The experience of nursing an AIDS patient whose secret was divulged to his family

This article concerns an Acquired Immunodeficiency Syndrome (AIDS) patient who had contracted the disease through casual sex. The secret of the nature of his disease was accidentally divulged to his family and friends by his care provider. The patient was rejected by his family and friends. The nursing experience of caring for the physical and psychological symptoms of the patient was reported. The author collected data through observation, physical assessment, interview, and telephone communication from January 20, 2005 to January 31, 2005. Because of the disease and his alienation from family and friends, the patient felt a lack of trust for his care provider, as well as anxiety, fear, a sense of guilt, self-recrimination, sadness and low self-esteem. The psychological symptoms were aggravated by the divulgence to family and friends of the fact that his disease was AIDS. The nursing problems were studied. The Watson theory of care was applied carefully. The patient was cared for with empathy and a positive attitude. A relationship of trust was established and the objective of quality care was accomplished. The nursing experience of caring for AIDS patients is unique. The privacy of the patient must be respected.     

Decision making in the critically ill patient

In the preceding discussion we have attempted to set forth some realistic guidelines for the primary care physician in the critical care area. We feel that he is of utmost importance in setting the tone for his patient's care. He is the first physician to be called when his patient becomes critically ill. He decides whether or not consultation is needed immediately. He should choose appropriate consultants, trying to provide required expertise and compatible personalities to relate with his patient and the patient's family. His work does not end with establishing roles and delivering care. He is the single most important physician when difficult ethical and medicolegal decisions must be made. He is the physician who knows the patient and the patient's family best. They look to him for guidance and decision making about their health care. He is best able to discuss the wishes and desires of the patient if the patient becomes unable to decide for himself. The primary care physician can be extremely helpful when the appropriate medical decision is to withhold therapy. He can comfort and console the family and help them realize that the proper decisions have been made. His previous close relationship with the patient and family makes difficult decisions much easier to accept. He is also of primary importance when trying to provide care to a patient who ostensibly refuses such care. The trust he has earned in the past because of the care he was provided allows him to be much more forceful than the subspecialist who may have been on the case for 1 or 2 days. He can be the difference between survival and death merely by his presence and advice. Other difficult decisions are always made easier by a primary physician who can relate to the consultants as well as the patient and his family. In conclusion, we feel that the technologic advances of the past 30 years have tended to drive the primary care physician away from the critical care unit. This is mostly because of a need for particular expertise to run the machines of medicine. One cannot be expected to become or remain an expert in primary care and critical care medicine. The primary care physician should not feel or be excluded from the critical care area. His knowledge of general medicine and his expertise in interpersonal and family relationships allow him to provide the much needed "high touch" component of "high tech" critical care medicine.     

Hospice care for an AIDS patient and his family

This article describes the emotional reactions, fear of contamination, and pressure to disclose HIV status of a patient who was recently diagnosed with AIDS, and his family. When the patient's condition deteriorated, his family and medical team faced ethical dilemmas about whether to disclose his condition to others, and the direction of his treatment. The authors and medical team applied the principles of hospice care. During each stage, the first author collected data by means of physical assessment, interview, participant observation, family meetings and team meetings, and provided a clear evaluation of the patient's clinical situation and disease prognosis. The first author applied the principles of hospice care and family-centered nursing care to enable the patient and his family to obtain physical comfort, to reduce the patient's fear of death, to enable him to enjoy the love of his whole family, and obtain his wife's forgiveness. After the patient's death, the first author called the family members and they came back to remember him in front of his room. The article shows that hospice care is crucial to AIDS patients and their families.     

An experience applying a spiritual care model to a first-time stroke patient

Patients with stroke-related disabilities are at risk of depression and social isolation. This can make it difficult for the patient to cope with his or her disease and increase caregiver burden. While good at dealing with physical illness, nurses are often poor at attending to patients' mental and spiritual needs. In this paper, the authors introduce their experience using a spiritual care model to care for a stroke patient. The patient, a 69 year-old retiree, was admitted to our hospital due to an acute stroke. During hospitalization, he suffered from acute confusion and persistent focal weakness. His disability resulted in physical dependence, which did not improve during rehabilitation. We used a model of spiritual care and in-depth evaluation to identify several underlying psychological issues. These included feelings of hopelessness and loss of control and motivation. The authors established trust through active listening. In addition to standard nursing education and physical care, we, in cooperation with the patient's children, provided encouragement and support to help the patient cope with his disease burden and actively participate in rehabilitation. We applied a multi-dimensional spiritual care approach to help the patient shift from hopelessness to hopefulness. This enhanced his motivation to participate in rehabilitation and improved his self-care abilities. We hope this case report on the application of a spiritual-care model is useful reference for nurses responsible to care for stroke patients.     

