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Discussion

What advice could I have given but...?

I had a patient tonite come in for surgery and she just found out from recent lab results that she has contracted HIV. She was crying and nervous all at the same time. She admits that she was scared to tell her boyfriend who she's been with for a few years and she feels really loves her. After recovering her, she started talking about how she was still in shock over the results and she asks me how should she confront this to her boyfriend? I was quite taken back by the question and didn't expect her to ask me for advice, but at the same time the nurse advocate and psychology 101 in me opened my mind and made me feel responsible for giving this young lady and honest answer. I told her to communicate this to her boyfriend ASAP, but at the right time. Certain things can be overbearing as this situation is and he may be too emotional to handle this if its not told at the right time and only she knows what that time is. He needs to be checked out right away to protect himself and others if he does decide to end the relationship. I also ask her if she had any clue of who she could have contracted this from and she wasn't sure. Was I appropiate? Should I have said more? :smackingf

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    I hate giving patients advice on personal conversations. That's tough.

    Seeing as we are MEDICAL with a dash of psych underlying I'd throw a medical approach in there as a safety. Maybe reminding them that they are in the collection phase and encourage patients like that to collect information before opening pandora's box.In the future I would just make sure my patient had as much information as they could at the present time. In this situation the doctor counseling them on screening, how long they could have had it, risk factors she partakes in, etc. Then suggest that will help guide her conversation further.

    It's not easy. Patients like to put nurses on the spot and we don't always have the answer immediately. I wouldn't beat myself up about it. It's unfortunate but you won't be the last one she talks to before she talks to her boyfriend.

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    I'd contact the infection control nurse where you work and get some help; that way it will be within the policies of your facility :)

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    I'm surprised the doctor who gave her the results didn't give her the opportunity to discuss this, but maybe she was too shocked to be able to think about it then.

    I'd have been inclined to advise waiting until she's over the shock, and to dicuss with an HIV specialist (councellor, support worker, NP or physician) the best way to approach it. Unless there's no other way she could have contracted the virus, her current partner may not be the source, which adds a whole extra layer to telling him.

    I'm not saying your advice was wrong, and it's certainly a really complicated, put-on-the-spot situation.

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    I don't think patients like to "put us on the spot". I think they respect our knowledge and trust us to help them. I also know patients can say the darndest things comming out of anesthesia.;) I will tell you , as I have become a professional patient, Doctors are always so "busy" and "preoccupied". They make you feel bad when you need to know more. It's frustrating when you're scared and anxious, the MD does their schpeel, they jump up to leave and when you go to ask a question.......... they glance at their watch, sigh and sit down looking at their watch every 2 seconds and ask you want you want. It just makes you feel "Never mind" I'll figure it out.....:rolleyes:.

    Patients will confide in us becasue we are safe. I think you answered well. But I also would have asked her if I could gather some information and numbers for her to place in her belongings for future reference. I would then check with the and or supervisor and get the numbers (they have them). If the patient was spending the night or a few hours I would contact Socila Services for a stat consult. BUt she really need to tell her SO so he too can be tested......:)

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    I disagree with giving someone advice. That assumes they haven't thought of a whole lot of options themselves. It also puts us in the spot of giving advice that isn't appropriate to the specific person or situation and then possibly having it backfire on the patient and us.

    Giving the patient all the information about the services that are available for her illness is a good thing. Getting others involved who can help (social worker, infection specialist, etc.) is good too. The patient needs to know all about it so she can make her own choices on what to do.

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    I think that infection control, her doctor, or the health department should have been contacted for post-HIV test counseling. HIV counseling is usually provided by the health department and the disease intervention specialists are great at it. I think that you provided some good basic info for her on communicating with her boyfriend and just letting her vent. I know that it's a touchy subject. If you have access to the internet at work the CDC has some resources on HIV counseling like the Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm). There's literature on the CDC website that you can print out and give to pts too.

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    I'd suggest to continue to be supportive, as you have been. You could identify what services are available to assist her with this issue; probably social services or the chaplain, maybe I.D., or perhaps there is an outside agency that specializes in this area.

    With proper treatment she can lead a normal life, for many decades. He needs to be tested, but the immediate issue is providing them the information and support they need to get over this first hurdle. There is so much mis-information and outdated information. She needs someone with her. She should not have to tell him alone.

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    The only thing I would add is that while she is waiting to tell the BF "at the right time," that she should absolutely practice safe sex in the interim. Might be too little too late, yet you never know...

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