The Process of Coping Among AIDS Patients Essay

Discussion Post

Phenomenological Inquiry

The topics “The process of coping among AIDS patients,” “Rituals relating to dying among nursing home residents,” and “Decision making processes among nurses regarding do-not-resuscitate orders” can be attributed to the phenomenological inquiry category. The three topics narrate a collective and similar experience among the populations that were researched. Thus, they help in understanding how and why some phenomena occur. According to Umanailo (2019), phenomenology is a great tool in helping researchers understand how the human minds work based on observations of occurrences in society. Impliedly, this form of research discusses the characteristics of an experience that is shared by a specific population at a given time.The Process of Coping Among AIDS Patients Essay

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Ethnography

The topic “The passage through menarche among Haitian refugees” suits the ethnographic research category. Hammersley (2017) defines ethnography as the study of people’s culture in a natural setting that involves customs of individuals. According to him, the researcher also participates in the activities of the population of interest from which they draw their results. Therefore, they live the experience and learn the meanings of various societal symbols and functions. The topic implies that the researcher focuses solely on Haitian refugees and their response to the first menstruation. Results from this type of research will help the study make an inference to the larger Haitian population and their experiences throughout this particular time.

A Grounded Theory Study

The grounded theory study deals with the collection and analysis of data relating to a research population’s perspectives and experiences with a given situation. An important aspect and strength of this type of research is that it enables the assessment of large volumes of data (Flynn & Korcuska, 2018). Besides, it allows researchers to use more diverse methods of obtaining data. The topic “The experience of having a child with leukemia” falls under this category because it endeavors to collect information on the behavior of parents, their concerns, and difficulties related to having a child suffering from the disease. Multiple surveys completed by parents will give a picture of what they go through.The Process of Coping Among AIDS Patients Essay

The early years of the acquired immunodeficiency syndrome (AIDS) epidemic in the United States were marked by rapidly increasing numbers of young people dying from a bewildering array of exotic infections, often following lengthy and costly hospitalizations. 1 A lack of knowledge about modes of transmission, combined with extreme prejudice against the populations at highest risk, engendered an aura of hysteria that impeded understanding and access to care. 2

By 1986, 21,570 cases of AIDS had been reported to the Centers for Disease Control (CDC); over half of these people had died. Urban hospitals were reeling under the human immunodeficiency virus (HIV) epidemic and the medical consequences of drug abuse and violence. The lifetime cost of AIDS was estimated to be $145,000 per person, almost all of which was associated with hospital use. 3 Medicaid programs were facing unanticipated costs. A strategy was needed to reduce reliance on hospitals by developing outpatient treatment and community support services.The Process of Coping Among AIDS Patients Essay

The Robert Wood Johnson Foundation (RWJF) initiated the AIDS Health Services Program in 1986 to develop integrated networks of human services agencies (consortia) and to coordinate the provision of services using case management. The program emphasized community-based care, inspired by the “San Francisco model,” which is based on the premises that patients prefer community care to hospitalization and that this approach is also less costly. 4 . This essay summarizes the program evaluation, with particular focus on the approach to organizing and delivering case management services. 5

EVALUATION DESIGN
The goals of the program evaluation were to assess the feasibility of developing community-based services for persons with AIDS and to determine factors that facilitated or impeded service development and provision. We viewed program sites as examples of how communities were attempting to develop and coordinate the diverse health and social services needed by persons infected with HIV. Indicators of service development processes included interorganizational conflict and extent of joint programmatic activities, targeting of case management services, case manager contact frequency, and the types of client problems addressed by case managers. Indicators of program outcomes included expansion of community-based services and the fulfillment of clients’ needs for services.The Process of Coping Among AIDS Patients Essay

The evaluation data collection strategy was complex; evaluators gathered extensive qualitative and quantitative information about each community in the program, as well as about the participating hospitals and community-based agencies and the clients served. During annual visits to program sites, administrative and clinical staff were interviewed. A management information system (MIS) was established to document clients’ characteristics upon entering the program. Interviews were conducted with a subsample of 1,386 clients to assess a variety of issues, including contact with case managers and the presence of unmet service needs.

