The phenomena of doing well in people with AIDS

Exploring positive adjustment in HIV positive African women living in the UK

Research into living with HIV/AIDS has to date mainly focused on quality of life and there is little on the adjustment process for this group. The numbers of African women living with HIV/AIDS in the UK is growing and yet little is known about the adjustment experience for these women. This study explored aspects of positive adjustment to living with HIV/AIDS among a sample of African women living in London, UK. Transcripts of semi-structured interviews with 12 women were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes emerged inductively from the data: positive changes in coping (subthemes: positive interpretation of their situation and positive behavioural changes) and positive growth since the HIV diagnosis (subthemes: changes in the value of life and, changes in goals and opportunities). While these women acknowledged the negative impact of living with HIV/AIDS, all participants mentioned changes in health behaviours to help regain mastery of their lives and comparing with others better-off and worse-off was used to enhance self-esteem and view their situation positively. The data show evidence for Taylor's Cognitive Adaptation Theory.

Becoming a "treatment success": what helps and what hinders patients from achieving and sustaining undetectable viral loads

Highly active antiretroviral therapy (HAART) adherence research has focused predominantly on individuals with less than optimal clinical outcomes; therefore, little is known about the experiences of individuals who sustain undetectable viral loads. The present study used a qualitative method to explore how individuals who have sustained undetectable viral loads account for their success, and to identify challenges, as well as possible needs, for continued success. Participants were 20 patients at an outpatient infectious disease clinic in an urban center. Participants completed two 60-minute interviews. The Critical Incident Technique was used to identify and classify critical incidents linked with sustaining treatment success. Of the 438 critical incidents collected, 316 were identified as helpful and 122 were identified as unhelpful. Helpful categories included resolving ambivalence, using personal strengths, and fostering helpful relationships. Unhelpful categories were mood, lack of social support, financial difficulties, and medication factors. Doing well on antiretroviral therapy is a dynamic process that requires ongoing attention from both the patient and care provider. The results of this study highlight the efforts of patients to maintain their health and remind care providers not to assume that patients are not facing continuous challenges. Findings from the present study suggest that psychosocial factors do contribute to improved clinical outcomes in patients taking HAART.

A focus for nursing intervention: Realistic acceptance or helping illusions?

Despite having a life-threatening disease, some people decide to live every remaining moment with intensity. Although they have accepted that their deaths might be imminent, they do not dwell on the possibility. They choose life and are sustained by vivid thoughts and inspirations. What can a nurse do to nourish such thoughts? Traditional theories of grief and loss maintain that one way to adjust to advanced stages of progressive disease is to accept death and prepare for it. Is it possible that these theories are simplistic and limiting in their assumptions about the way people "work through" the stage of adjusting to loss? This article is a critical reflection of the process.

Quality of life among people with high spinal cord injury living in the community

STUDY DESIGN

An exploratory, qualitative methodology.

OBJECTIVES

To explore perceptions of quality of life (QOL) among community-dwelling people with high spinal cord injuries (SCI) and the factors they identified as contributing to, enabling or constraining the quality of their lives.

SETTING

Urban communities on Vancouver Island and in the lower mainland of British Columbia, Canada.

METHODS

Semi-structured interviews with both men (n=11) and women (n=4) with complete high SCI (C1-C4). Interpretive analysis was grounded in the themes that arose from the interview transcripts.

RESULTS

Time since injury ranged from 4 to 28 years. The mean current age was 35 years, with a range from 21 to 50 years of age. High SCI disrupted not just a body but an entire biography of plans, daily activities and valued occupations. Initially feeling helpless and useless, the participants were unanimously glad to be alive at the time of the study and several described perceptions of very high QOL. The themes which emerged from the data were over-lapping and inter-dependent and described a process of refocusing values and re-establishing a view of the self as able and valuable following injury. The three primary themes addressed issues of autonomy, the meaningful use of time, and relationships.

CONCLUSIONS

The study findings suggest that life with a high SCI can be rich and fulfilling if society is prepared to enable and support this; and that QOL outcomes might be maximized by adopting a biographical orientation to the rehabilitation process.

SPONSORSHIP

This research was funded by a University of British Columbia Graduate Fellowship, a studentship from the Rick Hansen Man in Motion Foundation and a doctoral fellowship from the Social Sciences and Humanities Research Council of Canada.

