SUMMARY:

Nurses SOAR! (formerly known as the Global HIV and AIDS Nursing Capacity Building Program), is an

ongoing three year program to strengthen the leadership, education and clinical capacity of nurses to

provide HIV and AIDS services to those infected, or affected by, HIV and AIDS. Nurses SOAR! works in

close partnership with Ministries of Health and other stakeholders and PEPFAR in-country teams. The

program is currently active in South Africa and Lesotho. Scale-up to Swaziland is expected in FY 2008.

BACKGROUND:

Needs assessments during FY 2007 in South Africa with in-country nurses, other stakeholders and partners

strongly directed this program to initially focus its work in KwaZulu-Natal (KZN) province. Additionally, the

need for nursing curricula and national standards for South African nurses caring for persons with HIV and

AIDS led to initiating collaborative activities with the South African Nursing Council (SANC), the Universities

of KZN and Zululand, and in-country/region organizations (some PEPFAR supported). Nurses SOAR! is

active with national partners (such as the SA-based Foundation for Professional Development - FPD, and

SADC AIDS Network of Nurses and Midwives - SANNAM). The Anglican Diocese of Johannesburg has

engaged Nurses SOAR! to capacity build for VCT and ARV delivery; these activities will maximize

collaboration with PEPFAR partners and provide opportunities for Nurses SOAR! to scale-up nationally.

During FY 2008 and 2009, Nurses SOAR! will continue to build capacity within national nursing entities

while strengthening regional nurse capacity in KZN, Lesotho and Swaziland.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Needs Assessment

After permission to be active in-country was gained in January 2007, a comprehensive needs assessment

of the capacity to provide HIV and AIDS nursing leadership, clinical care, and education was the initial

activity completed at each selected site. These data provided specific priorities for HIV and AIDS nursing

capacity building activities (at pre-service and in-service levels) to improve the HIV and AIDS prevention,

care, and treatment for South Africans. During FY 2007, 10 nurse faculty, 10 nurse managers, 50 clinical

nurses and approximately 30 other stakeholders (e.g., SANC leaders) were engaged in the process (over

20 organizations involved). In FY 2008 and FY 2009, needs assessment data will be collected at each

additional program site to guide training plan development. Activities 2 and 3 address the findings of the

needs assessment.

ACTIVITY 2: Capacity Development by Systems Strengthening

This activity consists of four components:

i) Leadership activities have been designed to develop a critical mass of nurse leaders who can provide

leadership in the AIDS pandemic and bring voice to the profession that highlights the nursing contributions

to the African response. The program mentors a cadre of nurses committed to HIV and AIDS care,

developing and implementing individualized plans for professional leadership development. Activities focus

on communication, policy development, and strategic planning for the delivery of HIV and AIDS services

(improving outcomes of care at the local, national, and regional levels). Nurses SOAR! engaged others

working in this area (see activity 3). Currently, Nurses SOAR! is working with 20 nurses at all professional

levels. In FY 2008, the cadre will increase to approximately 40 nurses, and in

FY 2009, to approximately 70 nurse leaders.

ii) Education: this component a) enhances efforts to integrate HIV and AIDS educational content into the

local and national nursing curricula; and b) builds the HIV and AIDS knowledge base of clinical nurses and

nurse tutors building on prior activities by partners (e.g. Foundation for Professional Development - FPD).

Activities included a) didactic HIV/AIDS trainings; b) inserting HIV and AIDS content into nursing curricula,

classroom instruction, and clinical education (at colleges and universities); c) collaborating with the SANC to

integrate nursing standards into pre-service training and post basic education in HIV and AIDS prevention,

care, and treatment. In FY 2007, approximately 150 nurses or nurses in training received such support. In

FY 2008, this will increase to 400, and Nurses SOAR will support the scholarly development of nursing

faculty to increase their contribution to the South African HIV and AIDS literature. South African nursing

faculty expressed a need for support in conducting their research. Finally, great interest was shown by the

SANC to incorporate HIV and AIDS into the national curricula. However, due to managerial changes at the

Council, efforts have been slowed. Efforts will be made in FY 2008 to accelerate the integration of HIV and

AIDS content into pre-service education, and in FY 2009 to consider the development of a post-basic

education for primary care nurses and effective evaluation of nurse competencies.

