Use of North America's first medically supervised safer injecting facility among HIV-positive injection drug users

The objective of this study was to examine supervised injecting facility (SIF) use among a cohort of 395 HIV-positive injection drug users (IDUs) in Vancouver, Canada. The correlates of SIF use were identified using generalized estimating equation analyses. In multivariate analyses, frequent SIF use was associated with homelessness (adjusted odds ratio [AOR] = 1.90), daily heroin injection (AOR = 1.56), and daily cocaine injection (AOR = 1.59). The reasons given for not using the SIF included a preference for injecting at home and already having a safe place to inject. The SIF services most commonly used were needle exchange and nursing services. The SIF appears to have attracted a high-risk subpopulation of HIV-positive IDUs; this coverage perhaps could be extended with the addition of HIV-specific services such as disease monitoring and the provision of antiretroviral therapy.

[The experience of nurses caring for HIV-positive injection drug users]

Taiwan has experienced a clear upswing in HIV infection among injection drug users (IDUs) since 2004. Unsafe drug injection behavior has led to complicated infections including HIV and hepatitis C virus infection among IDUs. Nurses face challenges and threats in caring for this group due to the widespread criminal and behavioral problems related to drug use. The purpose of this phenomenological study was to explore nurses' experiences in caring for HIV positive IDUs. Purposive sampling was used to recruit 7 nurses with experience working with HIV positive IDUs. In-depth semi-structured interviews were conducted 1~2 times with each nurse. The length of interviews ranged from 1.5~3 hours. Interviews were tape recorded and transcribed verbatim. Data was analyzed using the Colaizzi method for phenomenology. Nurse experiences reflected low achievement level, difficulty in establishing rapport with IDUs, fear of drug use incidences during hospitalization, insufficiency and complications with family caregivers, fear of being threatened, and lack of support from other medical disciplines. Nurses used strategies that included being supportive of one another, learning appropriate communication skills, positive thinking, and anticipating substantial compensation from administrators. The results of this study provide essential information for in-service education and healthcare policy reform on IDU care. Interventions to ease nurse anxieties and feelings of insecurity in order to increase safe care should be developed and implemented. Positive feedback from IDUs with HIV infection enhances nurses' professional and personal growth.

Gaining insite: harm reduction in nursing practice

Insite, a supervised injection facility in Vancouver, British Columbia, is an evidence-based response to the ongoing health and social crisis in the city's Downtown Eastside. It has been shown that Insite's services increase treatment referrals, mitigate the spread and impact of blood-borne diseases and prevent overdose deaths. One of the goals of this facility is to improve the health of those who use injection drugs. Nurses contribute to this goal by building trusting relationships with clients and delivering health services in a harm reduction setting. The authors describe nursing practice at Insite and its alignment with professional and ethical standards of registered nursing practice. Harm reduction is consistent with accepted standards for nursing practice as set out by the College of Registered Nurses of British Columbia and the Canadian Nurses Association and with World Health Organization guidelines.

Developing a plan of care using the Roper, Logan and Tierney model

This care study, using the Roper, Logan and Tierney Model of Nursing, examines the presentation of a patient with a history of drug misuse and a current diagnosis of infective endocarditis and hepatitis C. While this particular model of nursing incorporates 12 activities of daily living, this care study will deal with three specific activities: maintaining a safe environment, communication and breathing. One of the main concerns arising from this care study was the inadequate management of pain for the patient. It is suggested in the literature that healthcare professionals do not always adequately address pain management, primarily because of fear of causing addiction. The authors suggest that the patient's history of drug misuse in this study may have further mitigated against him receiving adequate pain control.

Ethical decision-making when caring for the noncompliant patient

Ethical dilemmas frequently occur when nurses care for patients with a history of intravenous substance abuse who are hospitalized on medical-surgical units. This article discusses the recent findings on substance abuse, including its impact on the brain, effects on society and healthcare, available treatment options, and medical complications related to substance abuse. An ethical model is introduced to analyze ethical dilemmas with an accompanying case scenario. Resources available to nursing staff in many healthcare settings are identified as well as strategies to improve nursing care for this challenging population. The purpose of this article is to reduce nurses' feelings of frustration and stress in order to improve their morale. Finally, this particular contemporary ethical issue will be viewed as if perceived by Florence Nightingale.

