LITERATURE REVIEW

RUNNING HEAD : Literature Review

HIV /AIDS Health Promotion Program for Inpatients

HIV /AIDS Health Promotion Program for Inpatients

During an 18 month period , the researcher will design , implement and evaluate an HIV /AIDS health promotion program for inpatients in a non-profit hospital located in Los Angeles California

Introduction

Promoting health for these individuals is not as easy as it seems Several contributing factors need to be considered in every action taken , and essentially speaking , considering every angle of these patients as human beings are involved . In the whole course of

health promotion for HIV / AIDS patient discussion , it is essential to include various points that directly affect the situation for AID /HIV individuals . The study focuses on promoting health care for HIV / AIDS patient in a non-profit hospital in Los Angeles . The study considers various points of information that are featured in the discussion of the . The subjects to be discussed involve the actual condition of HIV /Patient

Employing the system of nursing process as the primary principle in formulating health promotion programs for the patients , assessment of the actual condition is indeed necessary . Awareness need to be built up to facilitate understanding of the subject matter . After which , the employment of health promotion principles need to be incorporated and applied as part of the planning phase of the dissertation . It is essential to include various points of health promotive measures that are crucial for the development of the program proper . Issues that are related to health promotion programs and those controversies that affect the implementation of the over-all program are also discussed in to possess the reality picture that may be encountered in the implementation phase

Organize the thoughts , intervention protocols and system procedures that are to be implemented all through out the promotion program . Input standards , criteria measuring the over-all quality of procedures performed , and guidelines to be used for the entire program proper assessment . Analysis and critical evaluation of the implementation proper is also done in to assess the effectiveness appropriateness , efficiency , acceptability and applicability of the interventions proposed hence , making this step part of the evaluation phase . This systematic process provides maximal formulation of the necessary health promotion program for the AIDS patient

Acquired Immunodeficiency Syndrome is a growing problem throughout the world that requires humanitarian attention . The World Health Organization (WHO ) estimates that several million adults are infected with HIV (Human Immunodeficiency Virus (Chenoweth , 2007

.53 . In the past , the conditions of HIV patients have faced tremendous discrimination , social shame and unequal health care provision primarily because of the characteristics of the disease itself . The society has gain wide stigma and fear over the communicability of this disease Misconceptions and wrong notions , such as false information especially about modes of transmission , impaired awareness about the disease itself , and anxiety of familial shame , have caused the build-up of a great society dilemma towards the disease . The idea and perspective of care given to these HIV patients before are strictly less and in some cases , are not even accepted in other hospital because of the impact of AIDS / HIV stigma . The role of patient care administered by the nurses has been affected by the societal perspective towards the disease (Poindexter , 2005

Ever since acquired immunodeficiency syndrome (AIDS ) was first recognized 20 years ago , remarkable progress has been made in improving the quality and duration of life of persons with HIV infection . During the first decade , this progress was associated with recognition of opportunities disease processes , more effective therapy for complications of prophylaxis against common opportunistic infections (OIs . HIV infection is an infectious disease hence , it is important to understand how HIV integrates itself into a person 's immune system and how immunity plays a role in the course of infection . Awareness in this disease is essential especially when giving care and establishing health care role for the patient

Due to the infectious character of this disease , various social and emotional alterations have occurred to both sides affected by the condition , health care provider and the HIV patient . As observed , the traits of HIV itself have altered and presented reluctance , in terms of care , over the health care providers , most especially the nurses However , gradually , the nursing role towards these HIV patients have shifted and revolutionized through the modernization and improvement of awareness over the condition of HIV

As the modern age approaches , the nursing roles have acquired its own place for the betterment of HIV patient as its primary goal of care . The improvement of medical care itself , specifically , through provisions of various infection control precautions , AIDS and Communicable Disease Precaution programs , and the establishment of medical studies and research regarding the condition , have made the modification of nursing roles a lot more flexible . The doubt of danger and the anxiety towards care have been alleviated through the improvement of prognosis hence contributing to the change of nursing roles (O 'Donnell , 2005

