Nurses and midwives provide the backbone of health care delivery systems worldwide. Members of this community share experiences and exchange information in efforts to raise the standard of nursing care and training.
The 64th World Health Assembly held by the World Health Organization in May 2011 reaffirmed the crucial contribution of the nursing and midwifery professions to strengthening health systems and recognized the need to support nurses and midwives through coordinated training and human resources programmes. (Sixty-Fourth World Health Assembly. Agenda item 13.4. WHA64.7. 24 May 2011. pdf) Implementing nurse mentoring and quality improvement initiatives is an important strategy to improve care, particularly in sub-Saharan Africa where patient care is being shifted from physicians to nurses, especially in HIV care and treatment (Kanchanachitra et al. 2011).
In 2010, Partners in Health in Rwanda/Inshuti Mu Buzima started a collaboration with the Ministry of Health in hospitals in two rural districts to create the Mentoring and Enhanced Supervision at Health Centres (MESH) program. This program aims at strengthening clinical service delivery through ongoing clinical mentoring of nurses, continuous quality improvement initiatives, and decentralized training of nurses. Led by Manzi Anatole, Director of the MESH Program, this expert panel discussion focused on clinical mentoring initiatives for nurses and touched upon issues ranging from monitoring and evaluation to integration in the health system.
Nurses working in developed and developing countries confront challenges in promoting adherence to HIV treatment, particularly among patients with numerous, complex needs. Good adherence is important because it strongly predicts viral suppression, drug resistance development, disease progression, and death (Bangsberg, 2010). Adherence has also been shown to be associated with lower overall medical costs, as patients stay healthier and out of the hospital (Nachega, 2010). Through this online discussion, nurses working globally exchanged tools and lessons learned while trying to prepare patients to begin life-long medication adherence.
The discussion began with two case descriptions of immigrant patients at a Boston infectious disease clinic. Subsequently, nurses with work experience in the U.S., Ethiopia, Nigeria and South Africa offered suggestions to improve patient care. Nurses emphasized the need to conduct assessments related to treatment readiness, cultural backgrounds, and literacy. Participants shared tools and training curriculums, offered step-by-step guides for working with patients from other cultures and discussed the need to involve patients’ families and communities.