Dr Hayter trained as a Nurse in 1987 and has worked in numerous clinical settings including Urology, Medicine, Gastro-entorology, Haematology and AIDS care. It was this latter role and subsequent work in sexual health clinics that led to his move into Nurse education in 1991 to develop and run sexual and reproductive health programmes in the Sheffield School of Nursing. He has a Bachelors Degree in the Social Sciences and a Masters Degree in Clinical Nursing. His PhD is in Medical Sociology and he is particularly interested in the sociological analysis of nursing practice. Dr Hayter has published widely and is most well known for his work on HIV nursing and sexual health and is particularly interested in child and adolescent health and the promotion of healthy lifestyles among young people. Alongside this he also has an interest in other aspects of nursing and has published in the areas of occupational stress, school nursing, wound care, mental health and chronic illness.
Abstract: AIM: The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds. BACKGROUND: Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. DESIGN: Systematic review and meta-analysis. METHODS: A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950-June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. RESULTS: Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI(95): 0.16-0.39, p < 0.001), reduced odour (CI(95): 0.24-0.52, p < 0.001) and pain-related symptoms (CI(95): 0.18-0.47, p < 0.001), decreased wound exudates (CI(95): 0.17-0.44, p < 0.001) and had a prolonged dressing wear time (CI(95): 0.19-0.48, p = 0.028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI(95): 0.04-0.33, p = 0.013) using silver dressings in wound management with no associated severe adverse events. CONCLUSION: This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further. RELEVANCE TO CLINICAL PRACTICE: The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds.
Abstract: AIMS: This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education. BACKGROUND: Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one-to-one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations. DESIGN: A qualitative study using a grounded theory approach was used. RESULTS: Three linked 'core categories' emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: 'reproductive education'. This core category is closely linked to 'surveillance' where women are taught to monitor their reproductive health and to 'contraceptive regimen' where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of 'contraceptive education'. CONCLUSIONS: Nursing practice in this important area of women's health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one-to-one consultations with women - providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection. RELEVANCE TO CLINICAL PRACTICE: Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side-effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.
Abstract: AIMS AND OBJECTIVES: This study aimed to explore the menarche and menstruation experiences of young females aged 10-12 years in elementary education in Taiwan. BACKGROUND: Menarche is a significant milestone in a woman's life and for female adolescents it is a sharply defined biological event that can be a traumatic and uncomfortable time. If used, school nurses can make a significant contribution in educating young people and help to ameliorate these problems. Understanding how young women feel about menstruation is a central element to sexual health education practice. DESIGN: A qualitative research design was employed using focus groups. METHODS: Data were collected from 20 female students, aged between 10-12 years. Focus groups were recorded, transcribed and subject to a thematic analysis. RESULTS: Three themes emerged from the data analysis reflecting the menstrual experience of participants. These were: 'Changing bodies: the physical effects of menarche and menstruation', 'Emotional issues: the psychological impact of menarche and menstruation' and 'Social dimensions of the menarche and menstruation'. CONCLUSION: Our findings show that young females can experience significant physical and emotional difficulties around menstruation - many of which stem from poor information and the reactions of their peer group to menstrual activity. The potential for school nurses to contribute to this education is significant and schools should explore the manner in which nurses can contribute to this area of health education. RELEVANCE TO CLINICAL PRACTICE: Nurses involved in health education work with young people and ensure that menstruation education addresses the social and psychological impact of the menarche as well as the physical elements of menstruation. Boys should not be absent from this education and the impact of their attitudes towards menstruation upon their female peers should be addressed in health education work.
Abstract: AIM: To explore the contributing factors and effects of Taiwan's mental health nurses' decision-making patterns on care outcomes for patients with borderline personality disorder. BACKGROUND: Patients with borderline personality disorder have been identified as difficult to care for. Taiwan's mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses' perceptions of how their decision-making process impacts quality of care for their clients. DESIGN: Descriptive qualitative research. METHODS: Data collected through semi-structured, face-to-face, in-depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan. RESULTS: The informants' caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses' expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a 'two-stage care process' was developed to depict the relationships among these five themes with different care outcomes. CONCLUSIONS: Although Taiwan's mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses' positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members. RELEVANCE TO CLINICAL PRACTICE: Mental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients' needs and to develop individualised in addition to routine care strategies.