PROGRAM AND POPULATION
The foundation selected nine projects located in eleven communities. However, because the New York City project was a coalition of community consortia and not a service-level consortium itself, we focus here on only the remaining ten communities ( Exhibit 1 ). Consortia typically included a public or nonprofit hospital (with the exception of West Palm Beach and Fort Lauderdale) and a community-based AIDS service organization (CBO) providing mental health and social services, support from volunteers, and other services, such as home meals and housing allowances. The consortia were administered by either the hospital, the CBO, an existing nongovernmental agency, or a state or local health department. More than half of the communities had multiple community AIDS service organizations; in two communities at least one of the CBOs was minority focused. All consortia had member agencies involved in home care; in six settings a hospice was involved in service delivery from the outset.The Process of Coping Among AIDS Patients Essay

Exhibit 1 Organizational Membership Of AIDS Health Services Program Consortia

PROGRAM SITE LEAD AGENCY NUMBER OF HOSPITALS NUMBER OF AIDS CBOS MINORITY CBOS HEALTH DEPARTMENT HOME CARE AGENCIES CASE MANAGEMENT AGENCIES
Atlanta AIDS CBO 1 1 No Not involved HHA, hospice AID Atlanta
Dallas Established community service agency 1 3 No Not involved HHA AIDS Arms
Fort Lauderdale Public authority hospital trust 5 3 Yes Involved HHA, hospice Broward County Public Health Clinic
Miami Public authority hospital trust 1 3 Yes Involved HHA, hospice South Florida AIDS Network
Nassau County (New York) Public hospital 1 3 No Not involved HHA Nassau County Medical Center
New Orleans Established community service agency 1 1 No Not involved HHA, hospice Association of Catholic Charities
Newark State health department 3 1 No Involved (state) HHA St. Michael’s Medical Center, VA Medical Center, University Hospital
Jersey City State health department 1 1 No Involved(state/local) HHA Jersey City Medical Center
Seattle County health department 2 3 Yes Involved HHA, hospice Haborview Medical Center
West Palm Beach Hospice agency 0 2 No Involved HHA, hospice Comprehensive AIDS Program
Source: AIDS Health Services Program Evaluation.
Notes: AIDS is acquired immunodeficiency syndrome. CBO is community-based organization. HHA is home health agency.

Case management designed both to advocate for program clients as a group and to expedite service delivery to individuals was present in all sites, although its locus varied. In several sites case management was conducted by both a hospital and a CBO.

The AIDS epidemic in each site varied substantially. For example, of the 808 CDC-reported AIDS cases in Newark in 1987, 25 percent were women, 60 percent were injected drug users, and 73 percent were black. In contrast, 85 percent of the 523 incident cases in Atlanta reported male homosexual contact with an infected partner as their sole risk factor for HIV infection; only 4 percent were women, and 30 percent were black.The Process of Coping Among AIDS Patients Essay

Most program clients were enrolled at one of two entry points: the public hospital or the AIDS CBO. The two points of entry served different client populations. Clients admitted via CBOs were more likely to be gay white males than were the clients admitted via hospital clinics. Lack of health insurance represented a problem for the majority of clients in states having the most restrictive Medicaid policies (covering the Atlanta, New Orleans, and Dallas sites) and in communities where a large proportion of clients entered the program before their condition progressed to AIDS (Miami, Fort Lauderdale, and West Palm Beach). The average annual population with AIDS in program sites increased 126 percent between 1987 and 1990, with increases ranging from 91 percent to 175 percent. During that period the average increase in the number of persons alive with an AIDS diagnosis in these eleven cities was 191 percent, ranging from 181 percent to 257 percent.

