The AIDS epidemic: caring for caregivers

AIDS has become a global health problem for individuals, families and health care providers. This disease has a tremendous impact on the physical and psychological well-being of these groups. Nurses are on the front line providing physical care and support for these patients and their families; but nurses also need support and caring as they carry out their important nursing roles. This article addresses the effects of AIDS on nurses and presents a model for nursing administrators to establish and maintain a supportive, caring environment for nurses.     

Palliative home care--the Calicut experience

A three-year-old palliative care unit in Calicut, in the south Indian state of Kerala, started a home care service in June 1996. This paper reviews the first year of operation of the service; in this period 340 home visits were made. The service aims to deliver palliative care to the patients who are unable to reach the hospital, to empower patients to care for themselves and to empower the family to care for patients. One doctor and a few trained volunteers form the team. In addition to control of physical symptoms and emotional support, the home visits permitted minor procedures including nasogastric intubation, catheterization of bladder, dressing of wounds and intravenous fluid therapy. In some cases, the visits helped to change the attitude of families towards the patients--for example, allaying fear of contagion. In some instances, the visits changed the attitude of the neighbourhood towards the patient for the better. In spite of problems like the distances involved and bad roads, the experience of this team shows that a home care system is possible and essential for delivery of palliative care in India.     

Identification of a new P450 subfamily, CYP4F1, expressed in rat hepatic tumors

This study focused on the belief of some nurse educators that caring cannot be taught directly and is learned by students from faculty role-modeling and faculty student interactions in clinical, classroom, and other situations. The purpose was to further explore these beliefs to determine if nursing students perceived that they learn caring behaviors through observing role-modeling by faculty, as well as to explore students' perceptions of other means by which they learn about caring. Since opportunities for faculty to model nurse caring behaviors in the clinical setting are varied and serendipitous, a videotaped scenario simulating a patient care situation, using professional actors, was created and shown to nursing students. The videotape was seen by 137 BSN and ADN students who then recorded their perceptions on a two-page open-ended questionnaire developed by the researchers. Results from this study indicated that students do learn about caring from faculty role-modeling, as well as from health care staff they encounter, often in a very paradoxical way. Many interesting and unintended results also occurred through the use of this research approach.     

Surgical removal of subretinal neovascular membranes

Although families can provide important support for individuals with life-threatening illnesses or injuries, the highly technological nature of critical care often limits opportunities for family involvement. While critical care nurses are seldom family specialists, they frequently provide support and assistance to patients' families. This paper describes four types of questions drawn from the family therapy literature that can be used by nurses who are not mental health specialists to support families and mobilize their problem solving skills. A case model of a head-injured child demonstrates the use of these questions with a family. These questions should be useful for the brief, problem-focused, family encounters which characterize critical care settings.     

Mothers as volunteers in an oncology clinic

Mothers of children who had died of cancer were successfully utilized as volunteers in a pediatric oncology clinic to provide emotional support and practical assistance to other children afflicted with the same disease and to their families. At the start of the program these volunteers were carefully interviewed to determine their willingness and their emotional ability to participate on a consistent basis. Following an eight-week training program with a psychiatrist, a social worker, and a nurse, they began working in a large pediatric oncology clinic one day a week. Over an 18-month period they have become valuable members of the oncology team by helping to improve communications, to alleviate frustrations, and in giving additional emotional support to the children and their families.     

Family physicians' involvement with dying patients and their families. Attitudes, difficulties, and strategies

OBJECTIVE: To determine family physicians' perceptions of the difficulty in caring for dying patients and how prepared they are to provide such care relative to strategies used with difficulties encountered, personal need for support and development, and cooperation with other caregivers. DESIGN: Exploratory. SETTING: Physicians' offices. SUBJECTS: Thirty-five randomly selected family physicians (doctors of medicine and doctors of osteopathy) representative of family physicians practicing in Franklin County, Ohio. INTERVENTIONS: None. MAJOR OUTCOME MEASURES: A semistructured interview guide corresponding to a three-dimensional theoretical model developed prior to the study was used to determine family physicians' perceptions regarding care of dying patients and their families. The three dimensions include family physicians' involvement with dying patients and their families, their personal needs and development, and their cooperation with other caregivers. RESULTS: Participants agreed that the care of dying patients and their families is an important and special component of practicing family medicine. Generally seeing themselves as adequately prepared, they still found such care difficult and desired more education and training to increase comfort of their patients and of themselves. Their perceptions regarding the care of dying patients and their families could be categorized in terms of communication as part of the care process, family issues, legal and ethical issues, coordination of care, physicians' feelings, and physicians' influence and support. CONCLUSIONS: Family physicians require formal training in death issues and need to find a way to maximize learning through personal experiences. Discussion of cases in a support group may be beneficial.     

Families and HIV/AIDS: Introduction to the special section.

