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a. Problem and its Background
Ever since acquired immunodeficiency syndrome (AIDS) was first recognized 20 years ago, remarkable progress has been made in improving the quality and duration of life of persons with HIV infection. During the first decade, this progress was associated with recognition of opportunities disease processes, more effective therapy for complications of prophylaxis against common opportunistic infections (OIs). HIV infection is an infectious disease; hence, it is important to understand how HIV integrates itself into a person’s immune system and how immunity plays a role in the course of infection. Awareness in this disease is essential especially when giving care and establishing your role for the patient.
Due to the infectious character of this disease, various social and emotional alterations have occurred to both sides affected by the condition, health care provider and the HIV patient. As observed, the traits of HIV itself have altered and presented reluctance, in terms of care, over the health care providers, most especially the nurses. However, gradually, the nursing role towards these HIV patients have shifted and revolutionized through the modernization and improvement of awareness over the condition of HIV.
As the modern age approaches, the nursing roles have acquired its own place for the betterment of HIV patient as its primary goal of care. The improvement of medical care itself, specifically, through provisions of various infection control precautions, AIDS and Communicable Disease Precaution programs, and the establishment of medical studies and research regarding the condition, have made the modification of nursing roles a lot more flexible. The doubt of danger and the anxiety towards care have been alleviated through the improvement of prognosis; hence, contributing to the change of nursing roles (O’Donnell, 2005).
b. Scope and Limitations
As for this paper, we shall focus on the change of roles of nurses by analyzing the past conditions and roles of care, and how did it progress upon the improvements of medical care. Basically, the paper shall review, interpret and analyzes the relationships between changes of nursing role and the improvement of medical science as well as prognosis towards HIV cases. The discussion shall revolve on the following proposed questions, and utilize these as the primary objectives of the entire study:
a. What is the role of nursing care for HIV patients in the past? Site the problems and the rationale for the occurrence of these role occurrence
b. In the advent of medical modernization, what is the role of nurses for caring HIV patient today? Provide the factors that caused the change of roles
a. Historical Perspective
In the past, the condition HIV patients have faced tremendous discrimination, social shame and unequal health care provision primarily because of the characteristics of the disease itself. The society has gain wide stigma and fear over the communicability of this disease. Misconceptions and wrong notions, such as false information especially about modes of transmission, impaired awareness about the disease itself, and anxiety of familial shame, have caused the build-up of a great society dilemma towards the disease. The idea and perspective of care given to these HIV patients before are strictly less and in some cases, are not even accepted in other hospital because of the impact of AIDS/ HIV stigma. The role of patient care administered by the nurses has been affected by the societal perspective towards the disease (Poindexter, 2005).
During this time, awareness and medical knowledge about the disease itself have not yet expanded and spread in the society. Because of this, further stigma that labels AIDS patient as sex addicts, fetish-dirty individuals and poorly respected persons has enhanced the societal pressure for these patients. Therefore, nursing care started to flaw back due to the vast discriminative notion about this condition. Moreover, there are no present tools, gadget and most especially direct cure for this condition (Lane, 2002). These factors have greatly induce the deprived care conditions of the patient since, nurses’ roles and care positions are not yet established at this moment.
Gradually, medical research and studies has been conducted with the aim of understanding the conditions, mechanisms and systems involve in the causation of AIDS. They have found out the core of the problem, HIV-retrovirus, and the primary system afflicted, which is the immune system. They have found out the possible means of disease transmission from the host, point of exit, mode of transmission, portal of entry and to the other susceptible host. The body of AIDS/ HIV awareness has been established, and with this, the possible care measures for HIV patients have started to develop (Herek, 2002). These conditions triggered the shift on nursing role and nursing care perspective towards wholeness care principles guided by proper precaution measures.
b. Emotional and Ethical Concerns
Nurses in all settings will be called to provide care for patients with HIV infection. In doing so, they encounter not only the physical challenges of the epidemic but also emotional and ethical concerns. The concerns raised by health care professionals involve issue such as fear of infection, responsibility for giving care, values clarification, and confidentiality, development stages of patients and caregivers, and poor prognostic outcomes.
