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AIDS is an increasingly urgent issue for clinical nurses, managers and for nurse educators. This paper describes the analysis of part of a set of interviews with a purposive sample of 21 AIDS counsellors, nurse educators and other health care workers. In particular, responses to the question: 'What are the psychosocial needs of the person diagnosed as HIV-positive or who has AIDS?' are discussed. The paper begins with a brief description of the study and then offers a more detailed description of the method of analysis used to obtain the findings. These are then reported within 16 categories. Psychosocial problems identified included issues of emotion, acceptance, a variety of fears, stigma, issues relating to insurance and travel, health care facilities and the attitudes of the Church. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted in order to understand how nurses cope with the risk of contagion while providing care to persons with AIDS (PWAs). Data were collected through in-depth interviews with 13 nurses who had cared for PWAs in an acute-care hospital in a western Canadian city. The data were analysed using the constant comparative methodology of grounded theory. The analysis revealed that caring for PWAs involved achieving a sense of control over uncertainty. One aspect of this process, making risk meaningful, centred on efforts to justify caring for PWAs in the face of risk. The purpose of this paper to describe how nurses make risk meaningful. A sense of meaning was found to be related to three major factors: accepting the patient as a person who needs and deserves care, finding work enjoyable and worthwhile, and professional commitment to care for all patients. Attaining a sense of meaning led to a reappraisal of the risk situation as worthy of investment and provided the motivation to care for patients in spite of risk. The paper concludes with implications for practice and suggestions for further research. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the challenges experienced by volunteer caregivers of people living with HIV/AIDS and the strategies employed in coping with these challenges.Background. Informal caregiving is associated with stresses that often results in poor health outcomes for caregivers. In South Africa, volunteers play a major role in the provision of care for people living with HIV/AIDS and have been shown to experience burdens as a result of caring. However, little is known about stress and coping among volunteer caregivers.Methods. An ethnographic study was conducted, using observation and in-depth interviews, to collect data with 20 volunteers and other stakeholders in two semirural communities in South Africa over a 19-month period in 2002/2003.Findings. 'Defying all odds' emerged as the central theme that encompassed the various ways in which volunteer caregivers dealt with the many practical challenges confronting them. These challenges initially posed a threat to volunteering work but were gradually appraised by volunteers as challenges that could be dealt with using various strategies in order to continue providing care. Eight themes highlighting these challenges and the coping strategies employed by volunteers were identified.Conclusion. A clear understanding of how volunteers deal with challenges of caring for people living with HIV/AIDS can give insight into their weaknesses and strengths and can inform the design of interventions aimed at providing support. Studies are needed to facilitate better understanding of the processes of appraisal of challenges by volunteers and the effectiveness of coping strategies, and to track coping strategies over time. [ABSTRACT FROM AUTHOR]

This paper examines the notion of risk assessment in relation to nursing patients with HIV infection or AIDS. Risk assessment consists in examining three features of a given hazard; its magnitude, its probability, and its acceptability. In relation to the last of these, an 'acceptability threshold' can be identified. If contact with HIV-infected patients is perceived to pass this threshold, nurses may seek to abrogate the usual 'duty to treat'. Rather than endeavour to pinpoint this threshold, the paper explores some of the factors which may either raise or lower it, and their ethical implications. In particular, the consequences of setting a high threshold, and thereby limiting or avoiding contact with patients infected with HIV, are examined. In this debate, the burden of proof is seen as resting firmly on nurses themselves, not on the patients at risk of being deprived of care. [ABSTRACT FROM AUTHOR]

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stima might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed. [ABSTRACT FROM AUTHOR]

