护理扩展培训在艾滋病干预模式中的探讨

新疆艾滋病形势严峻,艾滋病重点疫区的护理人员普遍存在着对艾滋病知识的缺乏,对艾滋病患者持有歧视、恐惧的心理及缺乏基本的防护知识等现状,艾滋病护理扩展培训项目的实施,通过对护理人员进行的艾滋病知识培训,对艾滋病干预模式进行了有益的探索和实践。     

The Morality of Refusing to Treat HIV-positive Patients

ABSTRACT Do physicians and nurses have an obligation to treat patients who are HIV-positive? Although an initial review of the possible sources of such an obligation yields equivocal results, a closer examination reveals a clear obligation to treat. The current risk of job-caused HIV-infection is not sufficient to warrant a refusal to treat. This is so because there exist rationally justified, general social, as well as specific peer expectations, that health care professionals treat HIV-positive patients. These expectations impose moral obligations on doctors and nurses. Moreover there is no sound libertarian argument entitling doctors and nurses to refuse to treat HIV-positive patients. A morally appropriate identification with his or her role would disincline a health care professional to refuse treatment to an HIV-positive patient. The likely source of such refusal is occupational alienation and an irrational reaction to AIDS symbolism.     

The National Commission on AIDS

A decade after the first cases were recognized in the United States, AIDS continues to vex policymakers and fascinate the public. It has been said that AIDS acts as a prism, refracting a spectrum of controversial topics. For bioethicists, these topics include: equity in the allocation of resources for treatment and research; forgoing life-sustaining care and proxy decision making; informed consent in the context of HIV testing and screening; the ethical duties of health care workers to provide care for persons with HIV disease; and competing obligations of health care professionals to patients and to third parties who may be put at risk.     

La tarification à l’activité (T2A) : Quelles transformations pour l’activité du personnel infirmier ? Etude exploratoire

This article presents an exploratory study, which attempts to analyse the changes which have occurred in the professional life of nurses in France since the introduction of the system of payment per medical act (T2A). The theoretical background is provided by theories on the activity. The T2A system is intended to provide a means of or ganising nursing care. The main results of qualitative analysis undertaken show above all changes in the way nurses’ work is organised (pace, rhythm, productivity, value for money and turnover). The more intense workload mentioned by the nurses concerns above all an increase in technical and administrative activity rather than any personal interaction with the patients, which appears to have suffered from the changes. The repercessions identified by the nursing staff include frustration, a loss of meaning in their work and a lower standard of nursing care provided.     

特需医疗服务供方意向调查分析

剖析目前特需医疗服务供方所存在的主要问题,初步探讨在我国发展特需医疗服务适宜的承担主体。采用个别访谈和问卷调查的方法对来自不同性质的医院的医护人员和医院管理人员进行了意向调查。结果显示,医院发展特需医疗服务并不是解决医务人员收入问题的有效手段;公立医院发展特需医疗服务势必会对其普通医疗服务带来负面影响。建议在确保大部分公立医院只提供普通医疗服务的基础上,由私立医院和一部分公立医院作为特需医疗服务的承担机构。     

Understanding the Ageing Process: A Developmental Perspective of the Psychosocial and Spiritual Dimensions

SUMMARY

This chapter describes a perspective of psychosocial and spiritual development in the later years of life. It outlines a study of nurses conducted in six nursing homes using pre and post workshop tests to identify changes in nurses' assignment of a list of behaviours as psychosocial or spiritual. Use of SPSS found significant changes between the pre and post tests. Pre workshop tests only identified items as spiritual if they included the word God, or Bible. Results from this study highlight the potential role for nurses in aged care to provide spiritual care as part of holistic care. It also highlights the fact that many nurses feel ill prepared for this role.     

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.     

The AIDS epidemic in Cuba

The strategy of the Cuban government to control HIV consists of examining the whole adult population and quarantining all seropositive persons in local institutions. Between 1986 and 1990, a total of 8,832,726 HIV tests were done using domestic ELISA and Western blot methods. 497 persons (362 men and 135 women) were found to be HIV-positive. 122 infections were directly attributed to Cuban intervention in Africa. 150 infected men were homosexuals and bisexuals. Infected blood products caused 9 cases, and neonatal transmission produced 3 infections. 63 AIDS cases were reported since December 1989. Compulsory testing would be more acceptable if HIV infected persons would get zidovudine (AZT) for secondary prevention. It is estimated that this policy has prevented 4000 new infections. The violation of human rights by quarantining people with false positive results is real: 23-53 such people are estimate to be quarantined. Tourists are not examined because of the economic need for more revenue from tourism, thus HIV transmission could continue despite quarantines. The cost of testing is high, although health care already made up 12% of the budget in 1989, increasing from 7.8% in 1983. Tracing sexual contacts requires 450 nurses and 200 epidemiologist. The public education campaign about AIDS involved 30 television programs and several hundred radio programs by groups of experts discussing transmission, AZT treatment, and treatment of opportunistic infections. Since 1988, schools have also included AIDS education from the 5th grade on. Condom use is stressed, but machismo often hinders its acceptance. While AIDS is a menace, the rate of syphilis increased from 7.2/100,000 in 1970 to 84.3/100,000 in 1987. Stressing personal responsibility in preventing HIV infection skirts the need for modification of high risk behavior and lulls the public into a false sense of security because of the belief that full protection from AIDS is provided by the quarantine.     

