Introduction
Hannah is a seventeen-year-old girl recently diagnosed with the Human Immunodeficiency Virus (HIV). She is still in a state of denial because she has not been sexually active, and reluctant to start medication because she has not experienced any symptoms. Apparently, she was born with the virus but her mother was hesitant to disclose the diagnosis to her until she attained legal age to care for herself. She is approaching puberty, has started dating, and none of her friends knows about her health status. Hannah’s case highlights several issues affecting the care process. For instance, it highlights the role of parents in the care process of minors, the right to access healthcare information for minors, the role of patients in self-care and the role of nurses in communicating diagnosis, training patients and tracking their care.
HIV is a disease that interferes with the human immune system jeopardizing the body’s ability to counteract infections. In the advanced stage it causes Acquired immunodeficiency Syndrome which is a chronic condition that can be life threatening. Antiviral drugs are used to manage the disease with other preventive measures used to contain its spread. The disease is transmissible through contact with infected blood, sexual intercourse or from mother to child during pregnancy or child delivery. In the early stages, the disease might not manifest serious symptoms thus it might take considerable time for the disease to weaken the body’s immunity even without medication. This paper aims at addressing the knowledge gap in a teen client who was born with the Human Immunodeficiency Virus. It identifies her health needs and adopts a systematic approach of teaching her about the disease and its management based on Gordon’s Functional Health Patterns. Moreover, it suggests various interventions applicable to the client and the role of the nurse in ensuring improved quality of life.
Importance of Education on Patient Diagnosis
In the application of Gordon’s Functional health patterns, the first step in addressing Hannah’s case is to deal with her health perception and management pattern. Her reluctance to commence medication is due to limited knowledge and awareness concerning her condition and poor participation in its management in the past. Her participation in the care process encompasses two different dimensions. It is key during decision-making concerning her treatment and her involvement in sharing information and accepting instructions from the nurse.
Parent involvement in the decision-making process, especially for minors, is a key consideration in the nursing process because of the legal implications pertaining to infringement on the rights of the patient. The literature reviewed suggests that involving patients in their own care results in improved management of diseases and fosters their compliance with secondary preventive measures (Bombard et al., 2018). As such, the foundation of the health promotion initiative is to adopt an intervention aimed at enhancing access to information, which would assist Hannah in decision-making. A key consideration, however, is her ability to make independent decisions and understand the implication of the diagnosis owing to her age.
The health promotion initiative can be implemented at three levels to tackle Hannah’s health perception. The primary level will focus on creating awareness of the health issue to the patient, her mother and her boyfriend. Thus, the role of the nurse is to provide the patient and her family with a comprehensive and organized approach to achieving a healthier lifestyle. The nurse must prioritize the needs of the patient and give information that will encourage a change of behavior and boost understanding of her health. The well-being of the patient is fostered if both the nurse and the mother support her in making decisions concerning HIV self-management and medication (Bombard et al., 2018). Ideally, the initial step would be to establish Hannah’s capacity to understand her diagnosis and appreciate the consequences that might result from her decision or indecision to start medication and adopt other protective measures that have the potential to prevent the viral infection of her boyfriend. Regardless of the information given to her, the resultant decision should be free from coercion and the nurse’s primary concern should be to minimize harm and maximize benefits to the patient.
Such mutually beneficial partnerships between the nurse and the guardians would ensure interventions are responsive to priorities. Involving close family members is a sign of respect for the patient’s right to privacy of healthcare information and dignity. It also incorporates cultural competency in the health promotion program because of the incorporation of patients’ cultural values in planning the care process (Henderson et al., 2018). The secondary promotion aims at identifying potentially harmful behaviors that would cause harm to others and cause severe health problems to the patient. It analyzes and offers information on mitigation approaches while tertiary health promotion would aim at the management of the disease in its chronic condition so that she can have a better quality of life.
