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：
10701868
负责人：
Christina Psaros
金额：
$ 25.92万
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/10701868
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 Eligibility Determination Empathy Enrollment Epidemic Evaluation Feedback Focus Groups Fostering Goals HIV Health Health Personnel Healthcare Systems Highly Active Antiretroviral Therapy Home Hospitalization 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 Vertical Disease Transmission Viral Viral Load result Wages Work World Health acceptability and feasibility barrier to care burnout clinically relevant coping efficacy trial experience feasibility testing improved interpersonal conflict member migration occupational stress patient-level barriers premature programs promote resilience 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.

项目概要南非 (SA) 是世界上艾滋病毒流行最严重的国家，有 720 万人感染，患病率 15-49 岁的成年人中，护士占 18.8%，是南澳医疗保健系统中最大的提供者群体。他们是艾滋病毒护理的一线治疗人员，他们因工作倦怠而感到特别严重。资源限制、长期超负荷工作和职业压力；工资；将工作转移给护士；以及艾滋病毒耻辱；这些压力在 COVID-19 大流行的背景下加剧。倦怠会导致艾滋病毒感染者 (PLWH) 患者出现负面结果，包括：(1) 自我报告对患者的护理和态度不佳；(2) 患者满意度下降；(3) 术后满意度增加；住院恢复时间；(4) 减少高效抗逆转录病毒治疗 (HAART) 的依从性； HIV 检测的采用是由于经历过或预期的负面患者与提供者互动的结果。提供者关系是艾滋病毒护理参与和保留的核心要素；患者更喜欢提供者；具有良好的沟通技巧，具有同理心、参与性和验证困难的行为在高压力和倦怠的情况下进行模仿，增强复原力的干预措施可以最大限度地减少这种情况。然而，尽管对个人、患者层面进行了数十年的研究，但工作相关压力的负面影响；影响艾滋病毒护理参与的因素，目前还没有已知的干预措施系统地尝试支持通过向南澳护士提供更有效地管理和应对压力源的技能，提高他们的福祉该应用程序的目的是调整放松。响应弹性计划 (3RP)，以满足南澳公共部门提供艾滋病毒护理的护士的需求增强复原力并减轻压力，并最终改善患者相关的结果。作为这一形成性可行性和可接受性研究的一部分，具体目标是：(1) 探索如何 3RP 要求进行调整，以满足在南澳公共部门提供艾滋病毒护理的护士的需求，基于从定性焦点小组讨论中收集数据，并相应地调整干预措施，以及（2）之后一项小型概念验证研究，对在公共部门提供艾滋病毒护理的护士进行随机试点在 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。了解如何缓解南澳公共部门艾滋病毒护理护士的高压力和倦怠感护士是世界上艾滋病毒负担最重的一线治疗者，这些数据将为我们提供信息。更大规模、多地点、随机功效试验，着眼于干预措施对护士福祉的影响，以及患者的治疗结果（例如，成功参与艾滋病毒护理、患者与护士的信任、对治疗的满意度最终，我们希望在全国范围内的公共卫生部门诊所中开发出一种解决方案。干预措施适用于其他资源有限环境中的其他提供者。