Accompanying this growth was a shift in the mix of clients served. Exhibits 2 and 3 present the growth in the number of new intakes into the MIS database per half-year broken down by risk group (homosexual versus heterosexual males) and by entry site. While 80 percent of all clients coming to CBOs were homosexual men in 1987, by 1990 this was true of only about 65 percent of new clients. The proportion of gay men coming to hospital clinic sites increased from about 33 percent in 1987 to more than 40 percent in 1990.The Process of Coping Among AIDS Patients Essay

Exhibit 2 Changes In Risk-Group Distribution Of New Clients Entering The AIDS Health Services Program Via Hospitals, 1987-1990

Exhibit 2
Source: AIDS Health Services Program Management Information System (MIS).
Exhibit 3 Changes In Risk-Group Distribution Of New Clients Entering The AIDS Health Services Program Via Community-Based Organizations, 1987-1990

Exhibit 3
Source: AIDS Health Services Program Management Information System (MIS).
CBOs grew dramatically. Between 1988 and 1990 the average CBO budget increased by 215 percent, with one agency’s budget growing by 535 percent between 1987 and 1990. In particular, the number of case managers showed a remarkable increase. Most agencies experienced problems coping with growth. CBOs struggled to develop the administrative and budgetary systems needed to operate organizations having annual budgets exceeding $1 million. The nascent HIV service systems were strained by this rapid growth as well as by the changing complexion of the epidemic, evidenced by the increasing proportion of clients who were minority and female. The shifting demographics of the epidemic created pressures for new services and brought new entrants into the network of providers.The Process of Coping Among AIDS Patients Essay

CONSORTIUM FUNCTIONING
Most consortia experienced some degree of interagency conflict. Conflict between the CBO and the local public hospital compromised operations in four sites, and conflict between CBOs occurred in one. In one site interorganizational relationships broke down to the point that there was no structure to exchange information between the major hospital and the CBO at any level Large hospitals and community-based AIDS service organizations were unaccustomed to dealing with each other as equals. Communication problems were often complicated by differences in service philosophy (medical versus social model) and by mistrust. Conflict was most evident in sites where a public hospital was the site’s lead agency. In such sites CBOs distrusted the hospital because it tended to allocate a disproportionate share of resources and decision-making authority to itself.

There was less conflict in consortia led by health departments, especially local health departments. Informants in several sites expressed the opinion that the lead agency should be seen as a neutral party. The lead agency’s authority in the consortium is facilitated if other members view it as providing a complementary (not competing) and valuable service. Lead agencies providing only case management found their authority undermined because some consortium members felt this service was unimportant.The Process of Coping Among AIDS Patients Essay

Conflict between CBOs typically centered on differences in philosophy or clientele. In one site the consortium had to deal with persistent conflict between one agency providing centralized case management services and a second community agency wanting a greater allocation of funds for direct services. The sentiment that case management was a “frill” was expressed in other consortia, especially during negotiations over funding allocation.

Joint programmatic activity was minimal in most sites. Agencies in each consortium were expected to meet routinely to discuss common issues in service delivery, but many consortia held meetings erratically or on a pro forma basis. Reviews of minutes of administrative meetings of consortium members suggest that for the most part their focus was on information exchange rather than policy formulation. Consortium development was hindered in some sites by the administrative inexperience or instability of the lead agency. This was particularly the case for consortia headed by fledgling community-based AIDS service organizations. Several CBOs experienced turnover in top administrators; most had to struggle to develop an adequate administrative and fiscal infrastructure.

There were few instances in which a consortium collectively formulated and enforced a policy (such as written guidelines for client eligibility or for staff interchange) or acted as a decision-making body. It apparently was rare for consortium members to analyze jointly deficiencies in the service delivery system and to consider possible solutions. There were few instances of agencies changing their policies or operating procedures in response to suggestions from other members, and in no site were formal mechanisms established for adjudicating disputes among consortium members. The tenor of interagency relationships in most sites was best characterized by one observer who called it a “forced marriage.”The Process of Coping Among AIDS Patients Essay

The program consortia had neither the structure, the authority, nor the incentive to address controversial or redistributive issues. We observed few attempts at service integration involving organizational restructuring, such as developing interagency programs or transferring staff from one agency to another. The agencies’ existing programs generally remained the same; similarly, the overall service delivery systems were rarely affected.

