Knowledge generation for the HIV-affected family

Families suffering with HIV/AIDS: what family nursing interventions are useful to promote healing?

The purpose of this clinical research project was to examine the usefulness of a family nursing intervention program offered to families experiencing illness suffering related to HIV/AIDS. The interventions were based on the Family Caregiving Model and the Illness Beliefs Model. Sixteen Thai families with one or more family members living with HIV/AIDS were offered three to four family clinical sessions by an advanced practice family nurse. The audiotaped family clinical sessions and field notes were analyzed using thematic analysis. The outcomes reported by families included a competence to manage illness care of family members experiencing HIV/AIDS, new meaning and purpose, improved family interaction, embraced facilitating beliefs and changed constraining beliefs, and a recognition of the family's strengths.

'I felt I have grown up as an adult': caregiving experience of children affected by HIV/AIDS in China

BACKGROUND

The growing global epidemic of HIV/AIDS has a significant impact on the lives of both people living with HIV/AIDS and their family members including children. Children of parents with HIV/AIDS may experience an increased responsibility of caregiving in family. However, limited data are available regarding the caregiving experience and its impact on psychosocial well-being among these children. This study was designed to address these issues by using qualitative data collected from children affected by HIV/AIDS in China.

METHODS

The qualitative data were collected in 2006 in rural central China, where many residents were infected with HIV/AIDS through unhygienic blood collection procedures. In-depth individual interviews were conducted by trained interviewers with 47 children between 8 and 17 years of age who had lost one or both parents to AIDS.

RESULTS

Findings of this study suggest that many children affected by AIDS had experienced increased responsibilities in housework and caregiving for family members. Such caregiving included caring for self and younger siblings, caring for parents with illness and caring for elderly grandparents. Positive impacts from children's participation in family caregiving included personal growth and emotional maturity. Negative consequences included physical fatigue, psychological fear and anxiety and suboptimal schooling (dropping out from school, repeated absence from school and unable to concentrate in class).

CONCLUSION

While the increased caregiving responsibilities among children reflected some cultural beliefs and had some positive effect on personal growth, the caregiving experience generally negatively effected the children's physical and mental health and schooling. The findings in the current study suggest that community-based caregiving support is necessary in areas with high prevalence of HIV and limited resources, especially for the families lacking adult caregivers. In addition, social and psychological support should be made available for children participating in family caregiving.

Stress, needs, and quality of life of family members caring for adults living with HIV/AIDS in Taiwan

The stress, needs and quality of life (QoL) of family members of people living with HIV/AIDS (PLWHA) are critical to explore in Taiwan where home care projects are not available to help the PLWHA families. We examined the extent of stress, needs, QoL and its correlates that family caregivers of PLWHA experienced with structural questionnaires survey. A total of 50 family caregivers of PLWHA visiting a medical center in Taiwan participated in the study from October 2005 to August 2006. Family caregivers felt most stressful on disclosure and stigma issues, and most worried about patients' interpersonal relationships. The most important needs were care-related needs including knowledge of the disease progression, methods of examination and treatment, and the related side effects. The level of stress significantly positively correlated with needs, and negatively correlated with QoL. Availability of alternative manpower to care PLWHA and being PLWHA's parents were two significant factors affecting family caregivers' QoL. In conclusion, family members of PLWHA experienced high level of stress, enormous caring needs, and poor QoL. A family-centered care for PLWHA and their families in the community is crucial to improve quality of care and to prevent family's overload, particularly for families with no alternative manpower and for those being PLWHA's parents.

Symptom management in HIV/AIDS: advancing the conceptualization

For people living with HIV, symptoms related to the disease, comorbidities, and treatment side effects make symptom management essential. Poorly managed symptoms result in reduced medication adherence, disease progression, and lower quality of life. The Self-regulatory HIV/AIDS Symptom Management Model is a conceptual model that describes how persons living with HIV/AIDS manage their symptoms. The model links symptom experience, symptom management, social support, adherence, and health-related quality of life. It can assist nurses, through a multidimensional approach to illness management, to enhance symptom assessment, better understand factors influencing symptom experience, and to improve symptom management among people living with HIV/AIDS.

The Advanced Nursing Practice Team as a Model for HIV/AIDS Caregiving in Switzerland

To offer advanced nursing care for people living with HIV, a participatory action research project was initiated that enabled constant learning and change at the levels of (a) the culture and organization of an outpatient department, (b) clinical leadership and interdisciplinary collaboration, and (c) development of new services. In this project, the development of the Advanced Nursing Practice (ANP) Team not only affected the practice of individual nurses with advanced degrees but also created a team of nurses educated at different levels. Through a systematic process, the nurses on the team became more educated and refined their clinical expertise. An essential aspect of the ANP Team was the specialization of each nurse in a self-selected topic within HIV/AIDS care. As members of the ANP Team, the nurses offer state-of-the-art nursing care including patient assessment, medication management and adherence support, symptom management, health maintenance and prevention, and family support for persons living with HIV.

In invisibility and isolation: the experience of HIV-affected families in German-speaking Switzerland

Based on critical hermeneutics, the author presents insights about caregiving experiences of HIV-affected families in Switzerland. Using a qualitative approach, she interviewed 11 families and conducted 3 group discussions with members of different families. Two main themes emerged--Caught In Between: Family Changes Forced by HIV/AIDS and No Request for Support: Family Caregiving in the Context of Invisibility. The former portrays the families' struggle with new family constellations. Members felt close to, ambivalent toward, or distant from the infected member and built subgroups representing these connections and values. The latter portrays the families' withdrawal from their environment, whereby one or two close family members almost invisibly provided caregiving without outside support. These behaviors were reinforced by the Swiss health care system, which focuses on individuals. Suggestions for interventions are introduced.

Disclosure after a sibling's death from AIDS

The purpose of this article was to describe patterns of disclosure among adults after their sibling's death from AIDS. A descriptive study design was done by use of a cross-sectional sample including 87 adults from separate families. Sibling responses were audiotaped and content analyzed. Six categories of disclosure emerged from the data: Purposeful, "If Asked I Tell," Selective, Protective, Restricted, and Avoidant. Categories differed across three dimensions: usual method of telling, goal of method, and underlying belief about public disclosures. It was found that siblings disclose variably after their brother's or sister's death from AIDS. In bereavement contexts characterized by stigma, bereaved siblings consider many potential consequences before choosing how they will tell others their brother or sister died from AIDS.