An experience in applying Watson's theory in caring for an enterovirus-infected child and his primary caregiver

Enterovirus is commonly seen in children. Its morbidity and mortality rate is about 18% (Department of Health, the Executive Yuan, 2003). This paper documents the use of Watson's theory in the care of a child aged two years and seven months and his primary caregiver. During the nursing process, the application of care and concern for the child and primary caregiver provided confidence, comfort, and relief of fear and anxiety caused by hospitalization, enabling the patient, during his time in hospital, to make physical and psychological progress. The caregiver was also able to gain an understanding of how to care for a child with enterovirus, which diminished some of the pressure caused by his admission to hospital and placed him and his family at the center of the nursing care.     

Nursing experience with an lymphangioleiomyomatosis patient with chylothorax

This article discusses experience providing nursing care to a patient suffering from Lymphangioleiomyomatosis who was re-hospitalized for recurrence of chylothorax complications, which caused dyspnea, sterility and mental instability. Based on parameters provided by Roy's adaptation model, the patient was identified as suffering from respiratory impairment, acute pain, sleep pattern disturbance and low self-esteem. Data was collected through interviews, observation and physical assessments. During the course of providing nursing care, the author established a good relationship with the patient through devoted attention to the patient's needs and by actively caring, listening and accompanying. Increased family member visits and interaction, resulting from the author's urgings, gave the patient added support and consolation. Eventually, the author gained the trust of the patient, who, in turn, regained self-control as well as physical and sociopsychological adaptabilities. Clinical nursing must attend to the physical care needs of patients as well as patient mental wellness, the latter of which extends beyond the disease itself, in order to achieve a truly comprehensive quality of nursing care. We are glad to share this successful experience with others in the nursing profession.     

The choice to end life as a ventilator-dependent quadriplegic

A 17-year-old male sustained a C5/6 fracture dislocation and complete C5 quadriplegia in a diving accident. Three days later sensory and motor function deteriorated and he required mechanical ventilation. Surgical exploration found no cause and a fusion was done. Neurologic function stabilized after three weeks with a C1 sensory level, no neck movement, and slight weakness of the tongue. Patient and family were followed closely by the spinal cord injury rehabilitation team from onset of injury. The patient was transferred to the ventilator-dependent pediatric rehabilitation program after ten weeks. Bowel, bladder, skin, and nutritional management were stabilized and taught to his parents who remained with him constantly. Communication was achieved with a "talking tracheostomy." He learned to use "Sip-n-Puff" control for driving an electric wheelchair and for Morse code input to a computer. He was passive but cooperative during hospitalization. Eight months after injury he was discharged to his home, which had been modified to meet his needs. A computer word processor, environmental control unit, and modified van were obtained; nursing care was provided around the clock. The patient enrolled in a community college course. Soon after discharge he contacted an attorney to explore legal actions for ending his life, which he considered intolerable. After obtaining medical and psychiatric reports, a court order was issued, which established his legal competence and directed people taking care of him to follow his directions. A few weeks later, 25 months after his injury, he privately said goodbye to his family, asked to be disconnected from the ventilator, and died. Medical and legal issues raised by this case are discussed.     

Territoriality as a universal need 0

Three aspects of territoriality are important to consider when planning nursing care: a physical space of one's own, a personal space, and the territory of expertise or role. Territoriality serves four functions: it provides security, privacy, autonomy, and self-identity, all of which are important for well-being. Many factors, such as age, sex, culture, and health status, affect the way people relate spatially to one another. The nurse should assess territorial needs routinely by asking the patient questions and by observing him in his environment. If the patient is in his own home, she should avoid invading his territory without his permission and should help him maintain and protect his territory. If the patient must leave his own home to be hospitalized, she should help him establish a temporary territory elsewhere and help him adapt to the loss of his own physical space, personal space, and/or territory of expertise and role. Careful attention to territorial needs, particularly when the person is ill, at a vulnerable age, or is facing a move, can contribute a great deal to his health and well-being.     

Rejection--a neglected phenomenon in psychiatric nursing

The basically asymmetric character of the ‘psychotic patient–psychiatric nurse’ relationship constitutes an ethical challenge for the nurse. One aspect of this relationship is that nurses must constantly self‐consciously control their behaviour towards the patient. There is some evidence that the patient sometimes feels offended because of his perception that the nurse rejects him. The purpose of this article is to examine the role rejection plays in the ‘psychotic patient–psychiatric nurse’ relationship and ethical implications this might have for the field of psychiatric nursing. This study is conducted using an ethnographic research design that includes participant observation and narrative interviews of nurses working on an acute ward of a psychiatric hospital. One case is analysed and discussed in depth through the philosophical insights (particularly ‘the ethical demand’) of the Danish moral philosopher K.E. Løgstrup. The psychotic patient, being vulnerable, dependent, and trusting, confronts the psychiatric nurse with a constant ‘ethical demand’ to take care of him. The patient's trust, and his fight to maintain his dignity, creates a risk of being rejected. The nurse, by resorting to the tactic of ‘impersonal professional routine’, which does not define the relationship as a personal encounter, creates boundaries between herself and the patient. The nurse's withdrawal from the patient's perception of reality is experienced by the patient as rejection and hence an offence of his dignity. The nurse's rejection of the patient has two causes: external factors – for example inadequate staffing – cause the nurse to be unable to live up to the professional ideal of ‘welcoming’ the patient; internal factors – for example the profession's understanding of itself – create an unclear understanding of the nurse's role and responsibilities. It is necessary to work with both the external and internal factors to improve psychiatric nursing.     

