Teaching about HIV/AIDS: the lessons learned.

To learn and teach about HIV/AIDS is to enter complex and sensitive territory that at times may be personally challenging. In the vast literature on HIV infection and nursing two main themes recur: nurses' lack of understanding, negative attitudes and anxieties related to HIV/AIDS and the need for education to change such attitudes and enhance nurses' knowledge and skills.

AIDS dementia complex: guidelines for nursing care.

AIDS dementia complex is one of the most common neurological problems associated with HIV-related illness. To date, the nursing care of individual with AIDS dementia complex has not been explored to any extent. As a basis for examining aspects of nursing care, the epidemiology, neuropathology, clinical presentation and diagnosis of AIDS dementia complex are reviewed and medical management considered. Using the stages of AIDS dementia complex, guidelines for nursing care are proposed. These guidelines are a basis for developing individualized care to enhance the abilities of persons with AIDS dementia complex and to support caregivers.

Caring for patients with complications after elective abdominal aortic aneurysm surgery: a case study.

The risks associated with elective repair of an abdominal aortic aneurysm have been reduced in recent years, but occasionally the extent of the aneurysm and the severity of the atherosclerotic process lead to life-threatening complications. The complications of myocardial infarction, acute renal failure, bleeding, and ischemia are examined in this article. To illustrate the complexities of nursing care when patients experience complications, the case of Mr. S is presented. Assessment and monitoring are considered as key components of nursing care, and ways to help patients and their families cope with unanticipated complications are outlined.

Evaluation of an educational programme for patients taking warfarin.

The outcomes of a structured warfarin patient education programme were compared with those of an unstructured programme. For both programmes, knowledge and satisfaction levels were determined, incidence of complications of warfarin therapy were noted, and prothrombin time results were examined. The 23 patients who participated in the structured educational programme were selected from among vascular surgery patients. The comparison group was composed of 10 patients who had mechanical prosthetic valves inserted. The structured programme was designed for the study, and implemented by staff nurses. The comparison group received the usual unstructured educational programme. Post-treatment assessments were made before discharge and at 1 month and 3 months after discharge. Interview guides were developed, to determine knowledge and satisfaction. At the predischarge interview, significant differences between the treatment and comparison groups were observed related to knowledge of elements of warfarin therapy. The most important effects of the programme related to specific instructions to promote safety. The interviews 1 month and 3 months after discharge demonstrated that knowledge changed in several areas for both groups. Overall, both groups were satisfied with the information they received. The majority in both groups did not experience complications. Prothrombin times were available for some patients. Those obtained indicated that prothrombin times were not consistently within the therapeutic range for 60% of the time or more. The study supports the use of a structured educational programme as one element in achieving safe, effective warfarin therapy. Reasons for changes in knowledge over time merit further exploration, as does the relationship between optimal control of therapy and educational programmes.

Devising standards for patient education in a teaching hospital.

The Patient Education Committee's work to develop patient education standards and criteria has been a challenging and positive experience for the committee members. Some questions about the standards and criteria have yet to be answered, and further refinement may be indicated by future monitoring and evaluation activities. For example, the question still remains of how realistic, achievable, and measureable are the standards. Work on patient education standards continues. Excellence in patient education will only be achieved when nurses are fully committed to it as an integral part of nursing care, when issues related to evaluation are clearly and consistently addressed, and when the process of patient education is continually refined to achieve effective outcomes and desired behavioral changes. Developing standards and working within the QA context is the first step along the path to high-quality patient education.

Warfarin patient education: are we neglecting the program design process?

Patient education is an important part of safe, effective warfarin therapy. A review of warfarin patient education programs described in the periodical literature over the past 20 years was undertaken. Fifteen relevant articles published between 1972 and 1988 were identified. Most of the articles describe content to be taught. Elements of program design receive limited attention. Patient input into program design is not considered. The literature review clearly demonstrates that principles of program design and outcome evaluation should be applied further by health professionals involved in warfarin patient education.

Positioning and handling: important considerations in the care of the severely head-injured patient.

Control of abnormal posturing is a challenge in the care of severely head-injured adults and must be a component of care in both critical care and acute rehabilitation stages of recovery. Severe head injury is indicated by a Glasgow Coma Scale rating of eight or less for at least six hours post-injury. Long-term disabilities are common among survivors, mostly men under 40 years of age. This paper examines the pathophysiology of abnormal posturing and positioning and handling techniques to prevent and/or control abnormal motor activity. The effect of positioning on intracranial pressure is also discussed.

Perceptual dysfunction: nursing assessment and management.

Perceptual dysfunction is a complex problem and can be a serious barrier to the patient's recovery of independence. Nurses play a significant role in the identification of a possible perceptual deficit and in the use of nursing interventions that complement and are coordinated with the work of the occupational therapist. Four common categories of perceptual dysfunction are identified. One-sided neglect and apraxia are emphasized and specific assessment data and nursing interventions for these two problems are discussed. Agnosia and visual-spatial relationship problems are described briefly. The related problem of visual deficits is outlined and discussed with reference to perceptual dysfunction.