Meeting the physical health-care needs of people with substance misuse problems: evaluation of a nurse-led blood-borne virus programme.

People who inject substances are at high risk of many physical health problems. The Blood-Borne Virus Programme (BBVP) is a nurse-led health screening programme for blood-borne conditions in substance misusers. The aim of this study was to evaluate the service delivery, organization, and outcomes of the BBVP. The researchers used a case study with three units of analysis: BBVP clinical activities during 1 year using a prospective audit; service users' (n = 20) and professional stakeholders' (n = 10) experiences of the BBVP using semistructured interviews; and service users' (n = 132) satisfaction with the BBVP using a satisfaction measure. The BBVP conducted 4450 consultations with 1940 service users; 847 of whom were new, and presented with many health problems compromising their physical health. The BBVP provided a range of interventions meeting its users' physical health needs. Users and other stakeholders were very satisfied with the service, and suggested ways in which the service might improve. The BBVP appeared to meet the physical health-care needs of people dependent on drugs. Nurse-led services, such as the BBVP, offer a solution that, in the view of users and professional stakeholders, is impacting significantly on the physical health and well-being of people dependent on drugs.

Ethical decision-making when caring for the noncompliant patient.

Ethical dilemmas frequently occur when nurses care for patients with a history of intravenous substance abuse who are hospitalized on medical-surgical units. This article discusses the recent findings on substance abuse, including its impact on the brain, effects on society and healthcare, available treatment options, and medical complications related to substance abuse. An ethical model is introduced to analyze ethical dilemmas with an accompanying case scenario. Resources available to nursing staff in many healthcare settings are identified as well as strategies to improve nursing care for this challenging population. The purpose of this article is to reduce nurses' feelings of frustration and stress in order to improve their morale. Finally, this particular contemporary ethical issue will be viewed as if perceived by Florence Nightingale.

Transforming the meaning of HIV/AIDS in recovery from substance use: a qualitative study of HIV-positive women in New York.

Recovery from substance use is a vital concern for many women with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). This qualitative study explores the meaning of women's HIV infection for their transition from drug use to recovery. Interviews were conducted with 15 female clients of a drug treatment program and AIDS nursing home in New York City. For most participants, HIV did not constitute the main reason for starting their recovery. The dual diagnosis program, however, facilitates an important transformation of the meaning of HIV/AIDS. Previously viewed as just another reason to use drugs, women now increasingly perceive their HIV infection as an incentive to stay clean and sober.

Utilization of formal and informal home care by AIDS patients in Boston: a comparison of intravenous drug users and homosexual males.

The assumption that intravenous (i.v.) drug users have weaker informal support networks than homosexual men has led to opposing policy recommendations: one emphasizes outreach and more formal (paid) home care for i.v. drug users, whereas the other maintains that formal home care programs are less effective for this risk group due to the lack of informal (unpaid) caregivers to coordinate efforts. Data from interviews with a sample of 231 persons with AIDS in the Boston area were used to compare the use of formal and informal home care between the two largest risk groups, homosexual men and i.v. drug users. Multivariate regression analysis was also employed to adjust estimates and to determine the significance of population characteristics in explaining utilization differences. IV drug users received about twice as much formal and informal home care as homosexual men. Controlling for functional status, income and assets, insurance and potential caregiver supply, i.v. drug users obtained significantly fewer formal home care services, but more informal care. Overall, i.v. drug users received a greater number of adjusted home care hours. These findings cast doubt upon the previous assumptions of the literature and suggest that members of both risk groups are appropriate candidates for formal home care services.

IV drug use, dementia, and nursing home care for PWAs (persons with AIDS).

Despite the usual focus on daily costs, because PWAs have higher costs per day than other SNF residents, LOS and days of care are important cost indices. Data on LOS for 102 admissions and annual days of care for 90 PWAs show average 64-day LOS and 67 days of care. Regression analysis and survival analysis show dementias and IV drug use to mean longer LOS and more days of care. Higher PWA costs must be sustained over longer periods for PWAs with dementias and for IV drug users, who may claim increasing shares of the SNF care provided to PWAs.