Historical and contemporary conceptualizations of caregiving have not addressed the active role of care recipients within caregiver-care-recipient relationships. Using an interpretive synthesis method, the authors developed the concept of protective care-receiving from three qualitative studies of different groups of care receivers (older adults with chronic illnesses, persons with AIDS, and persons in treatment for active cancer). This paper describes the focus of care recipients' protective care-receiving efforts, the goals they hoped to achieve, and the strategies they used to assist themselves in attaining their goals. Examples of their efforts and strategies are illustrated with quotations from the data. These findings extend what is known about care recipients' self-care activities. Moreover, the findings reveal a new dimension in the role of care recipients -- protective care given by care recipients to their professional care providers, family and friend caregivers, and other care recipients. The concept of protective care-receiving advances our understanding of caregiving relationships and presents researchers with the opportunity to investigate the complex encounter between caregiver and care recipient. Recognizing and facilitating care recipients' protective care-receiving is an ethical imperative for a 'caring' profession such as nursing. [ABSTRACT FROM AUTHOR]

Studies have shown that some nurses, doctors and other carers have negative attitudes towards people with human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Some cope by avoiding working with such patients, while others just do the best they can. But does it matter? This paper describes a review of the literature on the impact of attitudes to care and the barriers affecting the quality of care for people with HIV/AIDS by professional health care workers and other carers. Most of the reports identified were based on attitude scales, mostly unique and often unvalidated. Attitudes of health care workers based in the community, and 'house keeping' staff such as porters, receptionists, etc., have been neglected areas of research. There is also little information about the culture of organizations and the attitudes of individuals with HIV/AIDS to care. Only three references were found in which both patients' and carers' attitudes to each other were considered and none of these looked at negative feelings and their impact. There is scope therefore to investigate the attitudes of patients and carers towards each other and how this can effect the quality of care. It is anticipated that the benefits of such investigations could lead to the development of educational strategies designed to improve the quality of patient care. [ABSTRACT FROM AUTHOR]

This paper provides a review relating to the attitudes of health care professionals, students and the general public to HIV/AIDS and people with HIV/AIDS. This is done by describing the literature on attitudes to HIV and AIDS in three fields of research: medicine/nursing, psychology and the social sciences. In addition, we look at the countries in which research has been conducted in these issues and at the variety of tools and methodological approaches used and at the participants studied. The review shows that, during the 1990s, the research interest in issues related to HIV/AIDS attitudes has rapidly increased. Most of the work on HIV and AIDS has been done in the United States, with the main focus on empirical research using questionnaires. The attention has mostly been on students and their attitudes to AIDS/HIV and sexual behaviour, but increasing interest has also been shown in the attitudes of health care personnel and students. As it seems that attitudes have been highly resistant to change, more consideration needs to be given to finding appropriate ways of educating the general public, students and health care professionals. A comprehensive analysis is also needed of the different tools used in measuring attitudes and in international comparisons of the attitudes of adolescents, health care professionals and students towards AIDS and AIDS patients. [ABSTRACT FROM AUTHOR]

This paper reports on a postal questionnaire survey of district nurses' work with HIV positive patients. Each nurse was asked to provide information about their contact with HIV positive patients and the level of training they had received in HIV/AIDS care. The nature of nursing activities carried out for these patients was established along with levels of confidence the nurses had in being able to provide a high standard of care. Where the nurses indicated less than full confidence they were asked to indicate what factors predisposed their response. Questionnaires were completed by 101 district nurses. On average, each nurse made 1.25 visits to HIV-infected patients in the two weeks preceding the study. The nursing activities most commonly carried out for these patients were providing advice/counselling, carer support, general nursing care and specialist treatments. The activities least commonly carried out were technical procedures, tests and assessments. Nurses were most confident in providing a high standard in relation to general nursing care and least confident that high standards were being achieved in providing specialist treatments. The most frequently encountered explanations offered by the district nurses for their lack of confidence in achieving a high standard were a lack of specialist training and a lack of experience with HIV-infected patients. [ABSTRACT FROM AUTHOR]

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London. The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers. It is the service provider data which will be presented here. Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/AIDS in the Camberwell Health District. Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations. The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS. The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs. The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer). However, they also identified a number of problems which were either unique or more severe for people with the virus. Services for people with HIV/AIDS were generally felt to be poorly co-ordinated and a number of areas of overlap and gaps in service provision were identified. [ABSTRACT FROM AUTHOR]

The author comments on a paper published within the issue which highlights the stresses faced by volunteer caregivers for AIDS sufferers in South Africa. The author believes that poverty, war and government inaction are some of the many reasons why HIV/AIDS has not been contained. The author also thinks that failure to invest in AIDS services now will only result in future costs continuing to escalate.

