First clinicals disclosure obligations re: HIV+ patient?

Achoo!, LPN · Jul 30, 2004

They don't have you get report form the nurses before giving care? We had to sit in the lounge with the nurses and get report before we did stuff for my CNA clinicals.

DeanG · Jul 30, 2004

I also agree. I do question one thing though. I begin my first Nursing class on Aug 16, and I just completed a week long orientation today. In this past week, one thing I did learn was that as a NS I have a right and a requirement to my patient's chart. Before even looking in the eyes of a patient, I was told we are to review the chart. If this is true, wouldn't the student read that the patient was HIV+ in the chart? I know they are students, as I will be to, but as students we too must be responsible.

nontrad1964 · Jul 30, 2004

I dont get the secrecy of aids and hepatitis. If a patient has staph or strep or even teh chicken pox, they pass it along at report. But with aids and hep it is a big secret. I dont think that is fair to the health care provider in any situation. They tell us to treat all like they have something if working with body fluids, because you never know as a safety precuation. BUt when they know, we should know and I feel we have a right to know. waht if you go to pull the bed back to do vitals and the bed is wet or dirty, then you have contact. And one doesnt normally wear gloves for what they feel is casual client contact. Plus you have the laundry issue and garbage issue. If we dont know, then the dirty stuff is not properly disposed of and cleaned.

Was the person on reverse isolation, that should have been a good give away there was something serious. I once worked in a facility where we had an AIDS patient and they said an isolation sign and cart on his door was a violation of his rights, yet if a person had MRSA a sign and cart would have been there for sure.

Toby's mum · Jul 30, 2004

These were basic CNA clinicals and the pre-nursing students weren't given access to the patients' charts--they didn't even have access to the kardex. With HIPPA, it seems even the clinical instructors were hyper-conscious about what info they shared with the students. The only info given was the vital signs and flow sheet. Some had access to the I&O sheet. The info about HIV+ was not relayed in the report to the two students who had this patient. It just doesn't seem morally responsible to leave this critical information out. At the very least, these students could have been advised to double-glove in this situation--those gloves tear so easily especially, it seems, while you are doing a procedure.

jschut, BSN, RN · Jul 30, 2004

It's awful, but believe it or not, we are told that a person can keep it a secret and as far as being the healthcare professional, we are expected to use universal precautions, and as long as we do, there is nothing to worry about.

I think we should be told. Universal precautions or not. I have taken care of a gentleman with AIDS before until he passed away, and wasn't afraid of him, so where to the "higher ups" get off acting like we have no need to know? That really peeves me..... :angryfire

klone, MSN, RN · Jul 30, 2004

Is there anything more needed besides universal precautions with HIV patients? I imagine they didn't feel it necessary to tell them because it wouldn't have affected how they care for the patient or the precautions they were to take.

Altra, BSN, RN · Jul 30, 2004

I agree with the others above - seems like there are a few missing pieces of info in this story... didn't the students have to do some kind of prep before providing pt. care? That would have meant reading the chart. And if the pt. has active HIV, surely they would have been in reverse isolation, probably w/contact precautions - that would have been another heads up. And report from the nurses - even if they were just providing very basic care at this point, no meds or anything like that, I know in every single report I've ever heard in 3 semesters of clinicals that there are all kinds of little details passed along - like how well or poorly a person moves around, little personality quirks, anything and everything that's helpful to know when interacting with them.

So I suppose that different facilities & schools can have very different policies, but I'm having a hard time understanding how this particular situation could have unfolded the way that it did. :uhoh21:

twarlik · Jul 30, 2004

I agree that the students should have been told of the patient's HIV status. However, I don't believe it would have been necessary for them to double glove or take any other precautions, especially considering that the patient was already on contact isolation for c-diff.

jschut, BSN, RN · Jul 30, 2004

With gloves and body fluids, they say we should be safe....

I disagree.

What about with a needlestick if the pt gets out of hand (at a time of distress?) Should we not be prepared adn have two people in the room? (Just an idea...)

Altra, BSN, RN · Jul 30, 2004

I also agree. I do question one thing though. I begin my first Nursing class on Aug 16, and I just completed a week long orientation today. In this past week, one thing I did learn was that as a NS I have a right and a requirement to my patient's chart. Before even looking in the eyes of a patient, I was told we are to review the chart. If this is true, wouldn't the student read that the patient was HIV+ in the chart? I know they are students, as I will be to, but as students we too must be responsible.

Yes, absolutely, GMD - you will read your pt.'s chart. If your instructors are anything like mine, you'll be trying to cram the ENTIRE chart into your brain, lol. :rolleyes: :chuckle I suppose it's possible that a pt. could be hospitalized at a facility with no prior medical records and choose not to volunteer the info about HIV status, but once admitted, the pt.'s standard lab work (CBC w/differential, etc.) would probably soon point the way towards HIV. I don't think the situation described by the OP is typical.

It seems to me like the school in this particular instance was trying to provide bed-making & bathing experiences for its students, but ... even way back the first week of clinicals, at my school we never got near a pt. even just to do a psychosocial interview without first reading the chart. To tell a student to bathe a pt. without knowing anything else about them ... the more I think about this, it's like treating pt.'s as simply bodies. I've been taught that nursing is about caring for the whole person.

naggytabby, BSN, RN · Jul 30, 2004

I'd check the facts first - is this a first hand account of personal experience or an urban myth?

I agree that you should know the "story" of your patient BUT if you use universal precautions with everyone you're always safe. And you will not always know the whole story on every patient- not everyone will share various dx regardless of what those dx are.