The limitations of generic AIDS educational programs for the health professions.

Three major trends are driving the widespread need for continuing education in AIDS. First, with the spread of AIDS, increasing numbers of health care professionals are becoming involved in the care and treatment of AIDS, ARC and HIV positive individuals. Second, as the disease spreads beyond current AIDS epicenters, more persons with minimal information are required to have a baseline working knowledge of AIDS. Finally, the reluctance of many health care professionals to care for HIV-positive individuals, along with already existing staff shortages, limits access to care and makes the provision of responsive educational programs even more important. Generic programs to educate health professionals frequently lack sufficient specificity and sensitivity to address the needs of health professionals with varying levels of knowledge and role responsibility. This paper briefly summarizes the literature on the similarities and differences in knowledge and attitudes across and within professional groups. In addition, it presents specific research designed to provide initial direction for considering the circumstances under which health professionals, particularly nurses and physicians, may or may not profit from generic programs aimed at mixed levels and types of health care provider.

Building culturally sensitive substance use prevention and treatment programs for transgendered populations.

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.

Maladaptive coping in the critically ill population with acquired immunodeficiency syndrome: nursing assessment and treatment.

A diagnosis of the acquired immunodeficiency syndrome (AIDS) is a devastating experience, placing those with the syndrome at high risk for ineffective coping. During the acute stage of illness, when the patient is admitted to a critical care setting, a crisis can ensue and precipitate intense anxiety, anger, denial, depression, and even suicidal ideation. Although it is imperative that critical care nurses become proficient in accurately assessing, diagnosing, and treating the disease in individuals who have an increased risk of maladaptive coping, there is no systematic basis for assessing the coping of patients with AIDS. Our purpose is to present a theoretically based explanation of the coping experience of persons with AIDS and to delineate nursing interventions designed to deal with maladaptive responses. The early and deliberate assessment, diagnosis, and treatment of such responses by means of a full range of psychosocial interventions are needed to enhance the coping efforts of the patients and optimize their psychosocial adjustment.

Emotional exhaustion and distress among nurses: how important are AIDS-care specific factors?

This study describes distress symptomatology and levels of job-related exhaustion in a sample of 153 hospital nurses currently caring for AIDS patients. While the level of emotional exhaustion in the sample was not alarmingly high, these nurses did report symptoms of distress. Levels of emotional exhaustion were related to a variety of personal demographic, AIDS-specific, and job-related factors. These factors included: age, income, years of practice on the unit, recent change in shift, type of unit, discomfort caring for AIDS patients, willingness to continue caring for AIDS patients, number of AIDS patients cared for, job tension, job influence, and enthusiasm about returning to work. Regression analysis indicated, however, that six general job-related factors accounted for about 46% of the variation in emotional exhaustion. These results suggest that general job-related factors such as 8-hour shifts, changing shifts, level of job tension, and other factors characterizing all hospital care are particularly worthy of future study.

Correcting deficiencies in HIV/AIDS care for transgendered individuals.

Studies suggest that transgendered individuals are at high risk for acquiring HIV through injection drug use and sexual risk behaviors. Beginning efforts are being directed to identify the unique needs and concerns of these individuals and to develop culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse and HIV treatment services. These efforts include examining the available and needed services from the perspectives of both the transgendered community and health care professionals. This article reviews the phenomenon of transgenderism and the social context that places these individuals at risk for HIV. Additionally, this article proposes some guidelines for those who are in positions responsible for designing, evaluating, and implementing existing health care services to transgendered populations.

Patient satisfaction on AIDS and oncology special care units and integrated units: a pilot study.

The authors assessed patients' satisfaction with their nursing care in seven hospitals. Five of the hospitals utilized the special care unit (SCU) method of delivering care to AIDS or oncology patients; three had SCUs for AIDS patients. All seven of the hospitals had integrated units (IUs) where general medical, oncology, and/or AIDS patients were received in various proportions. Satisfaction with nursing care was measured with the Risser Patient Satisfaction Instrument. Patient satisfaction with nursing care was shown to be a function of delivery method; AIDS and oncology patients on SCUs expressed greater satisfaction with their care than medical, oncology, or AIDS patients on IUs (p less than .001). Patient satisfaction with nursing care was greater among whites than nonwhites. Also, some major sociodemographic and case mix variables, such as age, employment status, and diagnosis, were not associated with patient satisfaction directly; in other instances, the associations initially seen did not hold when delivery method (SCU vs. IU) and race were controlled for in a linear regression analysis.

The relationship of stressful life events, health status and stress-resistance resources in persons with AIDS.

Depression and hopelessness are major problems in persons with AIDS (PWAs). This study provides a paradigm for viewing these mental health states as outcomes that are dependent on stressors, physical health states, and stress-resistance resources. The sample consisted of 30 male, English-speaking PWAs with stage IV AIDS. A significant positive relationship was found between negative life events and the measure of depression, and number of complications and depression. Satisfaction with social support, intrapersonal hope, and global hope were all significantly, negatively associated with hopelessness. The findings support the importance of stress-resistance resources in promoting mental health in PWAs.

Women with HIV: living with symptoms.

