[Show abstract][Hide abstract] ABSTRACT: The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex.
[Show abstract][Hide abstract] ABSTRACT: Many nursing specialty groups in Canada have developed their own entry-to-practice frameworks to inform nursing curricula. This article focuses on the framework of HIV/AIDS core competencies developed by the Canadian Association of Nurses in HIV/AIDS Care.
The goal of this pilot project was to map the courses offered in one entry-level program to assess the applicability of the framework as a tool to inform curriculum development.
This project highlighted competencies that were well covered in the current courses offered in the program, as well as existing gaps. To address these gaps, five areas of improvement were identified.
The gaps and areas of improvement identified in this project are similar those identified in the nursing literature. As such, they reinforce the importance of incorporating education and training in entry-level programs with actual clinical experiences with and exposure to people living with HIV. [J Nurs Educ. 2015;54(7):409-415.].
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[Show abstract][Hide abstract] ABSTRACT: Increasing numbers of patients living with obesity (PLWO) are admitted to the intensive care unit (ICU). The goal of this qualitative study was to examine the experiences of ICU nurses who work with PLWO using the Othering framework developed by Canales in 2010. The first theme describes how PLWO become "Others" in the ICU. The second theme focuses on exclusionary Othering and how it manifests itself in the way PLWO are cared for and viewed. The third theme sheds light on inclusionary Othering in the form of strategies that are used by nurses to engage with PLWO. The last theme takes a closer look at the ICU environment and how resources impact the experiences of nurses working with PLWO.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Preview · Article · Jun 2015 · ANS. Advances in nursing science
[Show abstract][Hide abstract] ABSTRACT: In this article, we examine the concept of HIV viral load and how it has evolved over time (1995–2013) in the field of HIV/AIDS. Although the term viral load is used extensively in this field, few efforts have been directed toward the conceptualization of HIV viral load,
which is often left unquestioned, undertheorized, and portrayed as a neutral and objective laboratory value that has remained relatively stable over time—with the exception of progressive advancements in technology, techniques, and sensitivity. The purpose of this article is to apply
the evolutionary concept analysis method developed by Rodgers (1989, 2000a) to the concept of HIV viral load. To set the stage, we establish the need for a concept analysis of HIV viral load and provide an overview of the evolutionary view. Then, drawing on the steps proposed by Rodgers (2000a),
we outline the process of data collection, management, and analysis. We then offer an in-depth discussion of the findings (attributes, antecedents, and consequences) informed by Wuest's (2000) critical approach to concept analysis. We conclude by highlighting the implications of this analysis
for clinical practice, research, and theory.
Full-text · Article · Aug 2014 · Research and Theory for Nursing Practice
[Show abstract][Hide abstract] ABSTRACT: Interview location has been widely overlooked in the nursing literature. This paper presents a discussion of interview location in the context of nursing research with particular emphasis on the concepts of space and place. It draws on six research projects that were conducted between 2008 and 2013 in Canada, and is informed by key texts on the concepts of space and place. We argue that thinking about space and place in the context of interviewing is one way to engage in reflexivity. The reflexive accounts featured in this paper support the need for nursing researchers to engage in explicit analysis of their own interview locations and to discuss the significance of space and place in their own work. These accounts suggest that location is a fundamental aspect of the interview process.
[Show abstract][Hide abstract] ABSTRACT: When providing care to HIV-positive refugee women in the context of pregnancy, nurses must be able to move beyond the individual experiences of health and illness and acquire a more meaningful understanding of the historical, social, cultural, political, and structural influences that shape women's health and women's lives. Intersectionality is a framework that focuses on various dimensions of a refugee woman's social identity such as race, class, gender, as well as education, citizenships, and geographic location and how these dimensions intersect to influence the experiences of health and illness. In this article, we present a brief overview of the origins and evolution of intersectionality. From there we describe three distinct levels of analysis: (a) micro-level analysis to examine the influences that impact the social identity and social location of women; (b) meso-level analysis to explore informal and formal support systems; and (c) macro-level analysis to interrogate historical, social, cultural, political, and structural influences that shape health outcomes. Finally, we will examine how this framework may be useful for nursing practice, research, and knowledge development. We hope to illustrate how intersectionality is a useful framework to understand the experiences of HIV-positive refugee women in the context of pregnancy.
