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HIV Nursing and Home  & Community Care Conference
 

HIV Nursing and Home & Community Care Conference

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This joint presentation by Susann Nasewich and Greg Riehl will describe HIV Nursing as it relates to pre and post test counseling, and what is important to know for home and community care nurses and ...

This joint presentation by Susann Nasewich and Greg Riehl will describe HIV Nursing as it relates to pre and post test counseling, and what is important to know for home and community care nurses and aides.

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  • It pushes all the news buttons: it is a health emergency, it has a human face, it has elements of science, medicine, religion, it has deep grief and moments of extreme joy. <br /> It often has enemies: governments, the church, religious bodies, the fraudsters and snake-oil salesmen. <br /> It has heroes: the people living with HIV, community groups and NGOs fighting on the frontline of the epidemic, the scientists and researchers working for new treatments, a vaccine, a cure, and the doctors and nurses caring for the sick and dying. <br /> It is clear that HIV and AIDS is more than a disease that infects individuals. <br /> It is a social, economic and, in some countries, security crisis. <br />
  • The couple of media reports of HIV being cured, have all be updated, with people having HIV found on subsequent testing <br />
  • Diagnosis of AIDS is less common today. <br /> More often referred to as advanced HIV, HIV disease or chronic HIV infection. <br /> With care and treatment, ability to postpone, even avoid AIDS. <br />
  • Sexual Contact - unprotected sexual contact (oral, vaginal, anal) with someone with HIV <br /> (sexual health history, drug history, etc, people have to be comfortable with taking a good history wherever they work, and this can be the start of establishing trusting relationships, etc) <br /> insertive and receptive sex (pre-cum, semen, vaginal and anal fluids) <br /> Vertical transmission - to fetus/infant during pregnancy, at birth or through breast milk (discuss MTCT, term?) <br /> Blood Contact - Sharing needles or other drug using equipment with someone with HIV (e.g. spoon, water, filter; crack pipe; roll/bill/tube/straw for snorting) <br /> - Shared personal hygiene equipment (razors, nail clippers, toothbrushes, tattoo and piercing equipment) <br /> - Occupational exposure (i.e.. needle stick injuries) <br /> - Blood transfusions in Canada, in the past (before 1985) <br /> Other body fluids can contain HIV but would less commonly account for infection: <br /> CSF, amniotic , pleural , pericardial, peritoneal, synovial fluids <br /> Inflammatory exudates (pus) <br /> Tissues or organs for transplant <br /> Other fluids such as tears and saliva may contain HIV, however NOT in quantity enough to infect; http://aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/ <br /> Still other fluids such as urine or feces would not contain HIV, unless visibly contaminated with blood <br /> The basics conditions for HIV transmission to occur include: <br /> Source of organism - infected/contaminated fluid(s) – blood, body fluids containing visible blood, semen, vaginal fluids, breast milk <br /> Mechanism/Point of entry – open wound, break in skin – poke/puncture, mouth, vagina, anus, penis <br /> Activity that brings the infected/contaminated fluid(s) together with the point of entry – IDU, needlestick, sex – oral, vaginal, anal <br /> Susceptible Host <br />
  • discuss their feelings about getting tested, and again, the stigma of HIV <br /> WHY? <br /> 1:4 HIV positive people are unaware of their status.1 <br /> In spite of UNAIDS/WHO 2004 recommendations, people who should be tested are still being missed. <br /> Missed testing opportunities when providers are required to determine need for testing based on risk <br /> Missed testing opportunities when testing is mainly client-initiated <br /> Who? >13yrs, sexually active – at least once <br /> 13-64, but people don’t suddenly stop having sex the day they turn 65. <br /> Opt-out testing is considered cost effective if 1/1,000 tests yield a positive HIV result. <br /> Stigma and discrimination will lessen when testing is routine. <br /> Gives earlier opportunity for services, care. <br /> Helps people to live longer, healthier lives with treatment. <br /> Decreases worry about possible infection. <br /> Helps prevent transmission to others. <br /> Avoids the need to identify risks or exposures. <br />
  • The Saskatchewan HIV Provincial Leadership Team (SK HIV PLT) recommends that voluntary confidential HIV testing and counselling be conducted in the following circumstance, as close to the individuals’ home community as possible (UNAIDS/WHO, 2004). The type of testing technology used will be determined by the testing situation: <br />
