HIV Infected Healthcare Workers

Kristen ZiolkowskiHIV Infected Healthcare Workers Health service providers are the personification of a systems core values they heal and care for people, ease pain and suffering, prevent disease and mitigate risk the human link that connects knowledge to health action ("Why the Workforce," n.d.).. When a patient is admitted and is HIV positive, everyone seems to know within a matter of minutes. Suddenly we see people double glove for things they never did before. What if that person was our coworker? Maybe, it is someone we had stood beside for the past ten years. Would you treat them or expect them to be treated differently? This presentation will focus on HIV positive healthcare workers and their implications for practice. Primarily, it will focus on their role within the organization. In addition, we will bring attention to protecting the employees privacy while protecting the safety of patients and addressing the scope of practice of an HIV infected healthcare employee.

Introduction

Explore and identify the risks and benefits of telling your employer your HIV statusInvestigate informed consent of the employee and who has a right to know. Investigate the universal precautions deemed appropriate for staff that have HIV.Examine the risk of transmission during procedures.Privacy versus Responsibility. Examine the rules for reporting required by the Michigan Board of Nursing.

ObjectivesTheory Health Belief ModelThe Health Belief Model was created by Hochbaum, Kegels and Irwin Rosenstock in the1950s. This model attempts to provide a rational and prediction of health behaviors. The model is based on the theory that a person will take a health-related action if they feel a negative health action can be avoided. An example of this is using condoms to prevent the transmission of HIV during sexual encounters.

Health Belief ModelIrwin RosenstockConceptDefinitionApplicationPerceived SusceptibilityOne's opinion of chances of getting a conditionDefine population(s) at risk, risk levels; personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low.Perceived SeverityOne's opinion of how serious a condition and its consequences areSpecify consequences of the risk and the conditionPerceived BenefitsOne's belief in the efficacy of the advised action to reduce risk or seriousness of impactDefine action to take; how, where, when; clarify the positive effects to be expected.Perceived BarriersOne's opinion of the tangible and psychological costs of the advised actionIdentify and reduce barriers through reassurance, incentives, assistance.Cues to ActionStrategies to activate "readiness"Provide how-to information, promote awareness, reminders.Self-EfficacyConfidence in one's ability to take actionProvide training, guidance in performing action.Concepts, Definition & Application of the HBM

HBM related to Perceived risk of HIVConceptCondom Use Education ExampleSTI Screening or HIV Testing1. Perceived SusceptibilityYouth believe they can get STIs or HIV or create a pregnancy.Youth believe they may have been exposed to STIs or HIV.2. Perceived SeverityYouth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid.3. Perceived BenefitsYouth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.Youth believe that the recommended action of getting tested for STIs and HIV would benefit them possibly by allowing them to get early treatment or preventing them from infecting others.("Health Belief Model," 2010).4. Perceived BarriersYouth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level).Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options).5. Cues to ActionYouth receive reminder cues for action in the form of incentives (such as pencils with the printed message "no glove, no love") or reminder messages (such as messages in the school newsletter).Youth receive reminder cues for action in the form of incentives (such as a key chain that says, "Got sex? Get tested!") or reminder messages (such as posters that say, "25% of sexually active teens contract an STI. Are you one of them? Find out now").6. Self-Efficacy Youth confident in using a condom correctly in all circumstances.Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment).HBM related to Perceived risk of HIV continued

("Health Belief Model," 2010).TheorySymphonological Bioethical TheoryJames and Gladys Husted created the Symphonological Bioethical Theory (SBT) of which is the study of agreements between the patient and healthcare provider. The agreement is based on the relationship between the two people and their ethical obligations and commitments to each other. Ethics examines what ought to be done, within the realm of what can be done, to preserve and enhance human life (Alligood & Tomey, 1986/2010, p. 562).

Symphonological bioethical theory

Context of the situation- understanding of the situation and how to act within itContext of knowledge- knowledge of the situationContext of agents awareness- the agents awareness of knowledge and circumstances

The nurses ethical responsibility is to encourage and strengthen those qualities in the patient that serve life, health, and well-being through their interactions (Alligood & Tomey, 1986/2010, p. 564).

The bioethical standards of the theory are qualities that should be recognized in each patient. AutonomyBeneficenceFidelityFreedomObjectivitySelf-AssertionThree ConceptsBioethical StandardsSymphonological bioethical theory

Ethical obligation is the underlying foundation of this theory. The goal is that each nurse or healthcare provider will act appropriately to assure the patient receives the best care possible. If the healthcare provider feels they pose the risk of transmission then they should respond ethically to the situation and remove themselves. It is not necessary to divulge ones HIV status to the patient but to assure that the patient is not at risk of contracting the bloodborne pathogen; HIV. Furthermore, we have an ethical obligation to treat each other fairly and promote health despite the patients circumstances.

