Examplar

Critical nursing incidents where you made the difference

Helen Calabretto
School of Nursing, University of South Australia, SA

PP: 178 - 179

Article Text

Changing attitudes

Elizabeth Crock RN Cert in Infect Dis Nsg B Sc Grad DipEd (Women's Studies)
Margaret Kleeman SEN Cert in Infect Dis Nsg

Abbreviations used in this exemplar
Human Immunodeficiency Virus (HIV)
Acquired Immune Deficiency Syndrome (AIDS)
People Living with AIDS (PLWA)

The HIV/ AIDS epidemic has had enormous and enduring effects on nursing in Australia, from both practical and philosophical perspectives. One of the most significant epidemiological characteristics of HIV/ AIDS in Australia is that gay men constitute the greatest number of people infected and affected. This has meant that nurses caring for people with HIV/ AIDS have been confronted with large numbers of openly gay men and their partners and families. They have had to learn to address their complex needs sensitively within a health care system which had, until recently, stigmatised gay men as diseased and generally ignored any specific health needs they may have had.

While caring for gay men per se has posed no problems for most nurses, research indicates that some nurses have refused to care for PLWA or have provided substandard nursing care (Beaumont 1991, Brass & Gold 1985, Huerta & Oddi 1992, Johnstone 1994, The Panos Institute 1990). In addition, much evidence suggests that dislike and fear of (particularly male) homosexuality, commonly termed 'homophobia', is one of the main reasons for discrimination against and ill-treatment of PLWA within the health system (Alexander and Fitzpatrick 1991, see also Johnstone 1994).

Nurses are likely to be closely involved in the care of PLWA during many stages of their infection in both the community and in hospitals, and more generally are bound to be involved in the care of gay men and lesbians at some stage. It is important therefore, that nursing students and practising nurses gain some understanding of the lives and experiences of homosexual people so as to provide them with nursing care and support which takes into account their specific needs.

The following exemplar is offered as an illustration of how one nurse's attitude towards gay men changed while caring for PLWA and how she was therefore able to make a difference in a gay man's life.

'I was 'straight', had been married for twenty-five years and had little knowledge of gay relationships when I first started working in the area of HIV nursing. I was very judgmental about both injecting drug users and the gay 'lifestyle'. I think I quietly believed, like many others, that AIDS was 'God's revenge'. I was keen to learn about HIV/ AIDS in the nursing context, but I soon realised that the disease itself was just the tip of the iceberg. All people with HIV have different backgrounds, different needs. As I came to know them as people, my own attitudes and beliefs were challenged and changed radically.

One man I remember well was a New Zealander who was admitted to hospital with PCP (Pneumocystis Carinii Pneumonia). He was middle- aged like me and his mother was in New Zealand. His mother kept ringing and asking 'What's wrong with him?' One day I asked him, 'Doesn't she know that you're HIV positive?' and he answered, 'No, no, she doesn't even know that I'm gay and that's why I moved to Australia'. His mother was in her seventies. I said to him, 'Why can't you tell her now? When you are very ill and dying she will want to be with you and she'll want to help you'. He said, 'Oh, no, it would break her heart if she knew'. So I said, 'Well, it's going to break her heart a lot more if you die and she didn't know that you were dying'. Anyway, it was a brief conversation and I soon forgot about it and went home.

It was months later when I was in the Outpatient Department that the same man came in and called out to me, wrapping his arms around me. 'Thank you, I was coming up to see you, thank you!' he cried. I wondered who he was. He said 'Do you remember me? You told me to ring my mother and I did'. She had since come to Australia to live with him and look after him. I thought to myself, 'Well, if that's one success story, it's worth it'. I can still see his face now, I can remember his name, I can remember the whole thing. He actually died on our ward twelve months later and his mother was there.'

While this nurse's words were simple, their effect on this man's life and death was ultimately invaluable. He was able to overcome his fear of rejection by his mother and to contact her when he most needed her. The nurse believes that, had her attitudes to gay men remained as they were when she began nursing PLWA, she would never have had the brief, but significant interaction with him which helped to transform the last year of his life.

This anecdote illustrates how a sensitivity to, and an understanding of the specific problems and needs which are common to many gay men can contribute positively to their care. Nurses are skilled in adapting to change and providing holistic care in a variety of circumstances, and HIV/ AIDS nursing poses some special challenges. In particular, it demands that nurses lead the way in eliminating homophobia and other forms of discrimination from within the health care system.

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