Abstract: Study aims. The purpose of this study was to compare the costs and effectiveness of enterostomal education using a multimedia learning education program (MLEP) and a conventional education service program (CESP). Background. Multimedia health education programs not only provide patients with useful information in the absence of health professionals, but can also augment information provided in traditional clinical practice. However, the literature on the cost-effectiveness of different approaches to stoma education is limited. Design. This study used a randomised experimental design. Methods. A total of 54 stoma patients were randomly assigned to MLEP or CESP nursing care with a follow-up of one week. Effectiveness measures were knowledge of self-care (KSC), attitude of self-care (ASC) and behavior of self-care (BSC). The costs measures for each patient were: health care costs, MLEP cost and family costs. Results. Subjects in the MLEP group demonstrated significantly better outcomes in the effectiveness measures of KSC, ASC and BSC. Additionally, the total social costs for each MLEP patient and CESP patient were US$7396.90 and US$8570.54, respectively. The cost-effectiveness ratios in these two groups showed that the MLEP model was better than the CESP model after one intervention cycle. In addition, the Incremental Cost Effectiveness Ratio was -20.99. Conclusion. This research provides useful information for those who would like to improve the self-care capacity of stoma patients. Due to the better cost-effectiveness ratio of MLEP, hospital policy-makers may consider these results when choosing to allocate resources and develop care and educational interventions. Relevance to clinical practice. This study provides a cost effective way of addressing stoma care in the post-operative period that could be usefully transferred to stoma care settings internationally.
Abstract: AIM: This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. BACKGROUND: Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. DESIGN: A structured review of the literature. METHOD: The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. RESULTS: Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. RELEVANCE TO CLINICAL PRACTICE: The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention.
Abstract: AIM: To explore the impact of renal cancer treatment on patients' quality of life. BACKGROUND: Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients' quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking. DESIGN: Literature review. METHODS: A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study. RESULTS: From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review. CONCLUSIONS: This review discusses the complex effect of renal cancer upon a patient's quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care. RELEVANCE TO CLINICAL PRACTICE: Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices.
Abstract: BACKGROUND: The issue of relationships between patients in long-term care settings can present nurses with numerous challenges. However, addressing this element of patient care is recognised as an important element of nursing in this sphere of practice. What nurses think about patient sexual relationships and the difficulties of incorporating these into care is closely linked to the care they provide. However, the issue of patients sexual relationships within high security psychiatric hospitals is a relatively poorly researched area of clinical practice. AIM: To explore the attitudes towards patients' sexual relationships held by nurses working in high security psychiatric hospitals in England. METHODS AND PARTICIPANTS: A qualitative methodology was employed with data collected from 10 in-depth interviews with nurses working within secure psychiatric hospitals in England. Interview data were subjected to thematic analysis. RESULTS: Practitioners reject permissive policy in relation to patients' sexual relationships on account of perceived perpetuation of abuse and exploitation. Practices and attitudes are dominated by personal (lay) values that seek to restrict patient experience and undermine professional mores whilst also seeming to uphold a professional duty of care. CONCLUSION: Lay understandings are constructed as moral rights and priorities that are of higher order concern than professional values or the rights of the individual. This constitutes a clash of values and the minimisation of professional mores within the clinical context raises questions about the role of professional teaching, knowledge and policy in relation to professional socialisation.
