 ], we developed a VP simulation aimed at improving the nurses’ relational skills consistent with motivational interviewing (MI) [ 17 ] in situations of antiretroviral therapy nonadherence. MI is a person-centered, collaborative communication style that seeks to elicit people’s motivation and commitment to change.…”

Section: Introductionmentioning

confidence: 99%

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Codeveloping a Virtual Patient Simulation to Foster Nurses’ Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence

et al. 2020

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Background Although helping people living with HIV manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient (VP) having difficulty adhering to treatment to foster the relational skills that nurses require in such situations. Objective This viewpoint paper aims to describe the codevelopment process and the content of VP simulation, as well as the challenges encountered and the strategies used to overcome them. Methods We use a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strengths-based nursing, motivational interviewing [MI], and adult learning theories), and expert recommendations. We carried out 2 main phases: (1) planning the simulation development and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behavior change counseling techniques derived from MI) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), a dialogue is opened up with the VP. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the VP will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops. Results Two main challenges are discussed. The most salient challenge was related to the second phase of the VP simulation development. The first was to start the project with divergent conceptions of how to approach the VP simulation—the simulation company’s perspective of a procedural-type approach versus the clinical team’s vision of a narrative approach. As a broad strategy, we came to a mutual understanding to develop a narrative-type VP simulation. It meshed with our conception of a nurse-patient relationship, the values of strengths-based nursing (a collaborative nurse-patient relationship), and the MI’s counseling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool. Conclusions Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative VP simulations. As relational skills are used by all nurses—from novices to experts—and other health care practitioners, focusing on this clinical behavior is a good way to ensure the simulation’s adaptability, sustainability, and efficiency.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Codeveloping a Virtual Patient Simulation to Foster Nurses’ Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence

et al. 2020

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“…We conducted a qualitative exploratory study aimed at understanding HIV-nursing practice, its challenges, and the training needs of nurses. [8] One of the challenges was the misalignment between nurses' goals for patient ART adherence and those of their patients. When faced with patients' non-adherence, nurses in our study provided their patients with advice, information, and tips.…”

Section: Introductionmentioning

confidence: 99%

“…Used as a behavioural change counselling approach in nursing, as supported in this systematic review, [15] MI is promising in fostering HCP's relational skills in HIV care [16] and in enhancing medication adherence. [17][18][19] To ll the gap in this type of educational intervention for nurses, and based on a previous qualitative study, [8] we developed a virtual patient (VP) simulation [20]. The VP simulation was informed by a strengths-based nursing approach [21], MI [9], and adult learning theories [22], with the aim to improve nurses' relational skills.…”

Section: Introductionmentioning

confidence: 99%

Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed-methods study

Rouleau

Gagnon

Côté

et al. 2020

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Background: Some nurses may feel ill-equipped to support people living with HIV who do not optimally adhere to their antiretroviral therapy. In response, to enhance the relational skills nurses require in situations of non-adherence, we developed a virtual patient simulation that features an HIV-positive man struggling to adhere to his therapy. The simulation is informed by a strengths-based nursing approach, motivational interviewing, and adult learning theories This study aimed to assess nurses’ perception of simulation’s acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses’ learning experience.Methods: We conducted a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select Canadian registered nurses (n=49). who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. At the final stage of the study, we used a comparison strategy for integrating the quantitative and qualitative results.Results: Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research.Conclusions: The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses’ self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration: ISRCTN18243005, retrospectively registered on July 3 2020.

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“…In response to the paucity of this type of educational intervention for nurses, and based on a previous qualitative study exploring nurses' practice and challenges in the context of HIV care [15], we developed a VP simulation with the aim to improve nurses' relational skills [16]. The clinical case scenario is the story of Mr. Wilson, an HIV-positive man having di culty taking his antiretroviral therapy.…”

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confidence: 99%

Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed methods study

Rouleau

Gagnon

Côté

et al. 2020

Preprint

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Background Nurses must meet professional standards by attending continuing education activities. Despite the potential of virtual patient simulation in nursing education, it has rarely been used in nurses’ continuing education to address relational skills. We developed an automated virtual patient simulation informed by motivational interviewing to enhance nurses’ relational skills. The simulation features an HIV-positive man struggling to adhere to his medication. Quizzes and feedback loops embedded in the simulation allow learners to observe the consequences of their choices. This study aimed to assess nurses’ perception of simulation’s acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses’ learning experience. Methods We performed a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select registered nurses (n=49) working in Quebec, Canada, who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. Results Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research. Conclusions The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses’ self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration:ISRCTN18243005, retrospectively registered on July 3 2020.

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Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence

Cited by 32 publications

References 27 publications

Codeveloping a Virtual Patient Simulation to Foster Nurses’ Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence

Codeveloping a Virtual Patient Simulation to Foster Nurses’ Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence

Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed-methods study

Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed methods study

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