[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.

[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.

Placebos: the nurse and the iron pills

In sub-Saharan Africa, a nurse gives iron pills as placebos to terminally ill patients. She tells them, acting in what she believes is in their best interests, "these will make you feel better". The patients believe it will help their AIDS and their well-being improves. Do the motive and the patient's positive outcome in well-being make the deceit justifiable when other issues such as consent, autonomy and potential consequences regarding the patient and the wider community are considered? Is there a difference between lying and non-lying deception when the end result is the same? The patients feel better, but at what cost if the deceit was found out? It will be argued that although the actions of the nurse are understandable and to some extent defensible, they are unethical. It is not ethically acceptable to take away the patient's autonomy and risk the health of the community even though the risk of deceit being discovered is a small one.

A conceptual model of HIV/AIDS stigma from five African countries

AIM

This paper is a report on the development of a conceptual model delineating contexts and processes of HIV/AIDS stigma as reported by persons living with HIV/AIDS and nurses from African countries. It is part of a larger study to increase understanding of HIV/AIDS stigma.

BACKGROUND

Researchers have defined stigma, explored determinants and outcomes of stigma and attempted to measure its multiple dimensions. This literature is difficult to synthesize, and often does not distinguish adequately between experiences of stigma and its causes and outcomes.

METHOD

Forty-three focus groups were held with persons living with HIV/AIDS and nurses in five African countries in 2004. Focus group recordings were transcribed and coded. The data were organized into a conceptual model of HIV/AIDS stigma.

FINDINGS

Two components were identified in the data: contextual factors--environment, healthcare system, agents--that influence and affect stigma and the stigma process itself. The stigma process included four dimensions: triggers of stigma, stigmatizing behaviours, types of stigma and the outcomes of stigma.

CONCLUSION

A conceptual model is presented that delineates the dynamic nature of stigma as reported by study participants. The model may be used to identify areas appropriate for the design and testing of stigma reduction interventions that have a goal of reducing the burden of HIV/AIDS stigma.

[An experience nursing an intravenous drug user(IDU) with AIDS: applying the family stress model]

There is prejudice and fear in society about AIDS, causing the families of AIDS patients to be stigmatized. The number of patients infected with HIV has increased substantially in the past two years as presumably a result of an increase in the sharing of syringes. Intravenous drug users (IDUs) are often isolated from their families, with whom they usually have poor relationships. If they are infected with HIV, it becomes all the more difficult for them to be accepted by their family. The article describes the stress experienced by a family as a result of hospitalization of an IDU with AIDS. The findings from this case report demonstrate three main problems identified from the assessment of Boss's family stress management. These three health-related problems were that the primary caregiver felt exhausted, that communication between parents and children was poor, and that the family's coping ability was compromised. Encouraging positive communication between the client and his mother throughout the period of care enhanced the closeness and harmoniousness of their relationship, as well as the client's sense of security as he approached death. Furthermore, we consulted with social workers in order to facilitate the joint provision of social resources and to assist the family during its crisis.

[Expectations of hospitalized patients with HIV/AIDS regarding nursing care]

This study aimed at verifying the expectations of patients with HIV serum-positive patients, regarding to nursing care. This is a study with qualitative approach developed in the inpatient unit of a state public hospital in the municipal district of Fortaleza, CE. Data were collected in the period of September to October of 2003 through semi-structured interview, applied to 12 patients, randomly selected among the patients with diagnosis of HIV/AIDS. For data analysis it was used the Collective Subject's Speech (DSC) through emission of central ideas and/or key-expression. It was conclude that the patients expectations are for a more human care, more attention, contact verbal, more affectivity of the nursing team, a qualified and worthy attention. Besides their needs they should be informed daily about the vulnerabilities that they are submitted during the hospitalization.

Self-care and HIV/AIDS patients: nursing care systematization

This research aimed at systematizing nursing care to HIV/aids patients in view of Orem's Self-care Deficit Nursing Theory, using the convergent-care method and the Self-Care Nursing Process. Subjects were thirteen HIV/AIDS patients attended at a non-governmental organization in Fortaleza/CE, Brazil. We used interview techniques, physical examination, observation and information records, with a structured instrument, addressing requisites related to universal self-care, development and health alterations. Self-care deficits corresponded to nineteen nursing diagnoses, named according to NANDA's Taxonomy II, ten of which were based on the requisites for universal self-care, five on the requisites for self-care related to development and four on the requisites for self-care related to health deviations. In care planning, goals were established and the system and health methods were selected, prioritizing support-education actions in order to engage HIV/aids patients in self-care.

