Telling a Client they have HIV

  1. Hello, I am in a dilemma. Ok here is the scoop: I am a public health nurse, and I work in Teen Health as well as Women's Health. Working in this role, I have expanded RN functions like I do Pap Smears, STD exams, Breast exams...etc. Anyhow, I also draw blood and order labs like HIV, RPR, etc. Well a client of mine is 16 years old and I just drew his blood Monday. Unfortunately, the HIV test came back reactive. I am so devastated. I look at the teens as my peers, yet my "babies" although I am not too much older than they are. (Im 24). I have only been a RN for a year, and this is my first case. I feel such dread and I even feel sadness about having to give this news. Of course, I will call for back up and have others there with me to handle to counseling piece. But, I am just so sad about this even though I know HIV is a reality and many people have it. I am just struggling because I know this client is going to have a severe meltdown and Im afraid I may react as well. Any thoughts, comments, or suggestions??!
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    About BSN317, NP

    Joined: Apr '08; Posts: 68; Likes: 19
    Nurse Practitioner; from US
    Specialty: 7 year(s) of experience in Family Med, Mental Health, Public Health

    24 Comments

  3. by   melz34
    just break it gently to the client and it is ok for you to be emotional just stay strong in front of the patient and be emotional on your own it is best not to get to emotionally involved with a patient I work in a childrens hospital on a ward and I made that mistake I got to emotionally involved with a patient with CF and her CF was really bad and she had lots of breathing problems she had asthma and CF and she died at the age of 14 it was really emotional but I stayed strong for the parents
  4. by   rn/writer
    I strongly encourage you to contact HIV/AIDs treatment programs and support groups and others who will help you work through your own reactions before approaching this patient. Many years ago, the prognosis for HIV/AIDs patients was grim and the end usually came within months (or several years, at most) after diagnosis. Now, with proper treatment, seroconversion can be held off for a long, long time. The universal "death sentence" is not what it used to be.

    Arm yourself with accurate information about life expectancy, treatment options, and support. You can't stop having your own emotions, but this isn't about you, and you owe your patient the most realistically optimistic outlook possible. Do your crying elsewhere. Then support this young person in getting help.

    Living with HIV/AIDS is not always a walk in the park but the operative word is "living." There are HIV+ people around today who were diagnosed more than fifteen years ago. And new treatment regimens are being developed all the time.

    You may find that you do better with your own feelings once you have a more positive impression. Whatever happens, please find a way to get your own reactions under control so you can help meet this patient's needs.

    I wish you the best.
    Last edit by rn/writer on Jun 17, '09
  5. by   ElvishDNP
    The fact that you are concerned about doing it 'the right way' speaks volumes about you in itself. I second the other posters - give yourself time and space to work through your own feelings about this before you give this patient his results. Cry, grieve if you must, but when it comes time to sit down w/ this patient, you will need to have your game with you, so to speak.

    Is there a person on-site who is a certified HIV/AIDS counselor, or are you 'it'? If so, that person can be a great resource for this young patient. If not, there are still so many other programs and groups out there, and as Miranda said, HIV is not the death sentence it once was. Yes, it takes some adaptation. Yes, your patient will be angry, and grieve, and he may even deny it. All normal.

    But in the end, it will likely be you who helps him learn to cope with his diagnosis, and he will need you to have all the information you can. Thank you on his behalf for caring, and I too wish you the best.
  6. by   BSN317
    Thanks for the responses. I know I mustnt break down in front of the client, and I am just trying to sort out my own feelings as to how this process is going to proceed. I just want to be the best support I can for the client and offer empathy. There are a group of district employees whom are certified to do this type of thing, but we are required as RNs to be trained in HIV counseling and testing as well. So...it is just a little daunting for me since this will be my first case. In school, I never thought Id have to do this type of thing- I thought it was reserved for physicians.