No preview · Article · Nov 2013 · Research and theory for nursing practice
[Show abstract][Hide abstract] ABSTRACT: The aim of this paper is to explore the relationship between mandatory HIV testing and the institutional management of inmates in U.S. prisons. Mandatory HIV testing has been largely overlooked by the nursing community even though it has important human rights and ethical implications. Drawing on the work of Goffman (1990) on the inner workings of total institutions, the present article critically examines the deployment of mandatory HIV testing in U.S. prisons. To set the stage, we define mandatory HIV testing and describe the methods of HIV testing currently used in U.S. prison settings. Then, we provide a brief overview of the concept of total institution and the mortification process. Finally, we expand on the relationship between mandatory HIV testing and much larger institutional objectives of total control, total structuring, total isolation, and separation of inmates from society (as summarized by Farrington, 1992). And lastly, we provide a brief discussion on the implications of mandatory HIV testing (as a method of HIV testing) from a nursing perspective.
No preview · Article · Oct 2013 · Journal of Forensic Nursing
[Show abstract][Hide abstract] ABSTRACT: This paper is precisely aimed at exposing the limits of psychiatry's scientific claim-making and exploring how psychiatric diagnoses come to be utilized in practice and affect those who become pathologized. Drawing on research findings in the field of HIV/AIDS nursing, we portray the impact of psychiatric pathologization of women who see their bodies transformed by antiretroviral therapy and subsequently, must accept that their response to these changes become the target of psychiatric labelling and interventions. In this paper, we therefore engage with the reader in a critical analysis that exposes the tensions that exist between individual experiences of distress and psychiatric pathologization. The first section of the paper is dedicated to the presentation of a theoretical framework in which we explore the medicalization process and the ontological issues regarding psychiatric diagnoses. The second section seeks to present the results from a qualitative research study in the field of HIV/AIDS nursing and serves as a case example to foster discussions on the implications of psychiatric pathologization in clinical practice.
No preview · Article · May 2013 · Journal of Psychiatric and Mental Health Nursing
[Show abstract][Hide abstract] ABSTRACT: HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure 'community viral load'. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of 'community' through the re-configuration of space, the problematization of viral concentrations in specific microlocales, and the government (in the Foucauldian sense) of specific bodies which are seen as 'risky', dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition - forming the 'conditions of possibility' - for the recent shift to high impact prevention tactics that are being scaled up across North America.
Full-text · Article · Dec 2012 · Critical Public Health
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, the lipodystrophy syndrome has become one of the biggest challenges in the field of HIV/AIDS. Yet, few qualitative studies have examined how lipodystrophy affects the lives of people living with HIV/AIDS by reconfiguring their bodies in unexpected ways. The main objective of this qualitative study was to explore and describe the transformation process that women experience following the onset of lipodystrophy. The data were collected using semi-structured interviews and were then analysed following the principles of grounded theory. Overall, the research participants explained how lipodystrophy had transformed their bodies, disrupted their identities and confined them to a fragile social trajectory. In this sense, the experience of lipodystrophy was described as a profoundly disruptive transformation that includes three distinct stages: normalisation, problematisation and pathologisation. This process was characterised by the progression of lipodystrophy, as well as an intensification of the efforts to regain control over the body. At last, this study provides health care providers with a better understanding of the psychosocial impact of lipodystrophy and the needs of women who suffer from this condition.
[Show abstract][Hide abstract] ABSTRACT: As it currently stands, mandatory human immunodeficiency virus (HIV) testing of prisoners is performed by nurses in more than 24 states and throughout the federal correctional system. The aim of this article was to bring to the attention of the nursing community the inner workings of mandatory HIV testing and its implications for HIV-positive prisoners. Building on a recent report published by Human Rights Watch, we critically examine the deployment of mandatory HIV testing in state correctional facilities located in Alabama and South Carolina. We, therefore, intend to situate this practice within a bio-political logic and explore its human rights consequence.