[An evidence-based guideline to support HIV/AIDS patients with alcohol problems]

It is estimated that 300,000 people with alcohol problems and alcohol-related illnesses are presently living in Switzerland. Many of these are infected with HIV. Yet, the number is unknown. At the HIV outpatient department of the University Hospital in Basel, nurses are assessing patients and it is evident that alcohol intake is a serious health problem for some of them. In order to provide evidenced-based care to these patients, a clinical practice guideline was developed based on a comprehensive literature review and synthesis. The guideline has been implemented and helps nurses and other healthcare providers to effectively assess and provide a short-term intervention to those patients with HIV who have alcohol-related problems. For the assessment, two instruments are utilized: the AUDIT and the CAGE. These instruments were selected after evaluation as being the most sensitive and specific for patients in an ambulatory setting. Patients are also assessed for their readiness to change. In this article, the literature will be reviewed and the guideline introduced, as a basis for nurses and other health care providers to provide evidence-based care for HIV-infected patients who have alcohol-related problems.

Psychosocial impacts on caregivers of people living with AIDS

Estimates show that by 2010 up to six million South Africans will be HIV-infected. Simultaneously, public health care resources are overstretched and communities and families are taking more responsibility for providing care. However, little work in South Africa has investigated the possible psychosocial impacts on caregivers. This study investigates psychosocial impacts at household level with reference to gender, programme, and policy implications. Forty-five in-depth interviews were held with primary caregivers of people living with AIDS (PWA). Participants were recruited using purposive and snowball sampling. Forty-three respondents were women, signifying that gender is an important issue in this context. Data were analysed using a grounded theory approach. Care giving placed considerable demands on caregivers, which was exacerbated by insufficient support, dire poverty and the added responsibilities of caring for other household members. Lack of basic resources was common and chronic, and care giving impacted negatively on employment and social life. Stigma and prejudice towards caregivers was common and exacerbated stress levels. Assessment of support received from various sources ranged widely. The lack of support was often debilitating. Respondents who felt supported linked this support to improved psychosocial status. Recommendations for policy on home-based care are outlined.

Monitoring symptoms in patients with advanced illness in long-term care: A pilot study

The Edmonton Symptom Assessment Scale (ESAS) was administered daily by nursing staff in a long-term care facility (LTCF) to monitor symptoms. Scores greater than or equal to 5 on a 0-10 scale were considered moderate-to-severe and triggered prompt treatment. One hundred and eight patients with advanced illness and perceived prognosis of less than 6 months were identified for rapid symptom management over a 7-month period. Forty-six (43%) of these patients had at least one episode of moderate-to-severe symptoms during the follow-up period. Thirty-one of these patients (67%) had a primary diagnosis of advanced AIDS and 12 (26%) had advanced cancer. Pain was the most frequent of the 15 symptoms measured, occurring in 29 patients. In the case of pain (P = 0.001), tiredness (P = 0.004), and well-being (P = 0.003), rapid symptom management led to significantly improved distress scores within 48 hours. These data suggest that it is feasible for nurses in an LTCF to use the ESAS on a daily basis to assess patients and obtain prompt treatment for distressful symptoms. Rapid treatment of symptoms can be an important quality indicator in nursing home patients with advanced illness.

Analysis of proxemic communication with HIV/AIDS patients

This descriptive and exploratory study analyzed the proxemic factors of the nursing team and HIV/AIDS patients in a hospital environment in Fortaleza - CE, between October and November 2004. Data were collected through non-participant observation. Forty-one interactions were analyzed, in which no gender influence was observed. The professional's position towards the patient was mainly standing; intimate distance occurred in 21.95% of interactions, which were mostly related to technical procedures; personal distance predominated in 63.41% of cases, which were related to technical care; social distance occurred in 14.64% of interactions, which were aimed at conservation; obstacles were present in 15 interactions; local touch was the most frequent contact behavior; visual contact was present in 11 interactions, with a view to regulating the conversation flow; the tone of voice was found always adequate. Through proxemics, we can identify important factors in communication with HIV/AIDS patients.

The utility of the Purpose-in-Life Test in persons with AIDS

The purpose of this study was to describe the utility of the Purpose-in-Life Test among persons with AIDS using both Part A (quantitative) and Part B (qualitative). A cross-sectional descriptive design was used with a sample of 74 persons with AIDS from community settings. The Purpose-in-Life Test and a sociodemographic questionnaire were administered. Analytic methods included descriptive and inferential statistics and content analysis. Part A scores indicated that only one third of the participants reported a definite purpose in life; however, results from Part B demonstrated that the majority of participants viewed their life as meaningful and dynamic. Demographic characteristics such as race, income, and education were significantly related to purpose in life. Assessing purpose in life using both Part A and Part B of the Purpose-in-Life Test may assist nurses with a more in-depth understanding of purpose in life and assist persons with AIDS with identifying opportunities for personal growth.

