Iwu Emilia Ngozi, Holzemer William L
a Rutgers, College of Nursing , The State University of New Jersey , Newark , NJ , USA.
AIDS Care. 2014 Jan;26(1):42-52. doi: 10.1080/09540121.2013.793278. Epub 2013 May 23.
With 24% global disease burden and 3% global health workforce, the World Health Organization (WHO) designates the African region a critical workforce shortage area. Task shifting is a WHO-recommended strategy for countries with severe health worker shortages. It involves redistribution of healthcare tasks to make efficient use of available workers. Severe physician shortages, increasing HIV disease burden, and the need for improved access to antiretroviral treatment (ART) posed serious challenges for Africa. Shifting ART management from physicians to nurses was adopted by many countries to increase access to treatment. Growing evidence from Africa supports this model of care but little is known about its impact on African nurses. A PubMed literature search was conducted for most recent task-shifting studies in Africa between January 2009 and August 2012. Thirty-four studies were identified but 11 met criteria for "task shifting from physicians to nurses in HIV settings." The methodologies and findings related to patient outcome, nurses' perceived self-efficacy, and job satisfaction were summarized. Patient outcomes were measured in 10 of the studies and all demonstrated comparable results. Seven of eight studies showed no difference in mortality while five found better retention and lower client loss to follow-up in nurse-managed groups. Four studies showed that nurses built on existing nursing and HIV knowledge; improved HIV and other disease management skills; and had increased comfort levels with using treatment guidelines. Results of job satisfaction from three studies showed that nurses expressed "feelings of emotional rewards, accomplishment, prestige, and improved morale." In six studies, nurse-managed care was acceptable to patients in five studies, nurses in two studies, and majority of physicians and program managers in one study. Nurse-managed care had comparable outcomes and retained more patients but only two studies "directly" assessed nurses' perceptions. Research exploring nurses' response, self-efficacy, and job satisfaction are critically to sustainability.
非洲地区承担着24%的全球疾病负担，却只有3%的全球卫生人力，因此世界卫生组织（WHO）将该地区列为卫生人力严重短缺地区。任务转移是WHO为卫生工作者严重短缺的国家推荐的一项策略。它涉及重新分配医疗保健任务，以有效利用现有工作人员。严重的医生短缺、不断增加的艾滋病疾病负担以及改善抗逆转录病毒治疗（ART）可及性的需求给非洲带来了严峻挑战。许多国家采用将ART管理工作从医生转移至护士的方式来增加治疗的可及性。来自非洲越来越多的证据支持这种护理模式，但对于其对非洲护士的影响却知之甚少。对2009年1月至2012年8月期间非洲地区最新的任务转移研究进行了PubMed文献检索。共识别出34项研究，但其中11项符合“在艾滋病背景下从医生向护士的任务转移”标准。总结了与患者结局、护士感知的自我效能感及工作满意度相关的方法和研究结果。10项研究对患者结局进行了测量，所有研究结果均具有可比性。八项研究中有七项显示死亡率无差异，而五项研究发现护士管理组的患者留存率更高，失访率更低。四项研究表明，护士在现有护理和艾滋病知识基础上有所提升；提高了艾滋病及其他疾病的管理技能；对使用治疗指南的舒适度也有所增加。三项研究的工作满意度结果显示，护士表示有“情感回报、成就感、声望及士气提升的感觉”。在六项研究中，五项研究表明患者接受护士管理的护理，两项研究表明护士接受，一项研究表明大多数医生和项目管理人员接受。护士管理的护理有可比的结局且留存了更多患者，但只有两项研究“直接”评估了护士的看法。探索护士的反应、自我效能感和工作满意度的研究对于可持续性至关重要。
