Peggy Barnes
VSO Nurse trainer
Caring for individuals with HIV/AIDS presents a challenge for us all. It arouses are deadly fears of an incurable and deadly disease.
It makes us think about life styles which maybe very different from our own. It demands that we all keep ourselves up-to-date on the latest medical advances and infection control policies and test our skills and expertise.
When individuals are first diagnosed as being HIV+ they may not need physical car. Going back to the pattern of the disease, most people will be symptom free, or not very ill, for the first then or eleven years, but they will have quite demanding emotional needs.
They
will somehow have to come to terms with the knowledge that they are living with
a disease that as yet we can not cure. They will somehow have to get on with
their lives as normally as possible, to continue with their normal work and
other activities. They must learn to live a better life, take a good diet, be
certain about safe sexual practice, and be competent in using clean needles and
syringes if they are drug addicts and unable to drop their habits. Many will
suffer rejection and stigmatisation from their families, friends and place of
work if information is leaked. Somehow these people must get on with life and at
times that will seem to be very difficult and they will need someone to turn to
on many occasions.
Patients needs:
1.
Psychological and emotional
2.
Social
3.
Spiritual and cultural
4.
Physical
Counselling
will be the biggest issue and will be of great benefit to the individual. It
will also provide an excellent opportunity to give some health education,
particularly in the “risky behaviour groups”. Counselling must take place
before and after blood testing, and at any time during the disease process. For
those who test negative, it may go someway towards a behavioural change. It
should involve not only the patient, but also his immediate family and sometimes
his/her friends if that is the wish of the patient. It should take place in a
private area where there will not be interruption. It is necessary for the
counsellor and patient to build up a good rapport so that there is mutual trust
and support. People will need to know the implications of the illness and try
and understand what will happen to them. They may wish to discuss their own
particular fears on death and dying. They must understand methods of preventing
the spread of the disease to other members of society. Many of these people will
be very young and as it can be a difficult role for the counsellors, it is
important to look after yourselves and take plenty of time out for relaxing and
getting support from your colleagues.
Social care
should be patient centred, helping people to care for themselves for as long as
possible. Health care teams, whether they are in hospitals, clinics or in the
community are in an ideal position to offer support and this help may well
prevent a family crisis.
They
can dispel myths and fears associated with the disease and make the world a
better place to live in.
Spiritual and cultural
aspects depends very much upon the individual, but their personal needs should
be considered and dealt with according to the wishes of the individual
concerned.
Physical care
optimises then heath of the HIV/AIDS patients and promotes as far as possible
his/her comfort in the face of complication as the disease progresses. Health
maintenance includes sleep, exercise, stress management, the prevention of
infections and sometimes the management of addiction.
Once
the patient becomes symptomatic, the nursing care is specific to the disease
manifestation they may have. If for example a patient has Tuberculosis, he/she
should be nursed in exactly the same way as an antibody negative person with
Tuberculosis. Similarly it is the same for any other disease or tumour. The
patient who is dying of AIDS has the same fears and worries as any other person
who is dying.
•
Any patient we work with may be infected with a blood borne infectious agent
•
Universal precautions should always be applied
• Good basic standards of
hygiene and care will protect health care workers from being infected by the
majority of infection agents we may encounter while caring for our patients
Fear
is normal. It is the natural response to the unknown or danger. With education
and knowledge of the disease and its route of transmission, we are able to
protect ourselves from being infected with HIV, as long as we are vigilant with
regards to the Universal Precautions.
Although
we tend only to worry about being infected in our working environment, we must
not forget the risk we may be taking in our personal lives. It is easy to take
precautions while we are for known HIV/AIDS patients, but in our private lives
we do not always know the HIV status of those we meet outside the work place.
HIV is a blood born virus, which is transmitted by both man and women. From man
to man, men to woman and woman to men. If at any time you are in doubt, remember
the condom. Remember it is available and it is strong, sensitive, safe and
simple.
Remember
the three main transmission routes, sexual contact, blood and body fluid
exposure and vertical. It is quite safe to hold hands and put reassuring arms
around the patient. It is safe to use public showers, swimming pools, chopsticks
and bowls and public phones and mosquito bits pose no hazard.
Because
we are influenced by many different factors, these issues are far more difficult
to address. Only when we have dealt with our own feelings and modify our
attitudes, will we be able to care for our patients and the community. Many of
these people will be drug users, prostitutes and their clients. Many will be
innocent victims who through no fault of their own now suffer. However,
traditionally people have turned to health care workers for help, for support
and understanding when they are unwell or in distress. They need our expertise,
skills and knowledge and we have a duty of care that does not allow us to select
the patients that we would like to care for.
Often
we are faced with difficulties in coming to terms with numerous situations, but
invariably we are able to separate our personal feelings and maintain higher
standards of care.
People with HIV/AIDS are ordinary people. No amount of debate about whether the disease is due to their own neglect or life style will alter the situation.
Because of the nature of the illness, that is a window period followed usually by an asymptomatic stage of maybe 10 or 11 years we may often care for infected individuals without being aware of it, often there is no reason to suspect that anything is wrong. HIV/AIDS is not a disease that is limited to just a few; it is an infectious agent that knows no racial, border, gender or age boundaries. If people fear they will not receive care they will not come forward and will conceal their disease which will lead to further spread of the virus.
We have to consider not only our own fears and attitudes but also those of the community in which we live.
It
is unlikely that there are any differences, but our education gives us knowledge
and knowledge give us power. If we can spread our knowledge it will give the
community power and they will learn how to protect themselves.
Remember
Always
pass on correct information.
Provide
support
Encourage
behaviour change when it is needed.
Give
advice on healthy living.
Dispel
fears and myths.
•
Although there is no evidence that HIV is airborne masks, gowns and eye
protection should be worn when procedures which may cause aerosol spray of body
fluids, such as bronchoscopes /dentistry are carried out.
•
Skin must be thoroughly washed with soap and water if contaminated with blood,
body fluids, excretions or secretions from any patient.
•
Dispose safely of waste contaminated with blood and body fluid.
•
Careful handling of soiled linen.
•
Spillage of blood and other body fluid should be treated with a chlorine-based
compound and then cleaned up with disposable paper while wearing gloves and
aprons.
•
Cover broken skin sores or cuts with a waterproof dressing before contact with
patients.