South-South-North HIV/AIDS Nursing Network CURRICULUM

University of Malawi

University of Zambia

South-South-North HIV/AIDS Nursing Network

CURRICULUM

Mbirimtengerenji, Noel

1

DEDICATION

To all prospective Nurse-Midwife professionals, faculty members of the concerned colleges and the involved nations.

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DECLARATION We declare that this curriculum is entirely and completely the result of our own work and effort. This document has never been presented, used or submitted elsewhere for any purpose. Therefore no part of this document may be used or reproduced in any manner whatsoever without written permission, except for brief quotations embodied in critical articles and reviews. It has been prepared, analysed, compiled and written by : NAMES Mrs. Prof. Dr. Olivia Dibelius – Project leader and head of the Degree Programme Nursing Science/Nursing Management, Evangelische Hochschule Berlin Mrs. Dagmar Preiß-Allesch –Project administration and Health of the international office, Evangelische Hochschule Berlin Mrs. Simbirai Gwaze – lecturer of the health faculty, Africa University – Zimbabwe, Mutare Mrs. Violet Chikanya – lecturer at the faculty of health, Africa University – Zimbabwe, Mutare Mrs. Dr. Prudencia Mwemba – clinical nursing specialist, lecturer/consultant at the faculty of Health Sciences, University of Zambia Mrs. Patricia Mukwato-Katowa – lecturer at the faculty of Health Sciences, University of Zambia Mr. Noel Mbirintengerenji – lecturer Medical Surgical Nursing Department, University of Malawi – Kamuzu college of Nursing The Committee Members are: Mrs. Prof. Dr. Erika Feldhaus-Plumin, head of the BA-Programme of Nursing, Evangelische Hochschule Berlin Mrs. Martha Kamanga – lecturer Maternal and Child Health Department (MCH), University of Malawi – Kumuzu college of Nursing 3

Mrs. Concepta Kwaleyela, midwife, lecturer at the Faculty of Health Sciences, University of Zambia; Lusaka Mrs. Evelyn Chilemba, lecturer at the Faculty of Nursing, University of Malawi, Kamuzu College of Nursing, Lilongwe Mrs. Winnie Chilemba, lecturer at the Faculty of Nursing, University of Malawi, Kamuzu College of Nursing, Lilongwe Mrs. Caroline Chitsulo, lecturer at the Faculty of Nursing, University of Malawi, Kamuzu College of Nursing, Lilongwe

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Curriculum for South-South-North Network in HIV/AIDS Nursing Sciences ACKNOWLEDGEMENTS Our profound gratitude should totally go to all faculty members involved in developing the modules in this curriculum. This is because of their dedication during our learning process and curriculum development. Without their guidance, this curriculum could not have been logical, concise and comprehensive. Another heartfelt thanks should be extended to our families for their patience. The psychological support and encouragement that was given to us empowered us to achieve our ambitious goals, thus developing the South-South-North Network Curriculum. Our acknowledgement should also be extended to fellow workmates and nurses for their constructive criticism during the development of the curriculum. The support, guidance and counseling that we offered one another during sleepless nights and days helped us to come up with this successful curriculum. May God bless you all.

Executive Management South-South-North Network

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PREFACE The current trends in nursing education require all faculty members to develop, implement and evaluate their degree programs. In response to these trends, the faculty members of the newly formed South-South-North Network for HIV/AIDS decided to come up with this curriculum for nurses in HIV and AIDS management. The layout of the curriculum has been organized to help all professional readers to easily locate their area of interest and module in HIV and AIDS management. The first part of this curriculum concerns the mission, purpose and goals of the Colleges. It should be noted that the universities and concerned colleges exist for the provision of quality nursing education to all prospective Nurse/Midwifery professionals. The major concepts underlying the curriculum have been analyzed in the philosophy of the Colleges. These concepts were selected in accordance with their beliefs (and international approved theories in nursing). Later on the conceptual framework, HIV and AIDS, has been highlighted to briefly illustrate the basis of the Colleges’ philosophy. The characteristics of the Colleges’ graduates have been briefly presented after the conceptual framework to make sure that their philosophy is consistent withall aspects of HIV and AIDS management. It should be noted, that the curriculum has been based on nursing theories that are currently in use in most hospitals in the countries mentioned. Such theories include: Orem’s self care, Roper’s activity of living, Roy’s adaptation theories and Leininger’s theory of transculture. The HIV and AIDS programme objectives have been presented at each level to show how they have been broken down . These objectives have been arranged from simple to complex and from known to unknown. This design was chosen to ensure that the aquisition of knowledge, a professional attitude and skills in HIV and AIDS is logical and systematic. All courses that are going to be offered at the colleges, focus on the requirements of registration and the regulations of the nursing body in the specific country they are in. Therefore, HIV and AIDS counseling, HIV policies and ARV modules, which are the 6

backbone subjects, have been allocated more time than other subjects (see contents map). The focus of all subjects has been presented so that faculty and students are guided to the relevant HIV and AIDS contents.

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TABLE OF CONTENTS CONTENTS

PAGE

Dedication

2

Declaration

3

Acknowledgement

5

Preface

6

Table of contents

8

Organization structure

18

1 Introduction

19

1.1 Admission Requirements

19

1.2 Admission Criteria

20

2 Mission statement of the Network

20

2.1 Vision of the Network

20

2.2 The Institute of South-North Network in HIV/AIDS’s main objectives

20

2.3 Purpose and Goals

21

3 Philosophy

21

3.1 Man

21

3.2 Health

22

3.3 Nursing

22

3.4 Environment

23

3.5 Learner

23 8

3.6 Nursing Education

23

3.7 Core Values

24

4 Conceptual Frame Work

24

4.1 Man

24

4.2 Nursing

25

4.3 Health

25

4.4 Nursing Education

26

4.5 Learner

26

4.6 Environment

26

5 Concepts, Subconcepts, Subconcepts and Theoretical Formulations

27

5.1 Programme Objectives

29

6 Leveling the Objectives

30

6.1 Level 1 (Year One)

30

6.2 Level 2 (Year Two)

31

6.3 Level 3 (Year Three)

32

7 Curriculum Design

33

7.1 Modules Offered

34

7.2 Year One

34

7.3 Year Two

34

7.4 Year Three

34

8 Content Periodical Mapping

35 9

9 Content Map

36

9.1 Scheduling of theoretical training and inter-semester sessions

37

9.2 Module Descriptions Year One

38

9.2.1 Introduction to HIV/AIDS

38

9.2.2 Leadership and Management in HIV/AIDS

38

9.2.3 Communication and Counseling Skills

38

9.2.4 HIV and AIDS Policies

39

9.3 Module Descriptions Year Two

39

9.3.1 HIV Counseling and Testing

39

9.3.2 Antiretroviral Therapy

40

9.3.3 Nursing Care of Persons Living with HIV/AIDS

40

9.3.4 Nutrition in HIV and AIDS

40

9.3.5 Biochemistry

41

9.4 Module Description Year Three

41

9.4.1 Home Based Care

41

9.4.2 Care of the Carers

41

9.4.3 Prevention of the Mother to Child Transmission of HIV

41

9.4.4 Management of opportunistic Infections and Neoplasms

42

9.4.5 Management

42

9.4.6 Principles and Practice of Education in Nursing

42

9.4.7 Nursing Research

42 10

10 Syllabus

43

10.1 Modul 1: Introduction to HIV/AIDS

43

10.1.1 Overview of the Module

43

10.1.2 Instructions for Participants

43

10.1.3 Learning outcomes

44

10.1.4 Learning contract

44

10.1.5 Participant’s role

44

10.1.6 Facilitator’s role

44

10.1.7 Teaching methods

45

10.1.8 Time Allocated

45

10.1.9 Evaluation

45

10.1.10 Unit contents

45

10.1.11 References

47

10.2 Module 2: Leadership and Management in HIV and AIDS Module

48


48

10.2.2 How to use this Module

48


48


49


49


49


50 11


50

10.2.9 Time allocated

50

10.2.10 Assessment criteria

50


51

10.2.12 References

56

10.3 Modul 3: Communication and Counseling Skills

57


57

10.3.2 Instructions for the Participant

57


58


58


58


58


59


59

10.3.9 Evaluation

59


59

10.3.11 References

62

10.4 Modul 4: HIV and AIDS Policies

64


64


64

10.4.3 How the module fits into the programme

65 12

10.4.4 Overall learning outcomes

65


66


66


66


66


67

10.4.10 Evaluation

67

10.4.11 Assessment criteria

67

10.4.12 Mode of Assessment

68


68

10.4.14 References

75

10.5 Modul 5: HIV Counseling and Testing

76


76


77

10.5.3 How the Module fits into the programme

77

10.5.4 Overall Learning outcomes

78

10.5.5 Assessment Criteria

78

10.5.6 Assessment methods

79


79


79

10.5.9 References

90 13

10.6 Modul 6: Anti-Retroviral Therapy

91


91


91


92


92


92


93


93


93

10.6.9 Evaluation

93


94

10.6.11 References

97

10.7 Modul 7: Nursing Care of Persons Living with HIV and AIDS

98


98


98


98


99


99


99


99


100 14

10.7.9 Evaluation

100


100

10.7.11 References

101

10.8 Modul 8: Nutrition in HIV and AIDS

102


102

10.8.2 Instructions tfor Participants

102


103


103


103


103


103


104

10.8.9 Evaluation

104


104

10.8.11 References

108

10.9 Modul 9: Home Based Care

110


110


110


110


111


111 15


111


111


112

10.9.10 Evaluation

112


112

10.9.12 References

117

10.10 Modul 10: Care of the Carers

118


118

10.10.2 Instructions for the Participants

118


118


119


119


119


119


120

10.10.9 Evaluation

120


120

10.10.11 References

122

10.11 Modul 11: Prevention of Mother to Child Transmission of HIV

124


124


124 16


125


125


125


125


126


126

10.11.9 Evaluation

126


126

10.11.11 References

129

10.12 Modul 12: Management of Opportunistic Infections and Neoplasms 131 10.12.1 Overview of the Module

131


131


131


132

10.12.5 Particicpant’s role

132


132


132


133

10.12.9 Evaluation

133


133

10.12.11 References

139 17

South-South-North Network in HIV/AIDS CURRICULUM DEVELOPMENT Mission statement (Purpose and goals) Philosophy

Health

Man

Learner

Nursing Education

Environment

Nursing

HIV Programme objectives (Characteristics of a graduate)

Take responsibility in continued HIV education

Participate and utilise nursing research

Ability to use theories in nursing (Orem, Roper Roy)

Core nursing Concepts

Competent Practitioner using nursing process

Effective member of HIV health team

Concept framework

Man’s interrelationships With other major concepts

Nursing process Research Communication Theories

Leader in selected HIV administrative roles

Normal to abnormal

Horizontal and vertical strands -Health and ill-health continuum -Individual, family and community Behavioral level Objectives Intergration and sequencing, sequencing Of HIV learning activities reflected in three different levels Module descriptions Provide reasons for offering the HIV and HIDS Modules Module objectives Specify which knowledge, skills and attitudes students should have acquired as a result of instruction Module content Development and organisation of learning experiences

Program Evaluation -Student assessment -Curriculum meetings Theory

Clinical

Graduate performance

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1 Introduction The Institute of the South-South-North Network for HIV/AIDS was established in the year 2006 to meet the increased demands for health care in HIV and AIDS management among nations. The network intends to run a three-year integrated HIV management programme which concludes in the conferment of an Advanced Diploma in HIV and AIDS Nursing Science and Midwifery to successful candidates. The network prepares a Nurse and Midwifery graduate with competence and cost-effectiveness to provide an individual, their family and their community with comprehensive nursing and midwifery care in accordance withthe World Health Organization Plan of 1999 – 2004. The Millennium Goals, particularly goal number six, clearly pronounce that HIV and AIDS Nursing education is the key to attainment of this goal. For this programme to be successful, an HIV and AIDS curriculum has been designed and this includes a mission statement, goal, philosophy, conceptual framework, characteristics of the graduate (program objectives), level objectives, course objectives, course outlines and a glossary of terms and references. The courses offered include: an introduction to HIV/AIDS, Leadership and Management of HIV/AIDS; Communication and Counseling; HIV/AIDS Policies; HIV Testing and Counseling; Antiretroviral Therapie; Caring for people living with HIV /AIDS; Nutrition in HIV/AIDS; Home-based care; Care of the carers; PMTCT; Opportunisitic infections and bio-psychosocial sciences. The emphasis will be on promotive, preventive, curative, restorative and rehabilitative health services using the Primary Health Care approach (PHC). An eclectic model was chosen for the curriculum which includes Orem’s self care model, Roy’s Adaptation model and Roper’s activity of living model. 1.1 Admission Requirements Careful selection of thecandidates is necessary in aiming towards the goal of the programme. 

Registered Nurses who have passed their general nursing degree at a credit level (O' level equivalent) will be the primary target for this mature entry Diploma.



A pre-requisite for candidacy is two years’ experience in clinical nursing care

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1.2 Admission Criteria Applicants should either be male or female, single or married(regardless of origin), of 17 to 40 years of age, with a registered Nursing Certificate or its equivalent, obtained within the past 6 years There are 30 places available, but this may change, depending on the availability of staff and funding. 2 Mission Statement of the Network The mission of the Institute of the South-South-North Network for HIV/AIDS is to provide the students with basic quality and comprehensive and cost-effective nurse/midwifery HIV and AIDS education. This will enable them to prevent ill health, as well as to promote, restore and rehabilitate the health status of the people in specific regions. 2.1 Vision of the Network The network will contribute to global networking through HIV and AIDS education, training and research. Educational and training programmes will equip all nurses with the HIV and AIDS skills and knowledge to lead and serve their countries in their future careers. HIV and AIDS research activities will create and disseminate the knowledge needed to support the countries’ sustainable development. All of the college’s programmes and activities will be conducted at the highest standards of professional excellence and integrity. 2.2 The Institute of South-South-North Network for HIV/AIDS’ main objectives 

Contribute to the quality and quantity of HIV and AIDS knowledge and increase the availability of opportunities for higher learning generally, and for Africa in particular, through exploration of contemporary HIV and AIDS practices and research;



Create an optimal administrative and academic atmosphere which is productive for all staff and students, the school and other places of higher learning through the promotion of strong HIV and AIDS management linkages;

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

Link theoretical knowledge about HIV and AIDS to practical, problem-solving strategies with a view to accelerating and contributing (directly or indirectly) to the general economic development of people living with HIV and AIDS in different countries;



Integrate the College activities and its staff into the community and facilitate literacy on opportunistic infections management; prevention of PMTCT, HIV and AIDS Testing and counseling; ART management, home based care; , communication and other related social skills, which directly lead to the improvement of the quality of life of people living with HIV and AIDS.

2.3 Purpose and Goals The faculty believes that the main purpose of the of South-South-North Network for HIV/AIDS is to provide registered nursing students with a basic HIV and AIDS quality nursing education that will help them to be competent practitioners in nursing practice, using the available resources. The HIV and AIDS knowledge gained will prepare students for personal and professional growth as well as help them to utilize research information in their HIV and AIDS patient management. 3 Philosophy 3.1 Man The faculty believes that man is a biopsycho-social, spiritual being who interacts with his/her family, the community and the environment. He/she is a unique being, motivated to care for himself/herself and promote his/her own of health, with a potential to learn. He/she adapts to changing environments as he/she performs the activities of living. He/she is sexually active, and can contract sexual diseases. Therefore he/she should be cared for holistically, to prevent or rehabilitate diseases such as HIV and the AIDS pandemic. He/she has the right to individualized quality care to meet his or her health needs. If given the opportunity to learn, he/she can actively participate in caring for himself/herself and in decision-making throughout the nursing process, promoting his/her own health and/caring -.

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3.2 Health It is the conviction of the Nursing Network, that health is a state of physical, mental and social well-being. It refers to an optimal level of independence that enables an individual to function at his or her maximum. The individual’s health is determined by his/her ability to cope with stressful situations like having the HIV disease. Good health is the right of every individual and no privilege. It is a personal experience that can be judged by the individual and/or significant others. The health professionals must rely upon the individual and significant others to determine the individual’s level of well-being and assist them in making choices related to restoring and maintaining optimal health. It is a right valued by everyone in society and the responsibility of each individual and significant others to meet the health needs of the individual and society. Health and ill-health are inevitable dimensions of a person’s life. Ill-health occurs when an individual and significant others are incapable of caring for themselves as a result of a maladaptive response to a changing environment. Therefore, the nurse’s role is to restore or rehabilitate an optimal state ofhealth. 3.3 Nursing Nursing is a caring profession with a unique body of knowledge. Its focus is assisting the individual to perform self-care activities which sustain his/her health. It involves meeting the individual’s existing care needs in order to promote and protect his or her function as a human being. The goal of nursing is to promote a persons’s adaptation to their environment. Nursing actions are based on the nurses’ perceptions, feelings and professional judgment of the patients’ behavior. Nurses utilize the nursing process, which is a problem-solving approach to providing care for the individual, their family and their community. The goal of nursing is to promote self-care, so that the individual adapts positively to environmental changes like those of HIV and AIDS conditions.

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3.4 Environment The faculty also believes that the environment consists of internal and external conditions, situations or circumstances that directly or indirectly affect man. They influence the development and behaviour of an individual. They are continously changing and can be controlled by man via HIV and AIDS prevention. Both the internal and the external environment are continuously changing, thereby positively and negatively influencing a person’s health and the type of nursing care provided to him/her. Nursing care is given in either a health institution or community where the individual is based. 3.5 Learner A learner is an individual with cognitive, affective and psychomotor components who undergoes a sequential process of learning. He or she has responsibility for autonomy in his/her own learning. This process of learning involves acquiring the knowledge, attitudes, skills and values of the profession. He or she is born with a need to learn, therefore a teacher should be a facilitator. The learner should be regarded as a student and not as a clinical service provider ; as a participant and not just as a recipient in the classroom environment. 3.6 Nursing Education It is also the conviction of the faculty members, that HIV and AIDS nursing education is a teaching/learning process which involves assisting the student nurse to acquire relevant HIV and AIDS quality, knowledge, attitudes and skills in order to bring about a change in sexual behaviour. It prepares the students to make their own competent and independent decisions in the provision of holistic HIV and AIDS care. The goal of nursing education is to produce a competent nurse-practitioner who will be able to provide quality nursing care to patients. In order to achieve this, the teacher should encourage and facilitate the process of learning by presenting learning materials which are relevant, appropriate and well- sequenced.

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HIV and AIDS It the conviction of the faculty that HIV and AIDS is an incurable pandemic condition that needs restorative and rehabilitative quality nursing care. All HIV and AIDS clients live in a stressful environment. Therefore, nursing is needed to promote a better quality of life in the environment the HIV and AIDS patients find themselves in. 3.7 Core Values The Network’s values are: 

Respect for life



Compassion



Promotion of good health



Holistic care



Professionalism



Rehabilitative home-based care



Restoration of life

4 Conceptual Frame Work 4.1 Man Man is a unique being belonging to a family, a community and a society. He is exposed to a wide range of experiences like HIV and AIDS, which makes him different from others. He has the right to individualised, quality nursing care to meet his or her health needs. If given the opportunity to learn, she/he can actively participate in promoting his/her own health with selfcare activities and in decision- making throughout the nursing process. Therefore, he/she should be encouraged to participate in self-care activities. Nursing care is required when a health care deficit occurs.

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4.2 Nursing The practice of nursing involves assisting HIV and AIDS clients to maintain or attain optimal health. It is a caring profession with a scientific body of knowledge based on the biological, psychological and behavioural sciences. The nurse utilizes this knowledge in the provision of nursing care for patients, their family and their community. Nursing involves choosing actions designed to create desirable conditions in a person and his/her environment. These actions are based on nurses’ perceptions, feelings and professional judgement of the patients’ behaviour. Nurses utilize the nursing process, which is a problem-solving approach, to provide care for the individual, their family and their community. The goal of nursing is to promote self-care, so that the HIV and AIDS individual adapts positively to environmental changes. 4.3 Health Health is a dynamic life experience, based on an individual’s response to stress. An individual’s concept of health is derived from patterns based on age, gender, cultural experiences and economic factors. It is a personal experience that can be judged by the individual and/or significant others. The health professionals must rely upon the individual and significant others to determine their level of well-being and assist them in making choices related to restoring and maintaining an optimal level of health. It is a right valued by everyone in society and the responsibility of every individual and significant others to meet the health needs of the individual and society. This means that HIV and AIDS clients have the right to quality nursing care regardless of creed and culture It is a right valued by everyone in society and the responsibility of every individual and significant others to meet the health needs of the individual and society. Health and ill-health are inevitable dimensions of a person’s life. Ill-health occurs when an individual and significant others are incapable of taking proper care of themselves as a result

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of a maladaptive response to their changing environment. Therefore, the nurse’s role is to restore a state of optimal health. Health and ill-health -are inevitable dimensions of a person’s life. Ill health-occurs when an individual and significant others become incapable of taking care of themselves as a result of a maldaptive response to their changing environment. Therefore, one role of a nurse is to restore a state of optimal health. 4.4 Nursing Education Nursing education involves assisting students to gain knowledge, a professional attitude and skills through the teaching and learning process. It helps the student to move from the known to the unknown. This occurs at different rates for different people. This is why the teacher should encourage and facilitate the process of learning. The goal of nursing education is to produce a competent nurse-practitoner who will be able to provide patients with quality nursing care. In order to achieve this, the teacher should encourage and facilitate the process of learning by presenting the relevant learning materials appropriately and in the proper sequence. 4.5 Learner A learner is a person who has specific learning needs and interests. He/she has cognitive, affective and psychomotoric capabilities. His/her response to learning can be monitored through a change in his/her behaviour. He/she should be motivated to learn and take the initiative when establishing his/her own educational goals in HIV and AIDS client care. The learner should be regarded as a student and not as a service provider in the HIV and AIDS clinical area; as a participant and not just as a recipient in the classroom environment. 4.6 Environment Environment is described as internal and external influences including family members, the community and society. Both one’s internal and one’s external environment are continously changing, thereby positively and negatively influencing one’s health and the type of nursing 26

care needed. Nursing care is given in either a health institution or community where the individual is based. 5 Concepts, Subconcepts, Subconcepts and Theoretical Formulations No.

Concepts

Subconcepts

Theories/Models

1.

Nursing

Noble Profession

Self Care

Caring

Goal Attainment

Nursing Process

Personal/Interpersonal

Dynamic

Role

Role

Change Transcultural

2.

3.

4.

Human Being

Health

Society & Environment

Noble

Adaptation

Unique

Self care

Biopsychosocial

Goal attainment

Spiritual

Systems

Dignified

Interpersonal

God’s creation

Developmental

Adaptive

Behavioural

Wellness

Adaptation

Illness

Systems

Adaptation

Self care

Health-Illness continuum

Health Belief model

Internal

Adaptation

External

Systems

Individualistic

Goal attainment

Groups

Transcultural 27

Family Community Norms Values Beliefs Community Management Process 5.

Midwifery care

Critical Thinking

Self care

Decision making

Goal attainment

Risk Identification

Adaptation

Midwifery Management Systems Process Role Change Behavioural 6.

HIV and AIDS

Transmission

Adaptation

Prevention

Self care

Positive living

Goal attainment

Counseling

Systems

Testing

Interpersonal

ART intake

Developmental

Home Based Care

Behavioural

HIV Policy Opportunistic infection

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5.1 Programme Objectives By the end of the programme, the Nurse Midwife Technician is expected to have acquired the following characteristics: 

the graduate should be able to assess, plan, implement and evaluate the health status of HIV and AIDS individuals, the family and community to meet their health needs.



The graduate utilizes the nursing process in order to promote, restore and maintain the health status of the HIV and AIDS mother and family prior to conception and during ante-partum, intra-partum and postpartum periods to help them cope with the childbearing process.



The graduate effectively participates as a member of the health team by assuming the dependent and independent functions of a nurse/midwifery technician and by carrying out selected administrative roles.



Use of practice-based research to improve the quality of HIV and AIDS nursing and midwifery care and for sustainable development of the community.



The graduate utilizes the knowledge gained in the programme for ongoing personal and professional development.



The graduate practices within the prescribed legal and ethical codes of nursing and midwifery, recognising his/her patient’s/client’s rights.



The graduate utilises the Orem self care model, Roy’s adaptation model and Roper’s activities of living model in providing comprehensive nursing care to individuals, their families and their community.



The graduate initiates and participates in activities relating to the development of his/her community.



Collaborates with the members of the health care team and guides subordinates to improve health care delivery during HIV and AIDS counseling and testing. 29



Functions as an agent for change, promoting quality in the performance of nursing and midwifery duties for people living with HIV and AIDS.



Applies critical thinking in nursing and midwifing HIV and AIDS patient care.



Participates in supervising and monitoring the quality of nursing and midwifery care in various Home-based patient care.



Participates actively in the promotion of nursing / midwifery education and practises nationally and internationally on PMTCT programs.



Demonstrates competence in providing information, counseling and health teaching to individuals, their families, groups and communities in need.



Participates actively in HIV/AIDS prevention, policy making, care and support programs.



Participates actively in professional organizations for the improvement of the nursing and midwife professions

6 Leveling the Objectives 6.1 Level 1 (Year One) At the end of first year, the students should be able to: 

Demonstrate an rudimentary understanding of Orem’s self care model, Roy’s adaptations model and Roper’s activities of living model for providing comprehensive nursing care to individuals, families and their community.



Demonstrate a rudimentary understanding of the nursing process.



Demonstrate an understanding of biological, physical, psychological, sociological principles and selected nursing theories related to HIV and AIDS client care.



Demonstrate basic nursing care skills and knowledge when providing care to HIV and AIDS individuals, their family and their community.

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

Demonstrate a rudimentary understanding of ethical and legal aspects of the nursing profession.



Demonstrate an understanding of effective communication and counseling for HIV and AIDS clients, health team members and the public to establish and maintain a therapeutic relationship.



Appreciate the dependent, independent and interdependent functions of the nurse in caring for terminally ill HIV and AIDS patients.



Appreciate the use of the nursing process in identifying the physical, spiritual and psychological needs of the HIV and AIDS client.



Demonstrate a rudimentary understanding of basic anatomy and physiology of the human body.

6.2 Level 2 (Year Two) 

Demonstrate knowledge and skills in the management of adults and children with opportunistic HIV problems, utilizing the nursing process in both a clinical and a community setting.



Utilise biological, physical and psychosocial principles and selected nursing theories when providing nursing care to patients/clients.



Apply knowledge and skills gained from nursing science and behavioural sciences in the management of patients undergoing surgery.



Apply knowledge of the ethical and legal aspects of the nursing profession in nursing practice.



Demonstrate an effective communication process with patients/clients, the health care team and the public to establish and maintain a therapeutic relationship.



Identify the health needs of the individual, their family and their community and take appropriate action using the primary health care approach. 31



Identify lowrisk mothers and provide the appropriate midwife care.



Demonstrate responsibility and accountability in patient/client care in a variety of health care settings.

6.3 Level 3 Objectives (Year Three) A.

Professional Nurse Withing the Social System 

Demonstrate knowledge of the biopsychosocial and environmental forces that influence HIV and AIDS care.



Identify the health HIV and AIDS care needs of individuals, their families and their communities.

B.

Professional Responsibilities/Personal Development 

Participate in the student nurses' professional HIV and AIDS project organization.



Apply nursing concepts in the care of HIV and AIDS patients/clients.



Recognize the continuing need for personal and professional growth in HIV and AIDS management.

C.

Nursing Process/Research 

Apply the nursing process and community health nursing to provide nursing care with varying levels of functions to individuals and families.



Utilize biological, physical and psychosocial principles that emphasize self-care in providing nursing care with varying levels of functions to individuals and their families.



Practice safe nursing care with varying levels of functions to promote, maintain and/or restore the optimal health of individuals and their families.



Demostrate the communication process when caring for HIV and AIDS individuals and families. 32



Understand the purpose of HIV and AIDS nursing research.



Apply the findings of HIV and AIDS nursing research to clinical practice.

D.

Management/Leadership/Change Agent 

Provide safe HIV and AIDS nursing care independently.



Collaborate with members of the health care team.



Demonstrate skill in applying principles of teaching/learning to promote, maintain and/or restore optimal health to individuals and their families.

7 Curriculum Design The integrated approach has been chosen because it is a requirement of the Nurses and Midwives’ Council. This approach enables students to apply the knowledge, skills and attitudes they have gained from basic courses to specific nursing and midwifery courses. It also considers the student’s learning needs and encourages his/her participation, which promotes initiative in decision-making. The student learns to solve problems by utilizing the nursing process. This approach promotes intergration, continuity and the sequencing of all courses. This will help the students to perform effectively in Malawian hospitals and community care settings.

33

7.1 Modules Offered 7.2 Year One

CODE TITLE



English Language and Communication.

