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Health Care Workers’ Attitudes Toward HIV-Infected People
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In this section... we will discuss five steps a caregiver can take in order to be supportive. The five steps include communicating effectively, offering support for spiritual concerns, working with health care professionals, working with others who also care about the client, and taking care of personal needs. As you listen to this section, consider the caregiver of your HIV positive client. Would it be beneficial for him or her to hear this section?
♦ 5 Steps for Being Supportive
♦ Step #1 Communicating Effectively with the HIV Client
First, let’s discuss communicating effectively. As you may know, one of the first challenges a caregiver may be faced with is helping their friend or relative accept that he or she has HIV. Joan, age 44, was the mother of Leonard, age 23, who had been diagnosed with HIV. Joan stated, "Leonard seems like he’s in denial about being HIV positive. He tells me there’s nothing wrong with him all the time. Doctors have already tested him for the antibodies twice, his CD4 count has decreased, and he’s got esophageal thrush, so there’s no way everything’s fine." How would you have responded to Joan?
I stated, "Denial can be a normal and healthy response if it helps Leonard live as normal a life as possible. Denial can be harmful, however, if it leads him to do things that make the illness worse, like avoiding medicine or other treatment, or engaging in physically harmful activities. Sometimes what looks like denial could actually be Leonard’s attempt to protect you from the hard realities of HIV. If so, reassure him that you are willing to listen and talk about all aspects of the illness, even though it may be hard for both of you. Also, support Leonard’s efforts to have a normal lifestyle." Think of your Leonard. Could your client’s caregiver benefit from understanding denial?
Other elements of communicating effectively I discussed with Joan include creating an
-- encouraging environment,
being understanding during conflicts,
having realistic and flexible expectations for communication,
-- and helping the client cope with anxiety and depression, which we will discuss in more detail later in this course.
♦ Technique: Skills for Conflict Resolution
Next, let’s examine conflict. Joan stated, "Sometimes Leonard and I will argue. Last Wednesday, Leonard wanted to go with his brothers to the lake to ride jet skis. I was concerned about the physical danger involved, so I argued against it. Now I almost wish I hadn’t fought with him, because he went anyway, but was mad at me all week." Joan was in a position to benefit from learning skills for conflict resolution. Therefore, I stated, "There are a few things you can do when you and Leonard disagree.
1. First, explain your needs openly. Just keep in mind that conflict resolution does not always mean that everyone is happy. It’s a give and take.
2. Next suggest a trial run for implementing the compromise that the two of you agree upon. Set a time limit for the trial run for evaluation.
3. Third, choose your battles carefully. Ask what’s really important. Are you being stubborn or is the issue really important? Finally, let Leonard make as many decisions as possible. As long as Leonard understands the consequences of a given decision, accept his right to make that decision.
When you take away his right to make decisions, you can undermine his sense of control over his own life, which might interfere with Leonard’s ability to cope with other aspects of HIV." Do you have a Joan who could benefit from learning skills for conflict resolution and hearing this section?
♦ #2 Offering Support for Spiritual Concerns
I also encouraged Joan to offer support for spiritual concerns. I stated, "One of the roles of a supportive caregiver is offering support for spiritual concerns. Spiritual questions such as ‘Why are we here?’ or ‘What is a good life?’ become especially important to a person dealing with a potentially terminal illness." Joan responded, "Well I don’t have the answers to those questions!" I continued, "Of course not. Your job is to support Leonard in thinking through his personal answers to these questions.
"He may want to make sense of his life experiences. As a caregiver, listening might be one of the most important thing you can do to help. You can share your experiences and feelings, too, but your main way of helping is listening. If you do decide to share feelings, share those that reflect his. For example, if Leonard expresses uncertainty, express your own uncertainties to show him that his concerns are normal and reasonable."
Has your Leonard begun raising fundamental spiritual concerns? How do you respond?
♦ #3 Working With Health Care Professionals
In addition to communicating effectively and offering support for spiritual concerns, the third step a caregiver can take in order to be supportive is working with health care professionals. Four basic guidelines I gave Joan to help her obtain information and help more effectively from health care professionals follow. As I list these guidelines, consider how the caregiver of your HIV positive client can implement them to work more efficiently with health care professionals. Here are the four guidelines as I gave them to Joan.
"Be clear about what you want and get to the point as soon as possible."
"Have ready all the information healthcare professionals may need when you call."
"Bring lists of medicines to appointments."
"Be firm and straightforward about getting the information and help you need."
Could your Joan benefit from using these guidelines for working effectively with healthcare professionals? Would your client benefit from more specific information regarding each guideline? If so, perhaps you could prepare such information in time for your next session.
♦ #4 Working With Others Who Also Care About the Client
The fourth step a caregiver can take in order to be supportive is working with others who also care about the client. Joan stated, "I’m the only one Leonard can really count on to be there 24 hours a day." Joan felt as though she was the only person Leonard could rely on for continuous care. This may have been true, but even so, the main idea here was to help Joan understand that she did not have to do everything herself.
As you know, family members, friends, clergy and community volunteers can all help out. As I explained this to Joan, she stated, "I guess I don’t have to do it all, but at least if there was no one else, I’d still be there for him." How can you help the caregiver of your HIV positive client accept the help of others?
♦ #5 Taking Care of Personal Needs
In addition to working with others who also care about the client, the fifth step a caregiver can take in order to be supportive is taking care of their own personal needs. In a later session, Joan had stated that she felt overwhelmed at times. Therefore, I decided to encourage her to pay attention to her own needs as well as Leonard’s.
I stated, "You need to be at your best if you are to do the best job of helping. Feel free to set limits on what you can reasonably expect yourself to do. Take time off to care for yourself and your needs. And don’t worry about asking for help before the stress builds up so much you break down." In subsequent sessions, I discussed techniques with Joan for coping with the various emotions she was experiencing. How do you help your clients deal with fear, anger, grief, or guilt? Think of your Joan. Could he or she benefit from hearing this section?
In this section... we have discussed five steps a caregiver can take in order to be supportive. The five steps include communicating effectively, offering support for spiritual concerns, working with health care professionals, working with others who also care about the client, and taking care of personal needs.
In the next section, we will discuss coping with depression. Three steps for coping with depression are taking care of personal emotional needs, talking about depression, and decreasing depression.
Peer-Reviewed Journal Article References:
Farber, E. W., Hodari, K. E., Motley, V. J., Pereira, B. E., Yonker, M., Sharma, S., & Campos, P. E. (2012). Integrating behavioral health with medical services: Lessons from HIV care. Professional Psychology: Research and Practice, 43(6), 650–657.
Prati, G., & Pietrantoni, L. (2019). Bifactor and item response theory analyses of health care workers’ attitudes toward HIV-infected people. European Journal of Psychological Assessment, 35(2), 156–163.
Wagner, A. C., Bartsch, A. A., Manganaro, M., Monson, C. M., Baker, C. N., & Brown, S. M. (2020). Trauma-informed care training with HIV and related community service workers: Short and long term effects on attitudes. Psychological Services. Advance online publication.
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