  • http://www.phac-aspc.gc.ca/aids-sida/info/4-eng.php <br />
  • Note: <br /> HIV testing without consent may be justified in the rare circumstance in which a patient is unconscious, his or her parent or guardian is absent, and knowledge of HIV status is necessary for purposes of optimal treatment of the patient themselves. <br /> Disclosure without consent is never justified. And this is often what nurses/health managers, want to know. They want to know who is positive, so they can ‘protect’ their community members, or so they can provide the best care possible (which is usually a smoke screen for finding out who is positive) <br />
  • Barriers to testing <br /> There are several barriers to increasing the uptake of HIV testing and reducing the proportion of people who are undiagnosed in Canada. <br /> These barriers include: <br /> inability to accurately assess levels of risk for exposure to HIV by some clients and providers <br /> lack of comfort discussing HIV testing and lack of knowledge about HIV among clients and providers <br /> provider time constraints for risk assessments and pre- and post-test counselling <br /> cumbersome consent procedures <br /> fear of stigma and discrimination associated with risk behaviors and/or testing HIV positive <br /> http://www.catie.ca/en/catienews/2013-05-09/new-phac-testing-guide-includes-recommendations-promote-routine-hiv-testing <br />
  • This describes when to get tested, and when to get tested subsequently <br />
  • prior to engaging in risky behaviour. <br />
  • Canadian AIDS Society also lists “using drugs with shared pipe or straw; tattooing, piercing, electrolysis and acupuncture with shared equipment/ink”. <br /> * These variables require some discussion! The level of risk is for these activities (as with most) is influenced by other variables such as where a tattoo was done and by whom, who was involved in the sharing, etc. <br /> CDC still indicates there is risk of transmission from these activities. In practice, we would consider the activities in the note here “exposure” and would do testing at 4 wks and 3 months. <br /> How much of the “discrepancy” in our treatment of the 2 different portions of this list is related to OUR procedures and what WE ask vs. how much is evidence based. <br />
  • Note HBV, HCV, HIV and risk – immunization, prevalence, virulence, post-exposure proph <br /> HCV 10x HIV; HBV 10x HCV (100x HIV) <br />
  • Standard or Universal Precautions. <br />
  • Public Health Act/Health Information Protection Act (HIPA) regulates/impacts: <br /> disclosure* <br /> age of consent/disclosure responsibilities <br /> charting (also comply with agency & professional guidelines) <br /> circle of care for client referrals <br /> consent for Release of Information <br /> storage of results, including access to positive results <br /> Acknowledge personal connections in smaller communities (rural, on-reserve, GLBTTIQ*) <br />
  • There is no good evidence that the criminal law is effective at preventing HIV transmission. Criminalization of HIV may drive people away from public health initiatives that have proven effective, such as HIV testing, counselling and support, and partner notification. The public attention given to criminal prosecutions may create a false sense of security that the law will protect people from HIV infection. It may also undermine the message that every person is responsible for his or her own sexual health, and lead to human rights abuses by increasing the stigma and discrimination faced by people living with HIV. <br /> http://www.aidslaw.ca/EN/issues/criminal_law.htm <br />
  • Health records need to be stored in secure environment. <br /> Do you think HIV positive individuals should have separate files to ensure they are kept safe? <br /> Who is your organizations privacy officer? Do you have a lawyer that you can consult with? <br /> http://www.health.gov.sk.ca/hipa-brochure <br /> Public Health Act/Health Information Protection Act (HIPA) regulates/impacts: <br /> disclosure* <br /> age of consent/disclosure responsibilities <br /> charting (also comply with agency & professional guidelines) <br /> circle of care for client referrals <br /> consent for Release of Information <br /> storage of results, including access to positive results <br /> Acknowledge personal connections in smaller communities (rural, on-reserve, GLBTTIQ*) <br /> Section 65 establishes significant penalties for offences under the Act <br /> . <br /> Individuals (including officers and directors of a corporation) can be punished by a fine of up to $50,000, one year imprisonment, or both. A corporation can be fined up to $500,000. <br /> Even information regarding age, ethnicity, gender by themselves can breech confidentiality depending on who hears/sees it. <br />