ENG

101



Introduction to HIV/AIDS

INHA

101



Leadership and Management of HIV/AIDS

LEMAHA

101



Communication and Counseling

COCO

101



HIV/AIDS Policies

HAPO

101



Nutrition

NUT

101

7.3 Year Two 

HIV Testing and Counseling

COTEHA

201



Antiretroviral Therapy

ART

201



Caring for people living with HIV /AIDS

PLWH

201



Nutrition in HIV/AIDS

NUHA

201



Leadership and Management of HIV/AIDS

LEMAHA

201

7.4 Year Three 

Nutrition in HIV/AIDS

NUHA

301



Home-based care

HBC

301



Care of the carers

CACA

301



PMTCT

PMTCT

301



Opportunisitic infections

OIHA

301



STIs

STI

301



Research

RES

301

34

8 Content Periodical Mapping Modul

Contact

Clinic

Notional

Total

1: Introduction to HIV/AIDS

10

40

40

90

2: Leadership and Management of HIV/AIDS

10

40

40

90

3: Communication and Counseling

15

40

60

115

4: HIV/AIDS Policies

10

40

40

90

5: HIV Testing and Counseling

20

40

40

100

6: Antiretroviral Therapy

60

30

90

180

7: Caring for people living with HIV /AIDS

10

40

40

90

8: Nutrition in HIV/AIDS

10

40

40

90

9: Home based care

6,25

0

11,25

17,5

(675 minutes)

1050 minutes)

(375 minutes) 10: Care of the carers

15

30

20

65

11: PMTCT

60

40

100

200

12: Opportunisitic infections

30

40

60

130

13: STIs

30

30

30

90

35

9 Content Map

YEAR OF STUDY

semenster OF THE YEAR

Year One

Semester 1

Semester 2

CODE TITLE

CODE NUMBER

THEORETICAL HOURS/WEEK

ENG SOC PS BI

101 101 101 101

2 hrs/wk x 10 wks 3 hrs/wk x 5 wks 3 hrs/wk x 5 wks 8 hrs/wk x 10 wks

NSG BI PHARM MICRO NSG NSG BI CHM NSG NUT SC

101 101 101 101 101 103 101 101 101 101 101

10 hrs/wk x 10 wks 8 hrs/wk x 4 wks 6 hrs/wk x 4 wks 3 hrs/wk x 4 wks 10 hrs/wk x 4 wks 8 hrs/wk x 4 wks 8 hrs/wk x 5 wk 8hrs/wkx 5wks 10 hrs/wk x 5 wk 5 hrs/wk x 5 wks 4hrs/wk x5wks 3hrs/wk x 5wks

LABORATORY HOURS/WEEK

2 hrs/wk x 10 wks 6 hrs/wk x 5 wks 2 hrs/wk x 4 wk 2 hrs/wk x 4 wk 1 hr/wk x 4 wk 6 hrs/wk x 4 wk 2 hrs x 4 wk 2 hrs x 5 wk 2 hrs /wk x 5wks 6 hrs x 5 wk 1 hr/wk x 5 wk

CLINICAL HOURS/ WEEK 40 x 5 40 x 10 40 x 10 wk -

CLINICAL TERM

SUBTOTAL HOURS/ SUBJECT

2 x 10 wks 3 x 5 wks 3 x 5 wks 80 x 10 + 20

20 hrs 15 hrs 15 hrs 110 hrs

100 + 30 +200 8 x 4 + 10 6x4+8 12 + 4 40 + 24 + 410 32 + 8 40 + 10

330 hrs 42 hrs 32 hrs 16 hrs 474 hrs 40 hrs 50 hrs

50 + 30 + 400 25 + 5

480 hrs 30 hrs

36

9.1 Scheduling of theoretical training and inter-semester sessions

Fri 11/08/11

15d?

Mon 14/08/11

Fri 01/09/11

1d?

Fri 01/09/11

Fri 01/09/11

1d?

Mon 04/09/11 Tue 05/09/11 Mon 11/12/11 Mon 25/12/11

Mon 04/09/11 Fri 08/12/11 Fri 22/12/11 Fri 12/01/12

60d?

Mon 15/01/10

Fri 06/04/10

1d?

Mon 09/04/10

Mon 09/04/10

69d? 10d? 15d?

2013

Jul Au

Aug Dec S4

Jan Ap

Jul Aug S5

Aug Dec

2014 Jan Ap S6

Jul Aug

Aug Dec S7

Jan Ap

Jul Aug S8

Aug Dec S9

Jan Aug

Internship

Fri 11/08/11

Ap Jul S3

Inter-semsester session

1d?

1d?


Fri 28/07/11 Mon 31/07/11

10d?

Jan Ap

Internship

Mon 17/07/11 Mon 31/07/11

69d?

2012 Aug Dec S2

Inter-semester vacation

To Mon 1/12/11 Fri 14/07/11

Jul Aug


From Mon 1/10/11 Tue 11/04/11

1d?

Ap Jul S1


Semester 1 Exams Inter-semester 1st vacation begins Inter-semester 1st vacation ends Inter-semester 1st vacation clinicals begin Inter-semester 1st vacation clinicals end Registration Semester 2 Semester 2 Lectures Semester 2 Exams Christmas and New Year's vacation "Intersemester session 1, clinicals " Registration Semester 3

TIME


Activity Registration Semester 1 Theory and Practical

TIME


2011 NO of DAYS

Inter-semester vacation (between semesters). Department of Nursing and Midwifery recess for 2 weeks. Inter-semester session (between levels). Department of Nursing and Midwifery recess for 2 weeks. 37

9.2 Module Descriptions Year One 9.2.1 Introduction to HIV/AIDS

INHA

101

This module is an introduction to HIV/AIDS. It is designed to equip clinicians with a detailed introduction to and understanding of HIV/AIDS. The acquisition of HIV/AIDS knowledge will enable practitioners/clinicians to give accurate information, counsel, management and support to people living with HIV/AID (PLWHA) and their families. This will ultimately lead to a reduction in stress, stigmatization and the discrimination of PLWHA. This module is divided into four units, focusing firstly on the Immune System, secondly on HIV Infection, thirdly onthe transmission and diagnosis of HIV/AIDS and finally, on the prevention of HIV/AIDS 9.2.2 Leadership and Management of HIV/AIDS

LEMAHA

101

This module is designed to prepare students for their roles as HIV and AIDS nursing managers of health services. A focus will be placed on the principles and theories of teaching and learning and on health service management. This module is divided into two parts. They are composed of many units and each unit has an exercise at the end which you must make sure you do. The references quoted in this module are supposed to be consulted as support for the module. Make sure you read all the required books as these are directly relevant to the achievement of the expected study outcomes. Make sure that you have competently mastered the concepts of a unit before moving onto the next one. Furthermore, you are required to attend every class session and submit the relevant assignments puntually. 9.2.3 Communication and Counseling Skills

COCO

101

This module focuses on the effective communication and counseling necessary for clients in varied circumstances and from different cultural backgrounds. The course is designed to equip nurses /midwives with the appropriate knowledge and skills to adequately and effectively interact with clients in a culturally diverse world and society.

38

It also enables the nurses/midwives to counsel clients and their relatives/ caregivers as well as team members. 9.2.4 HIV and AIDS Policies

HAPO

101

This module provides information on HIV and AIDS Policies. It includes problem solving, the guidelines for an effective response to HIV/AIDS, HIV/AIDS prevention, treatment, care, support, protection, participation and the empowerment of people living with HIV/AIDS. It also includes the protection, participation and empowerment of HIV/AIDS and Gender Equality: A Local Issue, POLICY MAKING AND IMPLEMENTATION; traditional and religious practices and services; HIV/AIDS in the workplace; sustaining a national HIV/AIDS research agenda; monitoring and evaluation; SERVICE IMPLEMENTATION STRUCTURE; testing issues; ethical issues; behaviorial change communication/service promotion; INDICATORS ON HIV; a policiy of monitoring and evaluation. 9.3 Module Descriptions Year Two 9.3.1 HIV Counseling and Testing

COTEHA

101

This Module, HIV Testing and Counselling, provides you with a basic knowledge of the art and science of professional HIV Testing and Counselling. This Module will lay two important foundations (a) a useful fundus of information on HIV Testing and Counselling and (b) basic skills needed for effective, competent and efficient HIV Testing and Counselling. This foundation will help you understand how HIV Testing and Counselling can be pivotal in the provision of quality care. This module forms a basis for the entire HIV Testing and Counselling profession and enables you to develop a framework for caring with compassion, confidence, competence, conscience and commitment. Foundation (a) focuses on the function of HIV Counsellingand the condition of a person with the goals of maintaining, supporting and restoring healthy functioning. To achieve these goals, you are required to identify the altered function and recognize its manifestations and their impact on HIV Counselling.

39

Foundation (b) focuses on HIV Testing practice based on the appropriate selection and use of testing interventions in response to a health problem, thus skills acquisition on HIV Testing. You need mastery in both (a) and (b).This module builds on knowledge from Modules 1 to 4 and you will need to refer to them as you study module 5. 9.3.2 Antiretroviral Therapy

ART

101

Antiretroviral therapy has been effective in the management of HIV/AIDS and associated opportunistic infections. This module provides participants with a broader perspective on antiretroviral therapy and its influence on HIV/AIDS, focusing on the current standard treatment. Issues of HIV/AIDS staging, recommended treatments and guiding principles, herbal therapy, adherence to the therapy and challenges are discussed. This module is divided into three units focussing firstly on an overview of antiretroviral therapy, secondly on antiretroviral therapy, and thirdly on the recommendations of the World Health Organization (WHO) for developing countries. 9.3.3 Nursing Care of people Living with HIV and AIDS

PLWH

101

Acute and hospice care have been effective in the management of HIV/AIDS and associated opportunistic infections. This module discusses care required in the management of HIV/AIDS, opportunistic infections and terminal diseases for both paediatrics and adults. This module is divided into two units, focussing firstly on assessment, diagnosis, planning, intervention and the evaluation of HIV/AIDS care, and secondly on acute and hospice care. 9.3.4 Nutrition in HIV and AIDS

NUHA

101

This module focuses on nutrition for people living with HIV and AIDS (PLWHA). It is designed to equip nurses/midwives with knowledge that will enable them to give nutritional advice, counseling, care and support to HIV and AIDS clients and their families so that they may live positively and maintain good nutrition.

40

9.3.5 Biochemistry

BIHA

202

4 Hours per week (Term II) 2 hrs/wk (Lab Term II) This course followsup on the Chemistry and Physics Course (SC 101) offered in year 1. It provides the student with basic knowledge and an understanding of the biochemical processes that occur in the human body. The course also provides an appreciation of the energy metabolism coenzymes and internal metabolism. 9.4 Module Description Year Three 9.4.1 Home Based Care

HBC

301

This module focuses on an introduction to “Home–Based Care“ as an intervention. It is designed to provide an understanding of the home-based care framework and addresses the issues of referral and networking as components in ensuring continuity of quality care for the patient/clients in home-based care. Community mobilization for effective and sustainable care is one of these components. 9.4.2 Care of the Carers

CACA

301

This module focuses on caring for the carers/ health workers who spend most of their lives looking after others, in particular people living with chronic conditions like HIV and AIDS. It is designed to equip nurses/ midwives with knowledge about their roles, the prevention and management of stress, as well as the identification of psychosocial support available to them. 9.4.3 Prevention of the Mother to Child Transmission of HIV

PMTCT

301

This module provides participants with evidence-based facts about PMTCT of HIV, with particular emphasis on the magnitude of MTCT, modes of transmission, factors influencing transmission rates and strategies that can reduce transmission rates. The recommended antenatal, intrapartum and postnatal care surrounding HIV is discussed. Furthermore, the two main feeding options for HIV exposed infants and young children

41

have been outlined, together with a description of the key components that promote optimal infant feeding for HIV infected mothers. 9.4.4 Management of opportunistic Infections and Neoplasms OPI

301

This module focuses on infections which a normal human body is capable of resisting but which people living with HIV and AIDS are prone to develop. It is designed to equip nurses/midwives with knowledge that will enable them to diagnose and effectively manage clients with an impaired immune system. 9.4.5 Management

MGT

301

This course introduces students to the basic principles of management in health care institutions. The knowledge, working ethos and skills acquired from this course will later enable students to effectively manage human and material resources. 9.4.6 Principles and Practice of Education in Nursing

NSG

301

6 hrs/wk (Term II) This course prepares students for their educational responsibilities when in nursing practice. It enables students to develop rudimentary skills of teaching and to apply theory to various settings. Both pedagogical and andragogical principles of teaching and learning will be discussed. 9.4.7 Nursing Research

RES

301

This course is designed to introduce the students to basic research principles. Knowledge acquired here will later help students to participate in data collection and disseminate and interpretresearch findings in nursing practice. Emphasis will be placed on the ability to broaden one’s knowledge by reading research articles and applying research findings to meet the self-care demands or biopsychosocial needs of the individual in a community.

42

10 Syllabus 10.1 Modul 1: Introduction to HIV/AIDS Participant Module (Mweemba, Prudencia) MODULE CODE

:

INHA 101

YEAR OF STUDY

:

One

SEMESTER

:

One/TWO

NUMBER OF LECTURE HOURS

:

4hrs/wk x 10 weeks

TOTAL NUMBER OF HOURS

:

40

NUMBER OF LABORATORY HOURS

:

None

10.1.1 Overview of the Module This module is an introduction to HIV/AIDS. It is designed to equip clinicians with a detailed introduction to and understanding of HIV/AIDS. The acquisition of HIV/AIDS knowledge will enable practitioners/clinicians to give accurate information, counsel, management and support to people living with HIV/AID (PLWHA) and their families. This will ultimately lead to a reduction in stress, stigmatization and the discrimination of PLWHA. This module is divided into four units focusing firstly on the mmune System, secondly onHIV Infection, thirdly on the transmission and diagnosis of HIV/AIDS and lastly on the prevention of HIV/AIDS 10.1.2 Instructions to Participants 

Wide reading in the areas specified by each unit, using books, journals and the internet



Extensive consultation on each topic including collaboration with colleagues



Active participation during contact and clinical hours

43

10.1.3 Learning outcomes By the end of this module the participant is able to: 

Explain the immune system



Describe HIV infection



Discuss modes of transmission of HIV/AIDS



Describe tests used to diagnose HIV infection



Describe measures used to prevent HIV/AIDS

10.1.4 Learning contract The student shall complete the module within the specified period of time in order to gain appropriate knowledge, skills and a professional approach. Student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.1.5 Participant’s role 

Is responsible for his/her own meaningful learning process



Continuously monitors his/her own progress from unit to unit and reflects to what extent his/her learning outcomes have been achieved



Carries out all individual activities before proceeding to the next unit



Actively participates in group assignments to enrich his/her studies

10.1.6 Facilitator’s role 

Provides participants with modules which enable them them to attain the expected learning outcomes



Provides guidance and support in the attainment of learning outcomes

44



Facilitates and moderates discussions and seminars

10.1.7 Teaching methods 

Lectures



Tutorials



Seminars



Demonstration



Group discussions

10.1.8 Time Allocated Contact Hours Clinical Hours

Notional Hours

Total Hours

10

40

90

40

10.1.9 Evaluation 

Continuous Assessment

40%



Final Assessment

60%

10.1.10 Unit content UNIT

CONTENT

SKILLS/PROCEDURE

TEACHING METHOD

ONE

Defence Mechanisms  Specific Immune System (acquired or adaptive immune system)  Lymphocytes  T Lymphocyte Cells  B Lymphocyte Cells  T-Killer Cells  Helper T Cells