Ethical obligation

Assessment of the health care environment* According to the Centers for Disease Control the risk of transmission in the workplace is relatively low providing that employees are using universal precautions. As a matter of fact, needle stick injuries account for less than 1% of transmissions. However, with the incidence of HIV infection in the United States at an all time high as healthcare professionals we cannot help but question our safety in the workplace. With more than 1 millions people living with HIV it is imperative that we know how to protect ourselves and others ("HIV Transmission," 2010).

Risk of Transmission

The Society for Healthcare Epidemiology of America (SHEA) has created a table of recommendations for healthcare workers infected with HIV. The recommendations are broken down into three categories. Each category is based on risk or potential of provider to patient transmission and what procedures constitute as having risk potential.Category 1 - Procedures with minimal risk of transmissionCollection of history and physicalCategory 2 - Procedures for which transmission is possibleMinor local proceduresCategory 3 - Procedures for which there is definite riskGeneral SurgerySociety for healthcare epidemiology of AmericaDouble glove for all invasive procedures of which include General SurgeryOpen Resuscitation effortsCaesarian DeliveryDeep SuturingInteractions with violent or epileptic patientsSurgeries lasting greater than 3hoursWhen using a power instrument

Comply with organizational policies and proceduresFollow Universal PrecautionsPromote and manage their own healthRemove themselves from situations in which they may pose a risk of transmissionWeeping dermatitisMental Confusion

policies

Healthcare providers have an ethical, professional and fiduciary responsibility to act in the best interests of their patients. Healthcare providers have a duty to ensure patient safety. The fact that healthcare providers are bound by the principle of nonmaleficence, which requires them to do no harm to patients and to do what is possible to prevent harm, is widely accepted (Henderson et al., 2010, p. 214). Healthcare professionals are obligated to continue to work within their scope of practice and pay close attention to prevent the spread of blood borne pathogens. They can do this by continuing to be knowledgeable and practice infection control measures. Quality and Safety

Providing that healthcare professionals are competent and following the standards of care they do not need to resign from their positions or notify patients of their HIV status. For physicians providing invasive procedures, the United States guidelines state that they not perform exposure-prone procedures unless they have sought counsel from an Expert Review Panel and been advised under what circumstances, if any, they may continue to perform these procedures. Such circumstances would include notifying prospective patients of the HCWs seropositivity before they undergo exposure prone invasive procedures (Henderson et al., 2010, p. 216). The patient will also need to be informed if an error has occurred and there may have been transmission of the disease from the provider to the patient. In this case the patient does not need to know specific names but rather the following steps to take. Privacy and responsibility

In general, limiting the practice of HIV-infected HCWs is inappropriate. The practice of an infected HCW should be evaluated by his or her physician and modified only if there is clear evidence that the HCW poses a risk of transmitting HIV through an inability to meet basic infection control standards, personal medical conditions, evidence of previous transmission of blood-borne infections, or because the HCW is functionally unable to care for patients. All infected HCWs who perform invasive procedures should practice only after the evaluation, and with continued monitoring by their personal physician and/or under recommendations of public health officials, expert panels, or in compliance with institutional policies (Guidelines for HIV-Positive, 2008, p. 23). Michigan State Law

Notification should be considered on a case-by-case basis taking into consideration whether exposure has occurred, an assessment of specific risks, confidentiality issues, and available resources. Any decision to notify patients should be made in consultation with local and state public health officials and the HCW, if available (Guidelines for HIV-Positive, 2008, p. 23). Michigan State Law

Discrimination in the workplace is one of the greatest challenges HIV positive workers will face. According to Meel, healthcare workers are one of the largest group of offenders. They discriminate by refusing to take care of patients of whom they know are HIV positive or by making personal recommendations or judgments. For example, recommending an abortion to an HIV positive mother.

Please view the following.http://movieclips.com/Q6PBH-philadelphia-movie-the-essence-of-discrimination/0/121.28/

Privacy and ResponsibilityFinding acceptance of diseaseDealing with others, their curiosity and preconceived notionsAdhering to the time schedule of medication administrationMedication Side-EffectsNauseaVomiting Co-infectionDiarrhea Lethargy HemophiliaMetabolic Changes Blood Sugar Changes

