Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 22466-22470 357

bothersomeness, clinical status, and function. A list of 21 symptoms was compiled
based on literature review, pilot interviews, and clinical experience. Subjects rated
symptom frequency and bothersomeness on 5-point ordinal scales; the indices
were summed using equal symptom weights. Cronbach's alpha was calculated
for each index. Bivariate analyses were done to examine index relationships with
health perceptions and functioning.
Results: Subjects studied to date (n = 57) are mostly male (n = 50), Caucasian
(n = 34), and gay (n = 41). Alphas for the symptom frequency and the symptom
bothersomeness indices were.90 and.89, respectively. Both symptom frequency
and bothersomeness were significantly (p <.001) related to health status and
function: the higher the self-rated symptom frequency and bothersomeness, the
worse the reported health status (r =.63, r =.57), the greater the interference
with social activities (r = -.51, r = -.44), the greater the number of days spent in
bed (r =.46, r =.44), and the greater the impact of illness or treatment on health
status (r =.63, r =.62).
Conclusion: These symptom frequency and bothersomeness indices are easily self-administered and may be valid measures of overall symptom burden.
The symptom indices measure independent concepts; however the high alpha
levels suggest that "symptomaticity" may have the features of an underlying unified construct in patients with HIV disease. It is not clear whether distinguishing
bothersomeness from frequency is necessary in health outcome assessment.
483*/22466 Home based nursing care: The cost-effective way
Lorna Scheepers. 14 Texas Avenue Colorado Park Mitchellsplain Capetown,
South Africa
Objective: Making homebased nursing care affordable, accessible, acceptable
and accountable at grassroots level.
Background: Home based nursing care was out of reach for the lower income
and unemployed chronically ill in our region. Institutions were full and the waiting
lists for admission to these institutions were long. The unemployment rate is very
high and relatives could not resign from there places of employment to take care
of their sick. In instances where relatives were forced to become caregivers, the
burn-out syndrome was high due to the lack of physical and emotional support.
Strategy: Making use of highly qualified, professional nursing staff to deliver
home based care was too costly. This category of patient does not always need
highly skilled nursing staff to take care of them either, so we adopted the "health
to the people, by the people approach". We developed a curriculum in basic home
nursing and then started training lay persons in basic home nursing. The course
consisted of both theory and practical. Their practica was done at institutions or
hospitals and sometimes even out in the community. The course was presented
by a multi-disciplinary team consisting of the nurse, social worker, physiotherapist, occupational therapist, dietician and the district nurse. On-going training and
in-service training were maintained to ensure uniformity and instill confidence as
well as improving knowledge and skills of the care workers. Regular support and
team building sessions were regarded as a very high priority.
Result: The service delivered was:
Acceptable because the careworker was known to the community.
Affordable because the careworker had no need to travel out of area and could
work at a lower rate, and accessible to any client in need of home care.
60* / 22467 Ambulatory nursing care for HIV positive patients in
treatment for tuberculosis
Veronica M. Sinkoc, I.S.A. Assumpcao, S.M. Cavinatto, F.H. Aoki. State
University of Campinas-Unicamp, Rua Marques De Tres Rios 242 BL. 1 AP 16,
Bota Fogo-Campinas CEP 13020-030, SP, Brazil
Issue: HIV seropositive and AIDS patients usually show poor compliance to
tuberculosis treatment. Poor compliance is a risk factor for the emergence of
drug-resistant strains.
Project: The poor compliance, added to the usual difficulties of tuberculosis treatment for out-patients led to the creation of a nursing-care group for
out-patients being treated for tuberculosis.
The activities of the group, operating since August 1996, are devoted to an
integrated approach to the patient and his family. Individual care is given to the
patient and his family, with information on self-administered treatment given in an
appropriate language.
Special attention is given to the use of other medications as indicated, aiming
to improving the understanding by the patient of the importance and particular
aspects of each medication, such as schedules and side-effects.
Patients are enrolled at the beginning of the treatment, when appropriate literature is furnished, together with short lectures and individual attention. Return
appointments are scheduled for periods of not more than 30 days. Patients that
miss appointments are followed-up by phone or mail.
Results: 94 patients were assisted from August 1996 to December 1997. 58
patients concluded there treatment. Case-fatality was 32.8%, 12.1% abandoned
treatment and were not reachable for follow-up, 48.3% patients were discharged
as successfully treated and 6.8% patients received a different diagnosis.

Lessons Learned: Notwithstanding the persistence of non-compliance, we
understand that special nursing care and orientation should continue to be an
essential part of the treatment of HIV positive patients with tuberculosis because
of the higher levels of non-compliance reported in the literature.

