HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania.
HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania.
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DOI：
10.1186/1478-4491-5-18
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发表时间：
2007-07-24
影响因子：
4.5
通讯作者：
Moland, Karen M
中科院分区：
文献类型：
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作者：
Leshabari, Sebalda C;Blystad, Astrid;Moland, Karen M
背景：在母乳喂养规范的环境中，婴儿喂养是预防母婴传播（pMTCT）规划中令人担忧的问题。护士辅导员面临着许多挑战，他们被期望就国家/国际准则中确定的更安全的婴儿喂养方法向艾滋病毒阳性妇女提供咨询。本研究旨在探讨坦桑尼亚北部乞力马扎罗山地区参加预防母婴传播项目的艾滋病毒阳性母亲作为婴儿喂养顾问的护士的经验和处境关切。方法：采用深度访谈和焦点小组讨论（fgd）对四个预防母婴传播站点的25名护士咨询师进行定性研究。访谈是手写的，fgd是录音和转录的，而“开放代码”程序协助整理和组织数据。采用“内容分析”进行分析。结果：调查结果显示，护士辅导员的压力和沮丧程度很高。他们发现自己无法就如何最好地喂养婴儿向艾滋病毒阳性妇女提供合格和相关的建议。她们对自己应建议艾滋病毒阳性妇女采用的喂养方式是否适当感到困惑，并认为纯母乳喂养和纯替代喂养在文化和社会上都不合适。然而，大多数咨询师认为，配方奶喂养是艾滋病毒阳性妇女喂养婴儿的正确方式。她们表示对自己对艾滋病毒和婴儿喂养的知识缺乏信心，也对自己评估妇女坚持某种特定喂养方法的可能性的技能缺乏信心。此外，护士们普遍对他们新获得的顾问角色感到不舒服，并认为这破坏了传统上赋予护理作为知识和关怀职业的权威和信任。结论：研究结果表明，在预防母婴传播规划中，作为婴儿喂养顾问的护士承担着巨大的负担，迫切需要提供必要的培训和支持结构，以提高专业信心和技能。咨询服务的组织必须在更大程度上考虑到护士作为艾滋病毒阳性育龄妇女咨询师的作用的当地现实情况。
BACKGROUND: Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania.METHODS: A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.'RESULTS: The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession.CONCLUSION: The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.