The article focuses on the International Council of Nurses (ICN) and the World Health Organization (WHO) who have released a Joint Declaration on AIDS. Approved by the ICN Board of Directors at its recent meeting in Geneva, the declaration speaks to the rights and the responsibilities of nurses worldwide in caring for people infected with Human Immunodeficiency Virus (HIV). Nurses are called on to safeguard the confidentiality of the patient and to assist their families and friends to cope with the complex problems surrounding AIDS. ICN will assist nurses through their national nurses' associations to be well-informed on new developments relative to the prevention of, and care for, people with HIV.

BACKGROUND: A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations. AIMS: To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS. APPROACH: The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention. RESULTS: Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition. CONCLUSION: Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines. [ABSTRACT FROM AUTHOR]

The attitudes and attributions of student nurses: do they alter according to a person’s diagnosis or sexuality and what is the effect of nurse training? The threat of an AIDS (acquired immune deficiency syndrome) epidemic in the early 1980s saw the emergence of strong negative attitudes from both the public and health care professionals alike. Certain ‘high risk’ groups in society, who were considered as susceptible to the disease, homosexuals and intravenous drug users in particular, became the victims of prejudice and discrimination. More recent research has indicated a possible shift to a more positive orientation, although the findings are far from conclusive. In this current study, the Prejudicial Evaluation and Social Interaction Scale (PESIS) was administered to four separate cohorts of student nurses approximately a year apart in training (n=192). Each cohort was divided into four groups, each one completing the PESIS after reading a version of a vignette that described either a person with AIDS or leukaemia, and who was either homosexual or heterosexual. The design therefore allowed for within-group and between-group comparisons. Overall the results showed that the student nurses held positive attitudes although they reported a significantly greater prejudice towards AIDS. No significant differences were found for sexual orientation. Additionally significantly greater levels of blame and responsibility were associated with the person with AIDS, but again there was no effect for sexual orientation. The findings suggest that a slightly more negative attitude continues to be associated with a diagnosis of AIDS but no longer with homosexuality. No effect across cohorts was noted either, student nurses being as positive at the beginning of training as at the end. Some of the limitations of PESIS and the difficulties of attitude assessment in general are discussed and future areas of research are identified. [ABSTRACT FROM AUTHOR]

Burnout and AIDS case-related factors in HIV community Clinical Nurse Specialists in the North of England ¶Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward. [ABSTRACT FROM AUTHOR]

Examination of four standardized nursing care plans for people with AIDS (PWAs) from four agencies with extensive experience with caring for PWAs revealed that there is little agreement about the nursing care problems of PWAs. Differences in language, conceptual clarity, and level of complexity related to problem identification have implications for nursing practice, quality assurance and research. Without consensus about patient problems, it is impossible to communicate effectively about nursing care problems for PWAs. Research is needed to validate patient problems that can serve as the basis for standards of care and provide guidance for nurses inexperienced in caring for PWAs. [ABSTRACT FROM AUTHOR]

The major changes resulting from the AIDS diagnosis and illness were measured, described and classified in the Behavioural Systems Model's eight subsystems -- achievement, affiliative, aggressiveness/protectiveness, dependence, ingestive, eliminative, restorative and sexual. Thirty male AIDS patients with Kaposi's Sarcoma were drawn as a convenience sample from a major medical centre's outpatient clinic. The subjects self-rated their perceived changes in the above eight major areas, using a 140-item instrument (DBSM) consisting of 24 categories of changes distributed in the above eight areas. Patients reported changes in all categories and described them in terms of direction, quality and relative importance. Ordinal ranks of changes existed among the eight major subsystems' frequency and importance of change scores, as shown by ANOVA and Tukey's studentized t-tests of rank. [ABSTRACT FROM AUTHOR]

