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Biomedical subjects

Rebecca Spirig

Publications and source records attributed to Rebecca Spirig.

12 recordsLinked to original sources
PubMed2005

[Ready for antiretroviral therapy? Therapy decision making experiences of persons living with HIV].

Readiness for therapy of people living with HIV is of major importance in the process of antiretroviral decision making. This qualitative study is part of a prospective multicentre investigation describing readiness for antiretroviral therapy (ART) and decision making in HIV-infected patients. The qualitative results present the daily experiences of people living with HIV in the treatment decision making process related to starting or changing ART. Based on a critical hermeneutic research design, interviews with twelve persons have been conducted. Two main categories were generated: "dealing with oneself and others" and "understanding and being understood". They describe the dialectical process of decision making with a focus on interactions with others. This process includes four themes: illness beliefs, health perspectives, therapy beliefs, life perspectives. The findings of this study reveal that partnerships of health care providers with HIV-infected patients are necessary for treatment decisions. Moreover; it is of major importance for health care providers to include patients' experiences and expertise and to allow time for the different dialogues.

Anti-HIV Agents↗
PubMed2004

Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study.

OBJECTIVES: To explore the association between a stable partnership and clinical outcome in HIV infected patients receiving highly active antiretroviral therapy (HAART). DESIGN: Prospective cohort study of adults with HIV (Swiss HIV cohort study). SETTING: Seven outpatient clinics throughout Switzerland. PARTICIPANTS: The 3736 patients in the cohort who started HAART before 2002 (median age 36 years, 29% female, median follow up 3.6 years). MAIN OUTCOME MEASURES: Time to AIDS or death (primary endpoint), death alone, increases in CD4 cell count of at least 50 and 100 above baseline, optimal viral suppression (a viral load below 400 copies/ml), and viral rebound. RESULTS: During follow up 2985 (80%) participants reported a stable partnership on at least one occasion. When starting HAART, 52% (545/1042) of participants reported a stable partnership; after five years of follow up 46% (190/412) of participants reported a stable partnership. In an analysis stratified by previous antiretroviral therapy and clinical stage when starting HAART (US Centers for Disease Control and Prevention group A, B, or C), the adjusted hazard ratio for progression to AIDS or death was 0.79 (95% confidence interval 0.63 to 0.98) for participants with a stable partnership compared with those without. Adjusted hazards ratios for other endpoints were 0.59 (0.44 to 0.79) for progression to death, 1.15 (1.06 to 1.24) for an increase in CD4 cells of 100 counts/microl or more, and 1.06 (0.98 to 1.14) for optimal viral suppression. CONCLUSIONS: A stable partnership is associated with a slower rate of progression to AIDS or death in HIV infected patients receiving HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[The work profile of family caregivers of persons affected by HIV/AIDS].

In Switzerland, HIV incidence has increased considerably during the past two years. This fact has raised concern both in the media and in the health care system. However family caregivers have not been considered in these debates, although their figures are increasing as well. In Switzerland, a few research studies were conducted focussing on the situation of family caregivers affected by HIV/AIDS. This particular qualitative research project focuses on the questions as to what kind of work these family caregivers are doing, under which conditions they are working, and which consequences arise from their work. Data were collected by conducting eleven semi-structured interviews, and data analysis was done through a content analysis. Results show that family caregivers provide a wide range and a large amount of family work. Not only are family caregivers working for the HIV-positive persons, but also for the benefit of other family members and friends as well as for themselves. Family caregivers achieve mainly stable life situations for their HIV-positive family member. The discussion focuses on the dynamics of family work which requires constant adaptations in daily life. In addition, ordinary family work needs to be noticed and appreciated in symbolic, social, and financial terms. Finally, implications for nursing practice are considered.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Outcomes and experiences of caring for families with children with cleft lip and palate at the Children's Hospital of Zurich].

The development and establishment of Advanced Nursing Practice is an important step toward an effective and sustainable care. Five diploma nurses of the Children's Hospital of Zurich started an ANP project in the field of children with cleft lip and palate under the guidance of an ANP Nurse. The purpose of this project was to address the needs of the families and to establish state-of-the-art care. Action research methodology built the background because it offers methods that connect theory and practice. Family management and organizational elements (project team, organization and new services) were the basic elements of the project. The goal of this paper is to present the first evaluation of this project. For instance, today, the families have the opportunity to visit the hospital before the first surgery. For the children, pain management and nutrition after surgery were adapted to state of the art knowledge. The evaluation also shows areas that need to be further developed in the future. The results emphasize, that the ANP-team projects with family management as core activity empowered the team members and led to an adaptation of nursing practices towards the needs of the families.

Child↗
PubMed2004

[A method combination for Advanced Nursing Practice projects].

In order to offer Advanced Nursing Practice (ANP) in Switzerland, some practice development projects have been established with the goal to enable entire nursing teams to become ANP Teams. These ANP Teams are led by ANP nurses with a high expertise in the specific practice area. The combination of the three methods action research, project management and evaluation research have proven useful for the ANP nurse as project leader. Action research is viewed as the leading force because of its scientific methods that allow focusing on practice problems and actions. With project management methods, the ANP project can be organized in an effective and efficient way. Evaluation research offers methods to systematically evaluate the project at the level of patients, team, and organization. The combination of these different methods allows the ANP nurse to work systematically and flexibly and improves results.

