Standardized care plans for i.v. therapy

The use of standardized care plans by nurses has become an efficient tool for communicating special needs of patients. We at Good Samaritan Hospital and Medical Center recognized that our I.V. Team and the patients we service could benefit from the use of such a care plan. Improved communication and documentation were accomplished by developing a standard care plan addressing problems that may be encountered in I.V. therapy. This form has become a valuable part of our care to patients receiving I.V. therapy.     

Infection prevention and control.

Nurses are clearly at risk for exposure to HIV through blood and body fluids, and they frequently use needles and sharp objects. In addition, critical care patients are at high risk for nosocomial infections due to other etiologic agents. This article addresses reducing the risk of infection for both nurses and patients using a variety of strategies.     

Perceived risk of infection and attitudes toward risk groups: determinants of nurses' behavioral intentions regarding AIDS patients.

The relationship of perceived occupational risk of AIDS and attitudes toward AIDS risk groups to behavioral intentions regarding the care of AIDS patients was examined among nurses (N = 496) residing in a selected area of New Jersey, a state with a relatively high number of reported AIDS cases. Hierarchical multiple regression analyses on anonymous mail survey responses revealed that, controlling for AIDS knowledge and years of education, nurses who perceived that caring for AIDS patients increased their risk of HIV infection scored higher on an index of intentions to avoid AIDS patient care. In addition, nurses who expressed more negative attitudes toward intravenous drug users or homosexuals were more likely to report similar intentions to avoid AIDS patient care. The implications of these findings for efforts to increase nurses' ability and willingness to provide quality care to persons with AIDS are discussed.     

Peripherally inserted central catheters and their use in i.v. therapy

Peripherally inserted central catheters (PICCs) can adequately and safely meet the needs of patients who require short- to long-term therapy in many clinical settings. Moreover, PICCs have been successfully used in the delivery of i.v. therapy in the patient's home. There is evidence available which indicates that a PICC can minimize the trauma to patients who undergo multiple, repeated cannulations. PICCs can also reduce catheter-related risks such as thrombophlebitis, infection and insertion-related complications. The use of PICCs has been shown to be clinically effective as well as cost-effective. In many centres nurses are leading developments in IV therapy. In order to ensure that high quality, clinically effective patient care is developed, patients must undergo thorough assessment before device selection.     

A creative approach to comprehensive i.v. therapy documentation

Specific, thorough documentation is required to provide continuity of care to patients receiving intravenous therapy. In addition, though the Joint Commission on Accreditation of Healthcare Organizations' regulations require documentation of patient teaching and patient response to treatment, this information is frequently omitted from I.V. therapy records. A checklist was devised to provide a systematic, comprehensive method of documenting I.V. therapy procedures.     

Enfuvirtide for nurses: answering patient questions on activity, safety, and lifestyle impact.

The introduction of enfuvirtide, the first self-administered parenteral antiretroviral, has reinforced the HIV nurse's role in patient education, support, and motivation. Detailed background knowledge of the drug will assist nurses to provide answers to common questions and concerns raised during patient training. Three particular concerns often raised are curiosity about how enfuvirtide works, what side effects can be expected, and how these and the process of daily injection will affect the patient's daily routine. This brief review is designed to provide nurse-educators with clinical information on these three issues to help them better provide the answers patients will need to help them feel confident self-administering this new drug.     

HIV disease in primary care

During the past decade, a large number of new drugs for treating HIV and its complications have been developed. The increasingly sophisticated use of these drugs in combination has led to a marked reduction in HIV-related morbidity and mortality in countries where they are available. HIV/AIDS patients receiving treatment are now expected to live into old age. The beneficial effect of HIV treatment has resulted in an expanding population of persons living with HIV/AIDS who will need the care of an HIV specialist because of the complexity of the treatment regimens and the rapidly changing HIV/AIDS knowledge base. However, this growing and aging population will also benefit from the care of a primary care physician. The primary care generalist is in the best position to recognize and diagnose HIV infection, evaluate HIV risk in his or her patient population, and help prevent HIV infection in persons at risk. In patients known to be infected, the primary care generalist will be best able to manage hyperlipidemia, diabetes, cardiovascular disease, and other disorders of an aging population with an increased risk of these and other conditions. Patients with HIV infection frequently accumulate a large number of specialist physicians, and the unique ability of the primary care physician to monitor their care and act as a knowledgeable patient advocate is a great benefit to the patient.     

