Understanding is the ability to comprehend information, integrate different pieces of knowledge and apply that understanding to accomplish tasks. Understanding extends beyond possessing a unique style of knowledge and is demonstrated by the ability to think flexibly and apply what has been learned across different contexts and areas of performance (González 2019). It encompasses both superficial and extensive levels of comprehension. Superficial understanding involves awareness of only the obvious or surface features of a concept without depth or thoroughness, whereas extensive understanding entails a deeper, more comprehensive grasp that incorporates complex knowledge aligned with development levels. According to Collins Dictionary (n.d.), deep understanding refers to complete and thorough knowledge or grasp of a subject. In this article, a boundary-based confidentiality training programme is developed to improve nurses’ understanding of the subject, aiming to foster extensive comprehension. By explicitly distinguishing between superficial, extensive and deep understanding, the framework provides a robust structure for designing training activities that cultivate not just rote memorisation but a comprehensive and nuanced comprehension of the material. To reinforce extensive understanding, the training goes beyond surface-level concepts, encouraging critical thinking and reflection on ethical principles and practical applications related to confidentiality.

Knowledge is the accumulation of facts, information or skills acquired through education or experience. It includes an understanding of facts, actions and ideas (Robbins et al. 2009). Several types of knowledge have been identified in scholarly literature. Polanyi (1966) described tacit knowledge as difficult to express or communicate, often gained through practice and personal experience. In contrast, explicit knowledge relates to understanding the relationships between causes and effects and is obtained through personal experience, social interaction and formal education (Starbuck 1992). Explicit knowledge can be easily shared because it involves negotiated meanings within social groups or communities of practice (Schalow 2013). Ambrosini and Bowman (2001) argued that tacit and explicit knowledge are interconnected and cannot be completely separated.

Across various disciplines, terms like skills, intuition, know-how, procedural knowledge, implicit knowledge and experiential knowledge describe tacit knowledge, highlighting its diverse conceptualisations. Anderson, Krathwohl and Bloom (2001) expanded on these ideas by defining four types of knowledge within a structured framework: factual knowledge, which includes the fundamental elements of a discipline necessary for problem-solving; conceptual knowledge, which involves understanding how different facts and elements relate and work together; procedural knowledge, which pertains to knowing how to perform specific tasks or methods and metacognitive knowledge, which encompasses awareness of one’s own thinking processes, learning strategies and understanding of the context or conditions under which cognitive tasks are performed.

This conceptual framework supports the development of a training programme designed to address both explicit and tacit knowledge acquisition. By understanding how these types of knowledge interact, the framework guides the creation of training that combines formal instruction with practical experience. This integrated approach instils a deeper, more durable understanding in participants, leading to more effective learning and application.

Confidentiality in nursing is a fundamental component of ethical patient care, grounded in respecting patient autonomy and fostering trust. It involves safeguarding personal health information from unauthorised access or disclosure (Chiruvella & Guddati 2021). Confidentiality in HIV and AIDS care is vital as it maintains patients’ privacy and autonomy and is essential for establishing trust (Pera & Van Tonder 2018). All patient information is considered confidential, encompassing any details used to identify an individual. Confidentiality emphasises the importance of establishing clear boundaries concerning what information is to be kept confidential, who has access to it and under what circumstances. By setting these boundaries, confidentiality is maintained within defined parameters, which helps prevent breaches and fosters trust among stakeholders. Thus, confidentiality can be defined as the ethical and professional duty to safeguard sensitive information by setting and adhering to boundaries specifying the scope and conditions of its protection. In this article, this outcome served as the conceptual foundation for designing the training programme.

Experience refers to the fact or state of having gained knowledge through direct observation or participation in events or activities. The Cambridge Dictionary (2020) explains experience as the process of acquiring knowledge or skills by doing, seeing or feeling things or as something that happens and affects an individual. Healthcare professionals interact with people regarding their experiences, and their perceptions of these experiences influence their ability to recognise the needs of individuals seeking care (Paulsen 2020).

By enriching their perspectives, professionals can develop a deeper understanding of the principles at work when engaging with clients concerning their experiences. An expected outcome is that many professionals will be better equipped to counsel, guide and supervise clients whom they might otherwise struggle to help (Paulsen 2020). This outcome will be achieved because professionals can access more perspectives when reflecting on client interactions.