THE PROCESS OF CASE MANAGEMENT
Eighteen organizations provided case management in AIDS Health Services Program sites. In some sites (Miami, Fort Lauderdale, Newark, and Jersey City) case management was conducted almost exclusively within the hospital or clinic setting, while in others (Atlanta, Dallas, and New Orleans) CBOs provided it. The remaining sites had case managers in both hospital and community settings. 6

The approaches to case management adopted by CBO- and hospital-based case managers were quite different. 7 Hospital case managers emphasized discharge planning, obtaining entitlements, and making referrals to home care agencies. CBO case managers linked clients to emotional support programs, buddies, and other volunteers and provided assistance with emergency housing and financial support.

For indicators of case management implementation, we focused on the extent to which clients were in contact with case managers. Specifically, we examined the proportion and characteristics of clients who said they had a case manager, the frequency of contact with case managers, and the types of problems presented to them.The Process of Coping Among AIDS Patients Essay

CASELOAD SIZE AND TARGETING.
By 1990 caseloads ranged from twenty-nine clients per case manager in Seattle to 290 in Fort Lauderdale, but in most agencies they averaged from fifty to sixty-five. 8 Growth had occurred rapidly and early in the program. High caseloads arose in part from lack of triage policies. The development of explicit triage protocols to allocate case management resources occurred slowly. In the absence of a formal triage system, clients have been implicitly triaged as case managers devote more time and effort to the most needy clients. By the end of the demonstration, most agencies had adopted targeting.

We interviewed people receiving services at CBOs and HIV clinics. Although all respondents were potentially eligible for a case manager, some reported not having one (19.7 percent of CBO respondents and 46.1 percent of hospital clinic respondents). 9 These results suggest some slippage (or implicit triage) in connecting clients to case managers, especially in clinic settings. Over time, the proportion of CBO clients with a case manager increased, but the proportion of clinic patients reporting a case manager declined.The Process of Coping Among AIDS Patients Essay

Controlling for client entry point (that is, CBO or clinic), we observed no differences in the likelihood that clients had a case manager as a function of race or risk group. Women were less likely than men to report having a case manager, especially among clinic respondents (44.9 percent of females versus 55.7 percent of males). As can be seen in Exhibit 4 , however, clients who reported needing services were more likely to have a case manager than were those without service needs. For example, of those recruited in a clinic who needed help applying for entitlements, 65.2 percent had a case manager, compared with 47.9 percent of clinic respondents who did not need such assistance. Similar patterns occurred for each service need listed in the exhibit, regardless of recruitment site. 10

Exhibit 4 AIDS Health Services Program Patient Characteristics And Service Needs

CONTACT FREQUENCY.
We found that clients with a case manager were contacted approximately monthly. While 15-21 percent of clients had no contact with their case managers in the last month, the same percentage had three or more contacts. Our examination of case management records revealed that 77.4 percent of case management contacts with clients were via telephone; home visits were rare. Minority clients, women, and injected drug users who had a case manager were contacted as frequently as their white gay male counterparts. Indeed, clients reporting that they needed assistance obtaining social services had more frequent contact with their case manager than did those who reported no need for assistance. Furthermore, our data suggest that contact frequency among those with a case manager increased as the program evolved.

PROBLEMS PRESENTED TO CASE MANAGERS.
Over 870 respondents were asked whether they had requested help with a problem from their case manager in the preceding three to four months. Of those with a CBO case manager, 62 percent had brought a problem to the attention of that person. For 60 percent, help was needed in obtaining entitlements such as Medicaid or Supplemental Security Income (SSI); issues concerning receipt of medical care (19 percent), emotional support (23 percent), legal assistance (11 percent), and housing (12 percent) occurred less frequently. Of those with a clinic case manager, 48 percent had sought assistance from their case manager. For 47 percent of these respondents, the problem involved assistance with entitlements; problems with medical care (24 percent) or emotional support (15 percent) were notable but less frequent.The Process of Coping Among AIDS Patients Essay

Clients’ evaluations of their case managers were very positive. Furthermore, clients’ sex, race, or risk group was unrelated to their satisfaction with case management. Clients were somewhat happier about their case manager’s personal attributes than their availability, but this is not surprising given case managers’ large caseloads.

