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
I have read posts that refer to reading the chart. Well that is not always possible.
I worked in a nursing home and the charts were locked up in the nurses office and the aides were not allowed access to them. They said it was a confidentiality issue. All we got was daily report on their adl's and change of status from the norm. WE had a patient on contact isolation and told not our business what was wrong with them.
I then worked in a second nursing home and the aides did not even get report, not their business. I asked the aide why and was told we could notice any change in them as we encountered them. (By the way, she was looking for another job.) The aides were not even consulted at end of shift about changes for report. If they did not mention it during care time it did not happen. I once went to them with my report papers and one by one asked about each patient and they were shocked I was doing so. It was a good thing I did that as they forgot to take care of somebody. He stayed in bed since not feeling well and did not get up for supper so they totally forgot about on him since did not have to get him ready for bed. They later turned me in for not doing my job so I quit. I really dont think I was the one not doing my job. I heard thru grapevine we had a patient with hepB but he was not in contact isolation cause against his rights. I guess when you have money, social status and private pay you are exempt from infection. I dont even think the MAR showed it as a diagnosis.
Most facilities go to clumping all the nurses notes for people in monthly format to keep staff from pulling the charts and knowing the truth about the residents. At least that is how it is in LTC. I guess that is why I will never go back.
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.
This is the voice of reason. Any patient can have HIV, so no, you don't need to be told. You should assume they all do.
Personally, I have seen enough bigotry and outright ignorance from healthcare workers towards HIV+ patients to believe that it should be a secret and nurses don't have the right to know (plus, it isn't like HIV is easy to transmit in the healthcare setting doing CNA work).
. I heard thru grapevine we had a patient with hepB but he was not in contact isolation cause against his rights. I guess when you have money, social status and private pay you are exempt from infection. I dont even think the MAR showed it as a diagnosis.
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Someone with Hep B doesn't need to be on contact isolation. It has nothing to do with money or social status, it has to do with scientific research. Hep B is transmitted basically the same way as HIV. So unless you get a needle stick injury or you're having sex with your patients or sharing their needles or mucking around in their bloody stool without gloves and with open wounds on your skin or something, you're fine.
This is the voice of reason. Any patient can have HIV, so no, you don't need to be told. You should assume they all do.
Personally, I have seen enough bigotry and outright ignorance from healthcare workers towards HIV+ patients to believe that it should be a secret and nurses don't have the right to know (plus, it isn't like HIV is easy to transmit in the healthcare setting doing CNA work).
I totally agree! You have to assume EVERYBODY is infectious. If you get into this habit of needing to know every patient's HIV status, it can lead to all kinds of problems. Just because someone isn't known to be HIV+ doesn't mean they don't have it! So what, are you going to be really really careful with the ones that you KNOW their + status, and be more relaxed on the ones who either are - or unknown? NO! You need to be careful with EVERYBODY! I believe there is a statistic out there that more than 50% of people who are HIV+ do not KNOW their status!!! And since it's not a routine test upon hospital admission, you're not going to know their status either.
Be careful of ALL sharps, wear glasses or other eye protection when necessary, and always wear gloves! Universal precautions always!
I think the students should have been told, but not for the reasons I've read (unless I missed something....)
They should have been told because their patient was more at risk than the "usual" med surg patient. Student errors (and there will always be student errors) can compromise an AIDS patient faster than almost anybody else.
Universal precautions protect caregivers (students) and patients as well. They are more than sufficient to protect the students against anything that isn't airborne.
My concern, probably, is that students coming out of a two week basic skills course should not be seen as able to protect themselves or their patients and they should have been taking care of low-risk patients who are almost ready to go home. Save the more challenging patients for nursing students who have been at it a little while longer.
But, recalling and repeating several of the "voices of reason" (whoever wrote that, that was good, and so appropriate) above, if you use universal precautions, you'll do OK.
And any place that didn't feel aides ought to get some kind of report on their patients is nuts. Work someplace else and don't let your family members or friends go there. If you feel confident (or are independently wealthy and don't have to work), maybe you can make a big deal of it, but chances are you aren't the first to be bothered by it, and you can actually run out of places to work by the time the blackball grapevine gets done with you. Do your best for your patients and your community, but don't get into any fights that will keep you from providing for yourself and those who depend on you.