Humans↗
PubMed2004

[Living with pain--elderly women as experts in the management on their chronic musculoskeletal pain].

Chronic musculoskeletal pain in the elderly is very common. The aim of this qualitative study was to gain insight in elderly people's pain medication beliefs. Problem-focused interviews with eight women were conducted. The results show them to be experts in managing pain, which task turns out to be too complex to be described in terms of pain medication beliefs. Using the method of qualitative content analyses five main categories including subcategories were inductively generated and presented in a structured way. The category "to be carried by one's life and illness trajectory" evolved as a basic category in the pain management. It includes the subcategories "to gain experiences from one's life and illness", "to have knowledge of the causes of pain and of their treatment", "to learn how to manage pain in everyday life" as well as "to rely on spiritual well-being". Most important for the women is their every day reality "to live with pain and its physical, psychological, practical and social effects". This leads to "weigh, to combine and to evaluate treatments for pain relief" which includes the subcategories "to be disciplined in carrying out non-pharmacological measures for pain relief", "to use pain medication sparingly but purposefully" and "to cooperate as a partner with health professionals". Some of the participants are challenged by "reaching their limits", which means "to reach the limits of endurable pain", "to experience the limits of failed treatment effects" as well as "to reach the limits of endurable treatment side effects". "To sustain one's quality of life in spite of pain" seems to be the aim of the elderly women's endeavour. The results of this study demand collaborative care in a partnership with elderly people with pain acknowledging their expertise. The results also ask for transdisciplinary efforts to support elderly persons with pain and for the development as well as the evaluation of self-management education programs.

Aged↗
PubMed2003

[Smoking cessation for HIV infected patients].

Cigarette smoking is one of the leading health problems of the general and also of the HIV population. At the HIV clinic at the University Hospital in Basel, Switzerland, many patients expressed the desire to quit smoking. Therefore, an evidence based smoking cessation program was established. The program bases on the two intervention strategies, which have been evaluated as most effective in the state-of-the-art literature: Nicotine substitution and counseling. Counseling bases on dialogues and empowerment. Our smoking cessation program includes a short-term intervention, general information, and a counseling program in several parts. Until recently, in Switzerland, mainly physicians have conducted smoking cessation programs. Moreover, in the German-speaking realm, no publications exist about effective nursing interventions regarding smoking cessation. Thus, the aim of this article is to present an evidence based smoking cessation program offered by both nurses and physicians. Practice experiences indicate that the combination of nicotine substitution and counseling in several parts may be a successful interdisciplinary intervention.

Combined Modality Therapy↗
PubMed2002

In invisibility and isolation: the experience of HIV-affected families in German-speaking Switzerland.

Based on critical hermeneutics, the author presents insights about caregiving experiences of HIV-affected families in Switzerland. Using a qualitative approach, she interviewed 11 families and conducted 3 group discussions with members of different families. Two main themes emerged--Caught In Between: Family Changes Forced by HIV/AIDS and No Request for Support: Family Caregiving in the Context of Invisibility. The former portrays the families' struggle with new family constellations. Members felt close to, ambivalent toward, or distant from the infected member and built subgroups representing these connections and values. The latter portrays the families' withdrawal from their environment, whereby one or two close family members almost invisibly provided caregiving without outside support. These behaviors were reinforced by the Swiss health care system, which focuses on individuals. Suggestions for interventions are introduced.

Attitude to Health↗
PubMedDate not supplied

Symptom management in HIV/AIDS: advancing the conceptualization.

For people living with HIV, symptoms related to the disease, comorbidities, and treatment side effects make symptom management essential. Poorly managed symptoms result in reduced medication adherence, disease progression, and lower quality of life. The Self-regulatory HIV/AIDS Symptom Management Model is a conceptual model that describes how persons living with HIV/AIDS manage their symptoms. The model links symptom experience, symptom management, social support, adherence, and health-related quality of life. It can assist nurses, through a multidimensional approach to illness management, to enhance symptom assessment, better understand factors influencing symptom experience, and to improve symptom management among people living with HIV/AIDS.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

The Advanced Nursing Practice Team as a model for HIV/AIDS caregiving in Switzerland.

To offer advanced nursing care for people living with HIV, a participatory action research project was initiated that enabled constant learning and change at the levels of (a) the culture and organization of an outpatient department, (b) clinical leadership and interdisciplinary collaboration, and (c) development of new services. In this project, the development of the Advanced Nursing Practice (ANP) Team not only affected the practice of individual nurses with advanced degrees but also created a team of nurses educated at different levels. Through a systematic process, the nurses on the team became more educated and refined their clinical expertise. An essential aspect of the ANP Team was the specialization of each nurse in a self-selected topic within HIV/AIDS care. As members of the ANP Team, the nurses offer state-of-the-art nursing care including patient assessment, medication management and adherence support, symptom management, health maintenance and prevention, and family support for persons living with HIV.

Clinical Competence↗