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What are your plans for the future?

Again, this course has reinforced the importance of political activism not just as a United States Citizen but as a nursing professional and expert. Moving forward, I’ll network, collaborate with key stakeholders, become an active member of my local nurses' association as well as my local and national certified registered nurses’ association. Together, we can join forces in moving our nursing profession forward as well as being great advocates for our patients. As an active member, I can contribute to our political action committee (PAC) that helps support politicians and lobbyists that support the nursing interest. I can volunteer my expert advice to policymakers to help shape policies so patients’ interests will be protected. I hope to be active in my local community helping share nursing knowledge, healthcare advice, as well as healthcare resources so we can build healthier and stronger communities. I’ll also advise young nurses to further their education and become advanced nurses as this helps strengthen their voices as political activists, giving credit to their views, advice, and suggestions.

Will you heed the call for action and join an organization like Nurses on Boards or become engaged with the National Nurse Campaign?

Yes, most definitely. Nurses are sociopolitical actors who promote improvements in health in our different facets of the profession (Melo, 2017). We are the frontline agents at almost every level of the healthcare system and the largest (Rasheed et al., 2020). We have a social mandate, to speak up for social justice and against health inequalities, to be advocates for public health issues, help reduce healthcare costs, medication errors, promote patient safety, enhance the quality of care, prevent, and manage communicable diseases (Buck-McFadyen & MacDonnell, 2017; Horton et al., 2019; Rasheed et al., 2020). I must therefore join an organization such as Nurses on Boards. In partnership with other leaders, will work tirelessly to promote change within the healthcare organization and improve healthcare outcomes for patients and the community.

Will you join a professional nursing organization?

Yes. I will join the Maryland Association of Nurse Anesthetists (MANA), the American Association of Nurse Anesthetists (AANA), as well as the American Nurses Association (ANA).

Do you have other ideas that would work to benefit your community or an organization that is important to you?

My idea is to engage my entire community in political activism, teaching others how to use their voices. I’ll join the community drive in helping those non-registered and eligible voters to register to vote. I’ll knock on doors, going door to door, encouraging others to vote, sharing why their voices are crucial and together we can improve outcomes, decrease social disparities, and improve quality of life for all.

Share with the class what your plans are now that you have a new awareness of your abilities and capabilities to provide advocacy beyond the beside?

I plan to engage and encourage other nurses to become politically active especially the young nurses or nursing students. Frequently, I’m invited to my nursing school alma mater to give a presentation on nursing courses or topics important to the profession. I plan on making political competence one of the topics. I believe that educating our young nurses early will be a great way of exposing them to politics and its importance. Through political competency and engagement, we become change agents, better patient advocates, protecting patient rights and safety, promoting healthcare reforms, reducing health inequalities, medical costs, and positively influencing healthcare reforms at local, state, national, and global levels (Rasheed et al., 2020).

Compose your final Tweet about this class. Remember to be concise as Twitter only allows 140 characters. Share your Tweet in the discussion

#NursesAreChangeAgents#WeHaveVoices#UseYourVoiceTosaveLives#PatientsDepndOnUs

References

Buck-McFadyen, E., & MacDonnell, J. (2017). Contested practice: Political activism in nursing and implications for nursing education. International Journal of Nursing Education Scholarship14(1). https://doi.org/10.1515/ijnes-2016-0026

Horton, S. E. B., Todd, A. T., Johnson, K. E., Gaskamp, C. D., Guillet, N., & Murray-Chavez, J. (2019). Public health policy simulation. The Journal of Nursing Education58(3), 178–181. https://doi.org/10.3928/01484834-20190221-10

Melo, W. S. de, Oliveira, P. J. F. de, Monteiro, F. P. M., Santos, F. C. D. A., Silva, M. J. N. da, Calderon, C. J., Fonseca, L. N. A. da, & Simão, A. A. C. (2017). Guide of attributes of the nurse’s political competence: A methodological study. Revista Brasileira de Enfermagem70(3), 526–534. https://doi.org/10.1590/0034-7167-2016-0483

Rasheed, S. P., Younas, A., & Mehdi, F. (2020). Challenges, extent of involvement, and the impact of nurses’ involvement in politics and policymaking in last two decades: An integrative review. Journal of Nursing Scholarship52(4), 446–455. https://doi.org/10.1111/jnu.12567

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Following the recent
ruling that pre-exposure prophylaxis (PrEP) can be prescribed for the
prevention of HIV within the National Health Service, what potential impact
might this have for individuals, health care and society?

