Developing a resiliency intervention to support healthcare workers engaged in the provision of HIV care

制定弹性干预措施，支持从事艾滋病毒护理的医护人员

基本信息

批准号：
10402106
负责人：
Christina Psaros
金额：
$ 18.52万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-09 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10402106
关键词：
Address Adherence Adult Affect Age American Attitude Behavior COVID-19 pandemic Care given by nurses Caring Chronic Client satisfaction Clinic Communication Coping Skills Data Discipline of Nursing Educational process of instructing Elements Enrollment Epidemic Evaluation Feedback Focus Groups Fostering Goals HIV Health Health Personnel Healthcare Healthcare Systems Highly Active Antiretroviral Therapy Home Human immunodeficiency virus test Hybrids Immunity Individual Intervention Interview Length Measures Medical Nurses Occupational Occupations Outcome Participant Patient Self-Report Patient-Focused Outcomes Patients Perception Personal Satisfaction Persons Prevalence Prevention Procedures Protocols documentation Provider Province Psychology Public Health Public Sector Randomized Recovery Relaxation Research Resource-limited setting Resources SARS-CoV-2 B.1.351 Shoulder Site Source South Africa Stress Time Trauma Trust Ursidae Family Vertical Disease Transmission Viral Viral Load result Wages Work acceptability and feasibility barrier to care base burnout clinically relevant efficacy trial experience feasibility testing improved individual patient interpersonal conflict member migration occupational stress patient-level barriers premature programs resilience response satisfaction shift work skills social stigma stress management stress reduction stress resilience stressor testing uptake therapy development virtual

项目摘要

PROJECT SUMMARY South Africa (SA) has the largest HIV epidemic in the world, with 7.2 million people infected and a prevalence of 18.8% among adults ages 15-49. Nurses constitute the largest group of providers in SA’s healthcare system and are frontline treaters in HIV care. They experience particularly high levels of burnout resulting from resource limitations, chronic work overload, and occupational stress; inadequate staffing, resources, and wages; increased task-shifting work to nurses; interpersonal conflict; and HIV stigma, including stigma by association. These stressors are worsened in the context of the COVID-19 pandemic. Provider stress and burnout leads to negative patient outcomes for persons living with HIV (PLWH), including: (1) self-reported suboptimal care and attitudes toward patients; (2) decreased patient satisfaction; (3) increased post- hospitalization recovery time; and (4) reduced adherence to highly active antiretroviral therapy (HAART) and HIV testing uptake as a result of experienced or anticipated negative patient-provider interactions. Patient- provider relationships are a core element of engagement and retention in HIV care; patients prefer providers who have good communication skills, and are empathetic, engaging, and validating, behaviors that are difficult to emulate in the context of high stress and burnout. Interventions that foster resilience can minimize the negative impact of work-related stress; however, despite decades of research into individual, patient-level factors impacting HIV care engagement, no known interventions have systematically attempted to support the wellbeing of nurses in SA by providing them with skills to more effectively manage and cope with stressors that negatively and directly impact patient outcomes. The objective of this application is to adapt the Relaxation Response Resiliency Program (3RP) to the needs of nurses providing HIV care in the public sector in SA to build resilience and reduce stress, and ultimately improve patient-related outcomes. We propose the following specific aims as part of this formative feasibility and acceptability study: (1) to explore the ways in which the 3RP requires adaptation to meet the needs of nurses providing HIV care in the public sector in SA, based on data collected from qualitative focus group discussions, and to adapt the intervention accordingly, and (2) after a small proof-of-concept study, to conduct a randomized pilot of nurses providing HIV care in the public sector in SA to test the feasibility and acceptability of all study procedures. The proposed work will contribute to our understanding of how to offset high stress and burnout among HIV care nurses in SA’s public sector, a setting with the world’s most significant HIV burden, where nurses are the frontline treaters. These data will inform a larger, multi-site, randomized efficacy trial looking at the impact of the intervention on the wellbeing of nurses, as well as on patient outcomes (e.g., successful engagement in HIV care, patient-nurse trust, satisfaction with care, and viral suppression) in public health sector clinics nationwide. Ultimately, we hope to develop an intervention with applicability to other providers in other resource-limited settings.

项目摘要南非（SA）拥有世界上最大的艾滋病毒流行病，感染了720万人 15-49岁的成年人中的18.8％。护士构成了SA的医疗保健系统中最大的提供商组并且是艾滋病毒护理中的前线卫生员。他们经历了特别高水平的倦怠。资源限制，长期工作超负荷和承受压力；人员配备不足，资源和增加对护士的任务转移工作；人际冲突；和艾滋病毒污名，包括协会。这些压力源是在19009年大流行的背景下被遗忘的。提供者的压力和倦怠导致艾滋病毒（PLWH）患者的患者结果负面影响，包括：（1）自我报告次优护理和对患者的与会者；（2）患者满意度降低；（3）增加之后住院恢复时间；（4）降低了对高度活性抗逆转录病毒疗法（HAART）和艾滋病毒测试是由于经验或预期的负面患者互动而导致的。病人- 提供者的关系是艾滋病毒护理中参与和保留的核心元素；患者更喜欢提供者谁具有良好的沟通能力，并且具有善解人意，引人入胜和验证的行为很困难在高压力和倦怠的背景下模仿。促进弹性的干预措施可以最大程度地减少与工作有关的压力的负面影响；但是，对个人，患者级的研究目的地影响艾滋病毒护理参与的因素，没有系统地试图支持通过为他们提供技能，以更有效地管理和应对压力源，使他们在SA中的福祉负，直接影响患者的结果。该应用的目的是适应放松响应弹性计划（3RP）满足在SA的公共部门提供艾滋病毒护理的护理需求建立弹性并减轻压力，并最终改善与患者相关的结果。我们提出以下内容具体目的是这项形成性可行性和可接受性研究的一部分：（1）探索方式 3RP要求适应以满足根据SA的公共部门提供艾滋病毒护理的护士的需求从定性焦点小组讨论中收集的数据，并相应地调整干预措施，（2）一项小的概念证明研究，以在公共部门进行艾滋病毒护理的随机飞行员在SA中测试所有研究程序的可行性和可接受性。拟议的工作将有助于我们了解如何抵消SA公共部门的艾滋病毒护理护士之间的高压力和倦怠，这是一个环境与世界上最重要的艾滋病毒伯恩（Hiv Burnen）在一起，护士是前线卫生师。这些数据将告知较大的多站点，随机效率试验，研究干预对护士福祉的影响，以及患者的结果（例如，成功参与艾滋病毒护理，患者 - 苏尔斯信托，满意度全国公共卫生部门诊所的护理和病毒抑制）。最终，我们希望发展在其他资源有限设置中适用于其他提供商的干预措施。