Patient empowerment plays a vital role in the care process because it challenges patients with intricate therapeutic regimes in both the hospital and home environment. Although most patients might want to be partners in their own care, lack of cognition and poor support structures are hindrances to the access to care when needed. Often, young patients exposed to such challenges experience poor therapeutic plan management caused by emotional problems such as denial.
Ideally, the therapeutic regimen would aim at assessing associated issues that may impede the client’s ability to follow the program. A nurse’s awareness of these factors offers direction for the design of interventions. These factors could be related to the physical or financial capabilities. An assessment of earlier attempts to follow a regimen is the foundation to understanding the complexities experienced in the execution of the health promotion plan. The patient must have a conviction to adopt a desired behavior aimed at improving her quality of life. Based on the theory of self-efficacy, successful outcomes result from a positive conviction (Lippke, 2020). As such, the nurse must assess the patient’s perception of the health problem as their understanding of susceptibility and the potential threat posed by the diseases influence their compliance to treatment. Ideally, the patient’s ability to adopt the regimen determines the type of education offered.
Nutritional and metabolic patterns
Nutritional education is vital to ensure the client understands the food and fluid requirements relative to her body development and metabolic needs. HIV attacks the CD4 cells of the white blood cells. The virus gets into the CD4 cell structure and replicates itself. In the long term, the cells die (Shoko & Chikobvu, 2019). Consequently, the body tries to make new CD4 cells, however the rate of generation is normally lower. As such, having a good dietary balance will ensure that the body has the required nutrients to support the production of CD4 cells, which play a vital role in fighting infections.
Appropriate nutrition entails adopting and maintaining healthy foods that support the strengthening of the immune system. In HIV patients, it enables them maintain good weight and facilitates efficient absorption of medicine (Stillhart et al., 2020). Ideally, the patient must eat a variety of foods comprising fruits, vegetables, starch and protein foods with low saturated fats, salts and sugars, which increase vulnerability to cause other opportunistic lifestyle diseases. Eating the right quantity of food is also vital to maintaining a healthy weight. Moreover, the diseases and medicines aimed at reducing its severity sometimes lead to nutritional-related problems. For instance, HIV-related infections such as dysphagia could cause difficulties in eating and swallowing, while medicines may lead to loss of appetite and nausea, thus impeding compliance to the treatment regimen. Food safety is also a key consideration in maintaining good nutrition and metabolic balance. Contaminated water and food can cause food poisoning and other foodborne diseases. As such, all consumed foods must be handled and prepared in a hygienic manner. Because of a weakened immune system, such illnesses may be more serious and prolonged in HIV patients compared to healthy individuals.
Basing nutrition counseling, and care interventions on the level of disease progression is key to achieving efficient care. The nutritional status is a significant determinant of the occurrence of opportunistic infections such as tuberculosis, which may cause weight loss if not diagnosed and treated promptly. More so, low energy foods intake in relation to the increased metabolic demands due to HIV infection drives wasting (Ahmed et al., 2018). Because Hannah is in the asymptomatic phase of the disease, good nutrition is important to maintaining balanced metabolic performance.
Elimination Pattern
Severe HIV infection can cause gastrointestinal diseases, which manifest in symptoms that span the entire digestive system. These symptoms include odynophagia, abdominal pains, vomiting and diarrhea. To correctly diagnose and treat gastrointestinal complications, the nurse must thoroughly understand the client’s medical history and perform a physical examination. For instance, diarrhea, which is a common symptom among HIV patients, is dangerous to the patients if untreated because it causes dehydration that may lead to other life-threatening complications. However, persistent diarrhea while taking antiviral drugs requires the patient to visit a healthcare provider who may change the type of prescription. Forgoing medication may lead to higher viral replication and subsequent drug resistance (Gupta et al., 2018).