Abstract: AIM: This paper is a report of a study to explore how school nurses perceive the influence of schools on their role in delivering sex and relationship education in primary schools. BACKGROUND: School nurses play a key role in sex education in English schools. However, sex education is a contentious issue meaning the sex education of children is often an area of tension within the curriculum. However, the impact of these tensions upon school nursing practice is poorly described. METHOD: Three focus groups with a convenience sample of 16 nurses experienced in conducting sex and relationship education were conducted during 2006. Focus groups were audio-taped, transcribed verbatim and subjected to a thematic analysis. FINDINGS: Four themes were identified in the data: 'covert surveillance' refers to school staff conducting clandestine surveillance of the classroom actions of the nurse; 'overt surveillance' reflects how nurses felt they were being openly monitored by teachers in the classroom; 'Teacher attitude' refers to the interventions of the supervising teacher in the classroom during the sex education session and 'resistance practices' detailed how nurses attempted to manage the disciplinary practices of the school. CONCLUSION: School nurses need to be pragmatic about the fact that there will be some attempts by the school to regulate sex education. Developing an early dialogue with the school can mediate this. Closer working practices and the involvement of school nurses in the development of sex education policy and practice is vital to ensure that they continue to make a valuable contribution to sex education in schools.
Abstract: AIM: This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds. BACKGROUND: Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so. METHODS: A systematic review of literature from 1950-May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds. RESULTS: Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors. CONCLUSION: The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies. RELEVANCE TO CLINICAL PRACTICE: This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.
Abstract: AIMS AND OBJECTIVES: The purpose of this study was to explore the experience of cancer patients living with a malignant fungating wounds. BACKGROUND: Malignant fungating wounds are caused by cancerous cells invading skin tissue. These wounds can then bleed, become malodorous and painful causing physical and psychological distress. However, little is know about how individuals experience these lesions. DESIGN: Qualitative. METHODS: Ten in-depth interviews were conducted with patients in one medical teaching centre in Taiwan. Data were subject to a thematic analysis informed by elements of grounded theory. RESULTS: Five key themes demonstrated an emerging model that offers an insight into how patients experience their wound. Firstly, 'Declining physical well-being' refers to the initial impact of the wound, this is linked to two further themes; 'Wound related stigma' and the 'Need for expert help'. Another theme; 'Strategies in wound management' describes the initial, ineffective attempts by participants to manage their wound and the impact of professional help around wound management. This was linked to a fifth theme; 'Living positively with the wound' that reflected how patients adjusted to the presence of the wound -- significantly influenced by the wound care they received. CONCLUSION: This study contributes to the understanding we have of how patients experience living with such wounds. It sets out the clear need for early use of wound specialists as part of the multi-disciplinary oncology team. RELEVANCE TO CLINICAL PRACTICE: The results of this study provides a description of patient experiences that can help to guide nursing practice as well as an understanding of what a malignant fungating wound means to cancer patients and how it influences their lives.
Abstract: AIMS: This study aimed to explore gender differences in attitudes towards sexual relationships of adolescent attending nurse led sexual health clinics. BACKGROUND: Nurse led sexual health clinics are at the forefront of promoting adolescent sexual health. To provide sensitive, effective and non-judgemental care, nurses need to understand the complexities of adolescent sexual behaviour and the social factors that influence sexual relationships. Design. A qualitative, exploratory research design was used. METHODS: Ten focus groups (five male and five female) involving sexual health clinic attendees aged between 14-16 years were conducted. Focus groups were asked to comment on four sexual relationship 'case studies'. Group discussions were recorded and transcribed. Data were subject to thematic analysis. RESULTS: Three themes emerged from the data analysis. 'Empathy' reflected how young women were more likely to try to see their partner's point of view. 'Complexity' also reflected that young women were more aware of the complex nature of relationships than were the male participants. 'Language' related to how young males used aggressive language in the context of relationships - a feature absent from female participants' discourse. CONCLUSIONS: Male and female attitudes clearly differ. Female responses are more complex and empathic because of the more complex nature of the social pressures that sexualise young women. Young males are not as subject to these social forces. Young men are socialized into behaviour that can place females under pressure to have sex - this pressure can include the use of alcohol. RELEVANCE TO CLINICAL PRACTISE: Nurses working in sexual health should attempt to encourage empathic thinking in male clients. Females should be educated to deal with the social pressures they may face from their partners. Practitioners should also recognise the problematic role alcohol can play within sexual relationships.