Introduction

Pre-exposure
prophylaxis (PrEP) is medication taken by individuals without a diagnosis of
HIV, in order to reduce the risk of contracting the virus (Spinner et al.,
2016). The regimen of PrEP is typically composed of antiretrovirals in a
combined pill, typically tenofovir disoproxil fumarate and emtricitabine
(Brydon, 2018). In HIV-infected individuals, these antiretrovirals serve to
treat the infection, reducing the viral load of the patient; lifelong therapy
is needed with antiretrovirals to prevent clinical disease (i.e. AIDS) (Kelen
and Cresswell, 2017). In HIV-negative individuals the purpose of PrEP is not to
prevent viral transmission or entry into the body, but to reduce viral
replication to a level whereby the immune system can eradicate infected cells,
preventing established HIV infection (Brydon, 2018).

The evidence base
supporting the use of PrEP is substantial, indicating a reduction in HIV
transmission, particularly in men who have sex with men (MSM), a key target
population (e.g. Volk et al., 2015; LeVasseur et al., 2018). Therefore, PrEP
can be considered an effective preventative approach, along with other
strategies to prevent HIV infection, such as condom use (barriers methods) and
male circumcision (Dolling et al., 2014). This has led to the approval of PrEP
for the prevention of HIV within the National Health Service (NHS) within the
last year, building on the availability of PrEP in Scotland (Nandwani, 2017).
The remainder of this paper will consider the potential impact of this approval
process, focusing on individual, health care, and societal outcomes.

Individuals

The changes in availability and use of PrEP can have massive
effects on the individual. Firstly, NHS funding of PrEP can increase access to
the drugs and affordability of these drugs (Nichols and Meyer-Rath, 2017). PrEP
was only available through third parties and pharmacies from other nations,
increasing the cost of this preventative strategy and the risk of unreliable
sourcing from online companies (Brydon, 2018). Affordability and access are
particularly important in vulnerable groups and socioeconomically disadvantaged
members of the population, who may be at a higher risk of HIV infection
(Spinner et al., 2016).

One of the main individual benefits of the availability of PrEP
is the expansion of options available for those who are at-risk of HIV. Current
preventative strategies can have significant limitations, which limit their
practical application (Frankis et al., 2016). For instance, condom use requires
access to condoms and positive attitudes to their use, which are not always
present due to perceptions of diminished sexual pleasure (Dolling et all.,
2014). In these individuals, PrEP can provide an alternative to condom use and
ultimately empowers individuals to manage health risk (Frankis et al., 2016).

Other factors that interfere with traditional HIV prevention
practices, including religious beliefs, cultural factors and personal attitudes
to condom use, may lead to an acceptance of PrEP, increasing the power of the
individual to prevent HIV transmission (Stewart, 2016). Providing increased
opportunities and options for individuals to prevent HIV transmission is vital
in promoting heathier sexual behaviours, while increasing individual autonomy
and self-efficacy (Harawa et al., 2017). Therefore, the impact of PrEP approval
within the NHS may benefit those at greatest risk, while broadening access and
availability of preventative measures.

It is important to note that PrEP use does not protect against
sexually transmitted infections (STIs) and that the role of condoms in
preventing both HIV and STIs remains important and should be communicated to
individuals interested in PrEP (Storholm et al., 2017). Furthermore, individual
benefits are only possible if adherence to PrEP is likely to be optimal;
non-adherence reduces the effectiveness of the drug combination and can
increase risk of HIV transmission (Storholm et al., 2017). Therefore, selection
of the target population and individual education on PrEP use will be essential
in ensuring benefits. At present, 10,000 people are enrolled onto the PrEP
IMPACT evaluation in England and the results of this trial will provide
valuable insights into the individual benefits of the use of PrEP (NHS England,
2018).

Health care

From a health care perspective, the funding of PrEP by the NHS
can be considered beneficial in a number of ways. Principally, PrEP has been
shown to have a significant impact on HIV transmission rates in trials and ‘real-world’
evaluations, which may translate into a reduced HIV burden in the population
(Fonner et al., 2016; McCormack et al., 2016; Sagaon-Teyssier et al., 2016).
HIV infection is still associated with significant morbidity and mortality in
the population and therefore prevention can have significant benefits in how
health services manage population health (Hankins et al., 2015).