Strategies adopted by late middle-age and older adults with HIV/AIDS to explain their physical symptoms

Although the attributions individuals make about what causes their physical symptoms are known to influence their care seeking and self-care behaviours, much less is known about the strategies they use to arrive at these attributions. The strategies employed to understand the causes of their symptoms were investigated using in-depth interviews with 100 late middle-age and older adults with HIV/AIDS in New York City. The data revealed that most participants actively sought to explain their symptoms. The explanatory strategies identified included: relying upon illness or medication representations, lay beliefs about the body and ageing, invoking pre-existing vulnerabilities, engaging in lay experimentation, social comparison processes, considering temporal ordering and consulting authoritative sources. While most of them offered a single cause for their symptoms, some offered more complex multi-causal explanations. These findings provide understanding into the reasons why some older adults with HIV/AIDS misattribute symptoms resulting in delay in care or care over-utilisation, suggesting the need for patient education.     

Blameless Guilt: The Case of Carer Guilt and Chronic and Terminal Illness

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care.     

Healthcare Chaplains’ Perspectives on Nurse–Chaplain Collaboration: An Online Survey

The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain–nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.

     

Stigma and Discrimination in Health-Care Provision to Drug Users: The Role of Values, Affect, and Deservingness Judgments

This study examined the role of values, affect, and deservingness judgments in health professionals' views of patients with stigmatized conditions (e.g., drug dependence). Participants were 277 nurses who responded to a survey containing 2 scenarios of a nurse providing high- or low-quality care to a patient with a condition related to prolonged use of alcohol or heroin. Affective responses to the patient were more positive for nurses with higher self-transcendence values, and more negative for nurses with higher conservation values. Deservingness judgments were predicted by positive and negative affect toward the patient, but not by attributions of responsibility for drug use. Deservingness judgments emerged as strong predictors of nurses' satisfaction with the provision of high- or low-quality care. The findings imply that the deservingness judgments made by nurses reflected strong entitlement norms concerning the provision of proper care for patients that were independent of patients' perceived responsibility for their condition.     

Women and AIDS: Implications for Counseling

Women's concerns regarding AIDS have been ignored or minimized by most writers and AIDS educators. Although women may share many similarities with men in their reactions to AIDS, they have unique concerns that must be recognized. Understanding these concerns is essential for counselors in order to give quality care to women at risk for infection. This article describes women at risk and offers suggestions for counselors in working with such women.     

Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals’ scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.     

AIDS‐Related Stigma in Individuals With Other Stigmatized Identities in the USA: A Review of Layered Stigmas

AIDS‐related stigmas have profound negative impacts on people living with and those affected by HIV/AIDS. While a considerable body of work examines AIDS‐related stigma, it is less clear how AIDS stigmas affect individuals in relation to other stigmatized identities, particularly ethnic minorities. This review examines the literature on AIDS‐related stigma among these groups. The limited available research indicates that AIDS stigmas can seriously interfere with HIV testing, treatment, and care. In addition, prevention studies conducted with incarcerated adolescents, a group characterized by stigmatized identities and high risks for HIV, indicate that interventions for this population do not address stigmatized identities and demonstrate limited effects on risk reduction outcomes. Research is needed to examine stigma in primary prevention of HIV with an at‐risk stigmatized group.     

Who Pays for Providing Spiritual Care in Healthcare Settings? The Ethical Dilemma of Taxpayers Funding Holistic Healthcare and the First Amendment Requirement for Separation of Church and State

All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.     

Developmental status and AIDS attitudes in adolescence.

We postulated that among adolescents and young adults, the development of consistent and responsible attitudes with respect to acquired immunodeficiency syndrome (AIDS) precautions would follow a pattern similar to that of the development of a sense of identity. Late-adolescent trainee teachers and nurses (N = 262) were administered identity and intimacy measures and a questionnaire measuring attitudes toward and knowledge of AIDS prevention. Attitudes were shown to be conceptually complex, with dimensions expressing the identity statuses of diffusion, foreclosure, moratorium, and achievement. Few relationships were found between AIDS attitudes and sex, course, measures of identity, or intimacy. However, attitudes toward AIDS precautions and identity status were predictive of future intention to use a condom. Intimacy level was negatively related to such an intention, suggesting that those in steady relationships may not recognize the need for AIDS protection.     

Catholic pastoral care as a response to the HIV/AIDS pandemic in Southern Africa

Recent estimates suggest that more than 10% of Southern Africa is HIV+. This article is based on a research study of sixty four pastoral care projects focussing on the HIV/AIDS pandemic in Southern Africa. The projects, which fall under the auspices of the Southern African Catholic Bishops' Conference AIDS office, focus on both education for HIV prevention and the pastoral care of people living with HIV/AIDS (PLWHA). The article recounts the results achieved by these projects over the last two years, discussing their strengths and weaknesses, and proposes some recommendations for further action. The author discusses the pastoral and theological dimensions of these pastoral services indicating the importance of socio-cultural mediation in pastoral responses.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior.