Promoting, nurturing and supporting engagement is best realised by providing:
- service coordination.
Tables 3, 4 and 5 outline some ways that nurses can facilitate each of these three key actions. Section 4 Key affected populations – how can nurses engage them in HIV care and prevention? provides more detail on issues faced by key affected populations.
| Table 3: Providing support
- Identify those most at risk of poor service engagement (Table 2)
- Ask yourself (and the client) – ‘am I the right gender, age, sexuality to work with this person?’, ‘is there a feasible and accessible alternative?’
- Ask yourself (and the client) – ‘is this the right clinic setting for this person? ‘Is there an alternative for ongoing care?’ explain importance of right ‘fit‘ for lifelong ongoing care. Facilitate engagement with an alternative and suitable clinic or service
- Is an interpreter appropriate and available? Sometimes clients will initially decline an interpreter because of concerns around confidentiality and cultural shame. Consider the use of phone interpreters and pseudonyms
- Make time
- Ensure privacy and confidentiality at all times
- Provide time-out – ‘do you want some time by yourself right now?’
- Pay attention to the client’s physical needs – is food or something to drink required?
- Pay attention to the client’s immediate needs – does he or she need to call an employer, child minder, cancel another appointment?
- Explore immediate support – ‘is there someone you trust that you’d like to call right now?’
- Listen, listen some more and listen again
- Let the person know they are being heard
- Anticipate and normalise the range of feelings the person expresses (Table 1)
- Let the client lead the conversation
- Correct misinformation and answer the common questions (Table 1) with simple, factual statements
- Provide hope – for the vast majority of people diagnosed with HIV infection the event is life-changing and not life-threatening
- Make sure the client will be safe. Consider:
- Is there a history of mental illness?
- Is the client expressing thoughts of self-harm?
- Have you asked that question?
- What supports does the client have?
- Who might provide support outside of the clinic?
- How does the client usually deal with a crisis?
- Where possible, if client agrees , involve a counsellor or social worker
- Provide written contact numbers for clinic assistance and include, if necessary, services such as Lifeline Australia: 13 11 14
- Provide ready access to the clinic – ‘drop in to see us or phone us whenever you want’, ‘these are our opening hours’
- Identify yourself or another person as the key individual to call or ask for – ‘this is how to get hold of me’
- Refer as appropriate to other internal or external service providers – follow-up and check the referral was received and actioned
- Arrange to see the client again within a week – be flexible with times
- Ask if it would be appropriate and acceptable to call or contact the client the day following a missed appointment
- Check you have the correct telephone number(s) and email address
| Table 4: Providing education
- Keep it simple
- Don’t attempt too much and avoid information overload
- Do not overburden with referrals to other services
- Be prepared to repeat information
- Adjust the level of information to the client’s ability to understand – avoid jargon
- Use the client’s questions and statements to raise key issues
- Address the key issues of the initial encounter sensitively and respectfully
- Prognosis – HIV is life-changing not life-threatening, near normal life expectancy for most
- Treatment - effective, simple and usually well-tolerated
- Modes of transmission and keeping others safe
- Legal obligation relevant to where the diagnosis is made;
- Who needs to know? (see contact tracing below) and importantly who doesn’t? Once someone has been told, they can’t be untold
- Clients without access to Medicare have particular concerns around the cost of tests and treatment and immigration
- Most HIV and sexual health clinics absorb the costs of further blood tests from their own budgets for this group
- Free access to treatment may be available through enrolment in clinical trials or through pharmaceutical company compassionate access schemes
- Low cost, generic, imported ART is available – see www.aidsdrugsonline.com
- Printed and online resources:
- Local AIDS Councils
- Australian Federation of AIDS Organisations - https://www.afao.org.au
- National Association of People with HIV - http://www.napwha.org.au/
- Multicultural HIV and Hepatitis Service - http://www.mhahs.org.au/
| Table 5: Service coordination
- Assume a case management role:
- assessment of need
- care planning
- care coordination
- regular review
- Communicate throughout with the multidisciplinary team
- Set up processes whereby clients who miss appointments are noted and called