Development Of The HIV/AIDS Clinical Nursing Practice Guidelines

Background The development of AIDS care is already quite mature in Western countries such as the United States:① established Association of Nurses in AIDS Care; ② founded Journal of the Association of Nurses in AIDS Care; ③ established HIV/AIDS Nursing Certification Board; ④ formation of a large number of high-quality specialty care resources. AIDS care practice was normative, mainly based on systematic, standardized guidelines, and other evidence-based resources. The development of AIDS care is hysteretic in China, and research on AIDS care was carried out late. Besides, there was no report related to evidence-based resources in AIDS care. AIDS care practice is relatively basic, mainly based on the work experience of nurses. To normalize nursing practice, decrease nursing variability, reduce nursing costs, improve nursing quality, and promote the progress and development of clinical nursing practice, it was suggested to develop HIV/AIDS clinical nursing practice guidelines suitable for China based on domestic and foreign evidence-based resources related to AIDS care or other nursing areas.Objective The general objective of this study is to develop HIV/AIDS Clinical Nursing Practice Guidelines, and evaluate it. Specific study objectives include: ⑤ describe and analyze understanding and introspection of stakeholders (patients, nurses, doctors, hospital administrators, etc.) on the status of HIV/AIDS clinical nursing practice. ② describe and analyze the current care needs of people living with HIV/AIDS (PLHIV). ③ evaluate and integrate evidence-based resources on management of Highly Active Antiretroviral Therapy (HAART) and HIV-related Symptoms. ④ develop HIV/AIDS Clinical Nursing Practice Guidelines. ⑤ evaluate HIV/AIDS Clinical Nursing Practice Guidelines.Methods Development of HIV/AIDS Clinical Nursing Practice Guidelines was based the JBI model of evidence-based healthcare, methodology of evidence-based nursing practice, ADAPTE methodology, and methodology of overviews of reviews. The development process included qualitative interview of 31 stakeholders, questionnaire survey of 423 PLHIV, adaptation of 30 clinical practice guidelines related to AIDS care, and overviews of reviews of 44 systematic reviews/Meta analysis. The quality evaluation of HIV/AIDS Clinical Nursing Practice Guidelines was based on applicability survey, written assessment and live demonstration meeting.Results1. A qualitative study was conducted in 15 nurses or doctors or hospital managers and 16 PLHIV using in-depth individual interview. The interview showed symptomatic care mainly based on nurses’clinical experience, and was lack of support from systematic research evidence; nurses can give PLHIV psychological care sometimes, but were required higher standard and improvement; nurses rarely involved in the management of HAART, and should undertake the work actively.2. A cross-sectional study was conducted in 423 PLHIV. The survey showed there were certain care needs in PLHIV on HIV-related symptoms management, HAART management and other health education, mainly focus on skin lesion (65.2%), "What should I do if antiretroviral therapy isn’t work?" (91.3%), "What should I do if I have other AIDS coexistent disease?" (93.6%) and so on.3.30 clinical practice guidelines related to AIDS care and 44 systematic reviews/ Meta analysis were included based on systematic evidence search, qualitative interview and questionnaire survey. Developing HIV/AIDS Clinical Nursing Practice Guidelines based clinical context, client preference, professional judgment and best practice evidence.4. A cross-sectional study was conducted to evaluate applicability of the guidelines in 23 nurses in AIDS care. The survey showed higher score on security, effectiveness, maneuverability and social ethicality of recommendations from the guidelines. A written assessment was conducted in 4 experts from nursing science, clinical medicine and public health, and a live demonstration meeting was conducted in 9 experts from nursing science, clinical medicine and public health, both the written assessment and the live demonstration meeting showed higher score (each scaled domain score>85%).Conclusion1. It is suggested that AIDS care in China should ensure adequate nurse staffing, improve professional standard, and strengthen PLHIV’s HIV-related symptoms management, HAART management, mental care, illness monitoring and so on.2. There were certain care needs in PLHIV on HIV-related symptoms management, HAART management and other health education. Meanwhile, PLHIV expressed higher care needs on HAART management and other health education.3. HIV/AIDS Clinical Nursing Practice Guidelines integrated all existing best practice evidence on management of HAART medication adherence and HIV-related symptoms (including psychological symptoms), and aimed at providing reference to PLHIV’s clinical nursing practice.4. Evaluation of HIV/AIDS Clinical Nursing Practice Guidelines showed better applicability and general quality. It is recommended to use the guidelines in AIDS care.