HIV阳性垂体瘤患者的围手术期循证护理

目的探讨HIV阳性垂体瘤患者的围手术期循证护理。方法根据循证护理模式,对1例HIV阳性垂体瘤患者进行围手术期的循证护理,包括4个连续的过程:循证问题、循证支持、循证观察、循证应用。为此举办有关艾滋病护理培训;组织护士进行专题循证护理学习。了解到HIV感染主要是通过性接触、血液、体液暴露和母婴垂直传播,不会通过日常接触传播,因此,直接护理的基本技巧与护理其他疾病没有显著区别,特殊措施包括消毒隔离及管理问题。结果通过医、护、患的共同努力,病人手术成功痊愈出院。结论通过循证护理,减轻了病人的痛苦,提高了医疗质量,使病人获得最佳的护理。     

Understanding the HIV risk reduction needs of heterosexual African American substance-abusing men.

With the increasing prevalence of HIV/AIDS, nurses find themselves caring for diverse populations at risk for HIV. One subpopulation at risk is African American men with a history of substance use. To better understand the risk reduction needs of these men, a focus group was conducted with 16 African American men attending an outpatient drug treatment program in Philadelphia. The purpose was to identify perceptions of HIV risk, engagement in HIV risk behaviors, and barriers to condom use in order to generate recommendations for risk reduction programs tailored to the needs of this population. Results revealed that African American substance-abusing men perceive themselves to be at risk for HIV infection and other adverse health outcomes yet lacked adequate information related to HIV prevention. The need for culture- and gender-specific interventions to reduce HIV-related risk behaviors among African American substance-using men is discussed.     

Current therapy for HIV infection and its infectious complications. A practical summary for primary care physicians.

Primary care physicians can play a crucial role in the care of patients with HIV infection. Treatment often requires orchestration of many complex drug regimens. In addition, the patient must make informed decisions about a broad range of care-related issues. Steps in the care of such patients include (1) staging of HIV infection, (2) instituting antiretroviral therapy, and (3) preventing opportunistic infections plus treating opportunistic infections when present. A wide range of established and investigational agents are available for these purposes, and new ones are continually being discovered.     

Nurses' health education program in India increases HIV knowledge and reduces fear.

Few health care facilities are adequately prepared to manage and care for HIV/AIDS patients in India. Nurses play a critical role in patient care but are often ill-equipped to deal with their own fears of occupational risk and handle the clinical aspects of HIV/AIDS care, leading to stigma and discrimination toward HIV-positive patients. The authors examine the impact of a 4-day HIV/AIDS health education program on knowledge and attitudes of nurses in a government hospital. This education program was developed using a training of trainers model and qualitative research. A total of 21 master trainers underwent 6 days of training and began training of 552 hospital nurses (in 2004-2005). Using a pretest-posttest design, the authors assessed changes in knowledge and attitudes of 371 trained nurses. Significant improvements were seen in nurses' HIV/AIDS knowledge in all areas including care, treatment, and issues of confidentiality and consent. Fear of interaction with people living with HIV/AIDS was reduced significantly. The short course was successful in increasing nurses' knowledge in all aspects. There is great potential to expand this stigma-reduction intervention to other public and private hospitals.     