Then again, there is always the anonymous call to the local health department if you can demonstrate that it negatively impacts patient care and public health.
And any place that didn't feel aides ought to get some kind of report on their patients is nuts. Work someplace else and don't let your family members or friends go there.
Agree with chris_at_lucas ... that's just crazy :angryfire
Someone with Hep B doesn't need to be on contact isolation. It has nothing to do with money or social status, it has to do with scientific research. Hep B is transmitted basically the same way as HIV. So unless you get a needle stick injury or you're having sex with your patients or sharing their needles or mucking around in their bloody stool without gloves and with open wounds on your skin or something, you're fine.
I totally agree!!, while i am not a nurse yet, i have volunteered at a place that deal with People with AIDS/HIV+. I Have also been train to give seminars about AIDS/HIV+ the disease and prevention etc. Granted its been about 2 years since i had a refresher on it all, BUT it not that easy to AIDS/HIV+ like it seem u guys are saying. I mean yes if u are working with needles etc u would be more at risk. BUT i would not think doing basic bedside care would put a person at great risk.
Also Fergus is right u be suprise just how many people are walking around with HIV+ and have no idea :uhoh21:. I for one will try to treat all my patients the same because u just never know :imbar
I agree, universal precautions are just that - universal. However, the OP described a pt. who is hospitalized w/active HIV and C. diff. In my humble opinion, does the pt. not need to be in reverse isolation due to their fragile immune status?
And did the students, as caregivers, not need to understand the fragility of the pt.'s condition? Or was the pt. treated as simply an available body to be bathed?
What is it you think they will give the patient by bathing him? Are they coming into work barfing and coughing? We don't put HIV patients in reverse isolation here or even contact isolation (can you imagine insisting that all their visitors don gloves and gowns to visit? It doesn't make sense). He was already on contact precautions thanks to the C-Diff. That's more than enough to cover the HIV.
What is it you think they will give the patient by bathing him? Are they coming into work barfing and coughing? We don't put HIV patients in reverse isolation here or even contact isolation (can you imagine insisting that all their visitors don gloves and gowns to visit? It doesn't make sense). He was already on contact precautions thanks to the C-Diff. That's more than enough to cover the HIV.
Barfing, most likely not. Coughing, quite possibly.
As a student, I'd like to better understand the several different lines of logic that have shown up in this thread. I haven't taken care of a pt. w/advanced HIV but in my limited experience it seems like when there is evidence of a pt. being immuno-compromised (for whatever reason - and that could include everything from HIV+ status to CA-related pan-cytopenia) they are placed in reverse isolation. Is an immuno-compromised pt. at a much higher risk of carrying other secondary infections, which also are an issue both for the pt. and the staff?
nontrad1964
42 Posts
I have read posts that refer to reading the chart. Well that is not always possible.
I worked in a nursing home and the charts were locked up in the nurses office and the aides were not allowed access to them. They said it was a confidentiality issue. All we got was daily report on their adl's and change of status from the norm. WE had a patient on contact isolation and told not our business what was wrong with them.
I then worked in a second nursing home and the aides did not even get report, not their business. I asked the aide why and was told we could notice any change in them as we encountered them. (By the way, she was looking for another job.) The aides were not even consulted at end of shift about changes for report. If they did not mention it during care time it did not happen. I once went to them with my report papers and one by one asked about each patient and they were shocked I was doing so. It was a good thing I did that as they forgot to take care of somebody. He stayed in bed since not feeling well and did not get up for supper so they totally forgot about on him since did not have to get him ready for bed. They later turned me in for not doing my job so I quit. I really dont think I was the one not doing my job. I heard thru grapevine we had a patient with hepB but he was not in contact isolation cause against his rights. I guess when you have money, social status and private pay you are exempt from infection. I dont even think the MAR showed it as a diagnosis.
Most facilities go to clumping all the nurses notes for people in monthly format to keep staff from pulling the charts and knowing the truth about the residents. At least that is how it is in LTC. I guess that is why I will never go back.