22468 Improving the capacity of nurses to care for patients with
HIV/AIDS in Nigeria
Musa Kolawole Jinadu. College of Health Sciences, Obafemi Awolowo
University, Ile-Ife, Nigeria
Issue: With the growing number of patients with AIDS seeking care in hospitals
in Nigeria, there is a growing concern about the quality of care rendered to them
by nurses.
Project: A recent investigation conducted among nurses in Nigeria shows
that although 95% of the nurses had adequate knowledge of HIV/AIDS, 8590
exhibited high level of anxiety about patients with HIV/AIDS. Therefore, a pilot
educational workshop for reducing the anxieties of the nurses about HIV/AIDS
was conducted in Osun State of Nigeria. About 205 nurses from various parts
of the state participated in the workshop. The workshop focused mainly on safe
practices when caring for patients with HIV/AIDS.
Results: Post-intervention evaluation conducted one month after the workshop
shows 73% reduction in the level of anxiety of the nurses about patients with
HIV/AIDS among the workshop participants. Majority of the nurses expressed
willingness to care for patients with HIV/AIDS either in the hospital or in their
homes. Some nurses who used to avoid contact with HIV/AID patients exhibited
more compassion for them. The need for this type of educational intervention was
expressed by nursing leaders and policy makers.
Lessons Learned: Educational intervention for improving knowledge, attitude
and practice of health care workers about HIV/AIDS is more likely to succeed if it
addresses their specific area of needs for education.
| 22469 A description of clients referred to community nurses
from a HIV unit in Sydney, Australia, 1993-1995
Adrienne Lucey1, B. Bicknell2, D. Burke2. 1Royal South Sydney CHC Sesahs,
Flat 570 Albion Street, Randwick, New South Wales; 2Australian Catholic
University, Sydney, NSW, Australia
Objectives: The purpose of this study was to identify demographic, clinical and
psychoemotional aspects of clients with advanced HIV disease who were referred
to Generalist Community Nurses (GCNs) from an inpatient HIV unit over a two
year period.
Design: Descriptive, retrospective study.
Methods: Data of 73 clients received from an inpatient HIV Unit and recorded
on 171 community nursing referral forms (n = 171), between June, 1993 and
June, 1995 was retrospectively reviewed. The data describing the demographic,
clinical and psychoemotional aspects of these 73 clients who died within the study
period was analysed using descriptive statistics and cross tabulations.
Results: The mean age of the sample was 40 years, and 68 (93.2%) of the
clients were male. Forty-eight (65.8%) clients, were born in Australia, 37 (50.6%)
clients, were identified as men who had sex with men and the sexual preference
of 27 (37%) clients was unknown. On first referral 50.6% of the clients, either lived
with their partner or by themselves. Substance use was infrequent. Clinically, the
most common past history per client on referral was oral candida (41.1% of clients)
followed by pneumocystis carinii pneumonia (30.1%) and herpes simplex virus
(27.4%). The most common symptom recently experienced per client on referral
was pain (61.6% of clients) followed by fever (58.9%) and lethargy (56.1%). The
most common reason for admission to hospital and/or new diagnosis prior to each
referral per client was oral candida (31.5% of clients) followed by mycobacterium
avium complex (27.3%) and anaemia (26.0%). At some time during the study,
35.6% of the clients recently felt depressed and 28.8% of the clients recently
experienced anxiety at the time of referral.
Conclusion: The most common requests of GCNs in this study were symptom
monitoring, emotional support and home assessment. Knowing the demographic,
clinical and psychoemotional aspects of these clients assists in the identification
of their nursing care needs. The findings of this study may be used comparatively
to form the basis for further research into these aspects of clients with HIV/AIDS
and how this influences community nursing strategies and interventions.
S22470 Bridging the gap: Collaboration of nurses and physicians
improving quality of community care for PWAs
Michael Ewers, D. Schaeffer. Institute for Nursing Science (IPW) Universitaets
Str. 25, 33615 Bielefeld, Germany
Objective: Providing outpatient care whenever possible and enabling PWAs to
remain in a domestic environment with a high level of autonomy despite the
severity of their disease, is one of the stated aims of German Health Care policy.
To reach this goal a close collaboration of nurses and physicians is indispensable.
Methods: The presentation is a result of a structural analysis of the Community
Care system in Germany and of an analysis of qualitative interviews with Home
and Nursing Care facilities to examine the perspective of nurses on the challenges
which occurred for them in providing home and Nursing Care for PWA's. Factors
affecting the collaboration of nurses and physicians were identified.
Results: The results show that structural and qualification deficits, funding

problems and the lack of creative power are affecting the collaboration of nurses
and physicians in a negative manner. Despite of this the quality of care for PWAs
is in danger to be reduced by the low professional status of nurses in Germany
and the physicians lack of interest in nursing.
Conclusions: Bridging the gap between nurses and physicians and promoting
workable relationships between both health care professionals is one of the most
important requirements to improve quality of care for PWAs in the Community.