The HIV /AIDS Condition

Health promotion requires the knowledge of the case proper in to provide adequate and appropriate planning and interventions to be incorporated in the program proper . The condition of HIV predominantly strikes males than females , as for the case of homosexuality . The Centers for Disease Control and Prevention (CDC ) estimates that 1 out of 260 Americans has HIV hence , it is possible that at least one employee from a worksite contains the virus or HIV positive (Chenoweth , 2007 br

.53 . Between 1981 (the beginning of the AIDS epidemic ) and 2001 , of 816 ,149 AIDS cases in the United States have been reported to CDC in Atlanta , Georgia . Of these cases , about 467 ,910 amounting to 57 have died . Mostly , the sexually active homosexual males have been the primary afflicted group and currently represent about 45 of these reported cases . Another 25 of the cases are or have been male or female injection drug users and 6 have come from homosexual drug users Lastly , heterosexual transmission , birth or by blood transfusion during the period when the American blood supply are not monitored for HIV antibodies (1981-1985 (Fan , Conner Villareal , 2004

.3 . Using the epidemiology data , we know that the primary focus of the health promotion programs include the homosexual individuals , who has been the primary at-risk individuals

Gradually , medical research and studies has been conducted with the aim of understanding the conditions , mechanisms and systems involve in the causation of AIDS . They have found out the possible means of disease transmission from the host , point of exit , mode of transmission , portal of entry and to the other susceptible host . The body of AIDS / HIV awareness has been established , and with this , the possible care measures for HIV patients have started to develop (Herek , 2002

HIV infection is an infectious disease , it is important to understand how HIV integrates itself into a person 's immune system and how immunity plays a role in the course of infection . This knowledge is also essential for understanding drug therapy and vaccine development Viruses are intracellular parasites . HIV belongs to a group of viruses known as retroviruses . These viruses carry their genetic material in the form of ribonucleic acid (RNA ) rather than deoxyribonucleic acid (DNA HIV consists of a vital core containing the viral RNA that is surrounded by an envelope consisting of glycoproteins (gp ) that protrude . For HIV to enter the targeted cell , the membrane of the viral envelope must be fused with the plasma membrane of the cell , a process mediated by the envelope glycoproteins of HIV (Wyatt , 2004

Viruses are intracellular parasites . HIV belongs to a group of viruses known as retroviruses . These viruses carry their genetic material in the form of ribonucleic acid (RNA ) rather than deoxyribonucleic acid (DNA HIV consists of a viral core containing the viral RNA that is surrounded by an envelope consisting of glycoproteins (gp ) that protrude . For HIV to enter the targeted cell , the membrane of the viral envelope must be fused with the plasma membrane of the cell , a process mediated by the envelope glycoproteins of HIV (Wyatt , 2004

The HIV life cycle is complex and consists of a number of steps . First the HIV GP120 and GP41 attach to the uninfected CD4 cell surface (receptor ) and fuse with the cell membrane . Second , the viral core contents are emptied into the host cell , a process known as uncoating Third , HIV enzyme reverse transcriptase copies the viral genetic material from RNA into double-stranded DNA . Fourth , double-stranded DNA is spliced into the cellular DNA by the action of another HIV enzyme integrase . Fifth , using the integrated DNA or provirus as a blueprint the cell makes new viral proteins and viral RNA . Sixth , HIV protease cleaves the new proteins (polyproteins . Seventh , the new proteins join the viral RNA into new viral particles . Finally , new viral particles bud from the cell and start the process all over (Porth , 2002

Since HIV infection is an infectious disease it is important to understand how HIV integrates itself into a person 's immune system and how immunity plays a role in the course of infection . This knowledge is also essential for understanding drug therapy and vaccine development

Principles of Health Promotion

Nurses in all settings will be called on to provide care for patients with HIV infection . In doing so , they encounter not only the physical challenges of this epidemic but also emotional and ethical concerns . The concerns raised by health care professionals involve issues such as fear of infection , responsibility for giving care , values clarification , and confidentiality , developmental stages of patients and caregivers , and poor prognostic outcomes . It is self-evidently the case that health promotion programs are more likely to be efficient if they are based on a systematic plan . Utilizing the Precede-Proceed Model (Green Kreuter 1999

