Symptom manageability in Swiss HIV-infected patients.

BACKGROUND: Managing symptoms in daily life is a challenging problem for people living with HIV. As traditional parameters used to identify symptoms needing management do not integrate aspects of daily living with symptoms, we introduced 'perceived symptom manageability' to fill this gap. AIM: The aim of this study was to quantitatively explore 'perceived symptom manageability' in a sample of 268 persons living with HIV. METHODS: Secondary analysis of existing cross-sectional data. Social support, gender, age, depressive and anxiety symptoms were bivariately and multivariately analyzed and related to symptom experience and manageability as measured by the HIV Symptom Assessment Scale and the HIV Symptom Manageability Scale. RESULTS: Least manageable symptoms were hair loss, vomiting and insomnia. Multivariately, age (beta=-.11; p=.024), symptom distress (beta=-.62; p<.001) and total anxiety and depressive symptoms (beta=-.18; p=.003) were statistically significant correlates of symptom manageability. CONCLUSIONS: Although a promising concept to identify symptoms needing management, further research employing primary data is recommended.

Development and pretesting of a set of symptom assessment tools in HIV: The HIV Symptom Experience Assessment Scale and the HIV Symptom Manageability Scale.

Symptom experience has been conceptualized to be multidimensional, but few instruments for use with persons with HIV or AIDS reflect this. The purpose of this study was to develop an instrument to measure the multidimensional nature of symptom experience in persons living with HIV/AIDS. Two scales: the HIV Symptom Experience Assessment Scale (HIV-SEAS) and the HIV Symptom Manageability Scale (HIV-SMS) were developed and tested in 26 patients. Results indicated that the items of HIV-SEAS appropriately assess three dimensions, whereas HIV-SMS covers one dimension. Overall, the HIV-SEAS and the HIV-SMS are promising instruments. Further testing with a larger sample of participants has started.

Comprehensive clinical adherence interventions to enable antiretroviral therapy: a case report.

Adherence to antiretroviral therapy is key for successful treatment of HIV-infected persons. To enhance adherence, multilevel interventions are necessary. This is often a challenge, as this case of an HIV-infected man with a history of poor adherence and multiple virological failures shows. With a multidisciplinary approach, comprehensive intervention strategies were used to facilitate the patient's adherence to an enfuvirtide-based regimen. The interventions are described in detail and include adherence support with modified daily observed therapy, support regarding symptom management, and social relationships. The patient's clinical progress was monitored using indicators such as clinical surrogate markers, adherence to antiretroviral therapy, and HIV-related symptom and depression scores. The case illustrates how interventions that were individualized, culturally sensitive, and provided by a team of health care providers enabled a patient to optimize his adherence, which led to significant improvement in his clinical surrogate markers and subjective quality of life.

Symptom management in HIV/AIDS: advancing the conceptualization.

For people living with HIV, symptoms related to the disease, comorbidities, and treatment side effects make symptom management essential. Poorly managed symptoms result in reduced medication adherence, disease progression, and lower quality of life. The Self-regulatory HIV/AIDS Symptom Management Model is a conceptual model that describes how persons living with HIV/AIDS manage their symptoms. The model links symptom experience, symptom management, social support, adherence, and health-related quality of life. It can assist nurses, through a multidimensional approach to illness management, to enhance symptom assessment, better understand factors influencing symptom experience, and to improve symptom management among people living with HIV/AIDS.

Intervening with at-risk youth: evaluation of the youth empowerment and support program.

This study evaluated a community-based intervention, the Youth Empowerment and Support Program (YES-P), a theoretically-based program designed to decrease drug use and strengthen connections to school in at-risk youth living in high-risk environments. The YES-P included several interventions, such as providing mentor support and social skills training; growing a positive peer culture; and developing youth in leadership roles for community service. These interventions were delivered by 10 nursing students in a weekly, after school, 2-hour, group activity for 20 weeks for 13 inner-city youth ages 10-12 years (7 girls, 6 boys). One girl identified herself as Hispanic and the others as Caucasian. Using a pre/post one-group design, data were collected in 1999 from program participants to evaluate the YES-P. Results of a 1-year pilot study suggest that the multilevel interventions were associated with positive effects on at-risk youth. In particular, respondents at the posttest reported higher levels of self-esteem, mentor support, positive peer bonding, social skills attainment, and school attachment. Attitudes against underage drug use decreased from pre-test scores revealing areas for strengthening the program. These results lend empirical support to the positive evaluation of the YES-P with at-risk youth living in high-risk environments.

Mentoring youth: a service-learning course within a college of nursing.

Faculty at the University of Southern Maine College of Nursing and Health Care Professions developed a service-learning course that connected students and faculty with at-risk children in a local community. Nursing students, with faculty supervision and support, developed, implemented, and evaluated interventions to reduce risk factors and increase protective factors to build and strengthen the participants' resiliency. Students enrolled in the service-learning course worked in the community where they gained an understanding of what it was like for children and adolescents to live in an impoverished community setting with disorganized family units and weak community support. The students learned to collaborate with police, schools, public health nurses, and churches, as well as students in other major programs. The benefits of this course for students and the community were far reaching and even life changing.