CD4MEASUREMENT FULL BLOOD COUNT PHYSICAL ASSESSMENT

Lecture Discussion Demonstration

45

TWO

THREE

FOUR

 Rα T T Cells  B-Cells and Antibodies HIV Infection  Introduction  Learning Outcomes  Background of HIV/AIDS  The Human Immunodeficiency Virus  Immunodeficiency Virus Structure  HIV/AIDS Life Cycle  Transcription  Post transcription  Translation  Post translation HIV Transmission and Diagnosis  Introduction  Learning Outcomes  Risk Factors for HIV  Mode of HIV Transmission  Clinical Manifestations of HIV Illness  Diagnosis Tests Used in HIV/AIDS Prevention of HIV/AIDS  Introduction  Learning Outcomes  Measures Used to Prevent HIV/AIDS  Prevention of sexual transmission  Abstinence  Being mutually faithful to one partner  Using Condoms each time one has sex  Prevention of Parenteral HIV transmission  Prevention of Perinatal HIV transmission  Replacement feeding  Early cessation of breastfeeding  Heat treatment of breast milk;  Breastfeeding counseling  Prevention to Care Continuum  Prevention to Care Continuum

Verbal and non verbal communication Counseling skils

Lecture Role play Discussion Drama

Verbal and non verbal communication Counseling skills


Testing skills

Lecture Tutorial Seminar Demonstrations Group discussions Role play Discussion Drama

46

10.1.11 References National AIDS Council. (2008). National Guidelines on Management and Care of people Living with HIV and AIDS, Lusaka, Zambia. Ministry of Health. (2007). Management of HIV with Antiretroviral Therapy, Lusaka, Zambia National HIV/AIDS/STD/TB Council (2001) Preliminary Report - Costing the Zambia National HIV/AIDS Strategic Frame Work 2001-2003 National HIV/AIDS/STI/TB Council (2003) Intervention Strategic Plan 2002-2005 Ministry of Finance and National Planning (2002) –Zambia Poverty Reduction Strategy Paper 2002-2004 Central Statistics, Central Statistical Office, Central Board of Health, and ORC Macro (2003) - Zambia Demographic and Health Survey 2001 -2002 Central Statistics, Ministry of Health, and Measure Evaluation (2004) – Zambia Sexual Behaviour Survey 2003 Central Board of Health, Swedish International Development Cooperation Agency (SIDA), Centres for Disease Control and Prevention (CDC), Tropical Diseases Research Centre (TDRC) (2003) – ANC Sentinel Surveillance of HIV/SYPHILIS Trends in Zambia

47

10.2 Module 2: Leadership and Management in HIV and AIDS Module (Mbirimtengerenji, D. Noel) MODULE CODE

:

MGT 101

YEAR OF STUDY

:

One

SEMESTER

:

One/ TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.2.1 Overview of the Module This module is designed to prepare students for their roles as HIV and AIDS managerial nurses in health services. A focus will be placed on the principles and theories related to teaching and learning and on health service management. 10.2.2 How to use this Module This module is divided into two parts. They are composed of many units and each unit has an exercise at the end which you must make sure you do. The references quoted in this module are supposed to be consulted as support for the module. Make sure you read all the required books as these are directly relevant to the achievement of the expected study outcomes. Make sure that you have competently mastered the concepts of a unit before moving onto the next one. Furthermore, you are required to attend every class session and submit the relevant assignments puntually. 10.2.3 Instructions for Participants 


48







10.2.4 Learning outcomes  Discuss management and leadership concepts, theories and principles  Analyze contemporary issues in leadership and management  Analyze the economic, political, demographic and environmental factors affecting health service delivery.  Discuss the principles and theories of adult education.  Explain the relevance of the educational principles and theories to patients, clients and nursing students. 10.2.5 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.2.6 Participant’s role 











49


Provides participants with modules which enable them to attain the expected learning outcomes







10.2.8 Teaching methods  Lectures  Tutorials  Seminars  Demonstration  Group discussions 10.2.9 Time allocated Contact Hours Clinical Hours

Notional Hours

Total Hours

10

40

90

40

10.2.10 Assessment criteria  Group projects

40%

 Examination

60%

50

10.2.11 Unit contents UNIT

CONTENTS

SKILLS/ PROCEDURE

ONE

TWO

GENERAL MANAGEMENT  Learning outcomes  WHAT IS MANAGEMENT?  The meaning of management  Nature of management  Management  Who is a manager?  Classification of managers according to organizational structure  First – line managers  Middle-level managers  Top-level managers  Management roles  Management skills  Importance of management ORGANIZATIONAL AND MANAGEMENT PROCESS  Introduction to Organization  Learning outcomes  Introduction  Definitions  Three Characteristics of organization  Classification of organization  Informal organization  Choosing an organizational structure  Types of organizational structures  Bureaucratic / Vertical organizational Structure  2. Decentralized / horizontal organizational structures  3. Matrix organizational structure  Informal organization  Comparison of formal and

TEACHING METHOD

Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama


51

THREE

FOUR

FIVE

informal organization MANAGEMENT PROCESS  Learning outcomes  Definition  MANAGEMENT TOOLS:  Philosophy  Organisational objectives: ward/unit objectives  Standards of performance  Job Description  Procedure Manuals  Management By Objectives (MBO) Prevention of HIV/AIDS  Introduction  Learning Outcomes  Measures Used to Prevent HIV/AIDS  Prevention of sexual transmission  Abstinence  Being mutually faithful to one partner  Using Condoms each time one has sex  Prevention of Parenteral HIV transmission  Prevention of Perinatal HIV transmission  Replacement feeding  Early cessation of breastfeeding  Heat treatment of breast milk;  Breastfeeding counseling  Prevention to Care Continuum  Prevention to Care Continuum MANAGEMENT FUNCTIONS  Learning Outcomes  Management functions PLANNING  Learning Outcomes  Definitions  Types of plans



WARD MANAGEMENT

52



Breadth: strategic versus operational  Time frame: short term versus long term  Specificity: directional versus specific  Frequency of use: Single-use versus standing  Strategic or corporate plans (long – term plans with a time frame beyond three years  Characteristics of strategic plans  Cover a wider time frame  Cover a broader view of the organization  Include the formulation of goals  Explain the following types of plans: long-term plans; shortterm plans; specific plans; directional plans; single-use plans; standing plans  Process of planning  The planning hierarchy  Philosophy  Assessment  Mission statement  Goals and objectives  Types of goals  Policies and Procedures  Rules and regulations  Importance of planning ORGANIZING  Learning outcomes  Definition  Organizing Nursing Services: The nursing care delivery systems  Common types of nursing care delivery systems COORDINATION DELEGATION  Introduction  Purpose of planning

53

SIX

 Enabling others.  Definition  Steps to effective delegation LEADING/DIREC-TING  Learning Outcomes DEFINITION OF LEADERSHIP  Leadership and Influence  Creating a vision and sharing  Showing the way forward.  Paying attention to the business environment.  Setting objectives.  Explain the following sources of power  Leadership and Power SOURCES OF POWER  Expert Power  Referent Power  Legitimate Power  Coercive power  Reward power STYLES OF LEADERSHIP  Learning Outcomes  Explain the Authoritarian  Describe the Democratic  Explain the principles of Laissez –faire leadership  Authoritarian  Democratic  Laissez -faire FUNCTIONS OF A TEAM LEADER  Linkage function  Information sharing function  Spokesperson function:  trust.  Innovative function:  Delegation function  Conflict management function  Teaching function  Performance evaluation function  Negotiating function


54

SEVEN

EIGHT

NINE

CONTROLLING  Learning Outcomes  Introduction  What is controlling?  Nature of controlling: Controlling functions  DISCUSS the Control methods and control process  Use of Budgets in controlling  Control of Physical or Material resources  Control of Supplies and Equipment Quality assurance of HIV and AIDS care  Learning outcomes  Introduction  What is Quality?  The Four Orientations of Quality Assurance  THE QUALITY ASSURANCE PROCESS  QAP's Quality Assurance Process  The Quality Assurance Cycle  Planning for Quality Assurance  Setting Standards and Specifications  Definition of Standards CONTEMPORARY ISSUES on HIV and AIDS  Learning outcomes  Factors influencing health service management  Introduction  Political and statutory factors  Demographic factors  Economic factors  Legal factors




55

 

Social factors Environmental factors

10.2.12 References Alderman, H. S. & Taylor, L. (2003). On sustainability of project innovations as systemic change. Journal of Education and Psychological Consultation, 14 (1), 1-25. Booyens, S.W. (2001). Introduction to Health Service Management. Juta &Co, Ltd. Cape Town. Cole, G. A. (2004). Management: Theory and Practice. Ashford Colour Press: London.

56

10.3 Modul 3: Communication and Counseling Skills Participant’s Guide (Chikanya, Violet K and Gwaze, Simbirai)

MODULE CODE

:

COCOS

101

YEAR OF STUDY

:

One

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.3.1 Overview of the Module This module focuses on the effective communication and counseling necessary for clients in varied circumstances and from different cultural backgrounds. The course is designed to equip nurses /midwives with the appropriate knowledge and skills to adequately and effectively interact with clients from a culturally diverse world and society. It also enables the nurses/midwives to counsel clients and their relatives/ caregivers as well as team members. 10.3.2 Instructions for the Participant As you use this module you are expected to: 

Read widely in the areas specified by each unit, using books, journals and the internet



Consult extensively on each topic



Participate actively in class and group activities

 Do all the activities as indicated

57

10.3.3 Learning outcomes On completion of this module the participant should be able to:  Understand the communication and counseling processes  Appreciate the complexity of communicating and counseling behind behavioural change.  Communicate effectively with clients in varied circumstances and from different cultural backgrounds  Apply appropriate techniques to effectively counsel of clients in different situations and environments. 10.3.4 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.3.5 Participant’s role 















Provides guidance and support in the attainment of learning outcomes 58




10.3.7 Teaching methods  Lectures  Tutorials  Seminars  Demonstration  Group discussions  Role plays 10.3.8 Time allocated Contact Hours

Notional Hours

Clinical Hours

Total Hours

15

20

30

65

10.3.9 Evaluation  Continuous assessment (40%)  Final written examination (60%) 10.3.10 Unit contents UNIT

CONTENTS

ONE

COMMUNICATION PROCESS  Introduction  Learning outcomes  Definition of communication  Communication process  Sender  Message

SKILLS/ PROCEDURE

TEACHING METHOD Lecture Tutorial Seminar Demonstration Group discussions

59

TWO

THREE

FOUR

 Medium  Receiver :  Feedback  Models of communication process  kinds of communication  Settings of communication FUNCTIONS OF COMMUNICATION  Introduction  Learning outcomes  Unit contents and activities  Purposes and needs of communication  Effects of communication  intentional and unintentional effects of communication VERBAL COMMUNICATION SKILLS  Introduction  Learning outcomes  Unit contents and activities  Definition of verbal communication  verbal communication  Factors that influence verbal communication  Presentation of material  Vocabulary  Clarity and pacing  Voice tone and volume  Organization  Timing and relevance  verbal communication  denotation and connotation.  Denotative and connotative meaning NONVERBAL COMMUNICATION SKILLS  Introduction  Learning outcomes  Definition of nonverbal communication  Functions of nonverbal communication  nonverbal communication  Categories of nonverbal communication  Kinesics  five movements of kinesics  body language  gestures and facial expressions

Role play Discussion Drama




60

FIVE

SIX

 Proxemics  Haptics  Chronemics  Personal appearance  Paralanguage  Improving nonverbal communication LISTENING SKILLS  Introduction  Learning outcomes  Unit contents and activities  Active and passive listening  The listening process  Types of listening  Barriers to listening  Developing efficient listening skills  Barriers to communication  Barriers to verbal communication  Barriers to non-verbal communication  Barriers due to social and cultural biases  Other barriers  Questioning skills  Types of questions  enhance communication?  hinder communication COUNSELlNG  Introduction  Learning outcomes  Definition of counselling  counseling characterized  Different models of counseling  patient oriented model of counseling  Counselling process  Step 1: Prepare Yourself  2 Step 2: Prepare the counselling environment  Step 3: Beginning the session  Step 4: Conducting the session  Step 5: Ending the session  Steps in ending a counselling session:  Evaluating success of counseling process  Other approaches to counselling  GATHER



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SEVEN

 Counselling principles QUALITIES OF AN EFFECTIVE COUNSELLOR  Introduction  Learning outcomes  Qualities/characteristics of an effective counsellor  traits of a good counselor  non-judgmental while counseling clients  Skills of effective counsellors  Empathy  empathetic and sympathetic responses.  Non-judgmental  non-judgmental while counseling their clients  Attentive behaviour  Good listening skills  good and bad listening skills.  Reflection  Influencing skills  Questioning skills  Barriers preventing effective counselling


10.3.11 References Ewles, L. & Simmet, I. (1996). Promoting Health: A Practical Guide. (3rd ed.). Philadelphia: Bailliere Tindall. Guirdham, M. (1996). Interpersonal Skills at Work. (2nd ed.). London: Prentice Hall. Steinberg,S. (1995). Introduction to Communication: Course Book 1 The Basics. Cape Town: Juta & Co. Ltd. Hargie, ODW. (1997).The Handbook of Communication Skills. (2nd ed.). New York: Routledge Southern Africa HIV/AIDS Information Dissemination Service, World Health Organization & International Federation OF Red Cross and Red Crescent Societies

62

(2006). HIV prevention, treatment, care and support- A training package for Community volunteers. Module 5: Community-Based Counselling. Geneva: World Health Organization.

63

10.4 Modul 4: HIV and AIDS Policies (Mbirimtengerenji, D. Noel) MODULE CODE

:

HAPO 101

YEAR OF STUDY

:

One

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.4.1 Overview of the Module This module provides information on HIV and AIDS Policies. It includes problem solving, the guidelines for an effective response to HIV/AIDS, HIV/AIDS prevention, treatment, care, support, protection, participation and the empowerment of people living with HIV/AIDS. It also includes the protection, participation and empowerment of HIV/AIDS and Gender Equality: A Local Issue, POLICY MAKING AND IMPLEMENTATION; traditional and religious practices and services; HIV/AIDS in the workplace; sustaining a national HIV/AIDS research agenda; monitoring and evaluation; SERVICE IMPLEMENTATION STRUCTURE; testing issues; ethical issues; behaviorial change communication/service promotion; INDICATORS ON HIV; a policiy of monitoring and evaluation. 10.4.2 How to use this module Each unit requires you to read all the required and recommended HIV and AIDS books as these are directly related to the achievement of the expected learning outcomes. Learners are expected to review the HIV and AIDS national guidelines and the World Health Guidelines of all the systems covered in the module. They are also expected to attempt all activities in the module.