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This essay was based on a patient that was admitted to Gondar University referral Hospital Pediatrics main ward with a medical diagnosis of stage III RVI. The main aim of this essay was to explain the rehabilitation Nursing care for the patient living with HIV/AIDS by using holistic Nursing care approach specifically focused on rehabilitation issue. After analyzing the patient’s case, this paper will also deal with the rehabilitation care by searching and evaluating literature, guidelines and standards that support and argued this patient care. Finally, recommendation will give based on the evaluation of the care for improving quality of nursing care practice. For the purpose of confidentiality, the patients name was assigned as XY. 2. Case Description This is XY, a14-years –old female patient comes from Gondar town, Keble 18 admitted to Gondar university Referral hospital; pediatric main ward on 10/09/2008 E.C. She is a known RVI patient for the past 9years. She has history of ART follow up for the past 9 years back but the drug was changed from AZT + 3TC + NV to EFV + 3TC + TDF due to the side effect of AZT. She was relatively healthy two weeks back but at which time she starts to experience: right lower leg pain, erythematous, none pustule, none position dependant unilateral swelling > 72 hours associated with low-grade intermittent fever, loss of appetite. She has h(x) of dray cough but she has no h(x) of contact with PTB or chronic cougher; she has no history of trauma; she has no h(x) surgery; she has no h(x) of taking any anti-inflammatory drugs; she has no h(x) of liver, kidney and heart disease. 3. Discussion HIV is a chronic infectious disease caused by Human Immuno Deficiency Virus. HIV has a distinct characteristics of long period of asymptomatic presentation and finally it may end up with AIDS manifestation and leads to death [1]. Almost 3.4The Process of Coping Among AIDS Patients Essay  million children were living with HIV by the
2 Animut Alebel and Fasil Wagnew: Essay on Rehabilitation of Patients Living with HIV/AIDS end of 2011 from those majorities of them (91%) where living in sub-Saharan Africa. In Ethiopia by the year of 2013 it is estimated that 793,700 (716,300-893,200) people where living with HIV/AIDS from those 200,300 (172,400–232,400) were children. From the above number we can understand that Ethiopia is one of sub-Saharan Africa country, which is highly affected by HIV/AIDS [3]. Transmission of HIV can be of either sexual contact, parenteral exposure to blood, or vertical transmission from mother to child. Among all route, the primary route of infection in the pediatric population is vertical transmission which accounting for almost all new cases. Transmission rates in Africa and Haiti are higher (rangeis25-5[4]. Similarly, Patient XY acquired the disease from her family and currently she is an orphan since her mother and father dead due to HIV/AIDS. Perinatal treatment of HIV infected mothers with antiretroviral drugs has dramatically decreased the transmission rates of <2% in pregnant women one effective therapy. The clinical manifestations of HIV infection vary widely from infants, children, and adolescents. Clinical manifestations found more commonly in children than adults with HIV infection include recurrent bacterial infections, chronic parotid swelling, lymphocytic interstitial pneumonitis [5], and early onset of progressive neurologic deterioration. The HIV classification system is used to categorize the stage of pediatric disease by using two parameters: clinical status and degree of immunologic impairment. HIV in child can be diagnosis by different means but viral diagnostic assays, such as HIV DNA or RNA PCR or HIV culture, are considerably more useful in young infants. The currently available therapy for HIV does not eradicate the virus and cure the patient and instead suppresses the virus for extended periods and changes the course of the disease to a chronic process [4]. 4. Rehabilitation HIV is now a day considered as a chronic manageable disease, rather than terminal illness due to the universal availability of HAART. Like other chronic disease, HIV has also various psychological, social and behavioral maladjustments that need rehabilitation, especially in children [6, 7]. In our country, HAART was first introduced in 2003 in fee-based and 2005 in free-based. Because of HAART intervention, many people living with HIV/AIDS in developing and industrialized countries survive for a longer period [6, 8]. Despite improvements in survival, people living with HIV have arrange of physical, cognitive, mental and social health-related challenges associated with HIV, co morbidities and aging, a concept that may ‘ disability’ [8, 9]. In the context of HIV Rehabilitation is defined as continuous process of supportive care that includes both preventive and treatments. The rehabilitation care both covers impairments of physical activity, decrease from social involvement and cognitive impairments [9]. 