Abstract: BACKGROUND: Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status. AIM: To identify a strategy for improving the uptake of pulmonary rehabilitation. DESIGN OF STUDY: Qualitative interviews with patients. SETTING: Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK. METHOD: In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory. RESULTS: Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating. CONCLUSION: A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of 'regaining control' may improve patient uptake.
Abstract: AIM: This paper is a report of an analysis of the discourse about contraceptive efficacy and side effects used by nurses when prescribing contraception. BACKGROUND: All women seeking contraception should be informed of the efficacy and potential adverse effects of the particular method they are considering. This information facilitates an informed choice. Women also require this information in order to monitor for any side effects. Paradoxically, side effects are also a key factor in reducing adherence with contraceptive regimens. However, there is no literature that explores specifically how this issue is addressed in clinical consultations, or places these practices in a theoretical context. METHOD: Forty-nine consultations between nurses and women in sexual health clinics were audio-recorded during 2002. Data were subject to a discourse analysis using Foucault's 'procedures of exclusion' to explore the discursive construction of contraceptive efficacy and side effects FINDINGS: The nurses employed specific discursive strategies when discussing contraception. When addressing efficacy, discourse centred on medico-statistical facts, but side effects were described in lay terms that minimized their severity. Nurses contextualized contraceptive side effects within potential problems that women might experience in pregnancy, and also attempted to 'normalize' contraceptive-related problems. CONCLUSION: Discourse and its deployment play a key role in practitioner-client relationships that sexual health nurses need to become more aware of how they discuss clinical issues about contraception with women. Clinical data on contraceptive side-effects are present in the literature, and it is important that sexual health nurses use this to help women make truly informed decisions.
Abstract: This paper explores an under-researched issue within the reproductive health of women - the discursive construction of self-examination instruction in sexual health clinics. The study utilises Foucault's work on 'productive power', the 'practices of the self' and discourse to map out how nurses instruct contraceptive-using women in self-care practices. Forty-nine consultations in sexual health clinics were tape recorded and analysed. The data reveal how nurses utilise the discourse of risk as a technique to reinforce and develop self-care practices - a concept congruent with the Greco-Roman concept of the cura sui, the philosophical notion that one must make oneself into the object of care. Nurses build upon the notion of risk by educating women about their reproductive anatomy and physiology utilising medical texts as tools. This provides a contemporary example of the mia chora: identified by Foucault as the incitement for the individual to develop a usable knowledge of the body. Lastly, nurses instruct women in the development of a self-care regimen - the epimeleia, the development of habitual body techniques. It is proposed that this process is congruent with the Aristotelian notion of habitus, the development of body knowledge, body techniques and self-care practices necessary to pursue health.
Abstract: AIM: The aim of this paper is to report a study exploring the discursive construction of contraceptive use within nurse consultations with women in family planning clinics. BACKGROUND: This paper takes as its starting point the lack of a contraceptive 'strand' to the literature on the discursive construction of the female body generally, and the female reproductive system specifically, within health care practice. The literature in this field concentrates on pregnancy, menstruation and menopause, and the manner in which contraceptive use is discursively constructed is under-explored. Furthermore, the literature on nurse-women consultations in family planning clinics is also limited, with the current literature concentrating on assessing clinical skills rather than discourse. METHODS: Using a grounded theory methodology to explore how nurses educate women about contraception in family planning clinic, 49 consultations were audio-taped in two large family planning clinics in the United Kingdom (UK). FINDINGS: Open coding and subsequent axial coding resulted in the emergence of three elements of contraceptive education. One concerned reproductive anatomy, another reproductive physiology and a third education about contraceptive functioning. These three axial codes were formed into a core category: 'body education/reproductive vulnerability'. Within the consultation, nurses linked the 'vulnerable' reproductive system with the requirement for contraceptive 'protection'. This approach seems linked to ensuring women's future contraceptive use. CONCLUSION: The discourse employed by nurses differs from the body discourse aimed at menopause and menstruation. These areas of women's health were constructed as disintegrating, malfunctioning and failing, whereas reproductive vulnerability suggests a fully functioning, active system, in need of restraint. However, this discourse still constructs the female body as fundamentally weak and unstable, requiring contraception to protect it and prevent transgression.
