Can a mentorship intervention for nurses improve healthcare for people living with HIV?

A Canadian mentorship intervention¹ that brings experienced HIV nurses and people living with HIV together with less HIV-experienced nurses has shown that mentorship can improve nurses’ attitudes toward, and knowledge of, issues related to HIV.

The mentorship intervention

The mentorship intervention, which had four sites (two rural, two urban) across Canada, brought together experienced HIV nurses (nurse mentors), people living with HIV (HIV-positive mentors) and less HIV-experienced nurses (nurse mentees) to increase the capacity of nurse-mentees to provide comprehensive HIV care for people living with HIV. The intervention was evaluated through pre- and post-intervention surveys with all three groups of participants.

The content of the intervention and how it was delivered was collaboratively determined by nurse mentor, HIV-positive mentor and nurse mentee participants at each site; the community advisory committee that informed the intervention; and the research team. Participants were able to tailor content and format to their practice environments and learning needs.

At three sites, the intervention consisted of three workshops: one at the beginning of the intervention, one six months later, and the final one six months after that. At a fourth site, only two workshops were held, one at the beginning of the intervention and a final one six months later. This was due to participant preference and time constraints.

The workshops were facilitated by the research team, and a variety of methods were used, including body mapping, videos, guest speakers and case vignettes. The first workshop focused on relationship development and building knowledge of HIV care, treatment and prevention. Discussion centred on key social and political issues that influenced care, and issues related to key affected populations. Topics and structures for the second and third workshops were determined at each site during the first workshop.

Between workshops, monthly group meetings were held to continue discussions among all three groups of participants. These in-person meetings were facilitated by the mentors. Nurse mentors, HIV-positive mentors and nurse mentees discussed the lived experience of people living with HIV, client engagement in healthcare, and interdisciplinary practices in HIV care.

The overall time commitment for the program was two hours weekly for workshops, meetings and interviews for the duration of the intervention (six or 12 months).

Results

At the start of the program, there were

• 40 nurse mentees (eight to 12 per site)
• 8 HIV-positive mentors (one to three per site)
• 8 nurse mentors (one to three per site)

The program was completed by 70% (28) of the nurse mentees and 87% (14) of the mentors .

All of the nurse mentors had specialized in HIV care for more than 10 years and most of the HIV-positive mentors had been living with HIV for more than 10 years. All of the nurse mentees had cared for at least one HIV-positive person during their career, and 71% reported some training on HIV.

Significant increase in self-reported knowledge and changed attitudes among nurse mentees

The study found:

• a significant increase in preparedness to provide care to people living with HIV among participants who reported being unprepared or uncertain before the intervention.
• a significant improvement in nurse-mentee HIV-specific knowledge.
• a significant improvement in nurse-mentee knowledge specific to nursing.

Interviews with nurse mentees supported the positive impact found by the survey. Nurse mentees reported that intervention helped them:

• develop more positive attitudes toward people living with HIV
• recognize their preconceptions about clients living with HIV, gay men, people who use drugs and people living with mental health challenges;
• enhance their ability and their confidence to care for clients with HIV;
• feel more comfortable sharing their new knowledge with colleagues; and
• develop a desire to advocate for changes to the health system to improve care for people living with HIV.

Program had positive impact on nurse- and HIV-positive mentors too

There were no significant changes observed in the knowledge, attitudes and practices of the nurse mentors or HIV-positive mentors as measured by the pre- and post-intervention surveys. This was likely due to the high level of experience among mentors.

Nevertheless, both nurse mentors and HIV-positive mentors benefitted from the intervention. Interviews suggested that mentors gained confidence, updated their knowledge, and for HIV-positive mentors, gained an understanding of health service procedure and practice, and better understood themselves.  

What does this mean for Canadian service delivery?

People living with HIV in Canada are not optimally engaged in care.^2,3 Many factors may contribute to a reticence among some people living with HIV to access and remain in HIV and other healthcare services, including healthcare-provider stigma. This mentorship intervention demonstrated that positive changes in knowledge, attitudes and practice can take place if nurses are given the opportunity to learn from experienced nurses and people living with HIV. Education and support for clinicians to improve care for people with complex health needs, including people living with HIV, is available in Quebec, Manitoba, Alberta, and British Columbia.

References

1. Worthington C, O’Brien K, Mill J, et al. A mixed-methods outcomes evaluation of a mentorship intervention for Canadian nurses in HIV care. Journal of the Association of Nurses in AIDS Care. 2016 (in pres).
2. Nosyk B, Montaner JSG, Colley G, et al. The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study. The Lancet Infectious Diseases. 2014 Jan;14(1):40–9.
3. Gilbert M, Gardner S, Murray J, et al. Quantifying the HIV care cascade in Ontario: Challenges and future directions. Poster presented at: 24th Annual Canadian Conference on HIV/AIDS Research; 2015 May 30; Toronto, Ontario. Available from: http://www.cahr-acrv.ca/wp-content/uploads/2012/10/InfDis_26_SB_MarApr2015_Final.pdf

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