Archive for the ‘HIV/AIDS’ Category

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic

CascadeofCare

The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?

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AJN’s December Issue: Working During a Pandemic, HIV Foot Care, Healing Pet Visits, a Focus on Narrative

November 27, 2013

AJN1213.Cover.OnlineAJN’s December issue is now available on our Web site, just in time for some holiday reading. Here’s a selection of what not to miss.

Working during a pandemic. Flu season is in swing, but how do nurses feel about working during a flu pandemic? Researchers investigating terrorism and catastrophic events found that up to 96% of health care workers reported being unable or unwilling to work during some emergencies, with some infectious diseases associated with the highest rates of unwillingness. “Predictors of Nurses’ Intentions to Work During the 2009 Influenza A (H1N1) Pandemic,” December’s original research CE, suggests that providing adequate resources during an emergency (such as personal protective equipment) will not only ensure the safety of patients, nurses, and nurses’ families, but may also increase nurses’ willingness to work in times of crisis. Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

HIV foot care. Peripheral neuropathy, which causes debilitating symptoms such as burning pain and sensation loss in the foot, continues to be prevalent in people with HIV, but is often overlooked. “HIV Peripheral Neuropathy and Foot Care Management” reviews what is known about distal sensory peripheral neuropathy in HIV patients, and provides nurses with information on its assessment and management. You can earn 2.5 CE credits by reading this article and taking the test that follows.

Hospital noise reduction strategies. The importance of maintaining a quiet, restful environment for patients has long been recognized by nurses. Our Cultivating Quality article, “Quiet at Night: Implementing a Nightingale Principle,” describes how nurses implemented a noise-reducing strategy in their hospital to provide patients with an optimal environment for care. Listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article or downloading the podcast from our Web site.

Family pets in hospitals. Animal therapy for hospital patients can reduce stress and depression, and may aid in the healing process. “Family Pet Visitation” describes how nurses at one hospital instituted a pet visitation program to help patients feel more comforted and supported. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

Read the rest of this entry ?

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A Face in a Village: Remembering a First Encounter with AIDS in Africa

February 8, 2012

We’d already guessed there was a problem at the health post—we hadn’t received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren’t receiving reports.

That’s from “A Face in a Village,” the February Reflections essay in AJN by Susi Wyss, the author of a well-received recent novel, The Civilized World (Henry Holt, 2011). Set in Africa, the novel, like this essay, was inspired by the author’s international health career. In this essay, Wyss recalls a vivid first encounter with the ravages of AIDS and the hopelessness it inspired. (Click through to the PDF version for a cleaner read.)—JM, senior editor

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World AIDS Day, 30 Years On from That Fateful MMWR

December 1, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.”

So began the MMWR of June 5, 1981—the first herald of what became known as AIDS. Reading that report now, knowing the devastation that would follow, is chilling.

Today is World AIDS Day. It has been 30 years.

In some ways, we need this day more than ever, to remind us of the devastating potential of this condition—the Centers for Disease Control and Prevention (CDC) reports that only 28% of people in the U.S. infected with HIV get the treatment they need to suppress the virus. We need it to remind us of the millions who continue to suffer and die from it, mostly in Africa where two thirds of the AIDS cases occur.

We should also take time today to celebrate the victories. We’ve come far in the last 30 years. Effective treatments have been developed. Civil rights protections have been put in place. People with HIV can now live long, joyful, productive lives. Thirty years ago it was a death sentence, one that devastated those it affected—physically, socially, economically. Now it is a manageable illness that appears close to being controlled. Read the rest of this entry ?

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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

September 29, 2011

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole lot nicer. It may be cheaper, but it’s not “rationing”—it’s rational.

Now a matter of language rather than money: the Viewpoint essay by Kathleen Thies in the October issue of AJN is about the use of military language to refer to nursing staff. Here’s how it begins, and you can click the link to read the whole article, including the author’s suggestion for an alternative terminology. We’d love to know whether the author’s perspective resonates with you:

How often have you heard the term frontline staff used to refer to direct care nurses and others working at a patient’s bedside? It conjures images of the great world wars, of soldiers marching across battlefields to fight the enemy. The infantry are invariably young, dispensable, interchangeable. Commands are issued by generals and passed down through the ranks. No questions are asked.