No preview · Article · Mar 2012 · ANS. Advances in nursing science
[Show abstract][Hide abstract] ABSTRACT: GAGNON M, JACOB JD and GUTA A. Nursing Inquiry 2013; 20: 60–70 Treatment adherence redefined: a critical analysis of technotherapeutics
Treatment adherence issues in the context of chronic illnesses have become an important concern worldwide and a top priority in the field of health-care. The development of devices that will allow healthcare providers to track treatment adherence and monitor physiological parameters with exact precision raises important questions and concerns. The aim of this study is to interrogate the use of these new technological devices which allow for previously unavailable data to be recorded on an ongoing basis and transmitted via a tiny microchip inserted into the body. Drawing on the work of Michel Foucault, we analyze how this anatomo-political and bio-political instrument serves to discipline chronically ill individuals and govern the health of entire populations who suffer from chronic conditions. To support our analysis, this article comprises three sections. First, we provide an overview of treatment adherence and technotherapeutics. Then, we explain how technotherapeutics concern the government of bodies and conducts at the individual level and population level more generally. Lastly, we provide an example of how this analysis can be connected to routine nursing practice in the field of HIV.
[Show abstract][Hide abstract] ABSTRACT: Facial lipoatrophy has been described as the most distressing and stigmatizing expression of the lipodystrophy syndrome, a syndrome that is caused by antiretroviral combination therapy. In recent years, reconstructive treatments (such as poly-l-lactic acid and polyalkylimide) have been increasingly considered for this condition. These treatments allow for facial contours and facial fullness to be restored while being minimally invasive.
The main objective of this qualitative research was to explore and describe the experience of people who suffer from facial lipoatrophy, specifically in regard to reconstructive treatments.
A qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. The data was collected using semi-structured interviews and was then analyzed following the principles of thematic analysis.
Over a period of three months, 11 men and 1 woman enrolled in the study which was conducted in Montreal (Quebec), Canada.
Overall, participants explained that facial lipoatrophy had forced them into a situation of intense vulnerability by making them recognizable as persons living with HIV/AIDS and discreditable in the eyes of others. In this sense, they were willing to go to great lengths to restore their facial features and regain a sense of normalcy. Findings revealed that people who suffer from facial lipoatrophy engage in a process of reconstruction to reduce the visibility and disruptiveness of their condition but face many uncertainties along the way.
While the findings of this research corroborated what has been previously stated by other researchers about the impact of reconstructive treatments, they also shed light on the consequences of not making these treatments accessible as well as the undocumented realities of those who cannot afford the recommended course of dermal fillers.
No preview · Article · Nov 2011 · International journal of nursing studies
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, the lipodystrophy syndrome has become one of the biggest challenges in the field dof HIV/AIDS. However, few qualitative studies have examined how lipodystrophy affects the lives of people living with HIV/AIDS by reconfiguring their bodies in unexpected ways. The
main objective of this qualitative study was to explore and describe the transformation process that women experience following the onset of lipodystrophy. The data was collected using semistructured interviews and was then analyzed following the principles of grounded theory. The purpose
of this article is to synthesize our research findings with a particular emphasis on the basis social process (BSP) that emerged during the data analysis, namely, the bodily transformation process. Our objective is to highlight the experiences shared by women who go through this bodily transformation
process and the challenges they face as they move progressively from one bodily state to another. Following the presentation of the bodily transformation process, we will discuss the implications of our findings for the advancement of nursing knowledge as well as the development of theories
specific to the situations of people who suffer from chronic conditions and undergo a physical transformation as a result of medical treatment. Lastly, we will address the implications of our findings for nursing research and nursing practice.
No preview · Article · Feb 2011 · Research and theory for nursing practice