Women and HIV/AIDS.

The incidence of AIDS in women over the age of 13 is increasing dramatically in the United States, with 40,702 cases reported by the end of September 1993 (Department of Health and Human Services, 1993). Some data indicate women are becoming infected at an earlier age and have a shorter survival time than men. The authors provide a background to the female epidemic, discuss the unique pathophysiologic progress of HIV disease in women, and present the sociocultural and economic issues that contribute to women's risk. Nurses must become knowledgeable of the issues directly impacting on women in order to provide appropriate education, counseling, care, and leadership to women.

HIV infection in traditional rural communities.

The challenge to rural nurses to deliver knowledgeable and skilled nursing and health care to individuals with HIV infection and AIDS is indeed tremendous. Isolation of rural communities and health care facilities coupled with limited resources, financial concerns, conservative values of many traditional rural communities, and the tendency to exclude those who do not conform to community norms make it difficult to integrate the individual with HIV disease into the rural health care delivery system fully. Issues of particular concern to the rural nurse include maintenance of client confidentiality, obtaining and maintaining current knowledge and skills necessary to the provision of quality HIV nursing care, management of complex client health care problems, and provision of appropriate support services. Rural nurses must be innovative and creative in developing mechanisms to deal with these concerns. In addition, because rural nurses are well respected by the community and viewed as possessing a great deal of expertise in the delivery of health care, they are well positioned to provide leadership to the community in developing educational and care strategies to more effectively provide HIV care. Indeed, the delivery of high-quality HIV care in rural areas across the United States will likely depend on the expertise and leadership provided by rural nurses.

HIV issues for rural hospitals in U.S. frontier areas.

A Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals' experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection. Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV-infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV-positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV-positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in-house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.(ABSTRACT TRUNCATED AT 250 WORDS)

Survey of baccalaureate nursing schools' guidelines/policies on AIDS.

A descriptive survey of 242 National League for Nursing (NLN)-accredited schools was conducted to identify guidelines and methods used to deal with both student assignment to AIDS clients and students who are HIV (Human Immunodeficiency Virus) antibody positive or diagnosed as having AIDS. Results indicated that 96% of the nursing schools have no guidelines for dealing with infected students, 76% have no guidelines for dealing with student assignments to AIDS clients; and 49% have no plans to develop guidelines. Thirteen percent felt HIV antibody testing should be required of all nursing students. While 66% responded that another assignment would be made if a student refused to care for an AIDS client, 45% added other comments, primarily that they would employ student conferences and further AIDS education as well. In dealing with HIV antibody positive students who are not ill, 84% felt students should remain in theory classes and 64% said they should remain in clinical. When asked about students diagnosed as having AIDS, 79% would allow theory attendance, and 31% would allow clinical attendance. Regarding who should be notified, 67% indicated that student health center, 41% said only nursing faculty in direct contact with the student, and 61% said the nursing school administration. Results demonstrated few schools of nursing have existing guidelines, many have no plans to develop them, and uncertainty abounds in the resolution of these issues.

Home hospice care in Britain and the United States.

The British are long established and experienced in hospice care and indeed most clients who die within a hospice program in Britain do so comfortably, peacefully, with dignity and control and a sense of personal worth. American hospice programs have been modeled after those of the British and have achieved a level of sophistication in the care of the dying. The comparison presented here is not intended to place value judgments upon either country's methods but simply to present what the methods are. Perhaps Rev. Tom Scott, Administrator of Strathcarron Hospice in Denny, Scotland, summarizes the meaning of the hospice movement and our role as health care professionals in it when states, "Perhaps we shall learn that there is no perception for a good death--only the dignity which allows the dying person to mark the route and to choose the pace--and give us the privilege of enabling them to take that final step in acceptance and peace" (1985).