iii) Mentoring: Nurses SOAR! utilized clinical nurse experts from Southern Africa and North America to serve

as mentors that provided targeted on-site clinical precepting. Nurses, nurse tutors and the nurse

tutor/student dyad were mentored in the application of didactic knowledge to real life clinical settings to

improve delivery and outcomes of nursing care. Activities included working one-on-one with the clinical

nurses and the nurse tutors/dyads in their work settings. In FY 2007, approximately 20 nurses were

mentored. In FY 2008 and FY 2009, the number of nurses engaged in the program will significantly

increase.

iv) Nurse Retention: Nurses SOAR! also focused on building nursing capacity by addressing the health and

well-being of current and future nurses. Activities included reducing nurse morbidity from exposure to AIDS-

related multiple loss and grief by conducting uniquely designed Loss & Grief retreats. Local religious and

spiritual leaders were engaged to build a sustainable program to address the continued burden of grief and

multiple loss issues of nurses that contributes to nurse burnout and migration. The program also supports

HIV-infected nurses to encourage their access to appropriate support, care and treatment. Maintaining the

health and wellbeing of nurses requires the reduction of stigma and establishing a confidential support

system. Nurses SOAR! has engaged 29 nurses in the Loss & Grief program; it is expected that 150 nurses

will participate in FY 2008 and 250 nurses in FY 2009.

ACTIVITY 3: Capacity Development by Partnership and Network Development

The Program facilitates partnerships, collaborative systems, networks, and resources that build and sustain

a nursing workforce to meet the increasing need for nurses to deliver quality HIV and AIDS prevention,

Activity Narrative: care, and treatment services. The Georgetown team, and its partners the US Association of Nurses in AIDS

Care (ANAC) and the University of Incarnate Word (UIW), collaborate with key stakeholders such as SANC,

SANNAM, the Universities of KZN and Zululand, and other partners currently working in nurse development

such FPD. These relationships assure that the Nurses SOAR! Program is an ‘additive' program, filling high-

priority gaps in nurse capacity building and strengthening networks by a) facilitating the creation of a

professional network of nurses who deliver HIV and AIDS services; b) establishing a train-the-trainer (TOT)

network to provide on-going HIV and AIDS clinical mentoring for all levels of nursing; c) fostering focused

professional development and d) facilitating collegial relationships between nurse leaders, clinicians,

educators, and nurse mentors to enhance the quality of HIV and AIDS care.

FY 2008 COP activities will be expanded to include: down referral clinical sites that feed into the St Mary's

Hospital site (Mariannhill); nurse training support to the nurses delivering HIV and AIDS prevention, care,

and treatment services in the Mtubatuba rural area in KZN and in northern KZN (partner: Catholic Medical

Mission Board); nurse training support to the nurses delivering HIV and AIDS prevention, care, and

treatment services in Johannesburg (partner: the Anglican Bishop of Johannesburg); nursing association

technical assistance services for South African professional nurses; building academic capacity building

with nurse educators at the University of KZN to integrate HIV and AIDS content into graduate curricula,

increase HIV and AIDS nursing research, and disseminate HIV and AIDS data; extending nurse leadership

skills building to a second cadre of nurse leaders; increasing the caregiver support for HIV-infected nurses;

and extending the clinical mentoring to develop nurse experts in palliative care, pediatric HIV and AIDS, and

midwifery (including prevention of mother to child transmission).

Prevention: Although the program's main technical area is not ‘prevention', its work very closely supports

and facilitates increased prevention activities. The main prevention areas currently addressed are a) the

occupational transmission of HIV in the clinical setting; b) the upgrading of tutors' knowledge, nursing

curricula and effective teaching methods to assure that students integrate HIV prevention messages into

their clinical practice and c) an emphasis of the role of all nurses in reinforcing prevention messages for

vulnerable young adults (including tutor messages for nursing students).

Gender Issues: The Nurses SOAR! Program focuses on nurses, who are predominately female. The needs

assessment data identified several training topics influenced by gender inequalities. Nurses requested

training in empowering female nurses in professional interactions with male colleagues (e.g. usually female

nurses and male physicians). They also requested strategies for including males in the "family-centered"

provision of HIV and AIDS prevention, care and treatment services.