.213 ) is a case in point . Any such plans must include the following elements (Tones Tilford , 2001

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Identification of a need or a problem in respect of an individual target group or population

Providing the statement of aims and objectives

Diagnosis of essential characteristics of individuals , groups and organizations identification of contexts or settings and broad intervention strategies and their inter-relationship

Identification of specific intervention methods and associated resources

Evaluation criteria to assess program quality

In developing a health promotion program , it is essential to plan so that the program will be effective . An effective health promotion program produces changes in client knowledge , beliefs , behavior , and environmental conditions , which in turn facilitates achievement of the community 's desired health outcomes (Clark , 2002

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Promoting Health Care for AIDS / HIV

Currently , the role of the health care provider for HIV patients carries a lot of responsibility more than just giving medications and vital signs monitoring . The advent of infection control and communicable disease precaution has provided these health care providers the possibility of providing care while maintaining the security of their health conditions . In most hospitals , however , specific trainings are imposed for nurses in to establish and provide their care measures for these HIV individuals . The role of nurse as caregiver has greatly revolutionized because of these health promotion interventions

The role of the health care provider as educators has been established as well due to the formation of medical body of knowledge in terms of AIDS / HIV . The practitioner renders information for their clients especially for health promoting activities . The role of an advocate and counselor have been established as well since part of the health promotion 's responsibility is not only to impregnate physical alleviation of suffering but also to provide social , emotional and spiritual support systems . The wholeness aspect of the person is the focus of care . The physical , cognitive , psychological and affective dimensions are incorporated in every plan and interventions done by the nurse (Bakken , Grimes Holzemer , 2005

AIDS has had a high mortality rate , but advances in antiretroviral and multidrug therapy have demonstrated promise in slowing or controlling disease progression . It is not known whether current treatment regimens will remain effective , because viral drug resistance has developed with most previous medications . Hence , providing pharmacologic interventions for health promotion programs are not readily advisable since , the effects are not yet assured at maximum potency (Kerr , 2000

.245

Another focus of achieving health promotion results is the health care team itself . Many strategies have been used by health care providers to cope with the stress associated with caring for AIDS patients . Education and provision of up-to-date information help to alleviate apprehension and prepare health practitioner to deliver safe , high-quality patient care . Interdisciplinary meetings allow participants to support one another and provide comprehensive patient care . Staff support groups give health care providers an opportunity to solve problems and explore values and feelings about caring for AIDS patients and their families they also provide a forum for grieving . Other sources of support include nursing administrators , peers , and spiritual advisors (MacDonald , 2003 br

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Health Education for HIV

Health education is dependent on the values and philosophies of practitioners . The effectiveness of health education is only assessed if a change in perspective followed by a change in concepts , principles and lastly , behavior changes occur in the person . Behavior change is only possible if programs focus on specific behavioral goals , provide sufficient training and support for teachers , and use an age-appropriate and gender-sensitive design (World Bank , 2002

.28 . The following health education concepts are needed to be taught by the health care providers to the patients . Practitioners need to assess their level of reception after the health education

Preventive-Rehabilitative Teaching : The teaching type covers patients who currently possess the disease itself , and currently engaged in direct manifestations of the disease . Goals for the patient may include achievement and maintenance of skin integrity , resumption of usual bowel habits , absence of infection , improved activity tolerance , improved thought processes , improved airway clearance , increased comfort improved nutritional status , increased socialization , expression of grief , increased knowledge regarding disease prevention and self-care and absence of complications (Wyatt , 2004 . Skin and oral mucosa are assessed routinely for changes in appearance , location and size of lesions , and evidence of infection and breakdown . The patient is encouraged to maintain a balance between rest and mobility to change position every 2 hours in to prevent immobility-related complications , such as bedsores . Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown (Wyatt , 2004 . Patients are encouraged to avoid scratching , to use nonabrasive , nondrying soaps , and to apply non-perfumed skin moisturizers to dry skin surfaces . Regular oral care is also encouraged

