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.     

How Caring for Persons with HIV/AIDS Affects Rural Nurses

Prior research findings about caregiving for persons with HIV/AIDS indicate that caregiving impacts nurses in three separate domains: personal self as a nurse in practice; interactions with the nurse's family members, friends, and colleagues; and interactions with persons with HIV/AIDS. However the impact caregiving for persons with HIV/AIDS has on rural nurses has not been extensively explored. A qualitative study of rural registered nurses' experiences of caring for persons with HIV/AIDS was conducted to determine how caregiving affects registered nurses in rural areas. Content analysis was used to analyze rural registered nurses' written comments about their experiences of caring for persons with HIV/AIDS. Themes identified from the nurses' accounts of instances of caregiving were the perceived risk of acquiring the virus, a lack of concern about HIV/AIDS, and a need for ongoing continued education about the care of persons with HIV/AIDS.     

Theoretical Discussion of a Model of Caring for Persons with HIV Infection

A model of caring for persons with HIV infection is presented. The model, which identifies the characteristics of care as a holistic phenomenon, consisting of care actions and caring behaviours, was developed through a qualitative approach comparable to the ethnonursing method. The characteristics of care inherent in the model are validated through comparison with knowledge of care from selected historical, linguistic, and caring science sources as well as with care experiences, described in biographies of persons with HIV infection. It is proposed, that the model should be used for further investigation of caring for persons with HIV infection, for investigating caring for persons with other conditions, for teaching caring theory and practice, for planning of caring services and for policy formulation.     

The Georgia Rural-Based Nurse Model: Primary Care for Persons with HIV/AIDS

Abstract The need for specialized HIV education for nurses working in rural areas will increase as the incidence of HIV infection increases in rural areas. Public health nurses provide a viable alternative to providers in acute care facilities and will continue to be the primary care providers for persons with HIV/AIDS in rural areas. While approaches to HIV/AIDS education should include clinical treatment as the core, clinical knowledge alone will not promote the development of caring communities. The Rural-Based Nurse Model provides a comprehensive curriculum that addresses the many complex issues associated with the care of persons with HIV/AIDS. Additionally, participants are linked with care providers who serve clients across the continuum of HIV disease. Through meaningful educational opportunities and provider networking, this program has the potential for improving the quality of care in rural areas for persons with HIV/AIDS. HIV/AIDS education programs will require individualized community strategies that consider existing resources and barriers. However, the Rural-Based Nurse Model provides a formula for HIV/AIDS education that can be easily adapted to other settings.     

Nurses' experience of caring for inmate patients

AIM: The aim of this paper is to report the findings of a study of the experience of caring for prisoners through examining the everyday experience of nurses' delivering health care to inmate patients in a correctional setting. BACKGROUND: Prisons are most often viewed as places for punishment, while the goals of health and healing, and prevention of diseases in correctional facilities are often neglected. Nurses who deliver health care to prisoners are challenged to do so in a caring relationship that will facilitate their health and healing. The literature on the nature of prison nursing indicates that delivering health care to inmates must be carefully balanced against the need for security, and is affected by factors such as custody staff values, staff education, nursing management, and organizational practices. METHOD: In-depth interviews were carried out with nine Registered Nurses who had been employed in a variety of correctional institutions throughout their careers, and analysed thematically using Colaizzi's phenomenological method. Findings. Nurses' caring was experienced as an attempt to negotiate the boundaries between the cultures of custody and caring. Facing complex challenges and a number of limitations on the nurse-patient relationship, nurses strived to find a way to care for their inmate patients. Environmental risk meant that caution and vigilance were essential and these nurses demonstrated courage and persevered for the sake of their inmate patients. CONCLUSION: The findings make clear the challenging and frustrating experience of nurses' caring for inmate patients in restrictive settings. As a result, there are implications for nursing practice, education, and research to assure the best possible health outcomes for inmate patients, the integrity of caring nursing practice, and the safety of both nurses and patients.     

Older adults and HIV

As the number of older Americans grows, perioperative nurses increasingly will be called on to provide services to older adults infected with HIV. To provide quality patient care, perioperative nurses must understand the facts about HIV and aging individuals. Finally, perioperative nurses must realize the best defense against exposure to bloodborne pathogens (e.g., HIV) is compliance with standard precautions while caring for all patients, from newborns to older adults.     

Family-Centered Nursing Care of the Perinatally Infected Mother and Child Living with HIV Infection

ISSUES AND PURPOSE: The cohort of children with perinatally transmitted human immunodeficiency virus (HIV) infection is now entering young adulthood. One issue for nurses caring for this group living with a treatable chronic illness is the need to provide services that both prevent mother-to-child transmission and support antiretroviral (ARV) treatment. Using a case composite, this article describes the care of the perinatally HIV-infected woman and her child with HIV infection. CONCLUSION: A multigenerational family-centered nursing approach to HIV care both facilitated a mother accepting care and treatment for herself and her child and improved the adherence of the family to their individual ARV treatment regimens. PRACTICE IMPLICATIONS: Care of the family with multigenerational perinatally transmitted HIV infection requires that nurses build on their expertise in chronic illness, expand their interventions, and remain flexible.     

