Symptom management in patients with AIDS

Abstract

I N 198 1 young homosexuals with unusual illnesses were admitted to oncology units for diagnosis and treatment of problems that later became known as acquired immunodeficiency syndrome (AIDS). Oncology nurses applied their substantial knowledge, experience, and skill to this patient population. Transferring substantial expertise regarding family care, symptom management, bereavement, care of the immunocompromised patient , nutrition, and sexuality, these oncology nurses contributed greatly to the care of patients with AIDS. Since the earliest days, cancer nurses have directed extensive care efforts and psychosocial support to these patients. In a 1983 study performed at a comprehensive cancer center located in New York, it was found that AIDS patients required considerably more nursing care hours than the other oncology and bone marrow transplant patients on the medical units. Special emotional needs, intravenous (IV) care, isolation monitoring, and incontinence were indicated as causative factors. ’ When this study was repeated in 1988, the findings indicated that nursing care hours needed by AIDS patients had decreased. Allotted care time toward special teaching and emotional needs had abated. This was attributed to several factors: a deliberate attempt toward early detection of psychosocial stressors and identification of the at-risk population, community and extendedfamily intensive involvement in supportive and educative programs for AIDS/HIV patients, and the development of comfort and expertise in the oncology nurses through experience with many AIDS patients. The situation had changed from a crisis disease to a chronic disease with urgent-care episodes. However, nursing care hours can remain very high unless these factors are addressed. The Oncology Nursing Society position paper on HIV-related issues* states that cancer nurses have the responsibility to be involved at all levels in HIV-related education. Among the seven recommendations of this report, one is related to symptom management concerns: “Oncology nurses in particular are urged to assume leadership roles in responding to the challenges presented by HIV.“’ Oncology nurses have responded to the challenge in many HIV-related arenas.3 SYMPTOM MANAGEMENT AND ONCOLOGY NURSING Oncology nurses have targeted symptom management as one of their major concerns. Countless articles regarding clinical care of the immunocompromised host in regard to infections, infection control, mouth care, bowel management, safety, sexuality, nutrition, knowledge deficits, and others have been written. Cancer nursing research clearly addresses fatigue, nausea, impaired mucous membranes, and other issues that compound the magnitude of problems that AIDS patients encounter. But how can we distinguish between effective intervention with AIDS versus cancer patients? What similarities and differences exist? Our primary objective is to explore the nature of symptoms AIDS patients experience, the resultant distress, and the nursing management involved. We hope to differentiate the nursing management strategies for responses to AIDS versus responses to cancer. Our focus will be on the whole person because facets of men and women are not separable. Also, our fundamental premise is that a person cannot be separated from his or her environment. Environmental issues, ie, access to care and legal statutes regarding confidentiality, and internal issues, ie, self-esteem, stress tolerance and history, and vulnerability all blend to affect how an individual with AIDS faces the symptoms of illness.