Infection prevention and control in the era of the AIDS/HIV epidemic

The chronology of important events in the AIDS/HIV epidemic is presented in Table 2. Nurses are the largest group of health care workers and persons who provide direct care and handle sharp objects regularly. As the number of persons infected with HIV increases and as more infected persons become ill enough to require care, the opportunity for an individual nurse to have contact with an infected person will increase. Because many persons with HIV infection also have Kaposi's sarcoma and other malignancies, some oncology nurses may have more contact with HIV-infected individuals than nurses in general. However, it is well established that the major risk for HIV infection is from puncture injuries, and a number of strategies are available and are being developed to make needle and sharps handling safer. Nurses must take personal responsibility for knowing how to reduce their own risks for exposure to HIV and other infectious agents while keeping in mind the need not to increase risks of nosocomial infections in patients. Thus, all nurses need a comprehensive understanding of the purposes of barriers (eg, gloves, gowns, masks, handwashing, room assignment) and when and how to use them correctly. In addition, all nurses who have contact with blood and body fluids should take responsibility for their own immunity to hepatitis B by obtaining hepatitis B vaccination. By using all of these strategies in combination, many infection risks to nurses and patients will be minimized.     

Evaluation and use of advanced i.v. technology. Part 2: Patient controlled analgesia

Although many conflicting studies report different results with the use of PCA, it has proven to be a safe and effective alternative to controlling pain in many clinical settings. The patients perception of the care is improved with the feeling of having more control. PCA can also decrease the demand on nursing time required by the P.R.N. I.M. injections, allowing time to deal with other aspects of the patients care. The use of PCA does place greater responsibility on the I.V. nurse to maintain the integrity of the system and prevent I.V.-related complications.     

Protecting the intravenous nurse from blood-borne pathogens

Intravenous nurses are at risk for infection with blood-borne pathogens to the extent that they are directly exposed to blood. By classifying work-related tasks according to potential for exposure and by implementing appropriate precautions for each task, the I.V. nurse's risk of infection can be minimized.     

Absence of human immunodeficiency virus type 2 infection among patients in a hospital serving a New York community at high risk for infection. Centers for Disease Control and Prevention/Bronx-Lebanon Hospital Center HIV Serosurvey Team

BACKGROUND: Although human immunodeficiency virus type 2 (HIV-2) infection among United States residents is considered rare, there are US populations at high risk. Few studies have surveyed these populations with a high likelihood of infection, that is, those with high percentages of persons from HIV-2-endemic areas and high prevalences of behaviors that would allow for transmission. STUDY DESIGN AND METHODS: Patients (n = 832) enrolled in a confidential HIV serosurvey at a hospital that serves a community with a relatively high percentage of West African immigrants, drug injectors, and persons who practice high-risk sexual activity were evaluated. Sera were tested for HIV type 1 (HIV-1) and HIV-2 by rapid enzyme immunoassays, standard enzyme immunoassays and Western blots. RESULTS: Eight of 832 patients were weakly reactive to HIV-2 on rapid assay, but none was confirmed to be infected when tested by standard immunoassay and Western blot. Five of these eight were reactive to HIV-1. CONCLUSION: Weak reactivity to HIV-2 antibody on the rapid assay is best explained by cross-reactivity with HIV-1 antibody; thus, even in this population at high risk for infection, false-positive reactions are more likely than true infections. The finding that HIV-2 is absent in this population at potentially high risk for infection corroborates the findings of other studies that HIV-2 infection is rare among US residents. These results support previous recommendations that, in settings other than blood collection facilities, HIV-2 testing should be selectively offered to persons with epidemiologic risk factors.     