Many patients with HIV infection have engaged in “ stigmatized” behaviors. Because these behaviors challenge some traditional religious and moral values, nurses may feel reluctant to care for these patients. In addition, health care providers may still have fear and anxiety about disease transmission despite education concerning infection control and the low incidence of transmission to health care providers. Nurses are encouraged to examine their personal beliefs and use the process of values clarification to approach controversial issues. The American Nurses Association’s Code for Nurses can also be used to help resolve ethical dilemmas that might affect the quality of care given to HIV-infected patients.
Nurses are responsible for protecting the patient’s right to privacy by safeguarding confidential information. Inadvertent disclosure of confidential patient information may result in personal, financial, and emotional hardships for HIV-infected individuals. The controversy surrounding confidentiality concerns the circumstances in which information can be disclosed to others. Health care team members need accurate patient information to conduct assessment, planning, implementation, and evaluation of patient care. Failure to disclose HIV status could compromise the quality of patient care. Sexual partners of HIV-infected patients should know about his potential for infection and the need to engage in safer sex practices, as well as the possible need for testing and medical care. Nurses are advised to discuss concerns about confidentiality with nurse administrators and professional nursing organizations such as the Association of Nurses in AIDS Care, and to consult legal experts in their state to identify the most appropriate course of action.
Changing Roles of Nurses
The advent of medical improvements has led to the change of nursing roles from discriminative nature to caring attitude. Moreover, the stigma over these individuals has greatly reduced as compared from the past. In fact, in the United States, the stigma of HIV/ AIDS has been observed declining; however, some portions of the public are still unaware of the HIV realities and still hold various misconceptions especially in terms of disease transmission (Lane, 2002). The decline of stigma has reduced the anxiety levels of the public and the health care providers; thus, providing ease in implementing care measures and interventions.
Currently, the role of the nurses for HIV patients carries a lot of responsibility more than just giving medications and vital signs monitoring. The advent of infection control and communicable disease precaution has provided these health care providers the possibility of providing care while maintaining the security of their health conditions. In most hospitals, however, specific trainings are imposed for nurses in order to establish and provide their care measures for these HIV individuals. The role of nurse as caregiver has greatly revolutionized because of these health promotion and preventive discoveries.
The role of the nurse as educators has been established as well due to the formation of medical body of knowledge in terms of AIDS/ HIV. The nurses render information for their clients especially for health promotion and prevention as well. The role of an advocate and counselor have been established as well since part of the nurses’ responsibility is not only to impregnate physical alleviation of suffering but also to provide social, emotional and spiritual support systems. The wholeness aspect of the person is the focus of nursing care. The physical, cognitive, psychological and affective dimensions are incorporated in every plan and interventions done by the nurse (Bakken, Grimes & Holzemer, 2005).
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AIDS has had a high mortality rate, but advances in antiretroviral and multidrug therapy have demonstrated promise in slowing or controlling disease progression. It is not known whether current treatment regimens will remain effective, because viral drug resistance has developed with most previous medications. Many strategies have been used by nurses to cope with the stress associated with caring for AIDS patients. Education and provision of up-to-date information help to alleviate apprehension and prepare nurses to deliver safe, high-quality patient care. Interdisciplinary meetings allow participants to support one another and provide comprehensive patient care. Staff support groups give nurses an opportunity to solve problems and explore values and feelings about caring for AIDS patients and their families; they also provide a forum for grieving. Other sources of support include nursing administrators, peers, and spiritual advisors.
Moreover, the physicians are not the only person involve in the planning of care for these patients. Nurse’s role as a planner is now being utilized, and for this reason, they are promulgating health care plans for the promotion of maximal health care for HIV patients. Reverse isolation, being one of the precautionary measures for HIV patients, are also managed by the nurses. The roles of the nurse have greatly expanded as the medical body expands its knowledge of AIDS/ HIV patient care.
Many patients with HIV infection have engaged in “ stigmatized” behaviors. Nurses have felt reluctance of care in the past affecting various intrinsic roles of the nurse particularly as a caregiver, advocate, educator, and counselor. However, various improvements in medical science have provided the evolution of nursing roles and have shifted as well the quality care standards to a higher level. The stigma of AIDS/HIV patients has also reduced as accompanied by the effects of awareness expansion of this AIDS/HIV conditions.
The nurse is now able to render maximal health care measures for these patients with less anxiety however, proper precautionary measures are still necessary to be maintained.