Preventive Teaching for High-risked Individuals : The teaching involves the individuals who are high-risked of acquiring the disease , primarily homosexuals , injection-users . Safer sex may be defined as sexual contact that poses the least risk of sharing potentially infectious body fluids The safest sex is abstinence . The Public Health Service recommends condom use , which reduce transmission risk under potentially at-risk situations . The polyurethane female condom has been found to be effective against a variety of sexually transmitted diseases , such as HIV (Kirton , 2003

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Influence of Age to Person with HIV /AIDS

The condition of HIV patients is the extremely reduced immunological function and related as well to hormonal dysfunctions . As people age there is a decline in the mass of the thymus , and the proportion of lymphocytes within the thymus changes as well . Whereas it is generally accepted that T-cell function declines with age , there is no consensus however , on the effects of age on the B-cell response . As individuals age , self ' protein undergo some minor alterations and the antibodies initiated by the immune system performs a reverse action of attack hence , triggering now the potential condition of autoimmune attacks (Weinstein , 2000

.32 . Age , therefore , is a factor for rapid progression of the disease especially for older individuals . Blood transfusion is the primary contributing etiology for rapid AIDS progression in relation with age . Some investigators have shown that transfusions are the most virulent mode of transmission , resulting in the shortest survival period for all ages , whereas others have found no difference between the survival of older patients with a history of injecting drug use and those with transfusion-related AIDS (Nokes , 1996 br

.26

Another postulated cause of a shorter survival period in older individuals is the risk for the invasion of OI of Opportunistic Infections . It has been hypothesized that these types of infection occur less frequently with younger patients . However , it has been shown that there is no significant difference between those over and less than 40 years of age in the percentage of cases with pneumocystic carnii pneumonia , Candida esophagitis , or Kaposi 's sarcoma as their initial AIDS-defining diagnosis . Although this finding can be reexamined with a higher category of age group (Nokes , 1996

.26

As patients with HIV /AIDS attains their age , infections and the progression of signs and symptoms becomes more evident due to the further decrease of immunologic function . However , there have been no proven evidences that indicate any relationship between deaths of AIDS patient and the factors involving immunologic disease . Most of the time deaths are resulted by idiopathic etiologies especially for older individuals hence , negating the relationship of age over AIDS mortality count and immunologic drop (Hedge , Catalan Sherr , 1997

.250 . Health promotions for these patients require direct focus in terms of increasing their immunity functions . The proposed interventions in the health education section are some of the measures that can promote health conditions of these patients . Rendering the appropriate care and health measures are essential to prevent further progressions of disease manifestations hence , the health care provider and patient should maintain cooperation and strict awareness accompanied by proper monitoring of disease manifestations (Holden , 2004

.11 Length of Infection with the disease and Influence the Level of Education

The progression of the infection produces signs and symptoms that are accompanied in the overall process of disease manifestations . During this occurrence , the patient initiates the interest of increasing their awareness on what is the reality and the factual information that accompanies the condition that have occurred . This is the case wherein the patient employs greater knowledge over the disease condition , and readies their acceptance on every possible explanations or rationale over the disease occurrence . In fact , upon the initial diagnosis of the condition , the patient starts to gain information and education in to provide scope of the entire disease progression

Condition of the signs and symptoms encourage the patient more in to gain information about the further effects of the disease . However this does not occur to every patient since , depression and lost of hope usually affects patients the most . Patients sometimes neglect education due to the reasoning that this information cannot anymore help them alleviate the situation especially for those who possess the disease for a reasonably long period of time . In this case , the health care provider functions as an educator wherein teaching on the possible benefits of health education