64

10.4.3 How the module fits into the programme The module is designed to enable students to develop knowledge, skills and a professional approach for the management of the PLHA. It focuses on the nursing care of clients in SADC countries, Zimbabwe, Malawi and Zambia and Germany of all age groups. 10.4.4 Overall learning outcomes

 Discuss an effective response to HIV/AIDS in the SADC region  Explain the main areas of HIV/AIDS prevention  Explain the main policies on testing and counseling Issues  Explain the necessary areas of HIV and AIDS treatment, care and support,  Discuss the main policies on SERVICE IMPLEMENTATION STRUCTURE  Discuss the protection, participation and empowerment of people living with HIV/AIDS

 Explain the main areas of people living with HIV/AIDS: protection, participation and empowerment

 Discuss the principles of HIV/AIDS and gender equality  Discuss the main activities for traditional and religious practice  Explain the main policies for HIV/AIDS in the workplace  Discuss the principles of sustaining a national HIV/AIDS research agenda  Discuss the main policies of ethical Issues  Discuss the main policies for behavioral change via communication/service promotion

65

 Explain the INDICATORS for HIV  Explain the principles underlying monitoring and evaluation 10.4.5 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.4.6 Participant’s role 



















10.4.8 Teaching methods  Lectures  Tutorials  Seminars

66

 Demonstration  Group discussions  Role plays 10.4.9 Time allocated Contact Hours

Notional Hours

Clinical Hours Total Hours

10

40

40

90

10.4.10 Evaluation  Continuous assessment (40%)  Final written examination (60%) 10.4.11 Assessment Criteria Overall learning outcomes

Assessment Criteria

Analysing an effective response to HIV/AIDS in the SADC region

For a student to be assessed, he/she should competently explain a response to HIV/AIDS in the SADC region

Explain the main areas of HIV/AIDS Prevention Testing and Counseling; Treatment; Care and Support,



Explain components of HIV/AIDS prevention



Explain the main policies on testing and counseling



Explain the necessary areas in HIV and AIDS treatment, care and support,

 Discuss the main policies of SERVICE IMPLEMENTATION STRUCTURE Discuss the main policies for HIV and AIDS Protection, Participation and Empowerment

 Explain the main areas of people living with HIV/AIDS: protection,

67

participation and empowerment

 Discuss the principles of HIV/AIDS and gender equality Discuss activities for Traditional and Religious Practice; HIV/AIDS in the Workplace; the National HIV/AIDS Research Agenda in HIV and AIDS and Ethical Issues

 Discuss the main activities for traditional and religious practice

 Explain the main policies for HIV/AIDS in the workplace

 Discuss the principles of sustaining a National HIV/AIDS Research Agenda

 Discuss the main policies for Ethical Issues Analyzing the main policies on Behavioral Change via Communication/Service Promotion

 Discuss the main policies for behavioral change via communication/service promotion

 Explain the INDICATORS for HIV  Explain the principles of monitoring and evaluation

10.4.12 Mode of Assessment  Group projects

40%

 Examinations

60%


CONTENTS

SKILLS/ PROCEDURE

TEACHING METHOD

ONE

NATIONAL Response to HIV/AIDS in SADC region  introduction  learning outcomes:  policy guidelines  strategies targets the national agenda  indicators for the policy guidelines

Policy development


68

TWO

THREE

HIV/AIDS Prevention, Treatment, Care and Support  Introduction  Learning outcomes:  Contents  1st Information, Education and Communication (IEC) for Behavioural Change  strategies and indicators  behavioral change  Voluntary HIV Counselling and Testing  Policy Statements  Diagnostic Testing  National AIDS Commission on counseling  Routine Testing  2 Policy Statements  National Security Forces  Policy Statement  Beneficial Disclosure  Policy Statements  Condoms for HIV Prevention  strategies using Condoms  countries’ indicators on condom use  Prevention of Mother-to-Child Transmission (PMTCT)  of Sexually Transmitted Infections (STIs)  STI policy guidelines  major indicators for STI Strategies  Blood and Tissue Safety  Policy Statements  Universal Precautions  2 Policy Statements  Clean Injecting Materials and Skinpiercing Instruments  Policy Statements  Post-exposure Prophylaxis (PEP)  importance of PEP  to PEP in case of exposure  Treatment, Care and Support  Policy Statements Protection, Participation and Empowerment of People Living With HIV/AIDS

Counseling exercise


Drama

Lecture Tutorial Seminar

Tutorial

69

          

      

 

   

 FOUR

Seminar Introduction Learning outcomes HIV Policy Statements common strategies for the above policy introduction Protection, Participation and Empowerment of Vulnerable Populations The Goal Learning outcomes 2 Women and Girls Orphans national policy on orphans strategies for the care of orphans indicators (implications or strategies, depending on the meaning) for the care of orphans Widows and Widowers Children and Young People concept of poverty The Poor People Engaged in Transactional Sex Prisoners Mobile Populations People Engaged in Same-sex Sexual Relations People with Disabilities indicators for people with physical and psycho-social disabilities the main team on disabilities disabilities disadvantaged

Protection, Participation and Empowerment of Vulnerable Populations  Introduction  Learning outcomes  Women and Girls  Policy Statements  Rationale  Orphans  Policy Statements  Widows and Widowers  Policy Statements  5 Children and Young People

Demonstration Group discussions Role play Discussion Drama


70

   

FIVE

Policy Statements The Poor Policy Statements 7 People Engaged in Transactional Sex  Policy Statements  Prisoners  Policy Statements  Mobile Populations  Policy Statements  People Engaged in Same-sex Sexual Relations  Policy Statement  Policy Statements  People with Disabilities HIV/AIDS and Gender Equality   

SIX

SEVEN

Introduction Learning outcomes LGA leaders and institutions  female and male vulnerabilities and risk factors  main categories of vulnerable people  main indicators of gender equity THE NATIONAL HIV AGENDA  National HIV policies and strategies  Traditional and Religious Practices and Services  Policy Statements  national HIV cultural agenda  indicators of the HIV national Cultural Agenda  country`s traditional practices  Traditional Healers and Traditional Birth Attendants  Religious Practices and Services  Policy Statements Responding to HIV/AIDS in the Workplace  Introduction  Learning outcomes  Policy Statements  HIV and AIDS at the Workplace  HIV and AIDS in the Workplace  traditional practices

Drama



Lecture Tutorial Seminar Demonstration Group discussions Role play

71



EIGHT

NINE

Testing Issues  Stigma AND DISCRIMINATION  General Program Implementation  Quality Assurance  regarding stigma and discrimination  stigma and discrimination National HIV/AIDS Research Agenda  Introduction  Learning outcomes  Implictions of the national research agenda  common strategies that facilitate

Monitoring and Evaluation  

TEN

Introduction Learning outcomes  evaluate the implimentation SERVICE IMPLEMENTATION STRUCTURES  Introduction  . MOH HIV/AIDS Unit  National Reference Laboratory  The District CT Coordination Arrangements  Management Team will:  CT IMPLEMENTING STAFF  The District CT supervisor  The CT laboratory technician  CT trainers  Site CT supervisor  CT counsellors  Selection criteria for CT counsellors  CT counsellors’ responsibilities  HIV testing by CT counsellors  The use of volunteers as CT counsellors  District CT supervisor  CT laboratory technician  CT trainers  Site CT supervisor  CT counsellors  CT community-based counsellor

Discussion Drama

Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama Lecture Role play Discussion Drama Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama

72



Laboratory technicians CT support staff and volunteers  TRAINING AND PROFESSIONAL ADVANCEMENT  ROLES AND RESPONSIBILITIES  Programmes FOR PEOPLE LIVING WITH HIV AIDS  District AIDS Co-ordination Committees  National AIDS Control Programme  Donors  Service Delivery  Indicators for the monitoring of progress with HIV-disease management  Input indicators:  Output indicators:  Illustrative List of Minimum Process Indicators for VCT Programs Handout Management of ARV  Introduction  Learning outcomes  Strategy  The strategy is to mobilise  ARV Policy Package  Key strategies  Input indicators:  Output indicators 

ELEVE N

TWELF

THIRTE EN

Ethical Issues  Introduction  Learning outcomes  Implementation  Service Utilization  Adequacy of Input  Staff Capacity and Development  Counseling  Monitoring Questions Handout/Facilitator Reference  Behavior Change Communication/Service Promotion Monitoring and evaluation policy  Counseling  General Program Implementation  Quality Assurance

Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama

Lecture Tutorial Seminar Demonstra-

73

              

FOURT EEN

Ethical Issues Implementation Implementation (Service Utilization) General Program Implementation Quality Assurance Ethical Issues Example Monitoring Questions Implementation (Service Utilization) Implementation (Adequacy of Inputs) Implementation (Adequacy of Inputs) Staff Capacity and Development Implementation (Adequacy of Inputs) Staff Capacity and Development Counseling Behavioral Change Communication/Service Promotion Proposals for Legislative Reform  Rationale for the Proposed Reform  Proposed Legislative Reform  The Constitution  Labour and Labour-related Legislation  Criminal Laws  Sexual Intercourse with Children  Public Health  Patient Rights and Confidentiality  Enforcement of Rights  Regulation of HIV/AIDS Related Goods and Services  Condoms and Medicinal Products  HIV Test Kits  Voluntary HIV Counselling and Testing Services  Traditional Medicine, Traditional Healers and Traditional Birth Attendants  Workers‘ Laws and Ethics  Miscellaneous Legislative Changes  Customary Laws  The Legal Aid Act  Children  Marriage and Divorce  Taxation  The Disabled  Orphans

tion Group discussions Role play Discussion Drama


74

10.4.14 Reference National HIV/AIDS/STD/TB Council (2001) Preliminary Report – Costing the Zambia National HIV/AIDS Strategic Frame Work 2001-2003 Ministry of Finance and National Planning (2002) –Zambia Poverty Reduction Strategy Paper 2002-2004 National Council of State Boards of Nursing. (1996). Assuring competence: A regulatory responsibility. Chicago: http://www.ncsbn.org/public/resources/ncsbn_competence.htm Retrieved Feb 28, 2007 Pearson, W.S. & Hueston, W.J. (2004). Treatment of HIV/AIDS in the nursing home: Variations in rural and urban long-term care setting. Southern Medical Association, Vol. 97 No. 4 http://ww w.unaids.org/publications/documents/index.html http://ww w.worldbank.org/hipc/ http:// www.worldbank.org/aids-econ/ http://www.worldbank.org/poverty/ http://www.oxfam.org/advocacy/human_f.htm http://www.dfid.gov.uk/public/what/strategy_papers/target_strategy.html http://www.usaid.gov/pop_health/aids/index.html http://www.j2000.usa.org http://w ww.medscape.com http://www.ama-assn.org/aids http://www.aidsinfo.nih.gov http://hivinsite.ucsf.edu

75

10.5 Modul 5: HIV Counseling and Testing (Mbirimtengerenji, D. Noel) MODULE CODE

:

HACOTE

201

YEAR OF STUDY

:

TWO

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.5.1 Overview of the Module This module, HIV Testing and Counselling, provides you with basic knowledge of the art and science of professional HIV Testing and Counselling. This Module will lay two important foundations (a) a useful fundus of information on HIV Testing and Counselling and (b) basic skills needed for effective, competent and efficient HIV testing and counselling. This foundation will help you understand how HIV testing and counselling can be pivotal in the provision of quality care. This module forms a foundation for the entire HIV testing and counselling profession that enables you to develop a framework for caring with compassion, confidence, competence, conscience and commitment. Foundation (a) focuses on HIV Counselling, the function and condition of the person with the goals of maintaining, supporting and restoring healthy functioning. To achieve these goals, you are required to identify alterations in functioning and recognize its manifestations and their impact on HIV counselling. Foundation (b) focuses on HIV testing practice based on appropriate selection and the use of testing interventions in response to a health problem, thus skills acquisition on HIV Testing . You need mastery of both (a) and (b).This module builds on knowledge from modules 1 to 4 and you will need to refer to them as you study module 5.

76

The module has been written in simple English so it is easy to understand. The contents are divided into 14 units that flow from simple to complex - an easy to follow structure. At the end of each unit, there are activities and skills for you to practice and evaluate your learning methods. If learning has not taken place, go over the contents again until you have learned them. The nursing laboratory is open for you to practice from 8am to 5pm with somebody to guide and support you. 10.5.2 How to use this module For effective and maximum learning, use this module in the following manner:  Study the textbook required for the unit very carefully. You may need to read the chapter several times.  Do all the quizzes and laboratory practices under each unit  There is a practical book that goes with this module; it has a list of all the fundamental skills that you need to master for each unit.  Where possible, discuss and rehearse the theory and exercises of each unit with group members to facilitate mastery.  Plan and make appointments to demonstrate to the lecturer, who will sign your practical book only if each skill has been mastered competently.  There is a learning contract which you need to understand and sign. 10.5.3 How the module fits into the programme Nursing is an art and a science. It requires the scientific base of knowledge on what a human is - anatomy, how the body of a human functions- physiology, how a human relates to the environment- sociology, how the human mind works –psychology, what organisms and parasites infect humans- microbiology and parasitology. This scientific basis will give you the foundation for your nursing practice. When you understand these basics, you will understand human functioning. When there is an alteration in the normal health of a human, you will be able to pick it up and intervene appropriately. This

77

module will help you to take care of yourself before you can take care of others by giving you a invaluable knowledge base. The Bachelor of Science programme is designed to produce a nurse with a degree and it must therefore offer the sciences which will help one understand the fundamentals of nursing upon which the whole professional practice is built. This knowledge base is the scientific rationale for whatever you do in nursing practice so you can rationalise why you are doing what to whom. There is no generalization or specialization in nursing unless the foundation for nursing is laid. 10.5.4 Overall learning outcomes  Explain the fundamental nursing concepts  Acquire knowledge, attitude and skills for the nursing fundaments  Demonstrate competencies in carrying out fundamental nursing procedures 10.5.5 Assessment Criteria Overall learning outcomes

Assessment Criteria

Explain the concepts of HIV counseling and testing.

