COMMUNITY NURSING

Community nursing:
Community based voluntary counseling and testing (HIV)
Purpose:
The purpose of the community nursing is to enhance community based counseling and testing for the survivors of sexual related violations. It is also to conduct visits for monitoring of progress and to provide necessary support within available resources. To promote awareness to families and community groups on the availability of this compassionate support service.

Prerequisite knowledge, skills and attitude: For the GRIP nursing interventions to succeed, the following factors are considered:

Clarification of individual's own values
Sustaining a non-judgmental and non-discriminatory attitude.
To understand socio-economic and cultural values.
To have your own family support systems in order to reduce burnout.
To understand your own developmental stage and needs.
To have strong coping capabilities (internal and external)
To have available external support systems.

Nursing Processes of Intervention:

1. Vulnerable phase: (initial stage of ordeal)

Demonstrate a compassionate, sensitive and empathetic approach with courtesy and respect to reduce anxiety and promote calmness.
Establish rapport by creating trusting survivor-nurse relationship.
Select a suitable physical environment with maximum privacy.
Allow expression of emotions but do not prolong for early adjustment to current health challenges.
Defuse negative and self-destructive behaviors e.g. self-blame, suicidal intentions and feelings of helplessness.
Instill the survivor's potential to overcome and take control amid present challenge.
Exercise empathetic/therapeutic gestures for the most vulnerable e.g. children and elderly, to promote sense of belonging.
Ensure proper immediate health care (first-aid) for physical trauma, refer to a medical facility when necessary to reduce pain and suffering.
Encourage and use available family support to increase the sense of belonging.
Uphold confidentiality for self-identity preservation.
Provide viable and appropriate coping strategies e.g. availability of ARV's to promote early acceptance and to curb negative defense mechanisms.

2. Testing phase:

Emphasize the need of testing while indicating the advantages and disadvantages of the procedure (involve the parent or guardian where necessary).
Allow time to internalize implications of the testing; consider possible secondary shock and the reaction of certain personalities.
Conduct pre-test counseling.
Seek survivor's written consent.
Conduct both tests following prescribed procedures.

3. Reality -Reaction phase

Determine receptiveness as survivor as they are still undergoing various emotional changes.
Announce the results/outcomes of both tests and observe reaction of acceptance/non-acceptance for support.
Conduct post-test counseling.
Record outcomes according organizational procedures.
Refer according to outcomes.
If negative Re-test after 3 months and/or 6 months with precautionary measures.
If positive refer to medical facility in partnership/mutuality for further management.

4. Survival phase:

Plan for immediate short and long term goals by mutually exploring available options.
Empower on available alternatives and refer where appropriate.
Encourage necessary behavioral and lifestyle modifications to promote quality of life.
Invite and use survivors who have overcome (positive coping and adjustment) to form peer support groups for other survivors without promoting labeling or stigmatization.

Voluntary counseling and testing -Tools: The following tools are needed to conduct the HIV Field work intervention:

Testing devices
Prickers
Alcohol swaps
Glass/Plastic blood receptor.
Gloves
Container for sharps disposal.
Hand sanitizer
Plans
Consent forms
Statistic forms

Preparation for the survivor:

Exercise a positive approach after debriefing on the survivor's background without intrusion.
Choose an area that will provide maximum privacy.
Determine survivor's voluntary participation and complete the consent form (consider age for parent/caregiver involvement).

Procedure:

Explain the procedure to the survivor and outline expectations.
Check testing devices for expiring dates.
Prepare testing device without contamination (open in full view of the survivor).
Place both devices on a flat surface.
Lock pricker into position.
Sanitize hands to reduce potential for cross-infection.
Clean surface on the tip of the preferred finger with an alcohol swab.
Inform survivor of intention to prick.
Apply pricker once according to selected level.
Dispose pricker into sharps container.
Draw sufficient blood for both testing devices using glass receptor.
Place drops on testing zone (not glass window).
Mix with appropriate solution to prevent clotting.
Interpret results within 5 to 15 minutes (involve survivor).
Inform survivor on the implications of the outcome.
Intervene according to client response.
Maintain confidentiality.
Dispose used testing devices into plastic bag.
Sanitize hands.
Record results on the consent form provision.
Give advice accordingly.
Inform the survivor on the next contact date or on termination of testing and counseling.

The expectation of the Volunteer Counselor/Defuser:

The survivor's first point of contact at a Police or Hospital care room is with the defuser. Immediate support is given according to the survivor's response. The formulation of the relationship between the survivor and the defuser develops. Data collection takes place for continuity of care ( in collaboration with the relevant stake holder). The defuser outlines the plans for the survivor that will includes; visitations, VCT and 3 monthly intervals (twice), informs survivors of the significance thereof including the right to accept or not to accept services. The defuser then formulizes a plan for VCT and faxes it to the head office for attention to the field work nurse. The nurse will then verify the contact day for blood tests. The defuser will disseminate barriers if any, or take precautionary measures to be taken for the benefit of the survivor's health. The defuser can also accompany the community nurse during contact period.

The community nurse:

Consolidates received plans to determine exact location of the survivors. Group survivors according to catchment area. Confirms contact days telephonically with defusers. Submit fieldwork itinerary to CEO weekly. Mobilize recourses for service delivery for example transport and testing tools. Ensure stock of relevant forms (consent, referral and statistics). Execute plan accordingly. Assist defuser in the management of survivor's or family related challenges. Submit monthly fieldwork reports to the CEO to enhance service delivery.

Compiled by GRIP's Professional Nurse- Sister Ntombi Sebolele.