Older men's experiences of living with severe visual impairment

BACKGROUND

Little is known about how men react to their health and illness experiences. Lack of information about the lives of older men is unfortunate considering the anticipated growth of the older male sector of society and the fact that older men age differently than older women. One health-related experience common to many older men is severe visual impairment caused by macular degeneration, a chronic eye disease that affects central vision. Understanding the health experiences of older men is imperative if nurses are to provide quality care to this growing segment of society.

AIM

The purpose of this study was to gain an understanding of the experience of severe visual impairment from the perspective of older men with macular degeneration.

METHOD

A phenomenological approach was used to investigate the experience of severe visual impairment in eight older men with macular degeneration. Data were gathered through audiotaped interviews and analysed using a modified Giorgi method.

FINDINGS

The resultant general structural description revealed six central themes: (1) older men's lives were circumscribed by what they could and could not see and could and could not do, (2) cherishing of independence, (3) creation of strategies, (4) acknowledgment of the progression of visual impairment, (5) confrontation of uncertainties, skepticism, and fears about their diagnosis and treatment, and (6) persistence with hope and optimism.

CONCLUSIONS

A thorough nursing history and assessment must be completed, including information about the progression of the visual impairment, strategies used for living with visual loss, and presence of other health problems that may complicate life with visual impairment. Nurses must be aware that older men with macular degeneration are often sceptical about their diagnosis and treatment. Therefore, careful education and clear communication are essential.

Investigating the psychosocial impact of anti-HIV combination therapies

Developments in anti-HIV medication have meant that people with HIV/AIDS are now living longer, with some authors arguing that HIV should now be defined as a manageable rather than terminal illness. However uncertainty about the long-term efficacy of such treatments remains. This research aimed to examine the psychosocial impact of the new treatments and to explore whether, and in what ways, they affect psychological wellbeing. Clients were also asked about their use of services and whether they thought services should be changing in response to new pharmacological treatments. A semi-structured interview schedule was developed to elicit the views of six service users. From multiple readings of the qualitative data generated, prominent themes were identified suggesting that participants had ambivalent feelings about taking antiretroviral combination therapy and that being well with HIV raised a number of difficult issues. Four main themes were revealed: (1) disruptions in daily living: antiretrovirals as intrusions to life, (2) the tablets as a visible marker for HIV infection, (3) tempered optimism and increasing horizons, (4) an uncertain and fragile future: life without benefits and services. The results were discussed in terms of limitations of the current study and suggestions for further research.

Complementary therapy use in HIV/AIDS

OBJECTIVE

To examine the social psychological aspects of complementary therapy use in HIV/AIDS health care and to identify what happens in a person's illness management process when incorporated into their care for HIV-related symptoms.

METHODS

Grounded theory research method guided sampling, data collection and analysis with 21 males at various AIDS service organizations.

FINDINGS

A grounded theory model Finding a Way to Live was developed. Participants experienced a six-stage process whereby the HIV served as a precondition for a profound self-transformation; a commitment to and rediscovery of the meaning of life. Complementary therapies, referred to as 'tools' by the participants, were cited as an integral part of how people living with HIV found wellness within their illness. The type of therapy, meanings attached to them, intention for and frequency of use corresponded to where individuals were in the six-stage process. As participants began to experience personal growth, the nature of the therapies shifted from those being highly tangible and focusing on the physical self to those facilitating inner awareness, such as meditation.

CONCLUSIONS

The process of integration was a complex, ongoing process wherein complementary therapies were an integral part of facilitating learning, self-discovery and ultimately, healing.

Mastery over stress among women with HIV/AIDS

To better understand how women with HIV infection deal with the stress of their disease, the authors explored the relationships between stressors, resources for managing stress, and mastery over stress in 80 HIV-positive women. Nurses and other professionals recruited participants in a variety of settings in 10 states. Participants completed a packet of research instruments that measured the stressors of perceived stress intensity, interpersonal conflict, and severity of illness; the resources of social support, support networks, and spiritual perspective; and the outcome of mastery over stress. Participants reported high levels of social support, spiritual perspective, interpersonal conflict, and perceived stress intensity. Twenty-nine women (36%) had achieved mastery over stress. Mastery over stress was significantly and positively correlated with social support, spiritual perspective, and physical functioning, a measure of severity of illness. Mastery over stress was significantly and negatively correlated with interpersonal conflict. An exploratory stepwise multiple regression analysis yielded two predictors of mastery over stress: social support and spiritual perspective. Although a comparison of these results with those reported in the literature for men suggests that men and women differ in how they respond to stressors, further research will be needed to enhance our understanding of these gender differences. Stress management training, especially related to interpersonal conflict, may be an effective intervention to facilitate mastery. Other potential interventions include assessing social support and spiritual perspective, discussing the potential benefit of these resources, and making referrals for psychosocial services as needed.