This article provides an introduction and overview of the role of families in preventing and adapting to HIV/AIDS. The unique definition of family in the context of HIV/AIDS is discussed as well as the importance of considering the family as a context for research in this area. Families can be important in deterring the spread of the disease because of their pivotal role in education and training about sexual behavior and health promotion. Families also serve a critical role in helping their HIV-infected members cope with disease. A taxonomy of the problems faced by families is presented. The role of the National Institute of Mental Health's Initiative on Family and HIV/AIDS in supporting and stimulating current and future research is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary electrochemiluminescence studies of metal ion-bacterial diazoluminomelanin (DALM) interactions

Over the past 10 years there has been a growing body of literature on family nursing. Although the term 'family nursing' is not one which is in common use in the UK, a significant amount of literature has appeared which discusses issues relating to the nursing support of families with a member who is ill. This paper will review the concepts involved and will then discuss the appropriateness of such an approach within the specialty of intensive care. As the paper concludes that family nursing could be an appropriate approach to nursing the patient in this type of area, it would seem logical to consider what needs the family may have. The research concerning the identification of the needs of families when they have a member in intensive care is discussed in part two.     

Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years

OBJECTIVE: The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619). DESIGN: A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services. SETTINGS/PARTICIPANTS: Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group. Maternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth. MAIN OUTCOME MEASURES: Maternal reports of hospitalizations, doctor visits, and emergency department visits were used; data were averaged over the child's first 3 years of life. RESULTS: Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency department visits than residence in affluent neighborhoods. Families in middle-income neighborhoods reported more doctor visits than families in poor or affluent neighborhoods. CONCLUSION: Neighborhood residence influences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.     

Family dynamics in end-of-life treatment decisions

The decision to withhold or withdraw life-sustaining treatment is now regularly weighed in chronic or terminal illness. Families are usually supportive advocates and concerned surrogate decision makers for patients, although they can also counter the wishes of the patient and disagree with the treatment team. Understanding the range of factors--internal and external, confronting the individual members and the family as a whole--that can influence family responses helps in working with families at this critical juncture in an illness. Interventions to assist the family and treatment team are discussed.     

A liver-specific isoform of the betaine/GABA transporter in the rat: cDNA sequence and organ distribution

This paper discusses the findings of a quantitative study of nurses' willingness to care for patients with AIDS. It identifies several factors that enable nurses to confront the fear of AIDS nursing and to turn fear into compassion, and negative attitudes into positive ones. These factors include professional values, organizational support, group identity, patients' responses, spirituality, family and friends with AIDS, knowledge about AIDS, and the importance of personal choice. The value of these factors are further supported through personal statements made by nurses on AIDS-dedicated units as they express their feelings, thoughts, and positive experiences and expectations regarding AIDS nursing.     

Serological responses in Lyme disease: the influence of sex, age, and environment

Social workers in a rehabilitation hospital established an outreach service through which volunteers with previous amputations visited patients with recent amputations, acting as role models and offering emotional support and information. Volunteers received in-depth training and continued with their own system of support. Patients who were visited had strong positive responses to the program. Critical components of the program were developing a collaborative partnership between volunteers and social workers; demonstrating credibility to health care professionals; linking emotional support, information, and affirmation; providing benefits to both patient and volunteer; and strengthening linkages among patient, community, and institution.     

Resident training in nursing home care: survey of successful educational strategies

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.     

Psychological distress and burnout among buddies: demographic, situational and motivational factors

Work-related psychological distress (burnout) is a probable cause of drop-out among emotional support volunteers (buddies) who work with people living with AIDS. In addition to the emotional suffering and disruption to both the buddy and the buddied, burnout has significant cost implications for voluntary organizations in terms of training and recruitment. The aim of this study was to identify the demographic, situational and motivational factors associated with burnout among buddies with the intention of identifying individuals at risk at the recruitment stage. A cross-sectional single cohort postal questionnaire study design was used. All buddies registered with the Terrence Higgins Trust, a non-profit making organization set up in the UK to provide education about HIV/AIDS and care for people affected by the virus, were invited to participate. Psychological morbidity was measured with the Hospital Anxiety and Depression Scale, burnout with the Maslach Burnout Inventory and motivation was assessed using the Calvert Motivation Checklist. Information on the buddy relationship and the demographic details of each buddy was also collected. Of 586 questionnaires distributed, 324 (55%) were returned. More than 24% of buddies were classified as probable cases of burnout on one or more of the MBI scales but this is lower than has been reported in medical and nursing staff working with people living with AIDS. Although a number of demographic, situational and motivational factors were associated with burnout, logistic regression models were unable to identify a useful proportion of individuals at risk. It was concluded that although burnout is an important psychological factor in retaining volunteers, it was not possible to identify individuals at risk of burning out either from their self-reported motivations or from demographic factors.     

Second malignancies in cervical cancer patients in the west of Scotland

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.     