4.1. Self-Management Education When effective treatment of incurable diseases tends life expectancy and causes symptom remission, acute and terminal illness models must be replaced by a chronic care model (CCM) in which patient’s elf-management is a key component. HIV has been recognized as a chronic illness since the advent of antiretroviral therapy but HIV is still not universally included in chronic illness lists and discussions [10]. HIV meet several chronic disease criteria:The Process of Coping Among AIDS Patients Essay  uncertain course, a prescribed treatment regimen, requirement for self-care, some degree of stigma, changes in roles and relationships, identity changes, and psychological distress [11]. The goal of chronic illnesses health care is to control symptoms and prevent disability rather than curing the disease. Thus, the objectives of chronic disease interventions include managing physical symptoms, improving independence, and increasing quality of life. The majority of illness management takes place outside of formal health care. Patients are responsible for using medication properly, changing behavior to improve symptoms or slow disease progressions, interpreting and reporting symptoms correctly, adjusting to new social and economic circumstances, coping with emotional consequences, participating in treatment decisions, and preventing transmission of contagious diseases [10]. The Positive Self-Management Program combines health education with self-management skills, assuring that patients understand the risks and benefits of treatment options to participate in medical decisions. Common goals of self-management interventions to support physical health (e.g., medication adherence, symptom management, and healthy life style routines), psychological functioning (e.g., managing stress, promoting self-esteem, and maintaining positive emotional states), and social relationships (e.g., collaborative provider patient interactions, accessing social support, and enhancing role, and relationship functioning) [10]. Similarly, In patient XY she is currently adhered to her medication and had no recorded h(x) of dropout. this indicated that she had Good knowledge about self-management of the disease. 4.2. Dietary Management Causes of malnutrition are classified in three major groups; immediate causes, underlying causes and basic causes. Factors like inadequate dietary intake and infections including HIV/AIDS are considered as immediate causes of malnutrition [12]. Macro and micronutrient deficiency developed by PLHIV is becoming a headache for health profession. This nutritional complication is most commonly due to HARRT drugs especially nucleoside reverse transcriptase inhibitors [13]. Nutritional supply to improve food security for PLHIV has both physical and mental health improvement [14]. Human
Rehabilitation Sciences 2017; 2(1): 1-5 3 Immune Deficiency Virus (HIV) infected individuals are at a greater risk of having malnutrition compared to General population [15]. So many factors contribute for the reduction of Nutritional intake for PLHIV. Among those factors fungal infections involving in the mouth or throat, loss of appetite and higher incidence of diarrhea that leads to malabsorption have a significant role to develop malnutrition for PLHIV as a result, Nutritional intervention or therapy is a key for PLHIV [16]. The Vicious Cycle of Malnutrition and HIV Figure 1. Adopted from National Comprehensive HIV Care and Treatment Training for Health care Providers Ministry of Health June 2014. Nutritional Recommendations for PLHIV (Therapy) Specific nutrition recommendations vary according to the underlying nutritional status and extent (stage) of HIV disease progression. The disease progression categorized in to three stages: – Early stage, middle stage and late stage [17]. Early Stage: – at this stage peoples most common asymptomatic. Energy and Protein increase requirement increase by 10-15% and 50% respectively. Vitamins and minerals used by the immune system are also increased. The main objective eat this stage is to remain as healthy. Middle Stage:- At this stage of the disease, there is significant, unintentional or undesirable weight loss the main objective are to minimize consequences by increasing nutrient intake for recovery /weight gain. Avoid unhealthy behaviors like that of alcohol intake, smoking and drug use are recommended [17]. Late Stage:- this is AIDS defining stage. Therefore, the focus at this stage should be reducing nutritional consequences of AIDS as much as possible [17]. With similar to the above literature patient XY is currently diagnosed as having Underweight. The possible risk factor of her underweight may be she has also loss of appetite, one episode of bloody diarrhea these factors may contribute to malnutrition. 