A new role for pediatric nurses: teaching teen drug users how to sterilize their equipment for prevention of infectious disease; a course outline

This article discusses a sensitive issue that is complex and provocative, and will undoubtedly stimulate a variety of opinions. What do you think? Post your comments about this topic on the Pediatric Nursing Web site and read what others have to say as well. Visit our homepage at www.pediatricnursing.net and click on "Discussion". The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of Pediatric Nursing Journal or the publisher.

Transforming the meaning of HIV/AIDS in recovery from substance use: a qualitative study of HIV-positive women in New York

Recovery from substance use is a vital concern for many women with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). This qualitative study explores the meaning of women's HIV infection for their transition from drug use to recovery. Interviews were conducted with 15 female clients of a drug treatment program and AIDS nursing home in New York City. For most participants, HIV did not constitute the main reason for starting their recovery. The dual diagnosis program, however, facilitates an important transformation of the meaning of HIV/AIDS. Previously viewed as just another reason to use drugs, women now increasingly perceive their HIV infection as an incentive to stay clean and sober.

Injecting drug use: implications for skin and wound management

This article, the first of two parts, introduces the difficulties facing nurses working with injecting drug users with skin problems. Drug abuse is increasing globally, and has huge implications for healthcare practitioners. Increasing numbers of tissue viability nurses are also encountering drug injection-induced wounds in their practice, but there is a lack of evidence for management of chronic skin problems in this patient group. Together with rising numbers of injecting drug users, there are increased health implications such as bacteraemia, septicaemia, amputation and skin breakdown. Abscesses and chronic wounds as well as prolonged leg ulceration are common. Drug users may demonstrate chaotic lifestyles, which may inhibit access to usual healthcare provision. Issues relating to healing of these wounds are explored. The second part, which will appear in the next Tissue Viability Supplement, will describe the development of a specialist wound care clinic for homeless drug users.

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.

[Addicted patients. Attitude of nursing personnel]

Inside the realm of therapeutic relationships, one recognizes the importance of the nurse's attitude towards patients as one of those elements bearing influence on the objectives desired by the nursing profession. This study compares the attitudes towards via parenteral drug addicts held by nursing students and non specialized nurses. By means of a pilot study which used a selfadministered Litcker scale questionnaire developed by the study authors, two samples were selected: a student sample (n = 40) and a non specialized nurse sample (n = 40). These variables were evaluated in the two samples: age, professional experience, and the frequency in sporadic care for via parenteral drug addicts. The conclusion drawn from this study is that the attitude of nursing students is significantly more positive towards via parenteral drug addicts than the attitude held by non specialized nurses. The adoption of a more negative attitude towards these patients occurs at the start of a nurse's professional career.

Attitudes to drug users according to staff grade

The attitudes of professionals working with intravenous drug users are likely to be affected by clinical grade. Perceptions of service delivery to intravenous drug users are likely to be affected by status. Senior professionals tend to be more positive in their attitudes towards intravenous drug users. Attitudes and perceptions of service delivery are very important in determining the standard of care delivery.

Attitudes to drug users according to age of staff

The attitudes of professionals working with intravenous drug users, and their perceptions of service delivery, are likely to be affected by age. Younger professionals tend to be more positive in their attitudes towards intravenous drug users. Older professionals tend to be less concerned about the risks from HIV infection than younger ones. More research is needed into the effects of age group on attitudes.

Harm reduction: a realistic approach toward injection drug users

The injection use of illicit drugs is a major mode of HIV transmission in the heterosexual population. Indeed, because HIV is transmitted from injection drug users to their sexual partners and their children, there is widespread acknowledgement that controlling HIV infection in the general community may depend on controlling it in injection drug users. Unfortunately, a moralistic attitude toward illicit drugs and their users all too often deters health professionals from taking preventive action. This impractical attitude holds that stopping illicit drug use is the only answer. In today's age of AIDS, it's a dangerously simplistic stance.

