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

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, […]

2016-11-21T13:05:17-05:00March 6th, 2014|health care policy, nursing perspective|3 Comments
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AJN’s March Issue: New Series on Systematic Reviews, HIV Update, C. Diff on the Rise, Sexual Assault, More

AJN0314.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Advances in HIV testing and treatment. The photo on our cover, showing members of  Sexy With A Goal (SWAG), a program provided for lesbian, gay, bisexual, and transgender individuals affected by HIV and AIDS by the AIDS Service Center of New York City’s Lower East Side Peer Outreach Center, reflects the changing face of the AIDs epidemic. Thirty years ago, a diagnosis of HIV was tantamount to a death sentence. But the young men on our cover prove that this is no longer the case. With advances in treatment and patient advocacy, education, and support, HIV is now a chronic, manageable disease. A CE feature, “Nursing in the Fourth Decade of the HIV Epidemic,” discusses HIV epidemiology and policy in the United States, the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic.

If you’re reading AJN on your iPad, you can watch a video describing one author’s early experience with an HIV-infected patient by tapping on the podcast icon on the first page. The video is also available on our Web site. A

New option for victims of sexual assault. Until recently, survivors of sexual assault were […]

2016-11-21T13:05:18-05:00February 28th, 2014|nursing perspective, nursing research|0 Comments
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A Face in a Village: Remembering a First Encounter with AIDS in Africa

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

2016-11-21T13:10:46-05:00February 8th, 2012|Nursing|7 Comments
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Remembering the Big Picture, Hypothermia, Nursing Books of the Year

From its earliest beginnings, nursing has embraced a holistic view of health. What we eat, the environments in which we work and live, our social relationships—all these influence health. Yet, as nurses, many of us shy away from looking at the big picture; instead we narrow our focus, addressing only the immediate problems of this patient, this family. It’s true that many patients treated in hospitals or outpatient clinics are there only for a short time. But how will such patients and their families fare in the long run if they lack access to public transportation to get to their follow-up appointments? How can patients recover from illness when they must choose between paying the mortgage and filling prescriptions?

That’s an excerpt from “Voices Rising,” the editorial in the January issue of AJN by Shawn Kennedy, editor-in-chief. We hope you’ll take a moment to read the whole thing and give it some thought.

Also in the January issue, you’ll find plenty of reading suggestions in the AJN 2011 Book of the Year Awards; a CE on the causes, diagnosis, and management of hypothermia; and a great deal more, including a feature, “Cardiac Catheterization Through the Radial Artery,” that advocates the use of the transradial artery rather than the femoral artery for cardiac catheterization in certain situations.—JM, senior editor

2016-11-21T13:10:54-05:00January 20th, 2012|Nursing|1 Comment
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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

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 […]

2016-11-21T13:11:50-05:00September 29th, 2011|nursing perspective|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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