End of life in intensive care: Is transfer home an alternative?

The past decade has witnessed an increased focus on improving the quality of end of life care internationally. This has resulted in the development of specific health policy work streams to support patient choice and improve standards of care and patient experience. One concept well explored in areas outside of critical care is that of home care at the end of life. This paper seeks to challenge assumptions and practices about the options for transferring the critically ill patient home at end of life. As a piece of collaborative writing from a bereaved family member and critical care nursing team, this paper explores care given to one gentleman at the end of his life. In this, his journey is detailed, the decisions made are outlined and the experience for him and his family are examined with a retrospective narrative account from his wife that is woven throughout the paper. In this paper, we are not asserting that transfer home at end of life is desirable or feasible for all critically ill patients. We are challenging practitioners to consider when and how the initiative of transferring critically ill patients home at end of life, may occur.     

An operationalization of Martha Rogers' theory throughout the nursing process

Rogers (1970) presents a philosophical view of man that allows the use of assessment tools and technologies specific to the patients condition. Assessment tools and technologies will vary with the patient population and the scientific advances of society. They must not become the focus of nursing practice because they are time limited and can detract from the patient. The focus of nursing practice is man and the life force within man. The nursing science principles identify constants in the nursing of man, such as; establishing priorities, implementing change, and patterns of change.The theoretical framework of Martha Rogers paints a dynamic picture of man as ever evolving with increasing complexity from birth to death. The nurse enters the lifespace of the individual to help maintain his physical and emotional integrity in acute illness and/or as a change agent in chronic illness or permanent disability. The goal is to redirect his life events from patterns that produce decreased functioning or illness to patterns that lead to optimum health. The areas of nursing intervention are determined by the nursing diagnoses derived from the individual's life-style, patterns of interaction with the environment, as well as his physical and emotional states. The nursing diagnoses and nursing science principles unite in a prescribed plan of care for the patient. The knowledge that change in the patient occurs simultaneously with that in the environment directs the nurse to focus certain actions toward the environment and to predict a change in the patient as he interacts with the changed environment. Additional predictability is achieved by looking at the patient's previous adaptation patterns and life-style. If he has not changed his living patterns for a previous equally serious illness he is not likely to change for the current one unless a unique change force enters into his life-space. By entering into a scientifically based therapeutic relationship with the patient, the nurse can make the difference between the patient continuing a life of inadvertent self-destruction or reaching for his optimum health potential.     

An experience providing home care to a victim of cerebral vascular accident and purple urine bag syndrome

This article presents the case of a victim of cerebral vascular accident with long duration of urinary catheterization, who developed a purple urine bag syndrome (PUBS) because of deficiency of knowledge and skills in home care and lack of communication and support among family members. In this case, the main caregivers also experienced psychophysical fatigue and fear, which diminished family coping ability. During the period of nursing care, from March 10 to August 15, 2006, we carried out 10 home care visits and eight telephone consultations. Exiting urinary tract infection, constipation, and compromised coping and ineffective family were identified as the three main nursing care issues. As we successfully instilled trust and developed a positive relationship with the patient, we provided continuous and comprehensive nursing care to resolve the PUBS issue her which was causing her anxiety, and her constipation, as well as stabilizing her family function. Consequently, through this care experience involving a sick elderly patient, we promoted the function of nursing home care. From this case intervention, we found that health education should be closely followed up in order to maintain its effectiveness. Insufficient communication skills, however, were identified through meetings with the patient's family. We suggested related family communication skills and practices should be included in clinical nursing training courses to enhance skills in dealing with family issues and life quality among patients and their families.     

An experience nursing an organic psychiatric patient with vertigo

This study documents the nursing of an organically mentally disordered patient with chronic vertigo. The subject suffered a head injury in a traffic accident, resulting in impairments to his cognitive abilities as well as symptoms of recurring vertigo, which hampered his work and family activities. Holistic nursing assessment revealed four areas of nursing concern: risk of falls, impaired self-care ability, caregiver role strain, and powerlessness. Care provided to the subject concentrated on: (1) preventing him from falling again, (2) regaining his ability to care for himself, through gradual training exercises; (3) training his spouse in caring for herself and the subject; (4) establishing his self-assurance by means of cognitive-behavior therapy and vestibular rehabilitation.     

