Specific clinical need

‘Reflecting on a specific clinical need, for example pressure area care, nutrition, moving and handling etc; discuss whether the care provided was based on current best evidence’ The clinical incident for this assignment revolves around a patient, Mr. A, presenting at a walk-in Genitourinary Medicine centre for HIV screening. In line with guidelines published by the Nursing and Midwifery Council (NMC), specific names and places have been amended to retain anonymity for all concerned, and consent has been obtained from the patient and staff involved (NMC, 2008).

Involved in the event were the patient, Mr. A, my mentor, Miss D, and I. Mr. A is a homosexual gentleman who had had unprotected sexual intercourse, and as a result was worried that he had contracted HIV. He had attended the clinic three months earlier, just after the encounter, but due to the ‘window period’ for HIV infection of approximately 3 months (AVERT, 2009), he had to attend again after this time. My mentor began the consultation by asking a series of routine questions regarding his sexual history, culminating in asking whether he would consent to an HIV test at this time.

Mr. A said that he was happy to consent, and signed the appropriate consent form. He was then taken to phlebotomy, had his blood taken and then left. No where in this time was any counselling or advice given to Mr. A as to what he could expect, or how he would feel if his result returned as positive. In this case, the specific clinical need focussed on will be the recommended counselling provided to Mr. A during his consultation with a nurse. According to the Oxford English Dictionary and Thesaurus (2001), counselling is defined as “process in which esp.

Professional help is given for emotional or psychological problems”. While it could be argued that on arriving at the Genitourinary medicine clinic Mr. A did not explicitly have a psychological problem, in these particular circumstances there was the potential for a psychological problem to develop. HIV testing can promote feelings of shame, social detachment and fear for the stigma associated with a positive diagnosis (Lane et al. 2006). Therefore, some kind of explicit counselling relating to HIV and issues surrounding positive diagnosis could have helped to alleviate fears.

Initially, I felt slightly worried as to what to expect: I thought that Mr. A may feel it intrusive to have a student nurse observing him while the issues surrounding the HIV testing were explored. I felt that I would not want several different people watching me as I divulged sensitive information relating to my personal life and my feelings. As the consultation progressed and no attempt at counselling was made, I began to feel that something was wrong: having read extensively around the topic of genitourinary nursing, I felt sure that some mention of counselling should have been made.

The way in which my mentor rushed through the consultation made me think that she had done this too many times, and had become unconsciously dismissive of the psychological issues relating to HIV testing. After Mr. A had left, I felt distinctly that the consultation was conducted poorly. Despite all of this, Mr. A seemed quite content: probably because he had no considered that he may need any kind of counselling. Having raised this issue with my mentor, she seemed to feel that it was unnecessary to provide Mr. A with counselling, as in her opinion he had not asked for it, and further more would “not know what to say”.

During the discussion, I felt that my mentor had been very professional in her approach to Mr. A and his current situation. She had listened to Mr. A discuss some quite intimate details regarding his personal life and at no time did she appear to be anything else than concerned for his well-being. According to the NMC Code of Practice (NMC, 2008), Miss D acted in an appropriate way by in that she did “… not discriminate in any way against those in your care”. This showed that she was working not only to an appropriate set of guidelines set down by her governing body, but also in a morally acceptable way.

In contrast, the omission of the pre-test counselling appeared to be quite unprofessional. According to the same NMC Code of Practice (NMC, 2008), nurses must “… deliver care based on the best available evidence or best practice”. Evidence-based practice is using the best available evidence as well as clinical experience in order to obtain the best outcome for the patient (Sackett et al. , 1996). In this particular case, best practice could be guidelines from specialist HIV/AIDS organisations, such as the British HIV Association (BHIVA), or from larger, international organisations such as the World Health Organisation (WHO).

According to the guidelines produced by the British HIV Association (BHIVA), a pre-test discussion relating to the HIV should be offered to all patients requesting an HIV test within a genitourinary setting (BHIVA, 2008). Specifically, it is recommended that the discussion explores any of the patient’s conceptions or possible misconceptions around the testing and a positive result. This discussion could have identified any potential worries or fears that Mr. A was experiencing, many of which may have been calmed when given the appropriate information.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) advocates a “3 C’s” approach to HIV testing: Confidentiality, Counselling and informed Consent (UNAIDS, 2004). According to this principle, only one of the three criteria was being met, in that the testing …

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