Look in the mirror

Most people who go into nursing or health care do so because of a desire to help others. It may be difficult or even upsetting to recognise or admit that your own values or morals are stopping you from providing the best care you can. For most nurses and health care workers, treating some patients differently is subconscious – we don’t intend to do it and probably don’t realise we are.

Most health care providers act professionally and provide high quality care to all of their patients and colleagues. But because our values, morals, and beliefs are part of us, they can slip in to how we speak and our body language, often without us being aware it is happening.

What do I really think?

This is a good time to raise some questions about values, attitudes, and beliefs and how they might impact HIV-related care. Select the question marks in this animated image which features a selection of value statements. Think about these in relation to your own practice but also consider whether you have seen them reflected in the care your colleagues provide or in the ethos where you work.

Whether you agree or disagree, in part or in whole, with these statements is personal. Everyone, of course, has a right to his or her own opinions. But if these begin to affect how you or a colleague interact with certain clients, patients, or other colleagues, then it is important to recognise and acknowledge the issue and take action. Let’s look at how these opinions are formed and how they might influence the provision of HIV-related care.

Values, attitudes, and beliefs

Our attitudes, values, and beliefs come from a variety of sources, including:

These traits contribute to making us who we are and influence how we approach the issue of HIV. Watch this interaction between Katherine, a nurse in a busy GP clinic, and her client, Alana, a 22-year-old pregnant woman with HIV. As you watch the story, see if you can identify any of Katherine’s personal values and whether they are showing through in her approach and interaction with Alana.

In this interaction, Katherine did some things well. She was friendly when greeting Alana and checked that she was comfortable. But when she realised that Alana was HIV positive, her attitude changed and her tone of voice and language became judgemental. Some other ways our personal values and attitudes can 'leak' into our professional approach with our patients/clients are by:

And what about Alana? As a result of Katherine’s judgemental attitude Alana may be less likely to speak openly, ask questions, express concerns, or ask for help. All of which reduces the quality of the care she receives and puts her health, and that of her baby, at risk. These are things to think about regarding your own approach as well as that of your colleagues and employer in relation to caring for people who are HIV positive.

Does the disease matter?

The photographs below show two patients with different medical conditions. Lisa is a 45-year-old primary school teacher with type 2 diabetes. Nate is a 30-year-old gay man with HIV. Both patients have chronic medical conditions. Perhaps the quality of the medical advice they receive is the same but is the attitude towards them presented by their health care team the same? Or does the type of disease they have make a difference? Take a moment to think about what type of assumptions health care workers might make about Lisa and Nate because of the type of disease they have. Then select each image to learn a bit more about Lisa and Nate.

As these examples show, making judgments and assumptions about a person because of the type of disease they have does a disservice to everyone. It shouldn't matter that Nate has HIV and Lisa diabetes; all patients need to be treated without preconceptions, bias, or  judgment, regardless of the illness they have.

Does the route of transmission matter?

'I think at the beginning I was a little bit nosy, reading through the notes trying to find out how they contracted it, a bit about the lifestyle they led. But I soon realised that it’s just all walks of life' - a registered nurse .

'I don't think anyone has the right to judge other people. If I start judging people with HIV then they could start judging me and the things I do or have done in my life. It doesn't matter how they caught the disease - they have an illness and need our help' - a health care assistant.

In your workplace, does the approach towards and interaction with people with HIV vary according to how they contracted the virus? Is a child who was infected by his mother or a woman infected by her husband of thirty years treated more sympathetically than a gay man who engaged in unsafe sex? Acknowledging that some patients with HIV are treated differently from those with other illnesses or even those who were infected in other ways is important and necessary if change is to occur. If upon reflection you believe that this may be happening where you work, now is a good time to start an action plan to think about how you can help to change this attitude. You will find a template for this and a 'reflective record' in the 'Taking action' section. You may wish to save these documents to your computer and upload them to your e-portfolio as evidence of your continuing professional development. You may want to print your action plan and share or discuss it with your colleagues and your line manager.

Stopping beliefs, values, and attitudes from adversely affecting patient care

Nurses and health care assistants are professionals and most treat their patients and colleagues with respect and dignity. To ensure that your approach to HIV and caring for people is of the highest standard, here are some things you can do.