Empowerment serves as a key management strategy essential for fostering nurses’ professional development and has a beneficial impact on the standard of patient care (García-Sierra & Fernández-Castro 2018). Empowering professional nurse’s entails establishing a conducive work setting that provides access to essential information, resources and opportunities for ongoing professional growth. Both structural empowerment, which involves organisational backing, and psychological empowerment, reflecting internal motivation and confidence, promote positive experiences among nurses and ensure positive patient outcomes (Bahlman-van Ooijen et al. 2023). This conceptual framework for a confidentiality training programme for nurses managing patients with HIV emphasises the importance of empowering nurses to effectively maintain patient confidentiality. The programme’s success will be measured not only by participants’ knowledge acquisition but also by the demonstrable improvements in their confidence and ability to apply confidentiality principles in their daily practice.

The environment in which an activity takes place is crucial (Dickoff et al. 1968). Nghipondoka-Lukolo and Charles (2015) define context as the situation, framework or environment surrounding an activity. This training programme focusses on nurses working in community healthcentres within the PHC system of the OR Tambo District Municipality, specifically those facilities providing HIV and AIDS services. The context of the activity, in this case, public PHC facilities, operates within a legal and ethical framework, policies and procedures and in an environment that need to be conducive with resources and support to maintain confidentiality.

The legal framework includes the Constitution of the Republic of South Africa, the Health Act, the Nursing Act, the South African Nursing Council rules and regulations and policies and procedures on confidentiality in HIV management. The findings revealed that nurses work within their profession’s legal and ethical framework, where the scope of practice is considered during delegation and task-shifting of duties. Ethical issues, including privacy, confidentiality, justice, beneficence and informed consent, should be adhered to by institutions in all their activities. Hamid et al. (2016) concluded that management should ensure a suitable and safe working environment for nurses by providing opportunities for professional development to improve their competency.

Professional nurses’ confidentiality is guided by policies and procedures in the institution where the training programme is to be implemented. The previously described qualities and characteristics of a professional nurse enable the nurse to effectively maintain confidentiality while caring patients with HIV and AIDS. Policies and procedures formulated in the institutions, in line with the state’s legal framework, are utilised by nurses to achieve set objectives. These policies and procedures should benefit the agent and the patient, ensuring quality care. When health professionals understand the standards and processes in the institution, they are more likely to facilitate the effective implementation of policies and guidelines. Training will promote communication of these policies and guidelines on confidentiality.

Implementing an effective training programme requires a conducive working environment to achieve optimal results. No healthcare facility can function effectively without adequate space, human resources and financial resources. Therefore, effective resource management is vital for healthcare institutions in achieving quality HIV services. The findings of the preliminary study revealed inadequate staff and material resources, including mobile screens for creating privacy, which affects confidentiality in HIV care in PHC facilities. Furthermore, professional nurses indicated a lack of management support and limited awareness of policies and guidelines on confidentiality or the content of in-service training. Despite these challenges, professional nurses must create a conducive environment for privacy and confidentiality to improve the quality of HIV care.

According to Dickoff et al. (1968), dynamics are the energy sources of the activities within an individual or the internal motivational factors promoting success. In this article, the dynamics include the barriers to maintaining confidentiality as experienced by nurses during HIV care. These refer to the guiding forces that motivate the direction towards change and development. Based on the findings of the main study, facilitators of confidentiality exist, but nurses’ attitudes and behaviour affect their practices. Nurses expressed concerns about the attitudes of their peers towards training, noting that poorly managed attitudes may hinder the implementation of the training programme and discourage participation. Strategies to address these factors must be developed to ensure the successful implementation of the training programme.

Procedures report challenges or guide actions for implementing a policy or programme (Nangombe & Justus 2016). A procedure is further described as an orderly way of completing tasks, which is also regarded as a rule guiding the activity, comprising devices and protocols enabling the agent to achieve the goal (Dickoff et al. 1968). In this article, procedure is the training programme that will be developed and implemented at PHC facilities in the OR Tambo District Municipality. The primary purpose is to provide professional nurses with the knowledge, skills and abilities to maintain confidentiality in HIV care. The procedure outlines conducting needs assessment, developing a training content based on the independent variables and dependent variables identified in the themes and sub-themes, the development, implementation and evaluation techniques, including programme content, learning objectives and learning outcomes. The programme’s content will be derived from the confidentiality attributes. The learning content aimed to improve professional nurses’ knowledge and understanding of maintaining confidentiality in HIV care (Mothiba & Jooste 2013).