This exploratory study used a semistructured interview to describe women's experiences coping with HIV-symptoms, their descriptors of their worst and best days, and their attempts to control symptoms. A convenience sample of 44 women, largely women of color, of lower socioeconomic status, unemployed, seeking treatment in one of six outpatient clinics in Los Angeles, were interviewed. Fatigue, the most frequently reported worst symptom, was present in 98% of these women. Feeling physically sick and having negative mood were mentioned most often in descriptions of worst days; being active, feeling physically healthy, and having positive mood were descriptors of best days. Of the total, 59% used rest/sleep to control symptoms, and this often was used in conjunction with healthy diet. The results of this study reveal aspects of women's day-to-day experiences with HIV-related symptoms.

The stresses of hospitalization among AIDS patients on integrated and special care units.

This study examined the stresses of hospitalization in AIDS patients and assessed the extent to which two different inpatient delivery systems differed with respect to perceived stresses in these patients. Patients from four AIDS dedicated special care units (SCU's) and five AIDS integrated units (IU's) in eight acute care hospitals were surveyed using a modified version of the Volicer Hospital Stress Rating Scale. Stresses related to loss of independence, separation from loved ones and problems with medications were experienced equally by both groups of patients. However, SCU patients had lower total hospital stress scores than IU patients in terms of the number of stresses experienced (p = 0.008) and how bothersome these stresses were perceived to be (p = 0.02). Additionally, patients on IU's more frequently experienced and were bothered by factors associated with ambiguity about their care and condition and feelings of abandonment and impersonal or discriminatory treatment.

Emotional distress in men with life-threatening illness.

This descriptive survey explored the relationship of health status, functional status, stressful life events, stress resistance resources and emotional distress in 60 men with life-threatening illness (N = 30 with cancer and N = 30 with AIDS). Sixty-two percent met CES-D criteria for clinical depression. This study's results supported the hypotheses that poorer functional status and greater negative stressors are associated with both higher levels of hopelessness and depression. Twenty-four patients constituted a group with severe emotional distress. This group was significantly different from the less vulnerable group with poorer functional status (KPS), a greater number and severity of negative stressors, less satisfaction with social support, and less hopefulness.

Burn-out in hospital nurses: a comparison of acquired immunodeficiency syndrome, oncology, general medical, and intensive care unit nurse samples.

Previous research has shown that job-related stress and burn-out are associated with high levels of demand placed on the worker, especially in situations where influence is low. This study examined burn-out among nurses working on acquired immunodeficiency syndrome (AIDS) special care units (SCUs), oncology SCUs, medical intensive care units (ICUs) and general medical units to measure the extent to which delivery method (SCU, ICU, and general unit), patient diagnosis, or other key personal and work-related characteristics were associated with the level of distress in these nurses. A sample of 237 nurses from 18 units in seven hospitals were surveyed using the Maslach Burnout Inventory. This study showed no significant differences in burn-out scores across nurse samples representing variations in patient diagnosis and delivery method. Specifically, nurses on AIDS SCUs, oncology SCUs, medical ICUs, and general medical nursing units reported similar levels of distress on the burn-out subscales. There was one exception: medical ICU nurses scored significantly lower on the Personal Accomplishment subscale (P < .001). Regression analyses for the Emotional Exhaustion and Personal Accomplishment subscales indicated that greater job influence had a significant protective effect on emotional exhaustion and enhanced personal accomplishment (P < .05). As expected, job tension was a key predictor of exhaustion (P < .001), and being white was associated with greater feelings of accomplishment (P < .002). Working in a medical ICU continued to show a negative impact on accomplishment when race and other important covariates were controlled for (P < .05), and working on an AIDS SCU was predictive of exhaustion in a multivariate context (P < .05).

Personality hardiness, work-related stress, and health in hospital nurses.

Personality hardiness is a set of beliefs about oneself and the world one lives in. Hardier persons take control of their lives, believe that commitment to goals will result in positive outcomes, and perceive daily stressors as challenges. Hardiness has been linked with less stress and fewer health problems among various occupational groups. This study found that among 237 hospital nurses, work-related stress and emotional exhaustion were associated with greater health problems in the form of anxiety, depression, and somatic complaints. Hardier nurses reported less work-related stress, less emotional exhaustion, and less anxiety, depression, and somatization. This article discusses considerations for strengthening future studies concerned with the relationships between personality hardiness, work-related stress, and health in nurses.

Demystifying the influence of hospital characteristics on inpatient mortality rates.

Death, although not the only measure of adverse outcome, has been studied more than any other single occurrence. The authors discuss the findings of these studies and propose a conceptual framework to explain the relation between several hospital characteristics (e.g., profit status, RN ratios) and inpatient mortality rates. These studies raise the issue of whether some hospital characteristics are distal contributors and others, such as RN ratios, are more proximal explanatory variables of the mortality rate. Implications for understanding the relation of nursing's role in the array of potential contributors are discussed.

Age, developmental, and job stage influences on nurse outcomes.

This descriptive study surveyed 412 nurses in three hospitals and found that older nurses and nurses in more mature developmental stages showed greater job satisfaction, productivity, and organizational commitment. Job stages of entry, mastery, and disengagement were examined, and 24% of nurses reported being disengaged from their jobs, with lower satisfaction and commitment. Implications include the compelling need for nurses and organizations to do career planning together to avoid disengagement of nurses so critical to patient and organizational outcomes.

DRGs and primary nursing: are they compatible?

The diagnosis related groupings (DRGs) prospective pricing reimbursement system is already affecting nursing service budgets and unit level staffing patterns. As cost containment pressures rise, nurse administrators have to seriously reexamine primary nursing as a viable care modality. This article discusses the compatibility of DRGs and primary nursing. Approaches to future research on measuring outcomes to assess the continued use of primary nursing are suggested.