The Burford Nursing Development Unit Model BNDUM of Care for PLHIV HIV

The Burford Nursing Development Unit Model (BNDUM) of Care for PLHIV HIV is fuelled by inequalities across gender, sexuality, race, ethnicity and class. In England, there were approximately 101,600 people living with Person living with HIV (PLHIV) in 2017 (PHE, 2018) and its effect to individual, families and communities cut across different age, ethnicity, socioeconomic status, gender and profession (Nies and McEwen, 2015). Generally, PLHIV has a higher tendency of having depression, hopelessness and suicidal ideation upon knowing their HIV status due to various associated challenges, however; the minorities, gay, bisexual, and men who have sex with men remained the most severely affected group, some of them encountered major barriers in obtaining treatment and access to care (Unaids, 2013), faced with greater discrimination, experienced health inequalities and depression compared others with HIV (PHE, 2018). Initially, the disease was referred to as Gay-Related Immune Deficiency depicting that it was linked with sexual identity rather than sexual practice (Dickinson, 2017). The introduction of Highly Active Antiretroviral Therapy (HAART) has transformed HIV infection from incurable into a manageable chronic condition, hence the role of the nurse has evolved along with improved treatment models, from one of palliative care to one of complex case management (Curtis et al., 2015). This implies that PLHIV are now experiencing longer lifetime trauma and challenges such as stigma, poverty, depression, negative attitude towards their patient sexual orientation and substance abuse which can significantly affect their emotion, physical well-being and quality of life in general. For instance, in the United Kingdom, the life expectancy of PLHIV that adhere to hospital appointment is now the same as the general population (Howarth et al., 2017). This breakthrough nevertheless, depends upon the capacity of the indi¬vidual living with HIV to maintain a minimum of 95% lifelong ART adherence (Rajesh et al, 2012). This requires nurses to actively engage with the patient by developing adherence interventions according to individual needs. Consequently, this will help to maintain an optimum level of HAART adherence, thereby preventing progres¬sion of the opportunistic diseases and promoting a better quality of life and an increased life expectancy (Paparello, Zeller and While, 2014). The nursing care goal of reducing morbidity, mortality, increasing the quality of life of people that are at risk for HIV and those affected by the disease (Basavaraj, Navya and Rashmi, 2010) can be achieved through careful planning, coordination, assessment and implementation of interventions, education on both prevention and care, more innovative and effective ways of managing complex care needs, and review of care in addition to supporting self-care and management ((Losina et al., 2009; Carrier and Newbury 2016; Watson et al., 2018). Thus this will be able to address the physical wellbeing and psychological needs of the patient as highlighted above (Pratt, 2003). The nurse can apply strategic nursing care which is an individualised problem-solving care that is tailored to meet teach patient’s identified immediate needs and possible potential problems (Pratt, 2003). The need-based nursing models of Henderson, Roper, Logan and Orem which are models of needs and self-care requites necessary for healthy living are important tools by which the individualised nursing care of PLHIV related illness can be planned and implemented efficiently and effectively. Despite the importance of helping individuals with HIV to self-care, depression is a far-reaching co-morbidity that can undermine self-adequacy. Along these lines, evaluating for depression and other psychological effects are vital when delivering HIV care (Paparello, Zeller and While, 2014). Therefore, the nursing assessment must equally include an examination of how this episode of illness is affecting the patient as opposed to duelling only on the physical. The nature and complexity of HIV may require more than one nursing model in caring for an individual living with HIV. The Burford model requires nurses to connect with the patient beyond the conventional nursing model approaches. It involves a holistic assessment that would address the patient as a whole and not just the illness. Assessing such data in an acute care setting may be complex because often, physiological assessment usually takes precedent other types of assessment. However, considering the peculiarity of HIV, the importance of this approach cannot be over-emphasised; it enables the nurses to manage the physical, psychological and social well-being of the patient. To appropriately plan and deliver nursing care for HIV patient,both the need-based models and the BNDUM to gained information about the needs occasioned by HIV and about the person living with HIV disease respectively. This will enable the hospitalised patient to return to health or minimised the impact of HIV on the patient (Pratt, 2003). Holistic care for HIV patient incorporates managing the disease through the containment of the HIV viraemia and the process of restoring the immune. To maintain the health of HIV Patient, nurse assessment should be a continuous patient-centred, interpersonal, collaborative and systematic process (Howard et al., 2004). This will require the nurse to establish a nurse-patient relationship by building trust and a bond with the patient from inception. Among others, individualised care includes educating the HIV patient on the importance of eliminating or reducing risky behaviour. The patient should be encouraged to have safe sex by using appropriate protective mechanisms and to avoid multiple partners. Monitoring and managing the patient for any complication that may arise as a result of opportunistic infections, impaired breathing and weight loss or any other related complications. Nurses are to ensure that the patient skin integrity is maintained by encouraging the patient to avoid scratching and to use appropriate soaps and body cream; to perform regular oral care, and to clean the perianal area after each bowel movement with non-abrasive soap and water. The nurse should monitor the frequency and consistency of the patient’s stools and the patient’s reports of abdominal pain or cramping. Patient and the caregivers should be encouraged to monitor infection and HIV nurses should put an action plan in place to prevent infection. The nurse is to assist the patient to plan a daily routine activity that will maintain a balance between daily activities and daily rest. Improving the patient’s airway clearance by encouraging coughing, deep breathing, postural drainage, percussion and vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote airway clearance. The patient is to be encouraged to have adequate fluid intake, have balance diet and avoid food that are not easy to swallow. Prior to discharge from the hospital, the nurse should enlighten the patient and the family about precautions and the transmission of HIV/AIDS. Patients and their families or caregivers should be given information about how to prevent transmission of the disease which includes hand-washing techniques and methods for safely handling and disposing of items soiled with body fluids. Patients are advised to avoid exposure to others who are sick or who have been recently vaccinated. Caregivers in the home are taught how to administer medications, including the preparation of IV (Belleza, 2016). HIV/AIDS is also associated with fatigue, depressive symptoms, and psychological distress (Barroso and Voss, 2013). Nurses ability to identify changes in the patient’s physical and mental conditions is imperative as this forms the basis of clinical intervention and decision making (DeBourgh, 2012).

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