Assessing the Cultural Competence of Nurses Conducting the Informed Consent Process among Patients with HIV/AIDS

Transcription

1 Assessing the Cultural Competence of Nurses Conducting the Informed Consent Process among Patients with HIV/AIDS Salud B. Zaldivar, RN, MA 1, 2 Johann Fabrian Q. Bolinao, RN, MSPH 1 1 The Medical City, Philippines 2 Research Institute for Tropical Medicine, Department of Health, Philippines

2 INTRODUCTION Thirty years of AIDS epidemic has mobilized biomedical and social scientists to halt the phenomenon from becoming a global pandemic. The effort to reach vulnerable individuals to make their informed decision and adhere to behavior change and/or treatment needs to be intensified. The introduction of the informed consent process together with experiential method as innovative tool in transforming health care providers in their expanded role as humane counselors is timely. The purpose of this study was to evaluate the utility of this approach by conducting a seminar-workshop on HIV/AIDS counseling among health care providers to assess their personal sensitivity to the knowledge, perception, and practice (cultural competence) that would favorably contribute to their counseling skills, and to determine the significant difference between two groups of nurses in terms of cultural competency on the crucial components of the informed consent process.

3 THEORETICAL FRAMEWORK

4 REVIEW OF LITERATURE Through the review of literature, the choice of Purnell s Model for Cultural Competence (Larry Purnell, PhD, 1995) described the 12 cultural domains from which major assumptions could be derived where cultural competence, principles of informed consent process, and counseling skills could be readily adopted and modified to address the management of persons infected and affected with HIV/AIDS in a health care continuum. Each individual has the right to be respected for his/her uniqueness and cultural heritage. Culture has a powerful influence on one s interpretation of, and responses to health care. Prejudice and biases can be minimized with cultural understanding. If clients are co-participants in care and have a choice in health-related goals, plans, and intervention, health outcomes will be improved. To be effective, health care must reflect the unique understanding of the values, beliefs, attitudes, and lifestyles, and worldview of diverse populations, and individual acculturation patterns. Cultural competence includes people from low socioeconomic backgrounds marginalized citizens tend to be more passive and are reluctant to voice their opinions or preferences, and may be less willing to trust their own judgment,.

5 METHODOLOGY Offshoot of a request to conduct a seminar-workshop on HIV/AIDS counseling with special focus on the ethical issues related to informed consent process from two different teaching hospitals. Total of 70 participants. 35 each hospital. First group = nurses with years of clinical experience. Second group = nurses with <1 year of clinical experience. Before the seminar-workshop: A 10-item questionnaire was administered to assess the following: Perception of participants on HIV/AIDS Philippine AIDS law Hospital Policy During the seminar-workshop: Various teaching techniques were employed to encourage participants to actively get involved in the discussions and open forum. Experiential method, such as Role Play and Simulated Scenario were employed. The entire session was documented via CCTV with the participants permission. After the seminar-workshop: An assessment on the cultural competency on the crucial components of the informed consent process was administered, using a 10-item likert scale questions.

6 RESULTS (Assessment before workshop)

7 RESULTS (Assessment after workshop) Sum of Ranks Mann Whitney U test for Ordinal Scale Mean of Ranks Expected Sum of Ranks Expected Mean of Ranks U value Expected U value Group Group Group 1 and 2 combined Sum of Ranks: 2485 Mean of Ranks: 35.5 Standard Deviation: SIGNIFICANCE LEVEL = 0.05 TWO TAILED Z SCORE = P VALUE = U VALUE = 287 There is a significant difference between the two groups of nurses in terms of cultural competency on the four crucial components of the informed consent process (p=< )

8 DISCUSSION The nurses in the first group were more focused on their specialty areas other than the fact that they hold administrative positions in the hospital. The nurses in the second group seemed to be theoretically knowledgeable as they are new graduates, but because of the limited length of clinical practice, they are less aware of the discordance between the Philippine AIDS law and the actual implementation of hospital policies related to HIV/AIDS. The significant difference between the two groups of nurses in terms of cultural competency on the four crucial components of the informed consent process could have been brought about by the inclusion of the experiential method of the HIV/AIDS pre and post test counseling that elicited a true to life emotional reactions that most participants in the first group that provided them the opportunity to reflect on their previous clinical experiences.

9 DISCUSSION Interestingly, there are several issues that surfaced that needed to be addressed. Some of these were: Will there be a difference in the standard of care given among patients with HIV who are duly coded, and those who are not? Are primary physicians of patients with HIV required to inform other health care providers of their patient s diagnosis? Should there be an institutional policy that the patient who was the source of the body fluids be required to undergo HIV/AIDS screening and other tests for infectious diseases in order for the health care provider to access post exposure prophylaxis. Are Voluntary Blood Centers compelled to inform donors whose blood results turned out to be reactive to HIV test? Does the confidentiality of the patient's HIV diagnosis end with death, as this is required by Law to be indicated in his death certificate?

10 CONCLUSION Based on the findings, this study facilitated the participants the opportunity to make a self assessment of their cultural competence, whereby they are in a better position to make an informed decision to pursue and hone their skills on HIV/AIDS counseling. This innovative approach has good potential in improving the basic curriculum content and continuing education for nurses and other health care providers who are inevitably confronted with challenging ethical issues related to HIV/AIDS and patients' rights.

11 THANK YOU