4.3. Exercise Management Due to the introduction of ART therapy PLHIV now a day becomes long term survived consequently they become a risk of age related CVD and other related chronic disease that needs exercises therapy. A systematic review conducted on the effects of different types Of therapeutic, exercise on physiologic and functional Measurements in patients living with HIV/AIDS shows that resistance training, aerobic exercise, and concurrent training are associated with improvements in body composition, muscle strength, and cardiopulmonary fitness In adults living with [18]. Another systematic review conducted on the effects of concurrent strength and endurance training on the Health- Related Quality of Life and Cardiopulmonary Status in Patients with HIV/AIDS demonstrated that there is sufficient evident to support the effectiveness of concurrent training improves aerobic capacity in PLHIV. Despite major differences in exercise prescription and duration of different programs, the aerobic capacity was significantly improved [19]. Over the past decades, there have been multiple epidemiological studies showing the relationship between physical activity and overall health in non-HIV populations Physically active adults are less susceptible to viral and bacterial infections when compared with sedentary adults, suggesting that physical activity improves overall immune function. Research evidence supports the findings that exercise decreases age associated immunosenescence [20]. Regular physical activity can positively affect the HIV infected individual psychologically, and emotional wellness has been linked directly related to immune health [21]. A limited research base has examined the efficacy of exercise to treat the most common symptoms of HIV/AIDS and the adverse effects of HAART. The Process of Coping Among AIDS Patients Essay Some research suggested that exercise training for 8–12 weeks would result in reduced fatigue, anxiety and depressed mood, along with an improved quality of life. In addition, there is no evidence that HIV infected persons respond negatively to exercise [22]. However, to the opposite of the above literatures patient XY explained that she becomes fatigue and fells emotional instability while she done physical exercise and due to this she stay at home throughout the day this may be one risk factor for her leg swilling. 4.4. Psychosocial Intervention The positive effect of social support on reducing psychological distress among PLHIV has been widely confirmed by both cross-sectional and longitudinal studies There is strong evidence that supports mental health and HIV are bidirectional. Means there is high prevalence of HIV among peoples who have mental illness and there is high prevalence of HIV among mentally ill people [23]. Psychosocial support from different group of people had a significant impact on their life from depression and other mental related illness for people living with HIV. This study also shows most people living with AIDS share their Idea much in common with people living with HIV/AIDS in other cultural settings [24]. The psychological concern was common among children than adult according to his study form all participants 23% of children showed feeling of anger and 33 children shows frequent sicknesses, from this 19 felt isolated, 15 were fearful [25]. Functional social support has a profound prejudice on psychological as well as social activity of PLHIV. This therapy had an effect to reduce anxiety and depression [13].
4 Animut Alebel and Fasil Wagnew: Essay on Rehabilitation of Patients Living with HIV/AIDS 4.5. Family and Social Support Social support has different form and comes from different direction (family, friends) but in this essay, I am focused on family support that is the most important one. Social support can be define as a social system as others who help people to mobilize their psychological resources in order to deal with emotional problems (linking, loving, and empathy) [26]. Health profession and community health worker have an indispensible role to explain the importance of psychosocial support for the PLHIV from their family, friends, and community at large especially for females [27]. Majority of PLWHIV lives with