South African primary health care in the era of HIV/AIDS treatment and care : understanding the organisation and delivery of nursing care
Guise, Andrew George;
(2012)
South African primary health care in the era of HIV/AIDS treatment and care : understanding the organisation and delivery of nursing care.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.00878726
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The integration of Antiretroviral Treatment (ART) for HIV in to South African primary health
care (PHC) and task shifting are increasing nurses' role in ART and H/V care. There is
evidence this role is motivating nurses to adopt more patient-centred care. This study
explored this potential emergence of more patient centred care in PHC in the Free State
province, South Africa.
A multi-site, mixed-method observational approach was used, building on ethnographic
principles. A purposive sample of four clinics, two providing ART and two not, were the
focus for observation and interviews through four phases of data collection. Emerging
findings were explored in an additional six clinics in later phases of data collection. 34
professional nurses, 6 members of clinic staff and 21 patients were interviewed. A thematic
analysis that aimed to develop theory grounded in the study contexts through integrating
existing theory with inductively identified themes was used.
The study found care is patient centred and integrated to a limited extent, while ART and
HIV care are more likely to be patient centred than other aspects of PHC. These care
routines are then shown to emerge from nurses' agency mediating different levels of
structure: the rules of clinic interaction and then the clinic context. Further analysis of
nurses' agency explores how it is shaped by a complex identity and a health system context
of constant change.
The study provides in-depth understanding of a little explored health services issue, and is
the basis for recommendations to support patient centred and integrated care. The
analysis supports the reconceptualisation of patient centred care to consider Issues of
convenience, as a response to the specific context of nurse-led PHC in South Africa. The
study also introduces a structure-agency theoretical framework that can be applied to the
context of nurse-led PHC.