    I really appreciate the suggestions as tomorrow is the big "day." Thanks!
  7. by   Mexarican
    As a person who has done this several times in my former life i recommend you have a person from your local HIV/AIDs organization there on site when you give this young man his results. That way you have resources at the ready for this person. The way i did it was i would walk in the room with the patient. Have them sit down, and tell them, "So & So, your results came back positive for HIV antibodies" and then be quiet. Do it gently, but don't build up to it...get to the point. Let there be silence so it sinks in and so you can allow the patient "room" to react. Be prepared for the worst reaction but mostly people are in shock and initially don't freak out like you would think at the news. And others already "kinda knew" that there was a good chance it would come back positive.

    Nonetheless, after that the first thing i would ask is if they have a support person who KNEW they were getting tested? Do they have someone close to them who they can talk to the minute they leave the clinic? Allow them to call their support person if they wish. If you have a person there from the local AIDs organization they can "connect" them into support services immediately. If you do not have that resource at your disposal then i personally make an "appointment" with the patient to call them in 48hours to "check on them" and whether that would be ok. Gather yourself before you give the results but you should not put off giving the results any longer than your agency gives itself to deliver results. Good luck...this is never easy but you care, therefore you will do it right

    Mex
    Last edit by Mexarican on Jun 17, '09
  8. by   BabyLady
    Is this typical in public health?

    In the health department here, only the advanced practice nurse or the physicians there disclose HIV or a Herpes dx and counseling is ALWAYS immediately available as well as the client has to come in to get the dx in person.

    They delegated this to you??????
  9. by   Mexarican
    Quote from BabyLady
    Is this typical in public health?

    In the health department here, only the advanced practice nurse or the physicians there disclose HIV or a Herpes dx and counseling is ALWAYS immediately available as well as the client has to come in to get the dx in person.

    They delegated this to you??????

    Actually many many health departments do not offer Primary healthcare and therefore would not have a physician or NP on staff. The only offer basic women's health services and STD screenings and are staffed almost entriely by RNs and medical assistants. I worked at one like this for several years.

    Mex
  10. by   traumaRUs
    Who is your back-up? What do your protocols say about disclosing this info? What resources are available to you?
  11. by   jadelpn
    I thought there were specific privacy laws, and policies regarding telling someone of their reactive HIV status. Also, what responsibilities do you have in first off giving him test results, and his reaction to them? (For all you know he could jump up and run out of the clinic--then what?) I think this is a huge, huge undertaking that I would think be best left to your supervisor, following whatever agency policy you have in place, as there must be one in this type of setting. I would triple check that all my "I's" were dotted and my "t's" crossed especially before telling a child this news. There is no MD that originally ordered the test? Is it policy to retest to be sure it is not a false positive? I understand that the emotional nature of this, and I am sure your feelings of responsibility must be overwhelming, but I do think that someone not as emotionally attached to the patient needs to follow the proper protocol, perhaps the MD that ordered the test to begin with. Additionally, perhaps counseling prior to the test being drawn about "what if it is positive" could be in order, especially if the patient is participating in risky behavior to begin with.
  12. by   canoehead
    It's a great idea to have someone on hand from an HIV advocacy center. I would also approach it as a manageable chronic illness, not a death sentence. Currently people maintain negligible viral loads and have active healthy lives, for the most part.
  13. by   BSN317
    Hello again
    No, no physician ordered the test. The clinet came in requesting an STD screening due to symptoms that they were experiencing. As a part of the STD screening, we have to offer an HIV test, whether they accept it or decline it. The client accepted, so I drew the blood and sent it off. I work under a protocol, and it allows me to do this and other things as well; many things actually. I would like to add that I am not emotionally attached in the sense that I cannot perform my role, but only that I have never dealt with this before and just wanted some pointers. I was only looking for advice from others who may have handled this in the past. I contacted district clinical services and they will be on hand to provide the necessary counseling and serve as a resource as the client will then be a part of district care as an HIV client. I have composed my thoughts and I feel much better, but the Teen Clinic is the only care many of these youth receive and they become regulars, so maybe I came off wrong but I am not overly attached to them; I just care about their well being as I do any other patient.
  14. by   SweetOldWorld
    Since this is a minor, what is the role of the parent(s) or guardian? Will they be involved in any way?

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