Excellence in HIV Nursing

Shaun Watson, Clinical Nurse Specialist (HIV Community) NHIVNA Chair

What is a Nurse?

Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings (International Council of Nurses)

21st Century Nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual. Beyond the time-honoured reputation for compassion and dedication lies a highly specialised profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses, to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health (www.nursingworld.org)

Triple Impact of Nursing

• The need to globally raise the profile of nursing and make it central to health policy and enable nurses to reach their full potential by developing nurse leader and leadership.

• Enable nurses to work to their full potential. Nurses are too often not permitted or enabled to fulfil their true potential. Cultural, regulatory and legislative enablers and barriers need to be identified and removed and good practice shared and acted on.

• Collect and disseminate evidence of the impact of nursing on access, quality and costs, and ensure it is incorporated in policy and acted upon.

HIV Nursing Timeline

1996HAART – The treatment

cocktail was born

1981–87No treatment

available

1987NRTIs available

1995PIs available

1996NNRTIs available

2003–2008Three new classes of HIV treatment:

fusion inhibitors, entry inhibitors, integrase inhibitors

2017More than 30 treatment options available and

increasing response rates6

1980s: HIV and AIDS were death sentences. People

lived ~20 months and needed frequent hospitalisations

for acute infection and specialised terminal care. Nursing

focused on palliative and terminal care, developing

community services and

Early 2000s: HIV care focussed

upon ART compliance with many

severe, debilitating side-effects

from complicated ART

prescriptions. Nursing focussed on

adherence support.

Today: HIV is a ‘manageable,

long term condition’ with little talk

of AIDS and people are living to

old age. Nursing focussed upon

issues of ageing self-

management and long term

health monitoring.

1980s 1990s 2000s 2010s

Profile of HIV Caseload in EnglandRepresenting 68,607 patients receiving HIV care in England in 2016.

Kirwan et al. BHIVA 2017. Liverpool, UK, 4-7 April 2017. Oral #O30. Available at: http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170407/PeterKirwan.pdf [Accessed June 2017].

7%

80%

13%New patients

Newly diagnosed/ started ART within past 2 years

Stable patients

On ART, undetectable, no ongoing health concerns

Complex patients

• Cancer • Pregnancy• AIDS• Chronic liver

disease• End organ disease • Viral hepatitis• TB• Additional social

care or psychiatric needs

Role of the Nurse in HIV

HIV Testing & Diagnosis (initial

support and discussion)

Prescribing & management of ART (adherence support)

Complex case management

Long term health assessment and

management (annual review)

(Joint) Management of

palliative and terminal care

Encouraging self management and

expert patients

Social care, rehabilitation,

emotional, psychosocial support etc., etc., etc.….

Monitoring, supporting and

evaluation of ongoing health

Care, Compassion, Competence, Courage, Communication, Commitment

What Shapes Excellence in HIV Nursing

Advanced Nursing Pract ice

in HIV Care:Guidelines for nurses, doctors,

service providers and

commissioners

August 2016

Endorsed by:

Funded by:

But we are also shaped by

• Experience – managers, peers, patients, mistakes

• Education – university education (degree, masters, phd),conferences, ad hoc training sessions, best practice guidance, continuing professional development)

• Life!

Defining Excellence…

Proving our worth – How do we do it?

• It is important that nurses plan and carry out an evaluation of their service before managers demand that their time is spent elsewhere. If you are a nurse specialist, ask yourself:

• Can you demonstrate how you spend your time, describe the complexity of your work and quantify your contribution to safety, quality and efficiency?

• Is your work truly specialist?

• How unique is your role….can someone junior do the same?

• Language and role description – how do you describe what you do. Leary (2011)

Language & Professionalism

• ‘I care for people with HIV’ or ‘I manage and support the continuing care of people living with HIV’

• ‘I care for people living with HIV by assessing, monitoring and responding to their ongoing general and HIV health needs’ (call this rescue work and vigilance).

• Responsive to need – referring to GP and community services may prevent an unplanned hospital admission.

• Think about how you describe your role and what you do and don’t downplay it “I make a few phone calls”.

Demonstrating our Effectiveness

• Justification of roles and services can be achieved with data sourced from audits, evaluations, surveys and clinical coding. Check what data is already collected in your organisation.

• Case studies – what is YOUR role in this case?

• Economic assessment – if you weren’t there who would do your work. What are the implications if your post wasn’t there.

• Think critically about all the things you do in a day – the ‘little talks’ the ’quick phone call’ they all add up to effective case management.

The do’s and don’ts of Adding Value

• Don’t be shy – it’s very easy to say “It’s not just me it’s the whole team” if you’re the nurse it’s YOU!

• Be an HIV specialist (and add value as a generalist)

• Fight for professional development and training

• Show off…write about what you do case study, service development or present at a conference.

• Use language appropriately – you case manage, advise, monitor, assess and evaluate. Lose the words that down play what you do!

• Don’t assume that your manager understands the full extent of what you do (Leary, 2011)

Be Proactive

• Be PROUD to be a nurse!

• Collect quality data about what you do – think about the small stuff too.

• Get involved – is there nurse involvement in all areas of care. Where is the nurse voice?

• Discuss/write about what you do – Does everyone you work with know what you do? Don’t assume they do.

• Accept praise!

Future Opportunities

• Increase Nurse-led services – annual review, complex care and coordination of HIV.

• Innovate – develop and lead new services.

• Provide and present evidence (publish, conference).

• Advanced Nurse practitioners with formal training in physical assessment and non medical prescribing should be the norm (NMC education standards)

• Developing the next generation of HIV nurses – future training and opportunities for student and newly qualified nurses.

Why HIV Nursing?

• Ever Changing – no other area of care has developed so rapidly over the past 30 years and nurses had led the way in being responsive and flexible.

• The thrill of it - every day is different, every patient unique, no HIV pathway the same (from diagnosis to treatment response), there are daily challenges!

• Nurse led – autonomous practitioners, knowledgeable and skilled in areas usually shied away from (such as sex, sexuality, gender, drug and alcohol use, death and dying)

• Find your passion in nursing and run with it!

References