For a student to be assessed, he/she should competently explain the following concepts of HVI/AIDS: 

Basics of HIV and AIDS



Positive living with HIV

Acquire knowledge, attitude and skills Explain the indications for carrying out different fundamental nursing in HIV counselling and testing procedures Demonstrate competencies in carrying out fundamental nursing procedures Appreciate the different roles of a nurse in the fundamentals of nursing

78

10.5.6 Assessment

method

 Continuous assessment – assignments, practical, mid-semester test = 50%  End of Module examination = 50% 10.5.7 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.5.8 Unit contents UNIT

CONTENTS

ONE

INTRODUCTION TO HIV AND AIDS COUNSELING AND TESTING  Learning outcomes  Content and Activities  Cause of AIDS  drug users, sex workers and men who have sex with men  at risk of HIV and AIDS  importance of self awareness in counselling  concepts of values, attitudes and prejudices  BEHAVOURAL CHANGE  Sense of accomplishment  A comfortable life  Freedom  Happiness  Social recognition and leadership  Exciting life  Self respect

SKILLS/ PROCEDURE

TEACHING METHOD Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion Drama

79

 

TWO

Health Affection from immediate friend  Inner harmony BASIC INFORMATION ON HIV AND AIDS  Introduction  Learning outcomes  Define HIV and AIDS  relationship between HIV and AIDS  immune system  disease progression of HIV  difference between antibody testing, CD4 testing and viral load testing  prevalence of HIV in your district and country  number of VCT centres in your District and the region or country  STAGES OF HIV AND AIDS  STAGE 1 : Primary HIV infection  STAGE 2 : Clinically asymptomatic stage  STAGE 3 : Symptomatic HIV infection  STAGE 4 : Progression from HIV to AIDS  PROGRESSION OF CD4 ACCORDING TO AGE  symptoms associated with each stage  how to use a condom  Modes of Transmission  Methods of Risk Reduction  Changing sexual behavior  Reducing the risk of


80

THREE

MTCT  Safer use of injection equipment  factors that hinder risk reduction  factors that influence MTCT  factors that influence HIV transmission DEFINITION OF HIV/AIDS COUNSELLING AND TESTING (CT)  Type of model  Learning outcomes  Definition of VOLUNTARY COUNSELING AND TESTING  Compare and contrast the different definitions  what type of counseling  advantages and disadvantages  method of counseling  VOLUNTARY COUNSELLING AND TESTING (VCT) Models  Models of CT  Benefits of VCT  appropriate VCT training materials  benefits of the VCT  Types of COUNSELLING SERVICES  Routine COUNSELLING AND TESTING (RCT)  Diagnostic COUNSELLING AND TESTING (DCT)  THE GOAL OF COUNSELING AND TESTING  Rationale for CT GUIDELINES


81

FOUR

FIVE

Testing for HIV  Introduction  Comparison of HIV home sampling and home testing  different antibodies  window period  accuracy of antibody tests  All testing follows the same basic steps  Antibody tests  Rapid HIV test  Enzyme-linked immunosorbent assay (ELISA  Western blot test  Rapid HIV tests and ELISA  A Western blot assay  Rapid HIV tests  Rapid testing  Benefits of rapid testing include  ELISA  Antigen test (P24 test)  Fourth generation tests  PCR test  HIV home sampling and HIV home testing  Home sampling for Testing  Home testing Getting tested for HIV Role play  Introduction  Learning outcomes  Reasons to get tested for HIV  What does an HIV test involve  When should someone get an HIV test  HIV testing - a personal view  HIV TESTING RESULTS



82

 

SIX

The viral load test Other assessments after starting treatment that influence the viral load  Meaning of Test Results  Negative  Positive  Indeterminate  False Positive  False Negative  Confidentiality in HIV Testing GUIDING PRINCIPLES FOR VCT SERVICES  Introduction  Learning outcomes  Commitment to client protection of Human Rights  Commitment to Code of Ethics and Practice  Voluntary testing:  Anonymous testing:  Client Confidentiality  Related testing:  Minimum age for VCT  Persons of unsound mind  Youth Friendly VCT:  Gender Equity and VCT  Cost of VCT services:  Responsiveness to community needs and culture  Community networks for care and supportive services  Ethical Issues Surrounding VCT for Youth—Questions for Counselors  Human Rights  Ethics and Practice  Informed consent  Confidentiality:


83

SEVEN

 Minimum age REQUIREMENTS FOR VCT SERVICES  Introduction  Learning outcomes  Location of VCT services:  VCT clinic  importance of each equipment in use  Required facilities and infrastructure  A minimum package includes  traffic control  type of the rooms needed  required type of staff  Human Resources  Management of Information Systems (MIS):  Workplace safety:  control infection at the VCT centre  THE MISFORTUNES OF COUNSELING  Elements of Good Counseling  Communication Skills and Techniques  Interpersonal Communication Skills  competences of a good counsellor  different non-verbal communications  Self-Awareness: “Who Lives in Here  Self-assessment checklist  Determinants of the ability to change behavior

Drama


84

EIGHT

NINE

Pre-Test Information and Counselling  Introduction  Learning outcomes  advantages of knowing the test results  Individual pre-test counselling  Group pre-test counselling  Components of the pretest information and counselling sessions  Counselling couples  Advantages of couple counselling  Benefits of knowing one’s HIV status  Elements of HIV Prevention Counseling  Roles and responsibilities  Basic counselling skills  Empathising  Active listening  Open questioning and probing  Focusing  Correcting inaccurate information  Providing pre-test information,  Prevention of Mother-toChild Transmission of HIV Testing Counseling POST TEST COUNSELING  Introduction  Learning outcomes  Giving HIV Test Results  POST-TEST FLOW CHART  Post-test support and services  Scenarios for HIV- test



85

TEN

results  Psychological Issues and Emotional Reactions Surrounding HIV/AIDS POST TEST  Post-test counselling checklist, HIV-negative result  GATHER method  Post-test counselling checklist, HIV-positive result  HIV-positive test results  Post-test counselling VCT POLICY MAKING AND SERVICES IMPLEMENTATION STRUCTURE  Introduction  Learning outcomes  National Implementation of VCT policies and Strategies  SERVICE IMPLEMENTATION STRUCTURE  National AIDS Commission Counselling Officer  Health (VCT) Information Management System Officer  Central Hospital Laboratory Technicians  District AIDS Coordinating Committee of the Local Government Assembly  The District AIDS Coordinator  The District VCT Supervisor  The VCT Laboratory Technician Supervisor  VCT Trainers


86

   

ELEVEN

Site VCT Supervisor VCT Counsellors Laboratory Technician VCT Community-based Counsellor  VCT support staff and volunteers  Training and professional advancement  VCT Counsellor Training  VCT Supervisor’s course  VCT Training of Trainer Course  VCT Community Based Counsellor Course  VCT clinic  Clear roles and responsibilities VCT SERVICE PROVISION  Introduction  Learning outcomes  Forms of counselling in VCT  Individual counselling  Couple Counselling  Group Discussion  VCT PROTOCOL  Testing Procedures  Post-test Counselling  ISSUES TO BE CONSIDERED IN VCT COUNSELLING  Referral and follow up  Medical evaluation, care, and treatment  Reproductive Health Services  Repeat Testing and the “Window Period”  Accessibility of Condoms and educational materials  Discordant Couples  influence default referral


87



TWELVE

THIRTEE N

influence nurses to fail to follow up  Repeat testing and the window period  Accessibility of condoms and educational materials  Discordant couples  Quality assurance  Challenges of Counselling  strategies to overcome the challenges MONITORING AND EVALUATION  Introduction  Learning outcomes  Monitoring and Evaluation  Publication of VCT service data  Methods to enhance the supervision process include  Indicators, Methods and Measures  VCT monitoring and evaluation  methods to measure the indicators  measurement tools for the indictors  VCT monitoring tools ETHICS IN COUNSELING AND TESTING  Introduction  Learning outcomes  Ethical Code of Conduct for HIV Counselors— General Principles  Competence  general concepts and principle of ethics  Human rights  Respect


Lecture Tutorial Seminar Demonstrati on Group discussions Role play Discussion Drama

88

      

FOURTE EN

Justice Beneficence Maleficence informed consent parental consent Confidentiality characteristic of confidential counselor  breaches of confidentiality  Personal conduct and integrity  Some Helpful Questions about “Dual  Relationships”  Respect for human rights  HIV counselors might face a number of ethical issues, including  Other Ethical Considerations Living Positively with HIV/AIDS  Introduction  Learning outcomes  Positive living  Guidance on positive living  As a counsellor, do not give false hope, but do not take away hope  HIV-positive living  Control the Stress in Your Life  STRESS MANAGEMENT  on stress management  Safer sex  Risks of opportunistic infections  Pregnancy, and referral of HIV-positive mothers to services specializing in preventing the transmission of HIV from

Lecture Tutorial Seminar Demonstrati on Group discussions Role play Discussion Drama

89

    

mothers to babies Nutrition (adapted to the economic conditions of the migrant) Exercise (including sport) Affordable leisure activities Managing stress Accessibility of condoms

10.5.9 Reference Ministry of Health. (2008). Prevention of mother-t0-child transmission of HIV (PMTCT): Presentation graphics. Ministry of Health. (2007). Management of HIV with Antiretroviral Therapy, Lusaka, Zambia.

90

10.6 Modul 6: Anti-Retroviral Therapy Participant’s Guide (Mweemba Prudencia, Chilemba, Evelyn., Mukwato Patricia) MODULE CODE

:

ART

201

YEAR OF STUDY

:

TWO

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.6.1 Overview of the Module Antiretroviral therapy has been effective in the management of HIV/AIDS and associated opportunistic infections. This module provides participants with a broader perspective on antiretroviral therapy and its influence on HIV/AIDS, focusing on the current standard treatment. Issues of HIV/AIDS staging, recommended treatments and guiding principles, herbal therapy, adherence to the therapy and challenges are discussed. This module is divided into three units focussing firstly on an overview of antiretroviral therapy, secondly on antiretroviral therapy, and thirdly on the recommendations of the World Health Organization (WHO) for developing countries. 10.6.2 Instructions for Participants While using this module, you are expected to do the following: 







Active participation in class and seminar presentations



Do all activities in the order in which they are presented

91

10.6.3 Learning outcomes By the end of this module, the participant is able to: 

Explain the global impact of HIV/AIDS and antiretroviral therapy



Explain the background of antiretroviral therapy



Describe the classification of antiretroviral therapy and terms commonly used in HAART



Reflect on how the existing clinical staging of HIV/AIDS influences the treatment regimens used in HIV/AIDS



Develop an antiretroviral therapy adherence protocol



Describe the management of opportunistic infections



Demonstrate the relevance of the existing alternative therapies to antiretroviral therapy

10.6.4 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.6.5 Participant’s role 











92










Lectures



Tutorials



Seminars



Demonstration



Group discussions



Role plays

10.6.8 Time allocated Contact Hours

Clinical Hours

Notional Hours

Total Hours

60

30

90

180


Project

40%



Examination

60%

93


CONTENTS

ONE

INTRODUCTION TO ART  Introduction  Learning Outcomes  impact of Antiretroviral Therapy  Historical Background of ART  PLWHA on Antiretroviral  The Primary Goal of ART  ART Policy Package  Key Operations for ART  ART Progress Indicators to Measure Delivery  Input Indicators  Output Indicators  ART promotes quality  importance of a structured framework  influence of indicators in monitoring  Clinical Benefits of Using ART  Restoration and or preservation of immunological functioning  Improvement of quality of life  Reduction in HIV related illnesses  Possible reduction in transmission  Challenges of Using ART  challenges of living with HIV ANTIRETROVIRAL THERAPY  Introduction

TWO

SKILLS/ PROCEDURE


Lecture Tutorial Seminar

94

  

THREE

Learning Outcomes Antiretroviral Therapy Criteria used to commence ART  Advantages and disadvantages of the criteria  Goals of Antiretroviral Therapy  Classification of AntiRetroviral Therapy  ART drug class and drug name  The first line Regimen  Basic Principles for Choosing the Regimen  First Line Regimen  Second Line Regimen  The second line Regimen  Analyse the combination  pharmacodynamics and pharmacokinetics  major side-effects  health education  Practical hints to aid in choosing a specific regimen  Principles of AntiRetroviral Therapy  Do everything possible  Use of combinations of ARV drugs  Education for the patient  Rational sequencing of ARV drugs  Avoiding Resistance  principles of ART explain the IEC materials  Different classes of ARVs WORLD HEALTH ORGANISATION TREATMENT CRITERIA

Demonstration Group discussions Role play Discussion Drama

Lecture Tutorial Seminar Demonstra-

95

                           

Introduction Learning outcomes WHO Staging System for HIV Infection and Disease Clinical Stage I Clinical Stage II Clinical Stage III Clinical Stage IV important in ARV therapy nurse’s role in ARV therapy WHO Treatment Regimens for Adults WHO Treatment Regimens for Adults First Line Second Line Previously Recommended Regimens Discontinuation of ART Indications for Consultation/Referral Purpose of Monitoring ART WHO Staging System for HIV Infection and Disease in Paediatrics Clinical Stage 1 Clinical Stage 2 Clinical Stage III Conditions where a presumptive diagnosis Conditions where confirmatory diagnostic Clinical Stage IV Conditions where a presumptive diagnosis Conditions where confirmatory diagnostic testing Adherence and Counselling Adherence is monitored

tion Group discussions Role play Discussion Drama

96

      

using diary cards factors affecting ART adherence factors to be managed to promote adherence strategies that can be used for ART adherence The challenges of ART common challenges Reading on the actions of herbal therapy HERBAL THERAPY

10.6.11 References Baylor College of Medicine. (2006) .HIV Curriculum for the Health professional. Houston: Centre for AIDS Research Family Health International. (2004). Handbook on Paediatric AIDS in Africa. Kampala: ANECCA Malawi, Ministry of Health. (2003). Treatment of AIDS. Guidelines for the use of antiretroviral therapy in Malawi. 1st edition.Lilongwe: Ministry of Health and Population Ministry of Health. (2007). Management of HIV with Antiretroviral Therapy, Lusaka, Zambia. National AIDS Council. (2008). National Guidelines on Management and Care of people Living with HIV and AIDS, Lusaka, Zambia.

