Experiences of the Mobile Injection Team for Multidrug Resistant-Tuberculosis Patients in Ugu District, Kwazulu-Natal

Abstract

The purpose of this paper is to describe the experiences of the mobile injection team (MTI) for multidrug resistanttuberculosis with an aim of identifying the challenges facing the team and the institution providing the service. Giorgi’s essential phenomenological research method was conducted. Convenience census sampling was used as all the seven members of the MIT were included. The inclusion criteria were that at least six months’ working experience with MDR-TB patients in a MIT at Ugu District. And be an enrolled nurse registered with SANC, and/or be a TB assistant, be willing to participate in the study and be located at the decentralised or satellite site. Data were collected through individual in-depth interviews with the participants during November to December 2014 at both the decentralised and satellite hospitals and were analysed using Giorgi’s method of data analysis. The research findings revealed four broad themes (the perceptions held by the team, challenges, available support and needs to promote the service) and 73 sub-themes. The findings of the study indicated that the MIT experiences many challenges in the community and need to be supported in order to provide quality care to the patients. Biomedical Journal of Scientific \& Technical Research Volume 9Issue 1: 2018 Cite this article: Sitha Devi A, DLitt et P, Bethabile L Dolamo DC. Experiences of the Mobile Injection Team for Multidrug Resistant-Tuberculosis Patients in Ugu District, Kwazulu-Natal. Biomed J Sci\&Tech Res 9(1)2018. BJSTR. MS.ID.001736. DOI: 10.26717/ BJSTR.2018.09.001736. 6843 of treatment, leading to their selection as outpatient candidates for Ethiopia’s pilot outpatient programme. They argued that given the individual and public health impact of high loss to follow-up rates, community-based interventions should be considered an essential component of MDR-TB treatment programmes. Ugu District of KwaZulu-Natal (KZN) employed for the first time in December 2011 four mobile injection teams (MITs). At a meeting held in October 2011, the Ugu District Health (Office resolved to employ 22 teams for the district. Each team consisted of one enrolled nurse (EN) and one TB assistant (TBA) as per the WHO MDR-TB guidelines. The Ugu District Health Office placed two teams at the Ugu District decentralised MDR-TB site and two teams at the satellite site, which is a specialised TB hospital. The researcher has been employed at the satellite site as Assistant Manager Nursing since May 2011. The research study was conducted at both the decentralised and the satellite sites in the respective hospitals. As per the Management of DR-TB policy guideline, these teams administer injections to patients at their homes, supervise the intake of oral tablets, and also educate patients’ families about infection control. Patients who are unable to access a health facility daily should, for the duration of the injectable phase of their treatment, be visited five times a week at home by an MIT which should consist of a driver (TB Assistance) and an enrolled nurse. The functions of the mobile team are to provide directly observed treatment short course (DOTS) to all DR-TB patients in the area; to educate patients, their families and their community on TB; to monitor treatment side effects; to refer patients to the nearest health facility when necessary; and to maintain appropriate records [7]. Statement of the Research Problem Since the initiation of the MIT programme in 2011, when an MDR-TB patient is discharged, the injection team takes the patient home and thereafter visits the patient’s home daily to administer injections. The teams which are based at the hospital have to travel long distances to reach outpatients. Most of the patients live in rural areas that are inaccessible by vehicles, and at times the teams therefore have to walk to get to patients’ homes. The Ugu District Health Office does not provide cellular phones to contact patients telephonically, yet very often the patients are not at home when the team arrives. Ugu district was the first district in KZN to introduce mobile injection team for treatment of MDR-TB patients at home. No research describing the experiences of the MITs has previously been conducted at these hospitals. Therefore, the researcher found it important to investigate the mobile injection team’s experiences of caring for multidrug resistant-tuberculosis outpatients in Ugu district KwaZulu-Natal. Purpose of the Study The purpose of this phenomenological research study was to promote the functioning of the MDR-TB mobile injection team by designing and recommending an MIT guideline based on the experiences of the team members. The objectives formulated to guide the study were to describe the experiences of the MIT, gain an understanding of their experience, develop a guideline for the MIT and indicate what support does the MIT require to provide quality nursing care to the patients. The following research questions were formulated in order to achieve the purpose of the study: a) What are the lived experiences of the MDR-TB mobile injection teams in Ugu District? b) What guidelines should be recommended to improve the activities of the MIT c) What support do the MIT require? Definitions of Key Concepts Enrolled Nurse (EN): An EN is registered with South African Nursing Council as a person who is educated to practise basic nursing care in the manner and to the level as prescribed [8]. The scope of practice of an enrolled nurse is to implement a nursing regimen planned and initiated by a registered nurse or registered midwife and carried out under his direct or indirect supervision [9]. Distinguishing devices are the epaulettes and badges worn by nurses and midwives that indicate the capacity or capacities in which the wearer is registered or enrolled. White epaulette and maroon badge is worn by an EN as prescribed by SANC. For this study, an EN is the nurse in the MIT who administers injections to the patients, observes side effects, and provides advice where necessary. Experiences: The term “experiences” refers to the emotional sensations one undergoes [10]. To learn through experience involves practice, involvement, participation, familiarity or observation. To gain experience involves developing skills, knowledge, background, understanding and know-how [11]. For the purposes of this study, “experiences” will refer to the Ugu District MITs’ practices, involvement, participation, familiarity or observations in the care of MDR-TB outpatients. Multidrug Resistant-Tuberculosis: MDR-TB is defined as TB caused by Mycobacterium tuberculosis resistant in vitro to the effects of isoniazid and rifampicin [2], the two most potent TB drugs. These drugs are used to treat all persons with TB disease. TB Assistant: The TB Assistant is the assistant who accompanies the EN and provides health education to the patients’ relatives and the community [7]. In this study the TB Assistant is also the driver. Research Methodology This study employed a qualitative methodology based on Giorgi’s existential phenomenological research method. Phenomenology focuses on the meaning of the lived experiences of humans [12]. Giorgi’s existential phenomenological research approach follows the five steps: assuming phenomenology attitude; read of interview to attain sense of the whole; determination of primary meaning unites; transforming of meaning unites to psychological statements; and synthesize of psychological general and essential structure of experiences based on constituents (Hasanvand sa) and was therefore appropriate for this study. The phenomenological approach was employed for this research because the researcher was seeking to learn about the lived experiences of the MDR-TB Biomedical Journal of Scientific \& Technical Research Volume 9Issue 1: 2018 Cite this article: Sitha Devi A, DLitt et P, Bethabile L Dolamo DC. Experiences of the Mobile Injection Team for Multidrug Resistant-Tuberculosis Patients in Ugu District, Kwazulu-Natal. Biomed J Sci\&Tech Res 9(1)2018. BJSTR. MS.ID.001736. DOI: 10.26717/ BJSTR.2018.09.001736. 6844 MITs in Ugu District. Giorgi’s method of data analysis was used. King’s model on individuals whose interactions in groups within the social systems influence behaviour within the systems. As humans interact with their environment, their perceptions influence their behaviour and their health [13]. This model was used in this study to analyse the perceptions, judgements and actions of the patients, ENs and TB Assistants in their everyday interactions. The nurse and the patient as individuals form a group and interact to facilitate achievement of health-related goals resolve problems by communicating and setting future goals.