Problems Associated in Health Promotion

Many patients with HIV infection have engaged in stigmatized behaviors . Because these behaviors challenge some traditional religious and moral values , health care providers may feel reluctant to care for these patients . In addition , health practitioners may still have fear and anxiety about disease transmission despite education concerning infection control and the low incidence of transmission to health care providers . Practitioners are encouraged to examine their personal beliefs and use the process of values clarification to approach controversial issues . The American Nurses Association 's Code for Nurses can also be used to help resolve ethical dilemmas that might affect the quality of care given to HIV-infected patients

Health practitioners are responsible for protecting the patient 's right to privacy by safeguarding confidential information . Inadvertent disclosure of confidential patient information may result in personal financial , and emotional hardships for HIV-infected individuals . The controversy surrounding confidentiality concerns the circumstances in which information can be disclosed to others . Health care team members need accurate patient information to conduct assessment , planning implementation , and evaluation of patient care . Failure to disclose HIV status could compromise the quality of patient care . Sexual partners of HIV-infected patients should know about his potential for infection and the need to engage in safer sex practices , as well as the possible need for testing and medical care . Practitioners are advised to discuss concerns about confidentiality with nurse administrators and professional nursing organizations such as the Association of Nurses in AIDS Care , and to consult legal experts in their state to identify the most appropriate course of action

The advent of medical improvements has led to the change of health provider 's roles from discriminative nature to caring attitude Moreover , the stigma over these individuals has greatly reduced as compared from the past . In fact , in the United States , the stigma of HIV / AIDS has been observed declining however , some portions of the public are still unaware of the HIV realities and still hold various misconceptions especially in terms of disease transmission (Lane , 2002 .Reference

Bakken , S , Grimes , R Holzemer , W (2005 , January 22 . Utility of a standardized nursing terminology to evaluate dosage and tailoring of an HIV /AIDS adherence intervention . Journal of Nursing Scholarship

Chenoweth , D . H (2007 . Worksite Health Promotion . Human Kinetics

Clark , C . C (2002 . Health Promotion in Communities : Holistic and Wellness Approaches . Springer Publishing Company

Green , L . W Kreuter , M . W (1999 . Health Promotion Planning : An Educational and Ecological Approach . Mayfield Pub . Co

Herek , G (2002 , January 1 . Thinking about AIDS and stigma : A psychologist 's perspective . The Journal of Law , Medicine Ethics

Hedge , B , Sherr , L Catalan , J (1997 . The Impact of AIDS Psychological And Social Aspects of HIV Infection . Taylor Francis

Holden , S (2004 . Mainstreaming HIV /Aids in Development And Humanitarian Programmes . Oxfam

Hung , F , Conner , R . F Villareal , L .

(2004 . AIDS : Science and Society . Jones and Bartlett Publishers

Kerr , J (2000 . Community Health Promotion : A Field Book for Practitioners . Elsevier Health Sciences

Kirton , C . A (2003 . Anac 's Core Curriculum for HIV /AIDS Nursing . Sage Publications Inc

Lane , T (2002 , July 1 . HIV-related stigma falls , but some misperceptions about transmission persist . Perspectives on Sexual and Reproductive Health

MacDonald , T . H (2003 . The Social Significance of Health Promotion Routledge

Nokes , K (2000 . HIV /Aids And the Older Adult . Taylor Francis

O 'Donnell , M Zelnick , J (2005 , January 1 . The Impact of the HIV /AIDS Epidemic on Hospital Nurses in KwaZulu Natal , South Africa Nurses ' Perspectives and Implications for Health Policy . Journal of Public Health Policy

Poindexter , C (2005 , February 1 . The lion at the gate : an HIV-affected caregiver resists stigma . Health and Social Work

Porth , C (2002 . Pathophysiology : Concepts of altered health states (8th Ed . Philadelphia : Lippincott Williams Wilkins

Tones , K Tilford , S (2001 . Health Promotion : Effectiveness Efficiency and Equity . Nelson Thornes

Weinstein , B . E (2000 . Geriatric Audiology . Thieme

World Bank (2002 . Education And HIV /Aids : A Window of Hope . World Bank Publications

Wyatt , R (2004 . The HIV-1 envelope glycoproteins : Fusogens , antigens and immunogens . Science , 280 (5371 , 1884-1888

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