Throughout the years of the HIV epidemic, members of the nursing profession have expressed to the association concerns about the care of clients infected with the human immunodeficiency virus (HIV). In response to these concerns, the NYSNA Councils on Nursing Practice and Ethical Practice and the association’s HIV/AIDS Advisors have studied and researched the role of the professional nurse in the HIV epidemic. The CDC classification system for HIV disease includes a wide spectrum of conditions from asymptomatic states to acute infections and AIDS (CDC, 1993).
Since its recognition in the United States in 1980, persons infected with HIV have been clustered in certain geographical areas. While the disease has been observed worldwide and is considered an epidemic in the United States, New York state continues to report the greatest number of cases in this country including the highest incidence of HIV infected children.
Due to the nature of the HIV epidemic, considerable public anxiety has persisted. Early in the epidemic reports were issued regarding individuals avoiding persons with positive HIV status and about the maltreatment, or lack of treatment, these clients have received from health care staff in hospitals, clinics and home care settings.
The American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements provides the framework for ethical decision making in nursing. The Code is based on the belief that nursing encompasses the promotion and restoration of health, the prevention of illness and the alleviation of suffering. Principle One of the Code states that “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem” (ANA, 2001).
In New York state, professional nurses in accordance with the Nurse Practice Act, Article 139 of Title VIII of the State Education Law, are responsible for “diagnosing and treating human responses to actual or potential health problems through such services as casefinding, health teaching, health counseling and provision of care supportive to or restorative of life and well-being...” (SED, 1995). The Rules of the New York State Board of Regents which relate to definitions of unprofessional conduct state in Part 29.2(1) that “abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care” and “failing to use scientifically accepted infection prevention techniques appropriate to each profession” are considered unprofessional conduct (SED, 1995).
The purposes of New York State’s AIDS Confidentiality Law are to: encourage voluntary, confidential testing; limit the risk of discrimination and harm to an individual’s interest in privacy; assure that HIV related information is not improperly disclosed; and provide rules for the handling of HIV related information. All health care practitioners must follow the parameters established by this law (NYS, 2000).
It is an ethical, legal and professional responsibility of nurses to care for persons with HIV disease. In addition, these clients are entitled to confidential health care. The right of confidentiality has long been respected by professional nurses. In order to give holistic care, professional nurses must have access to all available information necessary to deliver quality nursing care while assuring and maintaining the client’s confidentiality.
The New York State Nurses Association is deeply committed to promoting access to health care for all persons, but especially for vulnerable populations and those with catastrophic illness, including persons infected with HIV. NYSNA supports voluntary, confidential and/or anonymous HIV testing with pre- and post-testing counseling, as well as the availability of voluntary and confidential partner notification services for HIV-seropositive individuals. NYSNA believes that at every health care encounter health care practitioners should offer HIV education and the opportunity to individuals for voluntary HIV testing.
In addition, the New York State Nurses Association is committed to assisting professional nurses in obtaining the information needed to care for persons with HIV/AIDS and to understand nurses’ responsibilities to this client population. Early in the epidemic, the NYSNA board of directors sent written communication to all deans/chairpersons of nursing programs and to all directors of nursing in health care facilities in the state urging that appropriate educational programs regarding the HIV epidemic and the nursing care of HIV infected persons be developed for nursing students and professional nurses.
It is the opinion of the New York State Nurses Association that:
The New York State Nurses Association advises all professional nurses in New York state to:
Contact this association if assistance or clarification in this area of nursing practice is needed. Approved by the NYSNA Board of Directors, January 16, 2002; January 18, 1991; May 19, 1988; September 27, 1983. Developed under the leadership of NYSNA’s Council on Nursing Practice, Council on Ethical Practice and HIV/AIDS Advisors.
American Nurses Association. (2001). Code for nurses with interpretive statements. Washington, DC: Author.
Centers for Disease Control. (1991). Recommendations for preventing transmission of human immunodeficiency virus and Hepatitis B Virus to patients during exposure-prone invasive procedures. Morbidity and Mortality Weekly Report, 40 (RR08), 1-9.
Centers for Disease Control. (1993). Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report, 41(RR-17), 1-19.
Centers for Disease Control. (1995). Case control study of HIV seroconversion in health care workers after percutaneous exposure to HIV-infected blood. Morbidity and Mortality Weekly Report, 44, 929-933.
Centers for Disease Control. (1999). Guidelines for national immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. (1999). Morbidity and Mortality WeeklyReport, 48(RR13), 1-28.
Centers for Disease Control. (2001). Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. Morbidity and Mortality Weekly Report, 50(RR11), 1-42.
Department of Labor, Occupational Safety and Health Administration. (1999). Occupational exposure to bloodborne pathogens (29 CFR 1910.1030).
Grady, G., Bechtel-Boenning, C. and Boland, M. (Eds.). (1996). HIV infection/perinatally transmitted HIV infection. Nursing Clinics of North America, 31(1).
New York State Department of Health. (2000). HIV reporting/partner notification - questions/answers. Albany, NY: Author.
New York State Department of Health. (1994). Department of Health Memorandum: 1993 Centers for Disease Control and Prevention revised case definition for Acquired Immunodeficiency Syndrome (Series 94-36). Albany, NY: Author.
The State Education Department, Division of Professional Licensing Services. (1999). Nursing handbook. Albany, NY: Author.
The 2001 guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents and the 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections. (2001). Washington, DC: US Department of Health and Human Services.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.