Blog roll update: We’ve added some interesting new blogs to our blogroll (they’re not new blogs, actually, just new to our blogroll). A few of them are by MDs, such as The Carlat Psychiatry Blog and Movin’ Meat, and a couple of are by nurses, such as madness: tales of an emergency room nurse, which has a good short post about why it doesn’t always help to be a nurse when your family member is in the hospital (there have been a few posts on this topic lately in different venues, I think?). Also added: The Nursing Ethics Blog, which is run by two people, a nursing professor/ethicist and a philosopher. It should be interesting to explore.

As the editor of the Reflections column (and this blog), I read hundreds of submissions each year about dying patients, with a subgenre of submissions devoted to dying infants or miscarriages. Read the rest of this entry ?

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A Primary Source Reminder from the Early Days of HIV/AIDS

June 6, 2011

By Maureen Shawn Kennedy, AJN editor-in-chief

Last week, I received a press release from the National Institutes of Health noting the publication 30 years ago of the first ‘official’ report that many consider to have heralded the beginning of the AIDS epidemic—a report in the MMWR (Morbidity and Mortality Weekly Report), a publication of the Centers for Disease Control and Prevention (CDC), about cases of Pneumocystis carinii pneumonia and Kaposi’s sarcoma in otherwise healthy young men who all happened to be gay.

This report (which included various causative theories, including speculation that the weakened immune system among these gay men might somehow have resulted from the use of lifestyle drugs such as amyl nitrate!), seemed late in coming for those of us who’d been seeing unusual infections among gay men since the mid-1970s.

In 1975, I became aware of these young men when they started coming for diagnostic consultation with the physicians I worked with in a private hematology–oncology practice in New York City. No one could figure out why they had developed opportunistic infections that were normally seen only in patients who’d been on chemotherapy or who had other immune disorders. We talked about the fact that similar cases were being seen at the (now defunct) St. Vincent’s Medical Center in Greenwich Village. Read the rest of this entry ?

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On the Road to the International Council of Nurses Conference in Malta

May 2, 2011

By Shawn Kennedy, AJN editor-in-chief

So I’m on my way to Valletta, Malta (Malta is a small Southern European country in the Mediterranean Sea between Sicily and North Africa and a five-hour ferry ride from Libya) for the International Council of Nurses (ICN) meeting. Since there’s no direct flight from my usual airport (Newark, New Jersey) to Malta, it was a no-brainer to go through Paris (April, Paris?) and stop there for a few days. I hadn’t been to Paris before—it was everything I thought it would be, and more. And its reputation as the “City of Light” is well deserved (see the photo of the Eiffel Tower at night, courtesy of my husband).  

This will be my third ICN meeting—I attended the centennial meeting in London, and then one a few years later in Copenhagen. It’s amazing to meet nurses from all over the world, many of whom are grappling with issues similar to those confronting us.

Many, though, are dealing with issues far worse than our own. For example, nurses from sub-Saharan Africa face enormous odds in the face of internal conflicts as well as HIV and AIDS, and nurses in Japan have recently dealt with a series of disasters. These nurses amaze me.

And then there are colleagues who seem to be on the same professional development trajectory we’re on. Read the rest of this entry ?

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What’s Ugly? — And Other Crucial Conversations for Nurses

April 18, 2011

By Shawn Kennedy, AJN editor-in-chief

Metal billboard, Bubaque, Guinea-Bissau, 2010. Photo by Dawn Starin.

Our monthly Art of Nursing department—often, a poem or image somehow related to health care—is a unique feature for a scholarly publication, but one we feel strongly about. We believe that in order to provide truly holistic care, nurses need to know about more than evidence-based clinical content—they also need to be aware of many other aspects of the human experience. 

One thing art teaches us is that people don’t always see things the same way. What’s beautiful, illuminating, or at least useful to one person may be ugly or offensive to another. Consider billboards with public health messages. To some, such a billboard may seem to be an eyesore blotting the landscape; to others, the image and message is a powerful tool for disseminating life-saving information. Our September 2010 Art of Nursing (click through to the PDF version) showcased billboards in Guinea-Bissau, a poor country with HIV prevalence  of epidemic proportions. The billboards, photographed by Dawn Starin (here’s a blog post she wrote about them), are used to encourage people to get tested. A blog post by AJN senior editor Sylvia Foley about the column noted concerns some had expressed about these billboards:

Are the billboards effective? Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

On the other hand, here’s an excerpt from a recent comment by one reader of Sylvia’s blog post:

I think using public health billboards in Guinea-Bissau to combat the epidemic of HIV-AIDS is a great tool to reach out to the community and create awareness. Creative billboards do in fact attract people’s attention especially when it’s something as important as getting tested for HIV and AIDS. I can speak from personal experience as one day I was driving down a major highway in Miami, Florida and saw a very creative billboard about getting tested. The message on the billboard stuck with me for days until I decided to get tested. These billboards may not motivate everyone to get tested but I’m sure I wasn’t the only one that this billboard inspired to get tested.