A European survey relating to cancer therapy and neutropenic infections: Nurse and patient viewpoints

PurposeSevere neutropenia and febrile neutropenia (FN) are the major causes of morbidity, treatment interruptions and dose reductions in patients undergoing chemotherapy. The European Oncology Nursing Society (EONS) conducted an European survey to evaluate nurse perspectives on prevention of infection and FN in this setting, and how much they educate their patients about this. A separate survey explored these issues in patients receiving chemotherapy.Methods217 nurse participants were identified by EONS from the membership database and 473 cancer patients who were receiving/had received chemotherapy were identified through patient advocacy groups. Questionnaires were completed anonymously online for both surveys.ResultsMore than 90% of the nurses agreed that preventing infections including FN is extremely/very important for a successful chemotherapy outcome and said that they, or other health professionals in their practice, advised patients about these issues. Most (90%) indicated that they favoured giving treatment to protect against FN and infections in chemotherapy patients at risk, rather than treating infection after it develops, but 82% expressed concern over patient concordance with measures employed. A substantial proportion of patients reported emergency room visits, hospitalization and/or chemotherapy delays or changes as a result of neutropenia, infection or FN. However, only 44% said that their infection risk was discussed with them before starting chemotherapy.ConclusionsOur findings indicate that nurses recognise the importance of reducing the risk of infection and FN in patients undergoing chemotherapy, as well as the need to educate patients. However, results of the patient survey suggest a need for better patient education.     

Factors affecting compliance in the home i.v. antibiotic therapy client

Home I.V. Antibiotic Therapy has been an accepted form of treatment for infections requiring parenteral forms of antibiotics since the late 1970s. Most clients successfully complete their course of therapy without complications, but for those who do not, interventions can be instituted to reach a successful completion of therapy. It takes the creativity and special skills of the I.V. Therapy nurse to overcome some of these obstacles. With proper training and identification of potential problems, most clients can finish their course of I.V. Antibiotics without incident.     

AIDS, nursing and occupational risk: an ethical analysis

This paper examines the notion of risk assessment in relation to nursing patients with HIV infection or AIDS. Risk assessment consists in examining three features of a given hazard; its magnitude, its probability, and its acceptability. In relation to the last of these, an 'acceptability threshold' can be identified. If contact with HIV-infected patients is perceived to pass this threshold, nurses may seek to abrogate the usual 'duty to treat'. Rather than endeavour to pinpoint this threshold, the paper explores some of the factors which may either raise or lower it, and their ethical implications. In particular, the consequences of setting a high threshold, and thereby limiting or avoiding contact with patients infected with HIV, are examined. In this debate, the burden of proof is seen as resting firmly on nurses themselves, not on the patients at risk of being deprived of care.     

可控加药型输液器的研制和临床应用

输液用药治疗现已广泛用于临床。在输液过程中，经常遇患者需多种药物多步少量输液。而临床所用液体多为瓶装２５０ｍｌ或５００ｍｌ，需将多余液体排弃。这不仅增加了护士的工作量，浪费了液体，增加了患者的经济负担，而且增加了污染的机会和造成输液量不准确，为治疗带来不良后果。作者设计了一次性可控加药型输液器，在普通输液器上增加了有容量刻度且可随时加药的可控管，经临床试用４０００余例，效果良好     

Acquired immunodeficiency syndrome: knowledge and attitudes of nurses in Northern Ireland

The number of people suffering from conditions associated with HIV infection is growing steadily. These people require care from nurses who should be well trained to undertake all the various aspects of nursing care. Surveys have indicated that health professionals associate AIDS with minority groups such as homosexuals, drug-abusers and prostitutes. Incidents of sub-optimal nursing care of AIDS patients, or suspected AIDS patients belonging to these minority groups, have been well documented. Surveys have revealed much ignorance and confusion among the general public as well as among health professionals with regard to this controversial syndrome. This study aimed to measure nurses' knowledge and attitudes towards homosexuals, drug-abusers and prostitutes, who through their lifestyle are at increased risk for HIV infection. Questionnaires were distributed to a random sample of 800 nurses in Northern Ireland. The sample was stratified by several demographic variables. A response rate of almost 60% was achieved. Nurses appeared to have a moderate knowledge of issues related to HIV infection, but there were large gaps in their knowledge of the terminology used in HIV infection. Nurses were not extremely worried about AIDS itself. However, homosexuals, prostitutes and drug-abusers were seen to be at least partly responsible for their own illness. Implications for nursing care and for nurse education are discussed.