97

10.7 Modul 7: Nursing Care of Persons Living with HIV and AIDS Participant Module (Mweemba, Prudencia) MODULE CODE

:

PLWH 201

YEAR OF STUDY

:

TWO

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.7.1 Overview of the Module Acute and hospice care have been effective in the management of HIV/AIDS and associated opportunistic infections. This module discusses care required in the management of HIV/AIDS, opportunistic infections and terminal disease for both paediatrics and adults. This module is divided into two units, focussing firstly on assessment, diagnosis, planning, intervention and the evaluation of HIV/AIDS care, and secondly on acute and hospice care. 10.7.2 Instructions for Participants 




Extensive consultation on each topic including colaboraiton with colleagues




10.7.3 Learning outcomes By the end of this module the participant is able to: 

Explain the process of HIV/AIDS care

98



Reflect on how the existing HIV/AIDS pattern influences acute care



Give a detailed background of hospice care



Demonstrate the relevance of the existing care strategies





Continuously monitors his/her own progress from unit to unit and reflects on to what extent his/her learning outcomes have been achieved
















Lectures



Tutorials

99



Seminars



Demonstration



Group discussions

10.7.8 Time allocated Contact Hours Clinical Hours

Notional Hours

Total Hours

10

60

110

40



40%



Final Assessment

60%


CONTENTS

ONE

The Nursing Process and HIV and AIDS Care

tion

TWO

 Learning Outcomes  Assessment  Data Collection  Physical Examination  Diagnosis  Planning  Care Plan  Interventions  Evaluation Acute Care and Hospice Care    

Introduction Learning Outcomes Acute Care Definitions

SKILLS/ PROCEDURE


Lecture Tutorial Seminar Demonstration Group

100

    

Guidelines Hospice Care Definitions Hospice Management Challenges of Hospice Care

discussions Role play Discussion Drama

10.7.11 References National HIV/AIDS/STD/TB Council (2001) Preliminary Report - Costing the Zambia National HIV/AIDS Strategic Frame Work 2001-2003 Ministry of Finance and National Planning (2002) –Zambia Poverty Reduction Strategy Paper 2002-2004 Central Statistics, Central Statistical Office, Central Board of Health, and ORC Macro (2003) - Zambia Demographic and Health Survey 2001 -2002 Central Statistics, Ministry of Health, and Measure Evaluation (2004) – Zambia Sexual Loeb, S. (1993). Diseases. Springhouse, Pennsylvania

101

10.8 Modul 8: Nutrition in HIV and AIDS Participant’s Module (Chikanya, Violet K.) MODULE CODE

:

NHA 101

YEAR OF STUDY

:

Year one

SEMESTER

:

TWO


:

4hrs/wk x 10 weeks


:

40


:

40

10.8.1 Overview of the Module This module focuses on nutrition for people living with HIV and AIDS (PLWHA). It is designed to equip nurses/midwives with knowledge that will enable them to give nutritional advice, counseling, care and support to HIV and AIDS clients and their families so that they may live positively and maintain good nutrition. 10.8.2 Instructions to Participants As you use this module you are expected to: 




Consult extensively on each topic including collaboration with colleagues






Do all activites as indicated

102

10.8.3 Learning outcomes On completion of this module, the participant is able to: 

Provide nutritional information for HIV and AIDS clients and their families



Promote healthy dietary habits among HIV and AIDS clients



Promote safe food practices



Provide information on opportunistic infections

10.8.4 Learning contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.8.5 Participant’s role The participant is expected to participate actively in all lectures and activities 10.8.6 Facilitator’s role The facilitator is to give lectures and guide the participant during his/her leaning process 10.8.7 Teaching methods 

Lectures



Tutorials



Seminars



Demonstration



Group discussions

103


Clinical Hours

Notional Hours

Total Hours

6.25

0

11.25

17.50

(675 minutes)

(1050 minutes)

(375 minutes)



40%



Final Assessment

60%


CONTENTS

ONE

LINK BETWEEN NUTRITION AND HIV AND AIDS  Introduction  Learning outcomes  Cycle of poor nutrition and HIV  Causes of poor nutrition in PLWHA  HIV affects nutrition  Decreased food consumption  Malabsorption  Changes in metabolism  effects of nutrition on HIV and AIDS  Food security  Definition of food security  Unique ways in which HIV and AIDS  services and programmes

SKILLS/ PROCEDURE


104

TWO

NUTRITION ASSESSMENT  Introduction  Learning outcomes  Definitions of nutrition and diet  Nutrition  Diet  Nutritional assessment




THREE

components of nutritional assessment  PLWHA regarding nutrition  advice about nutrition  A healthy diet  Risk factors for developing nutritional complications  risk factors for developing nutritional  how the risks factors contribute to nutritional complications  Dietary assessment  Dietary assessment history of PLWA  food square  dietary assessment DIETARY RECOMMENDATIONS  Introduction  Learning outcomes  Six major food groups  examples of food in each of the major food groups  Increased vitamin and mineral intake  types of food that contain minerals and vitamins  Recommended levels of food intake  recommended levels of food intake  Foods and habits that


105

FOUR

FIVE

PLWHA  type of foods and habits that PLWHA  Dietary recommendations for PLWHA  issues that need to be considered  Dietary recommendations  State dietary recommendations  Relationship between nutrition and ART  nutrition of clients WEIGHT MAINTENANCE  Introduction  Learning outcomes  Definition of weight maintenance  Importance of weight maintenance  PLWHA need to adopt to maintain  causes of weight loss  possible causes of weight loss  Actions that prevent weight loss  Ways to manage weight loss  foods and habits that should be avoided to prevent weight loss FOOD SAFETY  Introduction  Learning outcomes  1 Definition of food safety  WHO recommendations for food safety  Personal hygiene  Home hygiene  Safe Water  Food Preparation



106

  SIX

SEVEN

Food storage Conditions that may compromise food safety NUTRITIONAL MANAGEMENT OF COMMON OPPORTUNISTIC INFECTIONS  Introduction  Learning outcomes  Dietary management of HIV and AIDS-related symptoms  dietary management of HIV and AIDS  Common conditions related to HIV and AIDS  HIV and AIDS-related symptoms  different HIV and AIDS  related symptoms  Loss of appetite  prevent loss of appetite in PLWHA  Colds, Flu, Coughs and Fever  colds, flu, cough and fever are managed  Changes to taste  Nausea and vomiting  Diarrhoea  diet to treat diarrhoea  Digestive problems  treat digestive problems  Weight loss and muscle wasting  Anaemia  Sores in the mouth  diet to treat sores  Skin problems NUTRITIONAL CARE AND SUPPORT OF PREGNANT AND LACTATING WOMEN INFECTED WITH HIV AND AIDS


Lecture Tutorial Seminar Demonstration

107

  

     

    



Introduction Learning outcomes Needs for increased Nutritional requirements in HIV-infected pregnant or breastfeeding women requirements for energy, protein, and micronutrients risks of HIV-infected pregnant and lactating women nutritional risks of HIVinfected pregnant Recommended nutritional requirements micronutrient supplementation for HIV positive pregnancies Actions to improve the nutrition of pregnant and lactating women including HIV- infected women Infant feeding options exclusive breastfeeding and exclusive tips to good positioning exclusive breastfeeding Feeding recommendations of children from 6-36 months stage of child nutrition

Group discussions Role play Discussion Drama

10.8.11 References Lwanga, D. (2001). Clinical care of HIV-infected women in resource poor setting: Nutritional care and support. Baltimore, MD: Johns Hopkins Program on International Education for obstetrics and Gynecology (JHEPIGO). CD-ROM TUTORIAL

108

Mutangadura, G., Mukurazita & Jackson, H. (1999). A review of household and community response to the HIV/AIDS epidemic in rural Sub-Saharan Africa. Geneva: UNAIDS. Nutrition and HIV/AIDS – A Training Manual for Nurses and Midwives. www.fantaproject. (Accessed on 25 June 2009).

109

10.9 Modul 9: Home Based Care Participant’s Module (Kamanga, Martha) MODULE CODE

:

HBC

YEAR OF STUDY

:

TWO

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40

NUMBER OF LABORATORY HOURS :

201

None

10.9.1 Overview of the Module This module focuses on an introduction to “Home–Based Care“ as an intervention. It is designed to provide an understanding of the home-based care framework and addresses the issues of referral and networking as components in ensuring continuity of quality care for the patient/clients in home-based care. Community mobilization for effective and sustainable care is one of these components. 10.9.2 Instructions for Participants As you use this module you are expected to: 




Consult extensively on each topic






Do all the activities as instructed

10.9.3 Learning outcomes On completion of this module the participant is able to:

110



Discuss the concept of CHBC



Identify the key elements of CHBC



Describe the role of preventing infection in CHBC





















Lectures



Tutorials

111



Seminars



Demonstration



Group discussion


Clinical Hours

Notional Hours

Total Hours

6.25

0

11.25

17.50

(675 minutes)

(1050 minutes)

(375 minutes)



40%



Final Assessment

60%


CONTENTS

ONE

HOME-BASED CARE  Introduction  Learning outcomes  Definition  GOAL OF CHBC  Rationale  Key interventions in CHBC  interventions in homebased care  Ways in which HBC Services are offered  Benefits  Benefits of HBC for individuals  Challenges of HBC  Eligibility criteria

SKILLS/ PROCEDURE


112



TWO

THREE

FOUR

Caregivers for homebased care  Criteria for the selection of volunteers as caregivers  Evaluation BASIC CARE SKILLS  Introduction  Learning outcomes  Personal hygiene  Pressure area care  Ambulation/range of motion  Body parts that are prone to developing pressure sores  Role of nutrition in home-based care CLIENT AND HOME ASSESSMENT  Introduction  Learning outcomes  Areas of assessment  Client assessment  Home assessment  Significance of assessment in the CHBC  Significance of assessment in HBC CLIENT AND HOME ASSESSMENT  Introduction  Learning outcomes  Areas of assessment  Client assessment  Home assessment  Significance of assessment in the CHBC  significance of assessment in HBC  Support systems  Potential support groups at district and

Lecture Tutorial Seminar Demonstratio n Group discussions Role play Discussion Drama



113

FIVE

SIX

community levels  identified support group  The role of various support groups at district and community levels INFECTION PREVENTION  Introduction  Learning outcomes  Definition  Ways of preventing infections  Protective barriers  Compare and contrast the following concepts in HBC:  Decontamination  Cleaning  Boiling  Sterilization Standard precaution measures  Important considerations for the prevention of infection  Situations when to use gloves  Materials and resources for the prevention of infection  Decontaminate used equipment  Equipment used for decontamination in HBC NETWORKING  Introduction  Learning outcomes  Referral system for people living with HIV and AIDS  CHBC Program  Key elements of effective referral


Lecture Tutorial Seminar Demonstration Group discussions Role play Discussion

114

SEVEN

EIGHT

mechanisms  Basic elements of an effective referral system COMMUNITY MOBILIZATION AND PARTICIPATION  Introduction  Learning outcomes  Purpose of community mobilization  Process of community mobilization  Assessing needs  Developing plans  Mobilizing resources  Implementing actions  Monitoring and evaluation  effectively monitor and evaluate community mobilization  Challenges of community mobilization  Role of community members in CHBC  Brainstorm the roles of community members in HBC  Construct a TREE  potential groups  Groups that can support CHBC in the community Client participation in CHBC  Introduction  Learning outcomes  significance of client participation  Enhancing client participation in HBC  enhancing client participation in HBC  Challenges faced by

Drama



115

NINE

clients when participating in HBC HOLISTIC CARE   

TEN

Introduction Learning outcomes Essential elements of HBC  Provision of care  Continuation of care  Education  Supplies and equipment  Staffing  Financing and Sustainability  Monitoring and Evaluation  Support system of CHBC in Malawi & their roles  key care providers in HBC  Medical care  Nursing care  Emotional support  Psychological care  Social economic care  Human Rights  Legal Needs  Protection against violence and discrimination  palliative care Palliative care  Introduction  Learning outcomes  Definition  Components of palliative care  Pain relief  Spiritual and emotional support  Anticipatory guidance  Inheritance rights



116



ELEVE N

Importance of bereavement counseling  Bereavement counseling  Impact of palliative care in HBC ROLE OF THE COMMUNITY IN HBC  Introduction  Learning outcomes  Groups that can support HBC in the community  Role of community members IN CHBC  conflicting roles in HBC  Immediate family members  Extended family members


10.9.12 References Shaibu S (2006).Community home-based care in rural village: Challenges and strategies. J Transcult Nurs 2006 17: 89 http://tcn.sagepub.com/content/17/1/89 WHO(). COMMUNITY HOME-BASED CARE IN RESOURCE-LIMITED SETTINGS: A FRAMEWORK FOR ACTION

117

10.10 Modul 10: Care of the Carers Participant’s Guide (Gwaze, Simbirai) MODULE CODE

:

CACA 301

YEAR OF STUDY

:

THREE

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.10.1 Overview of the Module This module focuses on caring for the carers/ health workers who spend most of their lives looking after others, in particular people living with chronic conditions like HIV and AIDS. It is designed to equip nurses/ midwives with knowledge about their roles, the prevention and management of stress, as well as the identification of psychosocial support available to them. 10.10.2 Instructions for Participants 








10.10.3 Learning outcomes On completion of this module, the participants should be able to: 

Articulate the different roles of the nurse/ midwife



Carry out strategies for preventing personal and work related stress

118



Promote a conducive working and living environment



Provide information on psychosocial support systems available within the community





















Lectures



Tutorials



Seminars

119



Demonstration



Group discussions


Notional Hours

Total Hours

15

20

65

30


Continuous assessment (40%)



Final written examination (60%)


CONTENTS

ONE

THE CONCEPT OF CARE OF THE CARERS  Introduction  Learning outcomes  Unit contents and activities  Definitions  Definitions of above listed concepts  The flipchart or board  Compare definitions  Differences and similarities  Types of caregivers  Primary Caregivers  Secondary Caregivers  Roles and rights of nurses  Roles of the Nurse  ILO Code of Practice and ANA code of practice  challenges encountered

SKILLS/ PROCEDURE


120

TWO

 motivational factors. STRESS MANAGEMENT            

THREE

FOUR

Introduction Learning outcomes SIGNS OF STRESS Signs of Stress Physical Emotional Behavioral Self care Strategies Coping strategies Causes of stress Factors that increase stress  Methods of alleviating these stressors  Effects of stress  Cycle of effects  Personal, job and organizational change PREVENTION OF STRESS  Introduction  Learning outcomes  General adaption syndrom (GAS)  Stage of the syndrome  Defense mechanism  Used defense mechanisms  Common stressors across the life span  List of stressors  Stress prevention  Characteristics of mentally healthy people NON PHARNACEUTICAL METHODS OF MANAGING STRESS  Introduction  Learning outcomes  Personal self-nurturing methods  Common self-nurturing



Lecture Tutorial Seminar Demonstration Group discussions Role play

121

FIVE

SIX

methods  Creative Self-Nurturing Methods  benefits of two methods  benefits of humor  Relaxation techniques  relaxation techniques PSYCHOSOCIAL SUPPORT  Common self-nurturing methods  Creative self-nurturing Methods  Relaxation techniques  Deep breathing exercises and many more  Creating your own relaxation tape  Progressive muscle relaxation  Visualization CHALLENGES ENCOUNTERED BY NURSES  Introduction  Learning outcomes  Major challenges  Job Related Challenges  Organization Related Challenges  Personal Related Challenges  Possible solutions  Short and long term solutions.  Possible solutions to the identified challenges

Discussion Drama



10.10.11 References International Labor Organization (2008). Code of practice on HIV /AIDS at the work place. Geneva: ILO

122

Linn, M., Fabricant, S. and Linn, D.(1998). Healing : the eight stages of life. New York: Paulist Press. Manthei, R. (1997). Counseling: The skills of finding solutions to problems. London: Routledge. SAfAIDS /WHO /IFRC (2006). HIV prevention, treatment, care and support: A training package for community volunteers: Caring for carers module. GENEVA: WHO Holroyd, K. A. and Lazarus, R. S. (1982) Stress, coping and somatic adaptation. In Goldberger, L and Breznit, S (Eds) Handbook of stress (pp21-35) New York: Free Press. Kapoor, B. (2001).Text book of psychiatric nursing volume 1. Delhi: Kumar Publishing House. Makoni, P. (2002). Bioscience 1 Module. Harare: Zimbabwe Open University. Selye, H. (1976). The stress of life. New York: McGraw Hill Brummer, L. (1993). The helping relationship: process and skills. Boston: Allyn and Bacon. Fortinash, K.M.and Holoday-Worrent, P.A. (1996). Psychiatric mental health nursing. St Louis: Mosby.