Furthermore, one of the most important impacts of PrEP use in
MSM from a health service perspective is the potential for cost savings in the
short and/or long term due to reduced rates of HIV infection. A
cost-effectiveness and modelling analysis has shown that PrEP in MSM is
associated with cost savings, based on an initial rollout of 4000 men within
the first year (Cambiano et al., 2018). Similar analyses have been performed
and are associated with cost savings with PrEP use, depending on the length of
time the projections are designed, the use of condoms within the target
population, the rate of STIs in the target population and the cost of
antiretroviral drugs (Drabo et al., 2016; Cambiano et al., 2018; Fu et al.,
2018).

Possible negative effects of PrEP have been considered in the
literature, with a predominant focus on an anticipated decline in condom use,
rise in STIs and the costs associated with these conditions (Kelen and
Cresswell, 2017). Although the relationship between condom use and PrEP use is
complex, there is no clear evidence that PrEP reduces condom use during sex,
although up to 30% of HIV-negative men with HIV-positive partners suggested
that they may be less likely to use condoms if PrEP were available in one study
(Hoff et al., 2015). However, in the context of committed couples, this may not
translate to an increased risk of STIs, although the risk of HIV transmission
needs to be considered in individuals who are less likely to use condoms (Hoff
et al., 2015). Furthermore, the IPERGAY (Intervention Préventive de
l’Exposition aux Risques avec et pour les Gays) study found equal rates of STIs
in patients using PrEP and those not using PrEP to prevent HIV transmission,
suggesting that risk-taking may not be associated with PrEP use
(Sagayon-Teyssier et al., 2016).

The cost-effectiveness of PrEP use in the NHS will partly depend
on the potential for an increase in condomless sex and STIs, suggesting that
this possibility should be closely monitored to ensure cost savings and
population health (Cambiano et al., 2018). More data will be needed to assess
the health care impact of PrEP use, particularly as the target population
becomes more clearly defined and expansion of PrEP use in England occurs (NHS
England, 2018).

Society

Finally, on a societal level, there is an important need to
consider the wider ethical, social and cultural aspects of PrEP use and the
impact of PrEP. Indeed, views on HIV and HIV management are often highly
polarized in society and within the British media (Jaspal and Nerlich, 2017).
HIV is associated with a significant level of stigma and any strategies used to
combat infection rates and to reduce the risks of relationships between
HIV-negative and HIV-positive individuals may serve to reduce stigma to some
extent (Grace et al., 2018). The psychological toll of stigma should not be
underestimated and strategies that alleviate stigma can have significant
benefits for quality of life and wellbeing (Grace et al., 2018).

However, part of the polarized perception of HIV management in
society associates negative connotations with the use of PrEP. An argument
against PrEP use for the prevention of HIV in the general population is the
perception that the medication could be seen as an invitation to promiscuity or
condomless sex, with negative moral and health implications (Knight et al.,
2016; Brydon, 2018). Similar arguments are generally proposed for all advances
in sexual health services (e.g. oral contraception) but are not generally
supported by the research evidence (Calabrese et al., 2016).

Therefore, it is important to ensure that public awareness and
education of the role of PrEP and the massive potential benefits of the
approach are not obscured by misinformation or unfounded claims in the media
(Jaspal and Nerlich, 2017). Health care professionals are well-placed to inform
the public and address such sources of misinformation but need to be supported
by policy makers and national guidance (Calabrese et al., 2016; Desai et al.,
2016). However, wider societal attitudes and stigma associated with HIV needs
to be challenged through policy and law-making to ensure individuals at-risk of
HIV have access to PrEP (Serrant, 2016).

Conclusion

In summary, the use of PrEP for the prevention of HIV infections
in the UK is supported by the evidence base and has become an important aspect
of NHS-funded interventions for those at-risk of HIV infection. The potential
impact of PrEP can be seen on an individual, health care and society level,
with reductions in HIV infections, cost savings, and improved availability and
access to health services. The implementation of PrEP needs to be closely
monitored to ensure public awareness and education is facilitated to prevent
negative health behaviors and risks. 

 

 

 

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