Abstract: OBJECTIVE: To assess the views of service users towards sexual health nursing outreach clinics situated in youth clubs. The clinics were established in economically deprived areas to meet the needs of young people aged 13-18 yrs who are reluctant to attend mainstream services. DESIGN: Descriptive cross-sectional study. SAMPLE AND MEASUREMENTS: 250 questionnaires collecting data on service use and service users' views of the clinics were distributed to a 25% sample of clinic users. In addition, 20 semi-structured interviews were conducted with service users. RESULTS: 166 questionnaires were returned (66% response rate). The service was equally popular with males and females who often attended to meet friends but subsequently sought sexual health advice. Interviews found that young people appreciated the non-judgmental aspect of the clinics, although some reported concerns about confidentiality when the clinics were busy. Some respondents indicated that the clinics gave them confidence to discuss sexual health matters with others, but often the clinics provided advice for young people who had no one else to talk to. CONCLUSIONS: The clinics seem popular with young people, and situating services within an area young people access to socialize appears to be an effective way to target them with sexual health advice.
Abstract: The use of anti-human immunodeficiency virus (HIV) drugs after occupational exposure to HIV is a proven method of preventing some HIV infections. There is anecdotal evidence that this treatment is being used to treat recently exposed sexual contacts of HIV infection, known as non-occupational post-exposure prophylaxis (NONOPEP). This raises the issues of the impact of such treatment on sexual behavior and public health. Six hundred questionnaires were distributed to nurses working in sexual health clinics. Four hundred and six (67%) were returned. Questionnaires contained items related to awareness of HIV NONOPEP and items included attitudes related to its use. Seventy two percent of respondents were aware of HIV NONOPEP, and 17% had experience of its use in their clinic. Twenty one percent of respondents indicated that their clinic had a specific HIV NONOPEP policy. In relation to attitudes, practitioners were more positive of NONOPEP in relation to an HIV exposure within a long-term relationship than exposure within a casual relationship, indicating that the mode of HIV exposure was a factor in the justification of NONOPEP. Practitioners seemed to support the notion that HIV NONOPEP use in a casual exposure may increase the likelihood of unsafe sexual practice; however, practitioners with experience were less likely to express this view. It is suggested that an informed debate and NONOPEP policy development within all sexual health clinics will militate against judgmental views affecting access and care.
Abstract: Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.
Abstract: This article explores the use of drugs to treat patients who have recently been exposed to HIV. Known as postsexual exposure prophylaxis, this emerging practice has been accused of creating a number of problems for HIV prevention. However, there is a case that PSEP can make a significant contribution to HIV prevention strategies.
Abstract: Confidentiality is one of the most significant concepts in health care and nursing practice, particularly in the arena of HIV infection and AIDS. The implications for individuals of deliberate or accidental disclosure of their HIV status can and does have far reaching effects. This paper will explore the concept of confidentiality by discussing the legal and professional issue of confidentiality and AIDS. The nature of the law and guidance by professional bodies allow exceptions to the respect of confidentiality in certain situations. AIDS and the need for confidentiality often is in conflict when public health considerations are deemed to be involved. The law is poorly developed in this area and often professional guidance is less than clear.
Abstract: Developments in nursing practice in the United Kingdom are increasingly focusing on holistic models and approaches to care. The recognition of the importance of sexuality and sexual orientation of patients is a significant aspect of holistic care. This paper explores and discusses the literature in the arena of nurses' attitudes to patients' sexuality. From this discussion the concept emerges that nursing needs to recognize the effect that attitudes towards patients' sexuality has on nursing care, and develop strategies that allow this to be reflected on. The use of reflection facilitated by clinical supervision will be presented as a potential way forward.
