Objectives: To describe the safety and security healthcare needs of Black men infected with HIV upon their admission to an AIDS dedicated nursing home. Also to begin to explore the impact of an AIDS dedicated nursing home facility on the safety and security needs of Black men with HIV.
Design: A two-phase exploratory-descriptive study utilizing the triangulation of quantitative and qualitative research methods. Phase one consisted of a retrospective chart review and phase two consisted of one on one focused interviews. Maslow's Hierarchy of Human Needs provided the theoretical basis for the study. A Healthcare Needs Chart Abstraction Form and Focused Interview Guide were developed specifically for the study. Descriptive statistics (parametric and non-parametric) were used to analyze quantitative data and a modified thematic analysis approach was used to analyze the qualitative interview data.
Sample, Setting, Years: The convenience purposive sample consisted of 73 Black men (n=68, phase one; n=5, phase two) who were all admitted to the same nursing home from 1995 to 1999. Inclusion criteria included 1) being a Black male and 2) at least 18 years of age. Exclusion criteria included 1) all females, 2) less then 18 years of age and 3) having incomplete medical record data. The study was conducted in a free standing not for profit community based skilled nursing home located in Southern New England. This facility is solely dedicated to the care of individuals with HIV/AIDS. Variables studied: The safety and security need empirical indicators from phase one were (A) primary reason for admission, (B) admitted from, (C) referred from, (D) psychiatric history, and (E) lived alone prior to admission. Phase two included questions on all of the phase one variables as well as the addition of questions regarding how being admitted to the nursing home affected their safety and security needs and whether or not they felt those needs were being meet.
Findings: The mostly African-American (n=72) blue collar (n=51) sample were very ill upon their admission to the nursing home with most (n=70) having an AIDS diagnosis. Most of the men were referred from (n=51) and/or admitted from (n=48) a hospital setting. The reason for admission was most often for long term nursing care (n=28) or to complete acute care (n=26). The men also for the most part did not live alone prior to admission (n=47) and less then half had a past psychiatric history (n=33). All of the men interviewed (n=5) agreed that being admitted to the nursing home had positively impacted their ability to care for themselves. All of the men also stated that they felt safe and secure in the nursing home.
Conclusions: Having AIDS directly affects ones safety and security needs. Being physically safe from actual or potential harm is just as important as ones emotional safety. Unmeet needs in this area could result in actual harm to individuals and an increased sense of dependence on others. The safety and security needs of the Black men in this study are not unlike those of similar sub-populations of individuals affected with HIV/AIDS. Future studies need to continue to explore the reasons for admission, where people are admitted or referred from, their prior living arrangements and their psychologic state as indicators for safety and security healthcare needs. Like wise the dedicated AIDS nursing home model in this study proved to be an effective setting for these Black men to have their safety and security healthcare needs meet. Future studies need to also concentrate on other long term care models if we are to truly find the most effective settings for all affected.
Implications for nursing practice: Long term care institutions must maintain flexibility in their planning to meet the constantly changing and diverse set of healthcare needs that Black men with HIV/AIDS present with. Nursing care services are the foundation of day to day nursing home care. Given its centrality in delivering care services they should be involved in all aspects of planning to meet safety and security healthcare needs. This can be accomplished by attending to both the physical and emotional aspects of safety and security healthcare needs. Nurses in this context should directly assess whether or not the client is feeling safe in the setting as well as attending to any aspect of the setting that could potentially make the environment physically unsafe. Assessing for psychiatric problems (especially depression) and the potential impact of prior experiences with homelessness can also help in attempting to meet safety and security needs.
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