HIV/AIDS. Counselling drug users

This paper examines the uptake of the HIV test in a busy London drug dependency unit and looks at some of the specialist aspects of HIV counselling with drug users. HIV pre-test counselling is an important health education opportunity. The current guidelines for HIV pre-test counselling with drug users suggest that practitioners should adopt a more encouraging attitude.

Gear future training to practitioners' needs. Attitudes towards intravenous drug users

1. There is no clear-cut relationship between staff knowledge and their attitudes to HIV and Aids. 2. Perceptions of service delivery to drug users are likely to be affected by respondents' occupational backgrounds. 3. The effectiveness of service delivery is likely to be affected by situational constraints. 4. There is a need for improved training and support, particularly for non-specialist staff.

Utilization of formal and informal home care by AIDS patients in Boston: a comparison of intravenous drug users and homosexual males

The assumption that intravenous (i.v.) drug users have weaker informal support networks than homosexual men has led to opposing policy recommendations: one emphasizes outreach and more formal (paid) home care for i.v. drug users, whereas the other maintains that formal home care programs are less effective for this risk group due to the lack of informal (unpaid) caregivers to coordinate efforts. Data from interviews with a sample of 231 persons with AIDS in the Boston area were used to compare the use of formal and informal home care between the two largest risk groups, homosexual men and i.v. drug users. Multivariate regression analysis was also employed to adjust estimates and to determine the significance of population characteristics in explaining utilization differences. IV drug users received about twice as much formal and informal home care as homosexual men. Controlling for functional status, income and assets, insurance and potential caregiver supply, i.v. drug users obtained significantly fewer formal home care services, but more informal care. Overall, i.v. drug users received a greater number of adjusted home care hours. These findings cast doubt upon the previous assumptions of the literature and suggest that members of both risk groups are appropriate candidates for formal home care services.

Attitudes of professionals to drug abusers

Drug abusers are generally regarded as a demanding client group by health care professionals. The occupational background of health care professionals and their familiarity with drug users is likely to affect their emotional responses and attitudes. Professional carers who are more familiar with drug users, e.g. addiction counsellors and psychiatric nurses, tend to have a more positive attitude. Awareness of HIV infection may increase the fears and anxieties of professionals, resulting in a more negative attitude to drug users. Little research has been carried out into the attitudes of professional carers, particularly nurses, towards drug users. Attitudes of professional carers are very important in determining standards of care delivery and more research is needed into the effects of attitudes on the delivery of health care.

IV drug use, dementia, and nursing home care for PWAs (persons with AIDS)

Despite the usual focus on daily costs, because PWAs have higher costs per day than other SNF residents, LOS and days of care are important cost indices. Data on LOS for 102 admissions and annual days of care for 90 PWAs show average 64-day LOS and 67 days of care. Regression analysis and survival analysis show dementias and IV drug use to mean longer LOS and more days of care. Higher PWA costs must be sustained over longer periods for PWAs with dementias and for IV drug users, who may claim increasing shares of the SNF care provided to PWAs.

Nurses' attitudes toward patients with AIDS and AIDS-related risk factors

Three variables were experimentally manipulated by simulation measurement using six vignettes in a completely randomized, partial hierarchical, experimental design: medical diagnosis (AIDS v. non-AIDS), sexual orientation (heterosexual v. homosexual) and intravenous drug-use history (IVDU v. non-IVDU). Following each vignette, the same Prejudicial Evaluation Scale (PES) and Social Interaction Scale (SIS) were used to measure nurses' attitudes toward patients and their willingness to interact with patients. Vignette questionnaires were randomly assigned to 360 acute-care nurses. Although sexual orientation was found not to influence PES and SIS scores, an AIDS medical diagnosis and a history of intravenous drug use were found to increase nurses' negative attitudes toward patients significantly and reduce their willingness to interact with patients. Study findings did not vary according to nurses' age, academic preparation or previous practice experience with patients with AIDS.

Treating drug users in hospital wards

It seems likely that hospital wards will be admitting an increasing number of intravenous drug users over the coming year. Hal Satterthwaite offers hospital services a system of response to the needs of this population, based on a maintenance contract with individual patients. He argues that such contracts should be instigated as soon as is feasible after admission of the patient onto the ward.