Family caregiving for AIDS patients in the Democratic Republic of Congo

We conducted a qualitative study of women who were caregivers for HIV/AIDS-affected spouses in Bumbu Zone, Kinshasa, Democratic Republic of Congo in 2003. Twelve caregiving women, six home-based care workers and five key informants were interviewed via focus group discussions. Most women reported huge problems in providing care to their spouses due to psychological, social and economic factors. The secrecy around HIV/AIDS issues and care was a significant theme in the findings. The self-reported health status of the caregivers indicated poor health.

Caring for patients living with AIDS: knowledge, attitude and global level of comfort

AIMS

This paper reports a study that aimed to determine Nigerian nurses' knowledge, attitudes and overall level of comfort in giving nursing care to acquired immune deficiency syndrome patients; determine the relationship between these variables; and identify the sociodemographic variables that influence nurses' attitudes and how comfortable they are giving nursing care to patients with acquired immune deficiency syndrome.

BACKGROUND

There is little information on sub-Saharan African nurses' knowledge, attitude and feeling of comfort in providing care to patients living with acquired immune deficiency syndrome.

METHODS

Two hundred and seventy-seven nurses in two teaching hospitals and two general hospitals in Nigeria were surveyed in 2003. The survey questionnaire had two parts. Part I elicited demographic information and information on previous encounters with acquired immune deficiency syndrome patients and Part II consisted of three subscales assessing knowledge, attitude and level of comfort administering certain nursing procedures to acquired immune deficiency syndrome patients.

RESULTS

Respondents demonstrated low levels of knowledge and poor attitudes towards people with acquired immune deficiency syndrome. Attitudes appeared to be influenced by the nurse's speciality, rank, prior education and experience with patients with acquired immune deficiency syndrome. The responding nurses showed low levels of comfort in giving care to patients with acquired immune deficiency syndrome.

CONCLUSIONS

The findings suggest that Nigerian nurses will hesitate to care for patients with acquired immune deficiency syndrome, and that there is potential for avoidance behaviour towards them. Periodic continuing education and curriculum enhancement to include clinical clerkship, structured experience, guided discussion on ethical scenarios and attitude exploration are suggested in order to achieve and maintain adequate knowledge and a positive attitude. University-based professional and postprofessional nursing education, which could enhance acquisition of a broad knowledge base, therefore represents the future direction.

Knowledge of HIV/AIDS among nurses in southwestern Nigeria

The study was conducted to find out how much this group of nurses from south-western Nigeria knew about the HIV/AIDS phenomenon. A survey questionnaire was distributed to two population convenient samples of nurses; one group at a university teaching hospital, and the other at a post-basic institution of higher learning. The respondents stated that many of them knew quite a bit about HIV/AIDS, but only a few affirmed that they were taught informal classroom setting. Many of the nurses were able to identify the HIV as the culprit in causing the infection that leads to AIDS. The sources of information about HIV/AIDS vary. The nurses attributed the spread of HIV/AIDS to promiscuous teenage girls predominantly, as well as older men due to infidelity. Many of the nurses stated that sex education should be given to children as young as five years old, and as old as over sixteen years of age. It is recommended that curricular infusion should be done to incorporate HIV/AIDS education in the nursing schools in south-western Nigeria.

Perceived HIV stigma in AIDS caregiving dyads

This study examines perceived HIV stigma in AIDS caregiving dyads in the United States, assessing the measurement of and correlates of personal stigma (among care-recipients living with HIV), courtesy stigma (among caregivers), and dyadic stigma. Survey data from 135 dyads in which the caregiver is a midlife or older mother or wife, and the care-recipient is her HIV-infected adult son or husband, are analyzed with individual-level and multilevel regression models. Results indicate that: (1) perceived stigma can be reliably measured among both persons living with HIV (PLH) and caregivers; (2) personal stigma can be distinguished from courtesy stigma; (3) perceived stigma is relatively low in this sample, and is higher among PLH than caregivers, higher among caregiving wives than mothers, and similar between PLH who are husbands and sons; (4) dyadic stigma is influenced by the caregiver's HIV status, the ethnic composition of the dyad, caregiving duration, and household income; (5) stigma discrepancy within dyads is a function of health discrepancy within dyads; and (6) differences in multivariate correlates of perceived stigma at the individual-level, in comparison to the dyad-level, suggest that dyadic stigma is a unique construct. A recognition that perceived stigma bears its own unique influence on the caregiving dyad is important for understanding how best to allocate resources aimed at alleviating stigma among individuals and families impacted by HIV.