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Analysis and Application of Clinical Practice Guideline

Analysis and Application of Clinical Practice Guideline

�Select (1) one of the following issues: HOMELESS

� Analyze and critique the guidelines and complete the Clinical Practice

Analysis and Application of Clinical Practice Guideline

Scope and Purpose

The document addresses HIV and AIDS as two distinct diseases (Audain, Bookhardt-
Murray, Fogg, Gregerson, Haley, Luther, Treherne, & Knopf-Amelung, 2013). It is targeted
toward disease management practices, their prevention, as well as treatment. In addition, the
guideline includes the diagnosis, evaluation, and patient counseling practices in its scope for the


two ailments. The document covers multiple medical specialties including infectious diseases,
obstetrics and gynecology, hematology, and psychiatry among others. The targeted users of the
document include advanced practice nurses, physicians, pharmacists, nurses, dieticians, social
workers, public health departments, and other relevant groups. The document has the objective
of assisting clinicians to offer high-quality services to unstably housed HIV patients. The
designers of the guideline hope to do so by providing evidence-based recommendations
regarding optimal management practices for patients of HIV and AIDS in the selected
population. The targeted patient population for the guideline is unstably housed people including
the youth, women, minority groups, and immigrants. The guideline investigates the prevalence
rates for both HIV and AIDS among the selected population. It also focuses on important
concepts of the diseases such as CD4 cell count and viral loads among users of antiretroviral
medications. Other considered outcomes include the complications of the two diseases, their
morbidity, as well as mortality. The interventions in the guideline focus on disease diagnosis,
treatment, as well as management.

Stakeholder Involvement

The document engages different professionals as well as lay people. It includes peer
educators, peer advocates, and outreach workers who are expected to facilitate access to the
targeted patient population (Audain et al., 2013). The group would also facilitate practices such
as diagnostic testing and treatment of individuals for the two diseases. The team also includes
clinical professionals who are expected to actively engage patients when delivering services to
them. The clinical team includes paraprofessionals in addition to professionals. Clinicians are
expected to assess patients and understand their personal challenges influencing their
management of the selected diseases. Stakeholders from the clinical setup would base their care


on patient-centeredness so as to engage patients in decision-making approaches. Clinicians also
have the role of addressing psychosocial and medical factors that bar patients from accessing
high-quality health care. Team members would establish a therapeutic relationship with the
patients and build mutual trust. The team would engage in regular meetings so that members can
support one another and promote professionalism. Members would also engage in continuous
education so as to promote both active engagement and professionalism. Possible conflicts of
interest include a tendency by healthcare professionals to pursue financial gains at the expense of
patient wellness during the study. For instance, some professionals may be motivated by
marketing drugs and other services to the target population rather than focusing on helping the
troubled community. However, the authors state that the clinician network would practice in a
way that it avoids any conflicts of interest. The network further indicates that members who
would have conflicts of interests would disclose them and withdraw from making decisions
where the conflict of interest would happen (Audain et al., 2013).
Rigor of Development

The developers of the guideline relied on both primary and secondary sources of data.
They also consulted electronic databases, and they used both qualitative studies and randomized
control trials hence enhancing the rigor of their document. The developers relied on authoritative
and reliable data from sources such as World Health Organization, National Health care for the
Homeless Council, Pubmed, and Google Scholar (Audain et al., 2013). The designers also
enhanced the rigor of the guideline by ensuring that their data search was thorough, and it
covered a considerably lengthy period of clinical practice. In their development of the guideline,
the authors considered pre-existing guideline and borrowed insight from informative
bibliographies (Audain et al., 2013). The authors also indicated that their inclusion criteria


involved an expert evaluation of the importance of different sources to clinical practice. Only
sources that would apply to clinical care for homeless persons with HIV or AIDS were included.
Shortcomings in the developing the rigor of the document include failure by the authors to
indicate the exact number of sources they consulted. Also, the authors failed to indicate the
methodologies they applied in determining the quality of the sources they used. Again, the
authors did not indicate the methods they used in analyzing the evidence they gathered.
However, the developers indicated clearly that they used expert consensus when developing the
recommendations. They also peer reviewed the document before publishing it. Such activities
were necessary in enhancing the rigor of the document. The authors also indicated the benefits of
applying the guideline to the target community. The primary benefit was that the guideline
would increase the accessibility of standard healthcare services to homeless persons who had
HIV or AIDS. In addition, the authors outlined the potential harms of applying the guideline to
clinical practice. The document advocated for the use of antiretroviral medications, yet patients
could develop severe reactions to the drugs. The living conditions including lack of proper
shelters would exacerbate side effects such as explosive diarrhea, a reaction that often
accompanies the use of protease inhibitors. In addition, symptoms such as nausea and numbness
would be exaggerated if patients did not take enough food. The treatment of HIV and AIDS may
also trigger mental illnesses, and the guideline placed patients at such a risk. Other severe
occurrences associated with the interventions proposed in the guideline include development of
Stevens-Johnson syndrome and hepatic impairment.