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study

BACKGROUND

Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective.

AIM

The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS.

METHODS

The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method.

FINDINGS

The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'.

CONCLUSIONS

The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Perceiving benefits in adversity: stress-related growth in women living with HIV/AIDS

This study examines perceptions of illness-related positive of change or stress-related growth among a sample of African American, Puerto Rican, and non-Hispanic White women (n = 54) living with HIV/AIDS in New York City, USA. While these women acknowledged the negative stresses of living with HIV/AIDS, 83% reported at least one positive change in their lives that they attributed to their illness experience. A number of different domains of potential growth were identified including: health behaviors, spirituality, interpersonal relationships, view of the self, value of life, and career goals. While growth was reported by nearly all the women, some variation was found in the forms of growth reported in relation to the women's ethnic/racial background, class, and IV drug use history. These data suggest an expanded conceptualization of stress-related growth that includes behavioral aspects of growth in response to stress and illness, and which takes into account the diverse ways in which growth may be experienced.

A study of the experiences of women living with HIV/AIDS in Uganda

This small descriptive study investigated the experiences of Ugandan women living with a diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), exploring what assisted them to cope and identifying their future concerns. A purposeful sample of seven HIV-positive women was accessed through two indigenous non-governmental organizations in Eastern Uganda. Single semi-structured interviews were conducted on location. Following analysis of the narrative data, three principal aspects of their experiences emerged: loss and adversity, constructive living, and future uncertainties. Loss and adversity encompassed bereavements, multiple psychosocial losses and physical suffering. Constructive living related to the ability to adopt positive living activities, rebuilding shattered lives, sometimes from the brink of despair. Since the participants were all mothers, future concerns focused on child care anxieties. Stress and uncertainty surrounding HIV testing of children was also evident. Despite the cultural contrast, many of the findings were remarkably similar to those documented in Western literature. The women related their experiences with an absence of self-pity or resentment. Resilience, resourcefulness and hope were typically, perhaps instinctively, demonstrated.

Metasynthesis of qualitative research on living with HIV infection

Qualitative studies of people living with HIV infection are crucial for providing direction for practice and research because they provide the emic perspective. As more of these qualitative studies are conducted, researchers are challenged to develop ways to synthesize the findings for research and clinical practice. The purpose of the metasynthesis described in this article was to understand the experience of adults living with HIV infection as described in published research. Findings from the studies were categorized into six overarching metaphors: (a) finding meaning in HIV/AIDS, (b) shattered meaning, (c) human connectedness, (d) focusing on the self, (e) negotiating health care, and (f) dealing with stigma.

Living with diabetes as a transformational experience

The construct of transformation has been presented in many research studies as the epitome of living with a chronic illness. Because it has been inadequately defined, however, many other concepts (e.g., hope, meaning, control) are used in ways that suggest considerable overlap and correspondence with transformation. This article represents an attempt to explicate the structures and processes of transformation as they were revealed in a qualitative inquiry into the experience of individuals with Type I diabetes. In the accounts constructed with participants in this study, the process of personal transformation was significant in the attainment of healthy outcomes. The authors describe this transformation and examine its relationship to control and to the valued outcomes of intensified sense of self, meaning, and mastery.

Spirituality and chronic illness

PURPOSE

To present a comprehensive overview of spirituality and identify strategies to support the spiritual dimensions of nursing care for people with chronic illness, focusing specifically on HIV-related illness and AIDS.

SIGNIFICANCE AND SCOPE

The AIDS crisis has brought new emphasis to the need to develop therapeutic interventions to support the coping resources of people living and dying with chronic illness. Conceptual, theoretical, and empirical knowledge related to spirituality was reviewed, integrated, and interpreted within the context of nursing care for this population, emphasizing the spiritual needs of people with HIV-related illness and AIDS.

CONCLUSIONS AND IMPLICATIONS

Spirituality has evolved beyond religious considerations to encompass multidimensional and existential perspectives that are integral to maintaining well-being for the chronically ill. A deeper understanding of spirituality enhances the potential for nurses to identify spiritual needs and incorporate spiritual caring into practice.