护士关怀能力培养的效果研究

目的探讨关怀试点病房护士关怀能力培养的效果。方法采取关怀能力培养策略对关怀试点病房护士进行关怀能力培养。抽取护士676名进行调查,用关怀能力评价量表比较总体调查对象与常模、关怀试点病房与非试点病房护士的关怀能力差异。结果与国外常模比较,研究对象关怀能力在认识和耐心维度方面得分偏低,勇气维度方面得分偏高;关怀试点病房护士关怀能力在认识和勇气维度方面得分均高于非试点病房护士,耐心维度比较差异无统计学意义。结论护士总体关怀能力偏低;关怀能力培养策略能有效提高护士的关怀能力;护士关怀能力培养策略在内容、形式方面仍待完善。     

Patients' and nurses' experiences of delirium: a review of qualitative studies

Background: Knowledge of delirium accumulated over the past two decades has focused more on its characteristics, pathophysiology, incidence, aetiology and prognosis as well as interventions for preventing, detecting, evaluating or managing this syndrome and less so on how patients and nurses who care for them experience it. Aims: To present the state of knowledge derived from qualitative studies of the experiences of persons who suffered delirium and of nurses who cared for them to guide critical care practice. Results: Delirious patients experience incomprehension and various feelings of discomfort. Understanding, support, believing what they are experiencing, explanations, the presence of family/friends and the possibility of talking about the lived experience are interventions that might help them get through such episodes more easily. Nurses who tend to delirious patients fail to comprehend the utterances and behaviours of the persons cared for and experience various feelings of discomfort as well. Nevertheless, they intervene following different goals and intervention strategies that seem to vary as a function of their culture and values. Conclusion: Qualitative studies conducted on persons who suffered delirium and on nurses who cared for them have shed light on their lived experience and provide insight on how to improve critical care practice. Relevance to clinical practice: The findings suggest that nurses must acknowledge the lived experience of the persons cared for and they must seek out the meaning that patients ascribe to this experience to understand the situation and thus conduct interventions that meet the needs expressed.     

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.     

The i.v. nurse and the i.v. drug abuser: medical and psychosocial implications

When I.V. nurses treat I.V. drug abusers, they must be aware of the medical and psychosocial issues relevant to this group. Medical issues include the I.V. drug abuser's depleted venous access and this group's high rate of infection with HIV and other blood pathogens. Psychosocial issues relate to the various social and psychological problems associated with drug abuse. Further, when caring for these patients who are at high risk for HIV and other serious blood infections, the I.V. nurse may experience a conflict between her desire to care for the patient and her fear of contracting HIV or another infection through patient contact. Education is recommended so that I.V. nurses can reduce their risk of infection with blood-borne diseases and can better understand these patients. Also suggested are a multidisciplinary approach to treatment and referral to drug rehabilitation programs.     

HIV and older adults: clinical outcomes in the era of HAART

As the human immunodeficiency virus (HIV) epidemic enters its third decade, nurses are caring for increasing numbers of older adults with HIV who are on complicated medication regimens or highly active antiretroviral therapy (HAART). Although HAART has revolutionized HIV and acquired immunodeficiency syndrome (AIDS) care, little is known about how older adults respond to the new therapies. A review of the medical records of 19 older (> or = 50 years) and 18 younger (< 40 years) adults initiated on their first HAART regimen revealed both older and younger adults had similar positive clinical outcomes. Nurses need to individualize their care to patients of all ages rather than develop specific clinical guidelines for older adults with HIV.     

Refusal to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome: issues and responses.

Nurses historically have accepted the risk of contagion while caring for patients with infectious diseases. The duty to care for patients is directly related to the care the patient requires, the nurse's knowledge, and the extraordinary risk to the nurse. The current infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) highlights other factors, such as fear, ignorance, and homophobia, that influence a nurse's decision to refuse to provide care. Professional associations, nurse administrators, and educators must assist nurses to gain the knowledge and skill necessary to provide care as well as explore feelings about different life-styles.     

Acquired immunodeficiency syndrome: the nurse's legal duty to serve.

Some nurses are reluctant to care for human immunodeficiency virus (HIV)-infected clients because of fear of contagion and discomfort in caring for people with alternate life-styles. Various federal, state, and local antidiscrimination statutes limit the right of the nurse to refuse to care for people with acquired immunodeficiency syndrome (AIDS) or HIV infection. Other constraints are employment contracts, ethical codes of professional organizations, and regulations of state licensing boards. Nurses have rights as well as responsibilities in caring for AIDS or HIV-infected patients. They also have a professional responsibility to institute measures that minimize the need for litigation and ensure access to health care for everyone.     