123

10.11 Module 11: Prevention of Mother to Child Transmission of HIV (PMTCT) Participant’s Module (Mukwato-Katowa, Patricia and Mweemba, Prudencia) MODULE CODE

:

PMTCT

301

YEAR OF STUDY

:

THREE

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.11.1 Overview of the Module This module provides participants with evidence-based facts about PMTCT of HIV with particular emphasis on the magnitude of MTCT, modes of transmission, factors influencing transmission rates and strategies that can reduce transmission rates. The recommended antenatal, intrapartum and postnatal care surrounding HIV is discussed. Furthermore, the two main feeding options for HIV exposed infants and young children have been outlined, together with a description of the key components that promote optimal infant feeding for HIV infected mothers. 10.11.2 Instructions for Participants While using this module, you are expected to do the following 










Do all activities in the order in which they are presented

124

10.11.3 Learning outcomes By the end of this module, the participant is able to: 

Discuss the impact of MTCT on the HIV/AIDS pandemic



Outline factors that influence the MTCT of HIV



Outline different preventive strategies in PMTCT



Discuss the antenatal, intrapartum and postnatal care of a mother and baby in the context of PMTCT



Describe the relationship between nutrition and the MTCT of HIV



Describe the different infant feeding options with respect to HIV














125








Lectures



Discussions



Tutorials


Seminar Hours

Notional Hours

Total Hours

60

40

100

200


Continuous assessment

40%



Final Examination

60%


CONTENTS

ONE

INTRODUCTION TO PMTCT  Introduction  Learning outcomes  Definition of Relevant Terms  Modes of MTCT of HIV  During pregnancy (inutero/antenatal)  During labour and delivery (intra-partum  During breastfeeding

SKILLS/ PROCEDURE


126

TWO

(postnatal  Factors that influence the mother-to-child transmission of HIV  Factors influencing MTCT of HIV  Counselling and Testing in PMTCT  Interpreting screening and confirmatory test results  HIV Screening Test  HIV Confirmation Test  Patient’s HIV Results  Negative results  Positive results  Preventive strategies in PMTCT  Prevention of primary infection  Prevention of unintentional pregnancies in HIV infected women  Interventions to Prevent mother-to-child transmission  Linkages to treatment (ARVS), care and support of infected families ANTENATAL, INTRAPARTUM AND POSTNATAL CARE  Introduction  Learning Outcomes  Antenatal Care  HIV pregnant woman  Intrapartum Care  Avoiding transmission  Postnatal Care  Labour Ward Services  HIV Positive and Negative Women  Antenatal and labour


127

THREE

services  HIV positive  HIV negative at first visit  HIV positive postnatal mother  Algorithm for Care of HIV Positive Pregnant Women  Algorithm for Care of HIV Positive Pregnant Women  Responsibilities of the Health Care Provider  IEC to an HIV positive pregnant woman MATERNAL, INFANT AND YOUNG CHILD NUTRITION IN PMTCT  Introduction  Learning Outcomes  Maternal Nutrition  Infant and young child nutrition  Recommendations for Infant and Young Child Feeding  Recommendations for HIV negative mother or mother of unknown status  Recommendations when mother is HIV positive (0-6 months)  Exclusive breastfeeding.  Exclusive replacement feeding (infant formula)  Feeding options when the infant is tested positive with PCR at 06 months (early infant diagnosis)  Feeding of infants born to a HIV positive


128

    

   



mother after 6 months Other feeding Options in special circumstances Counselling for infant feeding in relation to HIV Counselling for infant feeding in relation to PMTCT Adapted from Zambia Ministry of Health, 2008 Key components that promote optimal infant feeding in the context of HIV Infant and young child feeding follow-up Growth monitoring Feeding a sick child International Code of Marketing Breast milk Substitutes and the country specific Legislation Baby friendly hospital initiative

10.11.11 References Ministry of Health. (2008). Prevention of mother-to-child transmission of HIV (PMTCT): A reference manual for health workers. Ministry of Health. (2008). Prevention of mother-t0-child transmission of HIV (PMTCT): Presentation graphics. Ministry of Health. (2007). Management of HIV with Antiretroviral Therapy, Lusaka, Zambia. National AIDS Council. (2008). National Guidelines on Management and Care of people Living with HIV and AIDS, Lusaka, Zambia. 129

Ministry of Health. (2010). 2010 National Protocol Guidelines: Integrated Prevention of Mother-to-Child Transmission of HIV, Lusaka, Zambia Ministry of Health. (2007). Management of HIV with Antiretroviral Therapy, Lusaka, Zambia. National AIDS Council. (2008). National Guidelines on Management and Care of people Living with HIV and AIDS, Lusaka, Zambia. Malawi, Ministry of Health.2003. Treatment of AIDS. Guidelines for the use of antiretroviral therapy in Malawi. 1st edition. Lilongwe: Ministry of Health and Population

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10.12 Modul 12: Management of Opportunistic Infections and Neoplasms Participant’s Module (Chikanya, Violet K.) MODULE CODE

:

MGTOI

301

YEAR OF STUDY

:

THREE

SEMESTER

:

One/TWO


:

4hrs/wk x 10 weeks


:

40


:

None

10.12.1 Overview of the Module This module focuses on infections which a normal human body is capable of resisting but which people living with HIV and AIDS are prone to develop. It is designed to equip nurses/midwives with knowledge that will enable them to diagnose and effectively manage clients with an impaired immune system. 10.12.2 Instructions for Participants 








10.12.3 Learning outcomes On completion of this module the participant is able to: 

Provide information on opportunistic infections



Promote the behaviour for a healthy lifestyle in HIV and AIDS clients

131

10.12.4 Learning Contract The student shall complete the module within the specified period of time in order to gain the appropriate knowledge, skills and professional approach. The student must achieve the stipulated learning outcomes on time in readiness for clinical placement and assessments. 10.12.5 Participant’s role 




















Lectures



Tutorials



Seminars



Demonstration



Group discussions

132


Notional Hours

Total Hours

30

60

130

40



40%



Final Assessment

60%


CONTENTS

ONE

OVERVIEW OF HIV DISEASE  Introduction  Learning outcomes  Viral Structure  The Normal Immune Response  immunity  antigens  humoral immunity  Lymphocytes  B Cells  T Cells  defense mechanism  immune suppression  Opportunistic Infections  Life Cycle of HIV and Action of Antiretroviral Agents  HIV Lifecycle and Sites of Action  Relationship between HIV plasma viral load, CD4+lymphocyte counts  HIV antibody levels.  Relationship between HIV plasma viral load, CD4+ lymphocyte count and HIV antibody levels  HIV plasma viral load, CD4+ lymphocyte count

SKILLS/ PROCEDURE


133

 

TWO

WHO Staging System WHO Staging System: Laboratory Classification  WHO clinical Staging System  HIV Diagnostic Tests Enzyme Linked Immunosorbant Assay (ELISA)  Western Blot  Rapid Tests FUNGAL AND PARASITIC INFECTIONS  Introduction  Oral candidiasis  LEARNING OUTCOMES  Fungal Infections  Pneumocystis pneumonia  Clinical Presentation  clinical presentation of a patient with pneumocystis pneumonia  Diagnostic Procedures  diagnostic tests that are done to confirm pneumocystis pneumonia  Treatment for pneumocystis pneumonia  First, Second and Adjunctive treatment for PCP  Cryptococcosis  Candidiasis  Diagnosis of candidiasis  procedures used in oro-pharyngeal candidiasis, oesophageal  Treatment for candidiasis  Signs and Symptoms of Cryptococcosis  symptoms of cryptococcosis  Diagnosis of cryptococcosis  Treatment for cryptococcosis  secondary prophylaxis for Cryptococcus  Histoplasmosis  Signs and symptoms of histoplasmosis  symptoms of histoplasmosis  histoplasmosis lesions

Lecture Tutorial Seminar Demonstra-tion Group discussions Role play Discussion Drama

134

  

THREE

FOUR

Diagnosis of histoplasmosis Treatment for histoplasmosis treatment regime for histoplasmosis  Parasitic Infections  Toxoplasmosis  Signs and symptoms of toxoplasmosis  symptoms of toxoplasmosis  Diagnosis of toxoplasmosis  Treatment for toxoplasma  treatment for toxoplasmosis  toxoplasmosi  Cryptosporidiosis  Diagnosis of cryptosporidiosis  Treatment for Cryptosporidiosis  Microsporidiosis  treatment for microsporidiosis  Treatment for Microsporidiosis  Diagnosis of microsporidiosis BACTERIAL INFECTIONS  Introduction  Learning outcomes  Bacterial infections  Respiratory Infections  Diagnosis of Bacterial pneumonia  Treatment for bacterial infections  Enteric Infections  Clinical Features and Treatment for Enteric infections  Atypical Mycobacteriosis VIRAL INFECTIONS  Introduction  Learning outcomes  Herpes Simplex Virus  Diagnosis of Herpes Simplex  Treatment for Herpes Simplex Virus  Varicella Zoster Virus  Diagnosis of Varicella Zoster Virus  Treatment for Varicella Zoster Virus  Molluscum Contagiosum  Diagnosis of Molluscum



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FIVE

SIX

Contagiosum  Treatment for Molluscum Contagiosum  Cytomegalovirus (CMV)  Diagnosis of Cytomegalovirus (CMV)  Treatment for Cytomegalovirus  Human Papilloma Virus (HPV)  Diagnosis and Prevention of Human Papilloma Virus  Epstein Barr Virus (EBV)  Oral hairy leukoplakia  Human Herpes Virus Type 8 (HHV8, KSHV) TUBECULOSISI AND HIV  Introduction  Learning outcomes  Overview of Tuberculosis  Effects of HIV on TB  3 Effects of TB on HIV  Collaborative TB-HIV activities  Clinical presentation and diagnosis of TB in adults  Diagnosis of Pulmonary and Extrapulmonary Tuberculosis  TB Screening Form  Laboratory Diagnosis of Pulmonary TB  Clinical Presentation and Diagnosis of TB in Children  Management of TB and TB-HIV in Children  Children Co-infected with HIV and TB  Treatment  Treatment in special cases  Common side effects of anti-TB drugs  Monitoring during treatment MALIGNANCIES ASSOCIACTED    

Introduction Learning outcomes Kaposi’s sarcoma Mode of spread


Lecture Tutorial Seminar Demonstra-tion Group discussions

136

SEVEN

EIGHT

 Presentation of Kaposi’s sarcoma  Diagnosis of Kaposi’s sarcoma  Treatment of Kaposi’s sarcoma  Lymphoma  Types of lymphomas  Non-Hodgkin’s lymphoma  Presentation of lymphoma  Diagnosis lymphoma  Treatment of lymphoma  Cervical Cancer  Clinical stages of cervical cancer  Screening tests for cervical cancer  Staging process  Treatment of cervical cancer COMMON MEDICAL PROBLEMS ASSOCIATED WITH OPPORTUNISTIC INFECTIONS  Introduction  Learning outcomes  Persistent Generalized Lymphadenopathy  Differential Diagnosis  Management  Persistent cough  Management  Headache  Differential Diagnoses  Management  Persistent fever  Differential Diagnoses  Management  Chronic Diarrhoea  Differential Diagnosis  Management  Weight loss  Differential Diagnoses  Management  Fungal Skin and Nail infections  Other Skin Conditions  Other Common Medical Problems COUNSELING AND OPPORTUNISIC INFECTIONS (OIs)  Introduction  Learning outcomes

Role play Discussion Drama


Lecture Tutorial Seminar Demonstra-tion

137

                                

Persistent Generalized Lymphadenopathy Differential Diagnosis Management Persistent cough Management Headache Differential Diagnoses Management Persistent fever Differential Diagnoses Management Chronic Diarrhoea Differential Diagnosis Management Weight loss Differential Diagnoses Management Fungal Skin and Nail infections Other Skin Conditions Other Common Medical Problems INTRODUCTION LEARNING OUTCOMES General Counselling Principles and Skills Counselling related to Opportunistic Infections Opportunistic Infections Clinic/Services Aim and objectives of Opportunistic Infections Services offered at the clinic Long term chemoprophylaxis Enrollment Procedures Follow-up visits Accessing Opportunistic Infections clinic services Newly Tested HIV Positive Clients Clinical Management

Group discussions Role play Discussion Drama

138

10.12.11 References Central Board of Health , Zambia (November, 2004) Management of Opportunistic Infections and Neoplasms: Participants Handbook Chin, J. (2000) Control of Communicable Diseases Manual (17th Ed.)] Washington: American Public Health Association Ministry of Health & Child Welfare, Zimbabwe (2005). Opportunistic Infections Management and Antiretroviral Drug Therapy. A Training Course for Health Care Workers. Participant Manual Mutangadura, G., Mukurazita & Jackson, H. (1999). A review of household and community response to the HIV/AIDS epidemic in rural Sub-Saharan Africa. Geneva: UNAIDS. Nutrition and HIV/AIDS – A Training Manual for Nurses and Midwives. www.fantaproject. (Accessed on 25 June 2009). Piwoz, EG, & Preble, EA. 2000. HIV/AIDS and nutrition: A review of the literature and recommendations for nutritional care and support in sub-Saharan Africa. Washington: SARA Project, Academy for Educational Development Regional Economic Development Service Office/East and Southern Africa of the U.S. Agency for International Development and the United Nations University in Tokyo (2003). Regional Centre for quality health care: Nutrition and HIV/AIDS: A Training Manual. Kampala: RCQHC. Southern Africa HIV/AIDS Information Dissemination Service, World Health Organization & International Federation OF Red Cross and Red Crescent Societies (2006). HIV prevention, treatment, care and support- A training package for Community volunteers. Module 6: Nutrition. Geneva: World Health Organization. Van den Berg, R. H and Viljoen, M. J (199 Communicable Diseases: A Nursing Perspective, Cape Town: Maskew Miller Longman

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