Support groupsSupport from coworkers and employerOrganizing your medication regimenPill BoxScheduling breaksScheduling antiemetic's/anti-diarhhealsBarriersCopingWorking with hivInferences and implications*We must keep the communication lines open. The best way to educate and promote awareness is to get people talking and participatory. Continue to promote safe work environments and Safe Needles Save Lives; a campaign to ensure proper disposal and use of needles.The majority of people infected with HIV do not transmit the virus to others. An estimated 5% of the infected population acquired HIV through transmission. Therefore, 95% of those infected did not transmit HIV. This is an 89% decline in the estimated rate of transmission since the peak of the epidemic in the mid-1980s. This decline is likely due to prevention efforts and availability of improved testing and treatment ("HIV Transmission," 2010).. The estimated proportion of persons in the United States with HIV who know they are infected increased from 75% in 2003 to 79% in 2006. This is a sign of progress for HIV prevention because research shows that most individuals reduce behaviors that could transmit HIV when they learn they are infected ("HIV Transmission," 2010)..Inferences

Stigmas attached to HIV/AIDS diagnosis prevent others from talking and getting tested. More than half a million people with an AIDS diagnosis in the United States died from the beginning of the epidemic through 2007.Late diagnoses continues to be a problem. The longer individuals go undiagnosed; the greater the risk of spreading it to others. In 2008, 32% of the population diagnosed with HIV/AIDS died within one year. This can be attributed to late diagnosis and the severity of the disease.

implicationsRecommendations* With education, we can help society to understand the HIV epidemic and that it can be prevented. We can strive to stop the press from campaigning against people living with HIV/AIDS. Human rights protection is possible by not discriminating and in turn will help fighting the epidemic. Protective measures could include enacting legislation to prohibit pre-employment testing. Legislation to regulate the provision of insurance and to prohibit or regulate insurance HIV testing and the wholesale refusal of AIDS-related coverage, more broadly drafted legislation to prohibit public enterprises from discriminating against persons on the basis of HIV or AIDS and to enshrine principles of indiscrimination (Meel, 2005, p. 151).Lawmakers and Legislation As nurses we made a commitment to continually strive to improve our practice and professionalism. We agreed to a set of standards that defined our practice. It is now in our nations fight against the spread and discrimination of HIV that we are able to use these standards by promoting health and safe environments, enhance quality and education. Most importantly, the time is now to initiate change and take action. American nurses association

Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, MO: Mosby Elsevier. (Original work published 1986)

American Nurses Association. (2004). Nursing: Scope and standards of practice (2004 ed.). Silver Spring, MD: Nursebooks.org. (Original work published 2003)

Guidelines for HIV-Positive Health Care Workers (The Center for HIV Law Policy, Trans.). (2008). Retrieved from https://fsuvista.ferris.edu/webct/urw/lc3799985696061.tp3801146796071/RelativeResourceManager/sfsid/4194341089041

Health Belief Model. (2010, September 7). University of Twente. Retrieved January 25, 2012, from http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/

referencesHenderson, D. K., Dembry, L., Fishman, N. O., Grady, C., Lundstrom, T., Palmore, T. N., . . . Weber, D. J. (2010, March). SHEA Guideline for Management of Healthcare Workers Who Are Infected With Hepatitus B Virus, Hepatitus C Virus, and/or Human Immunodeficiency Virus . Infection Control and Hospital Epidemiology, 31(3), 203-232. Retrieved from http://www.shea-online.org/Assets/files/guidelines/BBPathogen_GL.pdf

HIV Transmission. (2010, March 25). Center for Disease Control and Prevention. Retrieved January 25, 2012, from Department of Health and Human Services website: http://www.cdc.gov/hiv/resources/qa/transmission.htm

Jones, S. G. (2002, June). The Other Side of the Pill Bottle: The Lived Experience of HIV-Positive Nurses on HIV Combination Therapy. Journal of the Association of Nurses in AIDS Care, 13(3), 23-36.referencesLitwinczuk, K. M. (2007, June). The Relationship Between Spirituality, Purpose in Life, and Well-Being in HIV Positive Persons. Journal of the Association of Nurses in AIDS Care, 18(3), 13-22. doi:10.1016/j.jana.2007.03.004

Meel, B. L. (2005, June). Ethical Issues Related to HIVAIDS: case reports. Journal of Clinical Forensic Nursing, 12(3), 149-152. Retrieved from http://0-dx.doi.org.libcat.ferris.edu/10.1016/j.jcfm.2004.10.018

Sullivan, E. J., & Decker, P. J. (2005). Effective Leadership and Management in Nursing. Handling Collective-Bargaining Issues, 327-333. Retrieved from http://www.unc.edu/courses/2007spring/nurs/596/960/module12bargaining/sullivan24.pdf

Why the workforce in important. (n.d.). World health organization [The World Health Report]. Retrieved January 25, 2012, from http://www.who.int/whr/2006/overview/en/

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