  • You do not have to know everything, but you do have to be honest. <br />
  • The Golden Rule “do unto other as you would have them do unto you” or treat others how we would like to be treated – this is what many nurses were taught in training. In Nursing, this is seen as supporting the provider-client relationship. <br /> to truly empathize we need to give the power to the client <br /> When the client is culturally, ethnically, or spiritually different from the person or group providing care a dilemma evolves. For social justice to support inclusivity, avoid the Golden Rule, and shift our focus to the Platinum Rule, ‘treating others how they want to be treated’. <br /> The challenge for the Platinum Rule is evident in practice, and occurs when providers work with clients who are actively engaging in risky, unhealthy behaviours. Harm Reduction creates challenges for nurses, just as morals and personal values can often interfere with providing care to “those” people. <br /> The notion of a provider’s belief in a supernatural being who decides on right and wrong can affect interactions with marginalized people, especially those who “choose” harmful behaviours. <br /> I/we believe we should not treat everyone the same because we are all different. Patients, families, groups, and communities possess the knowledge to be active consumers and partners in health programming. Acceptance of all clients, with a focus on genuine empathy, regardless of lifestyles and choices, is required for health care providers and educators in today’s dynamic learning and client-first focused environment. <br /> Cultural Competence is part of the Platiunm Rule! <br /> Cultural safety stresses the importance of reflection & acceptance of differences. <br /> We should not treat everyone the same. <br /> We do need to recognize and acknowledge our blind spots. <br /> It is the position of the Canadian Association of Nurses in AIDS Care that: <br /> First Nations, Inuit and Métis people are a diverse, vibrant population who bring strength, fortitude and knowledge to our communities. <br /> First Nations, Inuit and Métis people experience unique barriers to health and well being due to a history of colonization and continued racism in both general society and within health care. <br /> Racism is a social determinant of health that must be addressed, explored, challenged and changed to ensure that all care is culturally safe. <br /> To provide optimal prevention, health promotion and care for First Nations, Inuit and Métis people, nurses require knowledge and skills about indigenous history, colonization, generational trauma and culturally safe practice. <br /> Nurses recognize that all interactions with clients are bi-cultural and nurses must understand their role as a ‘bearer of culture’ and examine their own realties, attitudes and beliefs. <br /> Nurses must acknowledge the power they posses as a nurse and its impact on others – cultural safety is determined by the person we are providing care to. <br /> Nurses should work with their organization to identify and address issues that may affect client’s accessing services. <br /> Nursing care should be undertaken whenever possible, with the input of the client and/or whomever the client identifies as their community, family, significant other(s) and support structure. <br /> Nurses working in HIV/AIDS care must be committed to ongoing professional development to obtain and maintain cultural competency. <br /> To optimize client outcomes, workplaces and nursing education programs should make every effort to recruit and retain nurses with First Nations, Inuit and Métis heritage. <br />
  • “We (nurses) don’t have a right to be uninvolved” Cathy Crowe, CANAC 2013 <br /> Nurses have a huge capacity to influence policy and politics <br /> Advocacy is integral to nursing practice <br /> Sharing best practice, skills, tools and knowledge benefits everyone involved <br /> Engaging the community in our learning and development benefits everyone and is highly valued by community members <br /> Involvement of people living with HIV/AIDS in the education of health professionals is not an ‘add on’ it is essential <br />
  • Know the difference between giving advice and sharing information <br />
  • Further research is needed on the pattern of HIV/AIDS and HIV testing among Aboriginal peoples to increase our understanding of the specific impact of HIV on Aboriginal peoples to guide prevention and control strategies. <br /> Are Aboriginal people more at risk for HIV? <br />

HIV Nursing and Home  & Community Care Conference HIV Nursing and Home & Community Care Conference Presentation Transcript