heir family when they are compared to peoples without HIV/AIDS this may be implies that PLHIV seeks more social support than peoples without HIV/AIDS [28] 5. Nursing Implication The role of nursing practice for this particular patient is indispensables in HIV case needs a lifelong therapy .in addition to this nursing care should be multidimensional (holistic) but to the contrary, patient XY has not been got this rehabilitation service still I meet her. Having that my key role was to fill this gap as a result; I tried to address her psychosocial as well as nutritional need as much as I can. The care was starting from her assessment and care that was given to her includes; I have tried to incorporate some of the rehabilitative activities such as education and counseling on the importance of self-care management behaviors, exercise under supervision, dietary habits, psychosocial support, family and social support to PLHIV. 6. Conclusion and Recommendation HIV is now a day considered as a chronic disease due to the introduction of HAART. This intervention helps to long time survivors of the patient and leads to age related CVD and other chronic disease that needs a lifelong rehabilitation care. Patient XY was risk of multiple factors that need rehabilitation care. Among this psychosocial problem, is the prominent one so, nursing profession has indispensable role in this aspect. As a result, Nurse who works in this hospital should apply holistic care for patients with HIV/AIDS. The hospital should also incorporate rehabilitation care as one component of care in ART clinic. References [1] Tsinuel Girma(MD), Habtamu Fekadu(MD), Goitom G/Yesus(MD), Assfa wossen Bekele(MD), Mekete Latebo(MD), WogeneTamire(MD), etal., Pediatrics and child health lecture note for health science.carter center, 2004. [2] T. W. B. WHO.UNICEF, “UNICEF-WHO-TheWorld Bank Joint Child Malnutrition Estimates,”ed. Available at http://www.who.int/nutgrowthdb/jme_unicef_who_wb.pdf,2012,p.3. [3] “COUNTRY PROGRESS REPORT ON THE HIV RESPONSE,”ed. Available from http:// www. Unaids .org/ sites/ default/ files/ country/ documents/ ETH_ narrative_ report_ 2014. pdf.,2014. [4] Nelsone Text Book of Pediatrics, 20 th Edition edned. vol.1: Elsevier. [5] E. DeLanghe, A. Seghers, P. Demaerel, P. Verschueren, and R. Lemmens, “Non-infective endocarditis with systemic embolization and recurrent stroke in systemic sclerosis,” Rheumatology (Oxford), vol. 55, pp. 589-91, Mar 2016. [6] I. Vander Heijden and S. Swartz, “Bereavement, silence and culture with in a peer-led HIV/AIDS-prevention strategy for vulnerable children in South Africa,” Afr JAIDSRes, vol. 9, pp. 41-50, Apr 2010. [7] G. Green and R. Smith, “The psychosocial and health care needs of HIV-positive people in the United Kingdom: areview,”HIV Med, vol. 5Suppl1, pp. 5-46, May 2004. [8] F. J. Palella Jr, K. M. Delaney, A. C. Moorman, M. O. Loveless, J. Fuhrer, G. A. Satten, et al., “Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection ,”New England Journal of Medicine ,vol. 338, pp. 853-860, 1998. [9] K. O’Brien, A. Wilkins, E. Zack, and P. Solomon, “Scopingthefield: identifying key research priorities in HIV and rehabilitation, “AIDS Behav, vol. 14, pp. 448-58, Apr2010. [10] D. Swendeman, B. L. Ingram, and M. J. Rotheram-Borus, “Commonelements in self-management of HIV and other chronic illnesses: an integrative framework, “AIDS Care, vol. 21, pp. 1321-34, Oct 2009. [11] K. Siegel and H. M. Lekas, “AIDS as a chronic illness: psychosocial implications, “AIDS, vol. 16 Supp l4, pp. S69-76, 2002. [12] P. Katona and J. Katona-Apte, “The interaction between nutrition and infection,” Clin Infect Dis, vol. 46, pp. 1582-8, May 152008. [13] G. Somarriba, D. Neri, N. Schaefer, and T. L. Miller, “The effect of aging, nutrition, and exercise during HIV infection, “HIVAIDS(Auckl), vol. 2, pp. 191-201, 2010. [14] K. Palar, K. P. Derose, S. Linnemayr, A. Smith, H. Farias, G. Wagner,et al., “Impact of food support on food security and body weight among HIV antiretroviral therapy recipients in Honduras: apilot interventiontrial, “AIDS Care, vol. 27, pp. 409-15, 2015. [15] J. R. Koethe and D. C. Heimburger, “Nutritional aspects of HIV-associated wastingin sub-Saharan Africa,” AmJ Clin Nutr, vol. 91, pp. 1138S-1142S, Apr2010. [16] S. D. Weiser, K. A. Fernandes, E. K. Brandson, V. D. Lima, A. Anema, D. R. Bangsberg, et al., “The association between food insecurity and mortality among HIV-infected individuals on HAART, “Journal of acquired immunedeficiency syndromes (1999), vol. 52, p. 342, 2009. [17] MOH, “National Comprehensive HIV Care and Treatment Training for Health care Providers, “ed, 2014, p. 287.  The Process of Coping Among AIDS Patients Essay