First clinicals disclosure obligations re: HIV+ patient?

[Toby's mum]

A situation occurred recently that I would love to get your opinion on regarding ethical and appropriate disclosure related to a HIV+ patient in active AIDS.

A 'brand new' group of pre-nursing students completed two weeks of basic care workshops i.e. bedmaking, ambulation, bedbath, oral & peri care etc. The third week consisted of 3 clinical days (from 7:30am to 12pm) on a med/surg floor. Students were paired and assigned a patient. Students were to provide bathing, bedmaking, vs, etc for that patient. Apparently, two students found out after the fact that their patient was HIV+. They did wear gowns because this patient had C.diff in addition to everything else. However, they didn't know about the AIDS. When I heard about this, I couldn't believe that their instructor didn't give them a heads-up on this situation. These were new students--and this was their very first time giving patient care. How can you not tell students--who are still getting the hang of handwashing, gloving, universal precautions etc--that their patient has the HIV+ virus and is experiencing active AIDS? I believe the instructor had a responsibility to inform these students so they could be extra careful, take a little extra time etc when dealing with this patient. What do you think? Thanks, Steph

[mattsmom81]

Caroladybelle, if you are angry the doc did not put the patient on respiratory precautions, would you not be angry at a nurse who did not share spitting, combative behaviors involving BBF to you, regardless of infectious status? (And yes this has happened to me.)

My point? We are safest wearing moon suit garb, full PPE, into each room...but that is not practical. Effective communication guides us in our choice of how much PPE we use...and if info is withheld, we aren't being given the tools to safely guide us, IMO.

If you don't agree with that, then lets just agree to disagree.

[caroladybelle, BSN, RN]

Then the nurse should have shared the spitting and the fact that the patient was behaving in this manner with you. That I whole hearted agree with. Any patient behaving in that manner would require the same precautions, HIV or not. There was no need to know the HIV status, if one takes appropriate precautions with a patient that one knows is spitting, peeing on the floor, or incontinent. Because the precautions are going to be the same for all patients.

But knowing the patient's HIV status was completely unnecessary. All patients coming in are on Universal precautions.

The MD in my case needed to place the patient on Respiratory or droplet precautions. Did I need to know the potential agent involved? As with HIV+, and if the illness was to be treated with meds, it would be good to know it (as I previously said), but not necessary to give the patient appropriate care and protect all staff. Because the respiratory or droplet precautions would protect us, regardless of the exact name of the agent.

If one is really worried about these issues maybe they should wear a bunny/space suit. I don't see the need for myself, though

And, yes, we will have to disagree on this one, Mattsmom.