The document offered recommendations for the design of service delivery, engagement of
stakeholders, effective diagnostic approaches, and patient management strategies (Audain et al.,


2013). The recommendations would have optimum applicability to nursing practice. A plan
developed on the basis of the recommendations would require clinicians to establish flexibility in
the service system. They would do so by allowing walk in appointments, providing outreach
services, and resolving challenges instantly (Audain et al., 2013). The document also requires
clinicians to facilitate the accessibility of mainstream health care to the patient population of
interest. Again, the stakeholders would coordinate interdisciplinary practice so as to provide
healthy foods to the patients, proper housing facilities, clothing, and other fundamental needs.
Nurses would play the role of treatment advocates where they would encourage medication
adherence among the selected population (McCarthy, Voss, Verani, Vidot, Salmon, & Riley,
2013). They would establish therapeutic relationships with the patients and educate them on the
benefits of adhering to treatment when managing diseases. They would also be educators where
they would enlighten patients on the basics of HIV and AIDS. They would teach the population
on preventive measures and management practices that would promote the quality of their lives.
In addition, nurses would educate patients on effective self-management approaches to
maintaining one’s health at its best. The professionals will also be important in diagnosing and
testing target populations for the two diseases (Kurth, Lally, Choko, Inwani, & Fortenberry,
2015). Their contribution would require financial support from the relevant agencies. Crucial
facilities for the effective implementation of the interventions include correctional facilities and
shelters. The professionals would also require laboratory equipment that would not only enable
them determine the HIV and AIDS status, but also the health of their clients regarding other
illnesses such as hepatic impairment and tuberculosis. For optimal outcomes of their
interventions, nurses would also require to provide basic commodities such as food to their
clients, especially if they suggest that patients use antiretroviral drugs. Other needs that would


require financial input include educative materials such as books as well as things such as
protective condoms.


The authors of the document did not include an implementation strategy for their
guideline. The guideline is associated with the occurrence of numerous undesirable experiences
for patients. Such complications would hinder the adoption of the proposed approaches of
disease management. In addition, the selected population is likely to face multiple personal
challenges and they may not cooperate in the promotion of their health. Patients may also face
societal stigmatization and fail to contribute actively to the implementation of the suggested
strategies (Saki, Mohammad Khan Kermanshahi, Mohammadi, & Mohraz, 2015). Also, the
scheme would require considerably large amounts of funds that may not be available. The above
factors would be hindrances to the effective implementation of the interventions. The authors did
not include a cost analysis in their document. Their proposed interventions would require the
healthcare sector to invest more in the care of HIV and AIDS patients. The sector would also
make such that care is accessible to the disadvantaged population. In addition to medication, the
document advocates for provision of basic services to the unstably housed population. Such a
move would necessitate extra funding in the healthcare sector. Reduced morbidity and mortality
of HIV and AIDS among the selected population would be outcome indicators for the
interventions. Other indicators would include improved quality of lives among the target group.




Audain, G., Bookhardt-Murray, L.J., Fogg, C .J., Gregerson, P., Haley, C .A., Luther, P.,
Treherne, L., & Knopf-Amelung, S. (Editor). (2013). Adapting your practice: treatment
and recommendations for unstably housed patients with HIV/AIDS. Nashville, TN:
Health Care for the Homeless Clinicians’ Network, National Health Care for the
Homeless Council, Inc.
Kurth, A. E., Lally, M. A., Choko, A. T., Inwani, I. W., & Fortenberry, J. D. (2015). HIV testing
and linkage to services for youth. Journal of the International AIDS Society, 18(2Suppl
1), 19433.


McCarthy, C. F., Voss, J., Verani, A. R., Vidot, P., Salmon, M. E., & Riley, P. L. (2013).
Nursing and midwifery regulation and HIV scale-up: establishing a baseline in east,
central and southern Africa. Journal of the International AIDS Society, 16(1), 18051.

Saki, M., Mohammad Khan Kermanshahi, S., Mohammadi, E., & Mohraz, M. (2015). Perception
of Patients With HIV/AIDS From Stigma and Discrimination. Iranian Red Crescent
Medical Journal, 17(6), e23638.

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