Emergency department presentations of Lyme disease in children

BACKGROUND AND OBJECTIVES: Family physicians frequently encounter patients' family members in family meetings regarding health care. Although residents are expected to learn how to interview families, no quantitative studies have examined variables associated with building residents' confidence in their ability to lead family meetings. The current study sought to clarify the relationship between a number of training, participant, and situational components and resident confidence. METHODS: All family practice residents (n = 90) in a five-residency program system were sent a survey that examined their experience in and perceived competence to conduct family meetings. Responses were analyzed with a hierarchical regression analysis and an ex post facto univariate analysis. RESULTS: Residents with higher perceived confidence in their ability to run a family meeting were male, had specific training for leading family meetings, had participated in and initiated more family meetings, perceived stronger family physician faculty support, and had more family systems training than lower-confidence residents. CONCLUSIONS: The results highlight the experiential, curricular, and environmental variables that are associated with building resident confidence to lead family meetings. Residents may benefit from early exposure to the skills needed for family meetings and from reinforcement of these skills through observations of skilled practitioners, the expectation that they will initiate meetings, and the opportunity to debrief meetings with supportive faculty. Family meeting curricula should include conflict management skills and incorporate input from other specialists and hospital personnel who meet with families.     

Care of persons with AIDS in the nursing home

BACKGROUND: AIDS is becoming a chronic illness for some patients whose significant accumulated functional impairments may limit community-based care. Nursing homes can provide an appropriate level of care, although reported experience caring for persons with AIDS in this setting is limited. METHODS: A retrospective case-series review was conducted in a 242-bed community teaching nursing home to describe the initial 26-month experience in providing care for patients with AIDS requiring nursing home admission. RESULTS: A total of 42 admissions by 32 patients with AIDS (mean age = 33.5 years, 81% male) involved a shorter length of stay (mean 63.1 days) and higher numbers of medications (mean = 11.2), facility charges (mean $11,971/admission, $189/day), and greater clinical management complexity than usual nursing home patients. Thirteen patients were discharged, seven for rehospitalization and six into community settings, although ultimately 29 of the 32 patients died in the facility. CONCLUSIONS: AIDS care in the nursing home presents significant, distinct challenges in complex management and terminal care prioritization.     

Post-operative thyroid status of patients with Graves'' disease is determined by the responsiveness of thyrocyte to TSH under the present thyroid gland remnant

OBJECTIVE: Differences in the perspectives of severely and persistently ill patients, their family members, and clinical care providers on key aspects of community-based care were examined to help inform community service planning and development. METHODS: A sample of 183 patients being considered for relocation from psychiatric facilities in Alberta, Canada, to community-based care, were interviewed, as were their primary clinical care providers. Family members of 130 patients were also interviewed. RESULTS: Among the 130 patient-family pairs, 41 percent disagreed about the desirability of relocation, with fewer patients favoring relocation than families. Forty-nine percent of the pairs disagreed about the desired proximity to the family of the relocated patient, with the patient desiring closer proximity than the family member in about half of these cases. Fifty-three percent of the pairs disagreed about the amount of financial and emotional support that the family would provide after relocation. In half of these cases, patients believed the family would provide a higher level of support than the family indicated it could. Among the patients, 49 percent preferred independent living, whereas only 10 percent of family members and 17 percent of clinical care providers preferred it. Fifty-five percent of patients expressed a clear desire to work, whereas care providers believed that only 12 percent of patients were employable. CONCLUSIONS: Persistently mentally ill residents of psychiatric facilities express clear preferences about key aspects of community-based care when they are asked, and these preferences often reflect different views from those expressed by either family members or clinical care providers.     

The cost of cancer home care to families

BACKGROUND: For the most part, previous research on costs of cancer care has focused on the formal medical care costs. Research on home care for patients with cancer has emphasized direct care costs (expenditures). Among indirect costs, only loss of income to family members has been studied. However, a major component of indirect costs, the family labor expended to care for the patient with cancer, needs to be included for a more realistic appreciation of home care costs. METHODS: The costs of family labor are estimated by imputing monetary values for the time spent caring for the patient with cancer. The assigned monetary cost either is equated with income losses of the helper in question or is based on a putative market value of the expended labor time. In addition, out-of-pocket expenditures examined in this study cover all cancer care-related expenses for which the patient was not reimbursed by third parties. Data were obtained from a convenience sample of 192 patients with cancer and their families in lower Michigan. RESULTS: When family labor is included in the cost calculations, average cancer home care costs for a 3-month period ($4563) are not much lower than the costs of nursing home care. The substantial variation in home care costs (standard deviation [SD] = $4313) appears to be unrelated to the type of cancer diagnosis, type of treatment, or time since diagnosis but seems to be driven by the functional status of the patient and the family living arrangements. CONCLUSIONS: Outpatient care for patients with cancer coupled with greater reliance on home care appear to be economically attractive because costs to families usually are underestimated.