We don’t know the results of this commenter’s test results—we can only hope they were negative. But the important point is that the billboard was effective: this person got tested. 

What are some other notable billboards promoting public health messages? If you’ve seen them, send us photos of the billboards (to Shawn dot Kennedy at WoltersKluwer dot com). We’ll post them online (and credit you!) and help spread the word.

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Harm Reduction or Stigmatization: What’s Your Approach to Drug-Addicted Patients?

November 1, 2010

By Alison Bulman, senior editorial coordinator

How much of your nursing education focused on how to handle drug addicts and substance abuse? Probably not much, according to speakers at a recent event I attended with my colleague Christine Moffa, AJN’s clinical editor, at the Center for Health, Media, and Policy at Hunter College.

The event was focused around a clip (longer than the one above) from “Bevel Up: Drugs, Users and Outreach Nursing,” an award-winning film by Canadian documentary filmmaker Nettie Wild. (A photo of a street nurse from the program appeared on AJN’s cover in July 2009, along with an article about the program.) Fiona Gold, BA, RN, and Juanita Maginley, MA, BSN, RN, whose work in Vancouver is the subject of the film, spoke on the panel about the value of harm reduction and about the systemic flaws and tendency to stigmatize drug addicts that prevent health care from reaching this population.

The powerful clip showed street nurses searching the city’s alleys and housing complexes for drug addicts, dealers, and sex workers. They carry bags full of syringes, condoms, and crack pipe mouthpieces which they deliver to those willing to take them. They ask street patients whether they might be pregnant, have unsafe sex, may have a disease, and if they want to have the nurses draw blood for testing.

The outreach project started in response to Vancouver’s alarming increase in HIV infections. Medical services were not reaching the most vulnerable people, so nurses devised a plan to go to them, a strategy they referred to as “meeting the client where they are.”

The nurses in the film show an amazing ability to balance gentle persistence and respect for the autonomy of their patients. We all know that some health care workers, including nurses, can be contemptuous of drug addicts, and may perceive addiction as self-indulgent and little more than a burden to the system. And far more money is spent on criminalizing drug use than on treating drug addiction as a disease.

My colleague Christine’s reaction to the clip reflected her experience as a nurse: ED nurses’ job “is difficult, and patients who are using drugs are not always easy to deal with.” But she also stressed that nurses don’t have a choice who they work with, and that the best approach we can take is to make sure they get enough training, both at school and at work, to meet the needs of this population.

To order the DVD of this film, which includes  a teaching module, go here. It’s sure to start some lively conversations among health care workers.

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Fighting HIV–AIDS with Public Health Billboards: September ‘Art of Nursing’

August 30, 2010

By Sylvia Foley, AJN senior editor

Public Health Billboard, Guinea-Bissau (detail)

On a recent trip to the capital of Guinea­-Bissau, Dawn Starin noticed numerous public health billboards urging people to get tested for HIV or to practice safer sex by wearing condoms. One of the six poorest countries in the world, according to the Central Intelligence Agency’s World Factbook, Guinea-Bissau faces an ongoing epidemic of HIV and AIDS. Prevalence is especially high in urban areas and among pregnant women and sex workers. Starin, a writer and a research associate in the department of anthropology at University College London, UK, was struck by the bright colors and larger-than-life figures in the billboards, and photographed several, including the one featured in the September Art of Nursing.

Are the billboards effective?  Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

Starin has also photographed public art by Thongleum Damviengkum, a mixed-media artist whose work appeared in the April Art of Nursing. Damviengkum’s often witty pieces, intended to raise public awareness about HIV and AIDS and address the stigma associated with having the disease, are on display at a restaurant in Bangkok, Thailand. “Humor is important if you want people to listen,” he told Starin.

As always, Art of Nursing is free online (you’ll need to click through to the PDF files). We invite you to have a look and tell us what you think in the comments.

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