Emotionally smart

In the fifth article in our Heart of Nursing series we examine how caring for patients demonstrates that nurses value and respect them. To achieve optimum care, nurses need emotional intelligence.     

Nursing's losses and gains

Overall, I believe that the most senior trust nurses must establish how many elderly patients receive the kind of care I have described. While new ways of working and new developments in practice are important, we must not forget the essential elements of care in our wish to be innovative. In 2005, it takes courage to be a leader in the NHS. But even greater courage will be required by my mother and her family if she is ever admitted to hospital again. Because an ever increasing number of elderly people need care, all those responsible for this vulnerable client group, including policy makers, need to consider carefully how such care can be improved.     

AIDS and Homosexuality: A Longitudinal Study of Knowledge and Attitude Change Among Rural Nurses

With no effective medical treatment or vaccine for acquired immunodeficiency syndrome (AIDS) available now or in the near future, nursing can make the most difference by providing emotional support and physical care for people with AIDS and their families. One of the least understood areas in providing such care is the feelings nurses have toward persons with AIDS, especially in rural areas. This study measured changes in knowledge and attitude toward AIDS and homosexuality before, immediately after, and three months after an all-day AIDS workshop for nurses. The program provided current knowledge about transmission of the human immune virus and risk behaviors, and addressed personal feelings regarding fear of caring for persons with AIDS as well as negative feelings associated with homosexuality. Results revealed significant positive changes in knowledge and attitudes three months later. Participants also became significantly less fearful and more willing to care for persons with AIDS. Feelings of fearfulness and willingness to care for people with AIDS were associated not with knowledge differences but with differences in attitudes toward the disease and homosexuality. Therefore, this program's affective component was more closely associated with precursors to behavior change than was cognitive education. As the education needs of rural and community nurses increase, programs specific to them must continue to be developed and studied. Future research must also explore and evaluate actual nursing care of AIDS patients in relation to education program objectives.     

Caring for the adolescent with HIV infection or AIDS in the critical care setting.

Caring for the adolescent with HIV infection or AIDS in the critical care setting is challenging. This article discusses medical treatments for HIV, aspects of adolescent development that influence their behaviors, certain behaviors that put adolescents at risk for HIV acquisition, ethical and legal concerns for caring for this population, nursing implications for care, and the needs of nurses caring for this population.     

Two women with multiple sclerosis and their caregivers: conflicting normative expectations

It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker's expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts or to find work. We show that their narratives of identity, relationship and value differ from the narratives that others use to understand and identify them. Since identities, relationships and values give rise to normative expectations, in both cases there is a conflict between what the women expect of their caregivers and vice-versa. The narratives also show that two similar persons with multiple sclerosis may need very different care. This implies that nurses caring for such persons should listen carefully to their stories and reflect on their own perceptions of self.     

Talking about persons – Thinking about patients: An ethnographic study in critical care

BackgroundNursing involves caring for the ‘whole person’ and it is considered inappropriate for nurses to think or talk about patients in objectifying or dehumanising ways. Objectifying discourses can dominate within the arena of critical care, and critical care nurses can experience moral distress as they struggle to think about patients as persons. No previous study has examined the role played by ‘impersonal’ talk in the delivery of nursing care. This paper reports a study which examined the relationship between nursing practice and the way(s) in which critical care nurses think and talk about patients.ObjectivesThe study objectives were to (1) identify and characterise the ways in which critical care nurses think and talk about patients; and (2) describe patterns of nursing practice associated with these different ways of thinking.Study designAn ethnographic study was undertaken within one critical care unit in the United Kingdom. Data were collected over 8 months through 92 h of participant observation and 13 interviews. Seven critical care nurses participated in the study. Data analysis adopted the perspective of linguistic ethnography.FindingsAnalysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice. Four of these seven Discourses were of particular significance because participants characterised it as ‘impersonal’ to think and talk about patients as ‘routine work’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Although participants frequently offered apologies or excuses for doing so, these ‘impersonal’ ways of thinking and talking were associated with practice that was essential to delivering safe effective care.ConclusionsCritical care practice requires nurses to think and talk about patients in many different ways, yet nurses are socialised to an ideal that they should always think and talk about patients as whole persons. This means that nurses can struggle to articulate and reflect upon aspects of their practice which require them to think and talk about patients in impersonal ways. This may be an important source of distress to critical care nurses and emotional exhaustion and burnout can arise from such dissonance between ideals and the reality of practice. Nursing leaders, scholars and policy makers need to recognise and legitimise the fact that nurses must think about patients in many ways, some of which may be considered impersonal.