Social support and long-term survivors of AIDS

A naturalistic study design using ethnographic interviews was employed to elicit data about the phenomenon of being a long-term survivor of AIDS from 14 men and 6 women. Data were generated through multiple intensive open-ended interviews, demographic data sheets, and self-reported CD4 counts. Data were analyzed using latent and manifest content analysis techniques and the method of constant comparison. One of the dimensions that emerged from the data was "being in relation to others," the complex set of interpersonal relationships that have been renegotiated to maintain the reconstructed life. Specific ways of being in relation to others included dealing with one's family, renegotiating the friendship group, helping others with HIV, and developing a relationship with a higher power. The results of this study have implications for counseling people with HIV disease, and for nursing actions to enhance social support in this vulnerable group.

Effects of social support, stress, and level of illness on caregiving of children with AIDS

The purpose of this descriptive correlational study was to explore the relationship between social support, stressors, level of illness, and perceived caregiver burden in caregivers of children with HIV/AIDS. Instruments used were: (1) the Classification System for Human Immunodeficiency Virus (HIV) Infection in Children Under 13 Years of Age (1987), (2) the Daily Hassles Scale, (3) the Tilden Interpersonal Relationship Inventory (IPRI), (4) the Derogatis Stress Profile (DSP), and (5) the Caregiver Appraisal Scale. The sample was drawn from two medical centers in New Jersey. The 49 caregivers of children with perinatally acquired HIV were predominantly HIV-positive biological mothers of African American descent whose education ranged from 8th grade through college. One-half of the children were classified at the CDC P2 level. Descriptive statistics and stepwise multiple regression were used to analyze the data. The results of the DSP indicated subjects were slightly below the 70th percentile for anxiety, depression, hostility, and work stressors and that subjects' social support levels were in the upper end of the low support category. Stepwise regression indicated that depression and anxiety predicted 40% of the variance in caregiver burden (R2 = .399; F = 14,985; p = .000). Hostility and level of social support predicted 37% of the variance in caregiving impact (R2 = .37; F = 13.254; p = .000). Finally, social support predicted 17.5% of the variability in the caregivers' sense of caregiving competency (R2 = .175; F = 9.788; p = .003). The child's level of illness and HIV status of caregiver did not significantly predict variance in caregiving appraisal.

Human association as a factor influencing wellness in homosexual men with human immunodeficiency virus disease

In-depth interviews of 29 homosexual men with varying degrees of human immunodeficiency virus illness were conducted using grounded theory methodology. The study participants indicated that the need for intimacy and community were of paramount importance to living well and suggested that feeling connected to others was a synergistic process that promoted an existential/ spiritual understanding of one's self as being well. Clinical recommendations for nurses include the use of intimacy-building care strategies that are capable of helping clients construct meaning of their experience to enhance individual well-being.

Focusing on living: attitudinal approaches of long-term survivors of AIDS

This naturalistic study reports the attitudinal approaches of long-term survivors of AIDS. Ethnographic interviewing techniques were employed to interview a purposive sample of 14 men and 6 women who had had AIDS for at least 3 years and who were living in the Tampa/St. Petersburg, FL, area. As part of a larger study on the phenomenon of surviving AIDS, participants reconstructed their lives within the context of AIDS. There were five dimensions involved in becoming a long-term survivor, and this article reports on the attitudinal dimension, labelled "focusing on living." Components of this dimension include having a positive attitude, planning for the future, and having a focus for one's energies. Implications for practice, theory, and research are discussed, and specific strategies are suggested for nurses to assist people in all stages of HIV disease.

Descriptions of wellness by individuals with schizophrenia

A major challenge in the rehabilitation of individuals with schizophrenia is to establish a system of monitoring disease status so interventions can be instituted to prevent disease exacerbation and to promote healthier functioning. Monitoring illness status has primarily focused on indicators of illness. The aim of the present study was to determine what individuals with schizophrenia described as evidence of wellness to generate descriptors for a wellness questionnaire. Twenty participants diagnosed with schizophrenia and living in a community setting were interviewed about their descriptors of wellness. Coding of transcriptions of the interviews yielded two major categories of wellness: Statements related to the reduction or absence of troublesome (illness) indicators and statements related to the presence of helpful or positive (wellness) indicators. Three subcategories, thoughts, feelings, and actions or behaviors emerged under both major categories. The majority of wellness descriptions focused on the presence of wellness and were actions or behaviors.