Health concerns of mature women living with HIV in the midwestern United States.

This study was performed to better understand the health concerns of mature Midwestern women living with HIV and to offer health care providers information about the spectrum of medical and psychosocial needs of this population. Individual interviews were conducted with 18 low-income women who were 41 to 68 years of age. Interviews showed multiple needs that encompassed both physical and emotional health: more frequent health screenings, the ability to differentiate symptoms of advancing HIV from those of aging, desire for knowledge about reasonable expectations for aging women with HIV, and attention to emotional health needs and social support. Interventions aimed at helping mature HIV-infected women cope as they age, education about the normal aging process, consumer information about appropriate timing of health care screenings, and mechanisms to facilitate the creation of social support networks to decrease isolation seem to be needed in this population.

How to evacuate a psychiatric hospital: a Hurricane Katrina success story.

This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans.

Successful adherence after multiple HIV treatment failures.

BACKGROUND: Non-adherence to human immunodeficiency virus (HIV) medications often results in irreparable drug resistance and poor outcomes. Hence, care providers generally think that treatment of HIV disease should be delayed until a person is 'ready' to adhere. However, little research has focused on understanding the process that results in readiness for successful adherence. AIM: The aim of this phenomenological study was to describe and understand the experience and decision-making processes of people who became adherent to their HIV medication regimens after previously failing treatment because of non-adherence. METHOD: A Husserlian phenomenological approach was taken, and in-depth interviews were analysed using Giorgi's method of phenomenological description and analysis. FINDINGS: Thirteen HIV-positive men and women who had previously failed two or more treatment regimens because of non-adherence were purposefully selected from two infectious diseases clinics in the Midwest region of the United States. They had achieved and sustained adherence to their HIV medications for 1 year or longer without formal intervention. All participants experienced a 'trigger' event preceding the process that led to the ability to incorporate lifestyle and health behaviour changes necessary for successful adherence. Factors associated with the process leading to adherence were: changing attitudes towards HIV medication, finding the right health care provider, creating the right support system, getting control of life and having goals. CONCLUSIONS: This study demonstrated that HIV-positive individuals who had been non-adherent and had been viewed as 'difficult to treat' nonetheless successfully adhered to treatment once they became 'ready'. Findings from this study implicate that readiness may be a necessary component for successful adherence, particularly in HIV-positive individuals who have previously failed treatment. Understanding the relationship between the phenomenon of readiness and subsequent HIV treatment adherence has implications for clinical decision-making and for development of interventions that enhance adherence and prevent HIV drug resistance.