Emotional and Ethical Concerns
Nurses in all settings will be called on to provide care for patients with HIV infection. In doing so, they encounter not only the physical challenges of this epidemic but also emotional and ethical concerns. The concerns raised by health care professionals in-volve issues such as fear of infection, responsibility for giving care, values clarification, confidentiality, developmental stages of pa-tients and caregivers, and poor prognostic outcomes.
Many patients with HIV infection have engaged in “stigma-tized” behaviors. Because these behaviors challenge some tradi-tional religious and moral values, nurses may feel reluctant to care for these patients. In addition, health care providers may still have fear and anxiety about disease transmission despite education concerning infection control and the low incidence of transmis-sion to health care providers (Chart 52-10). Nurses are encour-aged to examine their personal beliefs and use the process of values clarification to approach controversial issues. The Ameri-can Nurses Association’s Code for Nurses can also be used to help resolve ethical dilemmas that might affect the quality of care given to HIV-infected patients.
Nurses are responsible for protecting the patient’s right to privacy by safeguarding confidential information. Inadvertent disclosure of confidential patient information may result in per-sonal, financial, and emotional hardships for HIV-infected indi-viduals. The controversy surrounding confidentiality concerns the circumstances in which information can be disclosed to others. Health care team members need accurate patient information to conduct assessment, planning, implementation, and evaluation of patient care. Failure to disclose HIV status could compromise the quality of patient care. Sexual partners of HIV-infected patients should know about the potential for infection and the need to engage in safer sex practices, as well as the possible need for test-ing and medical care. Nurses are advised to discuss concerns about confidentiality with nurse administrators and professional nursing organizations such as the Association of Nurses in AIDS Care, and to consult legal experts in their state to identify the most appropriate course of action.
AIDS has had a high mortality rate, but advances in anti-retroviral and multidrug therapy have demonstrated promise in slowing or controlling disease progression. It is not known whether current treatment regimens will remain effective, because viral drug resistance has developed with most previous medications.