Management of Alzheimer's disease. A family affair

The various approaches to the patient with Alzheimer's disease are receiving much attention, but relatively little has been written about the important role physicians can serve in helping the patient's family deal with the disease. In managing Alzheimer's disease, the physician's relationship with family members may be as important as or even more important than his or her relationship with the patient. Establishing and maintaining a successful relationship involve early assessment of family function, periodic home visits, coordination of available community resources, regular assessment of caregivers' coping skills, and regular discussions about the limits of home care and the possibility of placement in a nursing home. When nursing home care is chosen, the physician can, by continuing his or her involvement, help assure provision of the highest quality care possible.     

End-of-life care for infants

Carey, diagnosed with Trisomy 13, was 4 months old when he died. The moment of his death was really quite beautiful. He looked so peaceful resting in his mother's arms. She kissed him softly and said her good-byes. Tears stained her cheeks as Carey's father gently put his arms around both of them. They relaxed as he took his last breath, confident that they had done their best in caring for him. They had given Carey the best 4 months he could have. They will always remember him.After a few moments alone with Carey, they handed him to the hospice nurse. She and the social worker took care of the last-minute arrangements while the extended family members consoled one another. That night, the family began a new phase of their journey, carrying the memories of Carey and his life with them forever.     

Being overwhelmed by the feeling of having a home and family. One aspect of the meaning of being dependent on care: a study of one patient and two of his nurses

RATIONALE: This article is part of an ongoing study which aims at disclosing the meaning of being dependent on care. From a larger body of data, interviews with one patient and two of his nurses were selected to study. AIM: The aim was to deepen understanding of the meaning of being dependent on care when this appears desirable for the patient. METHODS: A phenomenological-hermeneutic approach was used to interpret the material. Interviews were recorded and transcribed verbatim. FINDINGS/DISCUSSION: The interpretation discloses the meaning of being dependent on care as an overwhelming, unfamiliar feeling of having a home and family. The patient is beguiled into believing he is the ruler in an established relationship and his dependency on care gives him an opportunity to be surrounded by loving, altruistic, helpful people. Being dependent on care is overwhelming and irresistible, i.e. coveted, but simultaneously it is like walking on thin ice, i.e. treacherous. The irresistible desire concerns being unconditionally cared about. The danger is that this 'family membership' will not last. It is brought to the patient because of his dependency on care and it is based on his terms. There is reflection about the patient being unprepared for dealing with his own world of loneliness.     

An experience of providing emergency care on the basis of Watson's theory to a toddler suffering from minor burns

This article explores the application of Watson's Caring Theory to a child suffering from minor burns injury and his mother. After the nursing process, their physical and social-psychological needs were met. A trauma accident always affects the child and the caregiver, especially the mother. Burn injury brings physical injury, pain, and loss of control to the child and makes the mother feel very guilty and lose her confidence in her ability to take care of the child. After the caring behaviors had been practiced, relationships of mutual trust were developed between the child, his mother and the primary nurse. In the child, the medical treatments were accomplished, the pain was relieved, and he resumed his communication mode. Finally, abilities to deal with burn injury were also built between the child and his mother. This experience could serve as a reference in the emergency nursing of trauma children. The focus of emergency care is not only applying scientific knowledge in the physical area, but also using the caring behaviors to meet the individual's social-psychological needs.     

How Palliative Care Helped Me Make an Important Decision in My Life

The author writes about her father's illness and how her knowledge of palliative care and “dying with dignity” helped her make important decisions for her father in his last days. She and her family members were able to give him the kind of care he needed and desired. He could enjoy the time he had left, and the family had the satisfaction of serving him when he needed them.     

The application of the resiliency model to caring for the family of a head injury client

Head injury often occurs in accidents, with severe consequences affecting not only the injured individual but his/her entire family. The purpose of this paper is to describe a case of nursing care provided to the family of a head injury patient using the family resiliency model. From June 26 to July 10, 2002, one of the authors took care of the head injury patient as a primary nurse, then assessed the family in accordance with the five factors influencing the family crisis adaptation process identified in the family resiliency model. The major stressors for the family included the unknown prognosis for the patient, the lack of family income, and not knowing how to talk with the children about their father's condition. Three nursing problems were identified, as follows: the family's knowledge deficit concerning head injury treatment, compromised family coping, disruption of family life and lack of coping resources. Applying various nursing interventions (i.e. education, family conferences, and play therapy), the authors guided the family towards an understanding of the disease treatment plan and the stresses they were facing. Finally, family members were able to participate in the rehabilitation plan for the patient and to find the resources to solve the family problems. This demonstrated that the resiliency model is a good tool for assessing families in crisis and planning nursing care in order to facilitate the family's successful bonadaptation.