Ideally, treatment of gastrointestinal infections is by medication, Crofelemer drug for example, treats diarrhea resulting from antiviral drugs. Home remedies to the condition are concerned with lifestyle changes such as avoiding fatty foods, increasing fiber intake, and drinking more water. Similarly, the genitourinary system may experience complications because it is the primary site for infection. The key issues affecting the urinary performance of the patients include dysuria and hematuria caused by bacterial infections especially among patients with a low CD4 count (Rameshkumar & Arunagirinathan, 2018). Lastly, neurological complications may occur and result in urinary stasis.
Activity and Exercise Pattern
This regimen aims at addressing issues relating to daily self-care activities that require energy. Adopting moderate exercise patterns improves cardiovascular and nervous functioning among HIV infected individuals (Phillips et al., 2018). However, before commencing any exercising program, involvement of a healthcare professional is important to enable the patient to understand any limitations to the adopted type of activities. Ideally, the patient should not exercise when feeling unwell. Persistent intolerance to exercise may be an early symptom of cardiac dysfunction and the risk factors include anemia and lifestyle behaviors such as smoking.
Development of a suitable exercising regimen is based on the CD4 cell count in the patient, with asymptomatic patients encouraged to exercise for longer. This benefits the body improving flexibility, cardiovascular performance and mind-body fitness. Lack of medication, malnutrition and poor physical activities causes comorbidities among infected individuals. A study by Phillips et al., (2018) showed that exercising potentially reduces symptoms such as decreased strength, muscle wasting and fatigue. These changes are beneficial to the physiological and psychological performance of the patient.
Self-Perception-Self-Concept Pattern
Understanding the patient’s attitude and self-worth after being diagnosed with HIV is a key aspect of the health promotion initiative. Upon testing positive, some patients may sink into depression thus lowering their self-esteem while others may perceive it as an opportunity to improve care and quality life. The emotional stress imposes a greater amount of psychological burden causing anxiety and other mental disorders. These problems are aggravated by other social factors such as discrimination and stigma (Stockton et al., 2018). HIV-related stigma is a major problem affecting young individuals living with HIV and hinders their access to care. Hannah’s case presents a situation where both the mother and the client fear victimization owing to their status. She is therefore reluctant to share her health information with the boyfriend.
Interventions to curb depression and other psychological challenges among patients include talking to the nurse to offer therapy and medication for depression, joining support groups and seeking counseling services. Role relationship patterns may also be affected upon being diagnosed with HIV. Loneliness results especially among long-term survivors due to loss of close friends and family. Practical approaches to mitigate loneliness include psychosocial therapy, engaging in leisure activities and other interventions aimed at creating social bonds. Overall, acceptance plays a vital role in restoring the self-esteem of patients.
Sexuality and Reproduction
While sexuality could be a source of satisfaction for infected individuals, it may also conflict with perceived gratification. With sexual contact being a major mode of transmission people living with the Human immunodeficiency Virus, bear a burden of protecting their partners against infection. Study suggests that people with the virus are likely to be affected by sexual dysfunctions such as low libido and erectile dysfunction. Nurses should aim at addressing sexual problems in primary care. This can be implemented through sexual functioning discussions, counseling and encouraging screening to address the challenges from the root cause (Annerstedt & Glasdam, 2019). Because Hannah is approaching a sexually active stage, collaboration in the health promotion would guide the extent and structure of training. Reproductive health education would enable her to understand preventive measures to minimize harm to others.
Coping Stress Tolerance Pattern
Impaired adjustment could be a major hindrance to the care process resulting in poor quality of life. Adjustment disorder may be due to the stressful events that follow the HIV diagnosis phase. The patient may experience adverse conditions that lead to sadness, trauma disorders or even suicidal thoughts. In the long-term, poor management of such issues may affect an individual’s social relationships. Ideally, various factors influence how people react to stress. Life experiences, for instance, are likely to influence adjustment disorders with prevalence being high among individuals with childhood exposures.