Nurses with limited experience in caring for persons with AIDS (PWAs) were randomized into three groups receiving an educational session on universal precautions and (a) three group discussion sessions; (b) three sessions of caring for a PWA; or (c) assessment materials only. Both interventions were conducted by a nursing instructor experienced in care of PWAs and infectious diseases over a 3-4 week period. Measures included instruments for assessing prejudicial attitudes towards homosexual PWAs, self-ratings of infectious disease knowledge, ratings of perceived comfort and confidence in caring for PWAs, and a measure of willingness to provide care to PWAs. Results showed no significant change in willingness to provide care over time in any of the groups. Multiple regression exploring predictors of willingness to provide care found only the measure of AIDS prejudice to be an independent predictor of willingness to provide care to PWAs 6 months after completion of the intervention phase. [ABSTRACT FROM AUTHOR]

Persons living with HIV disease are faced with a broad array of physical and psychosocial problems across the trajectory of their illness. Almost all will be hospitalized for nursing care during the course of their disease. The purpose of this study was to explore the physical health and social correlates of perceived psychological support among hospitalized AIDS patients. The sample consisted of 168 AIDS patients hospitalized with Pneumocystis carinii pneumonia (PCP). Each patient rated his or her psychological support and physical condition on a scale of 1-10. Self-care ability was measured by the Quality Audit Marker. Physiological and social variables were obtained from an audit of the patient record. Stepwise regression analysis by sets indicated that only 12% of the variance was explained by the antecedent variables of physical health (self-care ability, white blood count, perception of physical condition, and first PCP admission)) and social (living alone and insurance status) correlates. Self-care ability and living alone were found to be significant predictors of self-rating of perceived psychological support in this sample. Further research is needed in the area of perceived psychological support among hospitalized AIDS patients as a basis for providing quality nursing care. [ABSTRACT FROM AUTHOR]

A survey conducted throughout the United Kingdom examined the current provision being made to train nurses to care safely and sensitively for patients with HIV and AIDS. Problems relating to intolerance and prejudice are still commonly encountered. The study recommends that HIV and AIDS should be set into a wider context of sexuality, death and infection control rather than singled out for special attention. Nurses, both students and qualified staff, need to gain insight into their own values and prejudices if these are not to inhibit the giving of good quality care. Teaching in this subject area requires special skills and there is concern that nursing is not equipped to deal with it. The involvement of clinical specialists in educating nurses is perceived to have a strongly positive effect, helping to bridge a credibility gap and compensating for the lack of clinical experience amongst the teachers. Providing opportunities for nurses to meet with people whose lives have been profoundly affected by the virus is also a powerful form of learning. There is, however, a great need for support in this stressful area of practice. [ABSTRACT FROM AUTHOR]

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings. Most community-based health care in the United Kingdom is provided by primary health care teams: general practitioners and community nurses, with support from social workers. However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role. Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA). Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses. The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms. Three models of care have developed in NETRHA: specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses. Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity. [ABSTRACT FROM AUTHOR]

The results are presented of a survey of the AIDS-related knowledge, attitudes and beliefs of a random sample of 600 qualified nurses in the Lothian Region of Scotland. This locality is characterized by a high rate of detected HIV infection which is mainly associated with intravenous drug use. This study indicated that 64% of respondents had contact with HIV-infected patients and that 48% had nursed people with AIDS. Levels of AIDS-related knowledge were not high and a substantial proportion of nurses reported lacking basic AIDS information and professional support to enable them to work effectively with people who have AIDS. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on the behavior of people towards patients suffering from AIDS. Number of people suffering from AIDS in the U.S.; Highlights of an interview with a man suffering from HIV positive; Need for moral support to people suffering from AIDS.