Why Nurses Matter: NP’s Thorough Assessment Points to Cause of Infant’s HIV

Karen Roush, AJN’s former editorial director, alerted me to a great story. A careful assessment by a nurse practitioner (NP) at St. Jude Children’s Research Hospital in Memphis, Tennessee, uncovered a potential reason for an infant’s HIV diagnosis. The staff at the hospital had been stymied in trying to ascertain how a nine-month-old infant developed HIV after earlier tests had shown her to be HIV-negative. The mother, who was HIV-positive, had not breastfed the child, nor was there evidence of injury or sexual transmission, and the infant had not received blood transfusions.

Marion Donohoe, the NP, in taking a detailed history from the mother, asked her about feeding practices, including pre-mastication. Yes, said the mother, she had been pre-chewing food for her daughter.

While the findings of the study, which was published in Pediatrics, don’t definitively prove that pre-mastication was the cause of transmission, “information in the three cases suggests that one factor aiding such transmission was mouth bleeding in the caregiver, as well as in the infant due to teething or infection. . . .

[The] caregivers’ lack of adherence to their own drug-treatment regimens probably increased their blood HIV levels, increasing the likelihood of transmission.” The researchers did, however, emphasize several caveats:

The findings do not warrant a blanket recommendation against pre-chewed food for infants, the researchers emphasized. The practice, which has been reported from many parts of the world including the United States may be integral to providing adequate infant nutrition and grounded in culture and tradition. . . . The findings also do not imply that HIV can be transmitted through saliva during oral contact such as kissing.

Whatever the eventual implications, one NP’s persistent questioning set all of this in motion. Nurses ask the questions that drill down into the details of a patient’s life. We can do this because we, more than any other health professionals, spend time with patients, and that lets us listen and focus on the details that others may miss.

In today’s fast-paced, short-staffed “e-world,” where much monitoring and assessment is done electronically, our time with patients is being whittled away by what seems like more important responsibilities. History taking and assessments are often quick check-off boxes that leave little room for narrative. Perhaps the best thing we might do is listen, really listen, to our patients—and then maybe we’ll know the right questions to ask.

Shawn Kennedy, editorial director

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

Comments are moderated before approval, but always welcome.

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