Therapy is one of the most effective ways of tackling adjustment disorder. Booking sessions with mental health care providers helps in influencing a person’s perception about their situation. This enables the victim to identify the cause of disorder, resolve it and prepare them for any event that might increase recurrence of the problem (O’Donnell et al., 2018). Cognitive behavioral therapy, for example, will address negative thinking and behaviors, thus, improving reaction to stressors and eliminating dysfunctional emotions and perceptions.
Challenges
The major challenges experienced in the health promotion is attributed to the knowledge gap that existed in both the client and the mother. Counseling was specifically difficult because of poor expression, fear and reliance on the guardian to offer vital information such as Hannah’s medical history. As such, it required more time to analyze the patient’s health needs and develop a friendly environment to enable the patient to understand the importance of medical compliance.
Conclusion
The client’s rating during the training session was remarkable as suggested by the average score of eight, on a scale of 1-10, for specific sessions. She alluded to be interested in the interactive approach, its effectiveness and the relevance of health information to managing her condition. Furthermore, the minor affirmed that it was great being part of the training, and therefore she was willing to enroll and participate in similar programs in the future. She, however, suggested that more scenarios, including audio visual aid and real patients of her age group should be added in other promotions. All aspects of information that are necessary to enable the client to meet her health needs were identified.
Through the adoption of a teach-back method of information dispensation, fear and embarrassment was managed in the minor. Moreover, it was possible to assess the client’s understanding of her healthcare concerns by engaging in a caring and more collaborative manner. By explaining a concept to the client and critically analyzing her response, her level of comprehension was assessed. Repeating the missed concepts ensured she benefited fully from the information. Overall, the promotion impacted positively on the client’s life enabling her to develop a positive attitude towards seeking various healthcare interventions aimed at improving quality of life.
References
Ahmed, D., Roy, D., & Cassol, E. (2018). Examining relationships between metabolism and persistent inflammation in HIV patients on antiretroviral therapy. Mediators of inflammation, 2018.
Annerstedt, C. F., & Glasdam, S. (2019). Nurses’ attitudes towards support for and communication about sexual health—A qualitative study from the perspectives of oncological nurses.Journal of Clinical Nursing, 28(19-20), 3556-3566.
Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., & Pomey, M. P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science, 13(1), 1-22.
Gupta, R. K., Gregson, J., Parkin, N., Haile-Selassie, H., Tanuri, A., Forero, L. A., & Bertagnolio, S. (2018). HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. The Lancet infectious diseases, 18(3), 346-355. Web.
Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590-603.
Lippke S. (2020). Self-Efficacy theory. In Zeigler-Hill V., Shackelford T.K. (eds) Encyclopedia of personality and individual differences. Springer, Cham.
O’Donnell, M. L., Metcalf, O., Watson, L., Phelps, A., & Varker, T. (2018). A systematic review of psychological and pharmacological treatments for adjustment disorder in adults.Journal of Traumatic Stress, 31(3), 321-331.
Phillips, A. N., Cambiano, V., Nakagawa, F., Revill, P., Jordan, M. R., Hallett, T. B.,… & Bertagnolio, S. (2018). Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modeling study. The lancet HIV, 5(3), e146-e154. Web.
Rameshkumar, M. R., & Arunagirinathan, N. (2018). Drug-resistant bacterial infections in HIV patients.Advances in HIV and AIDS Control, 83.
Shoko, C., & Chikobvu, D. (2019). A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy. BMC infectious diseases, 19(1), 1-10.
Stillhart, C., Vučićević, K., Augustijns, P., Basit, A. W., Batchelor, H., Flanagan, T. R., & Müllertz, A. (2020). Impact of gastrointestinal physiology on drug absorption in special populations––An UNGAP review.European Journal of Pharmaceutical Sciences, 147, 105280.
Stockton, M. A., Giger, K., & Nyblade, L. (2018). A scoping review of the role of HIV-related stigma and discrimination in non-communicable disease care. PloS one, 13(6), e0199602.