Practice sisters in GP group practices who often do the actual disease notification are not the ones to receive the statutory payment. Senior HIV/AIDS discharge co-coordinators (nurses) and research nurses have been employed with part of their job defined in terms which are normally part of the doctor's role. Needless to say, they are paid less than doctors. There is generally a lack of recognition and concern for the dilemmas nurses are faced with in this field. Although the ethical codes of both the medical and nursing professions are not at odds on these matters, the actual practice is. In fact, the nursing code in particular is quite advanced and very clear, but the conflicts and power struggles which still exist between medicine and nursing make it very difficult for nurses-advocates of the patients-to live by the letter and spirit of their code. Not only does the individual nurse suffer in this situation, but any decent nurse is forced into defending the rights of the patient in opposition to the quality of the data collected. This is not an argument against nurses entering the field of epidemiology, but rather an argument for bringing the rights of the individual patient and the public aims of epidemiology and health policy together. Nurses are often in the best position to identify these problems and should be listened to. (De Selincourt, 2000)
Literature Review/ Case Study
A young woman, Amanda, is pregnant. She attends the antenatal clinic, where a midwife takes her health history and runs a series of tests, such as blood, urine and blood pressure. She is counseled by the midwife on, among other things, the implications of human immuno-deficiency virus (HIV) and of being tested for it. Although the midwife has no reason to believe that Amanda has been exposed to HIV, she offers her an HIV test. Amanda declines, as there seems to be no need for one. She is also aware of the difficulties in obtaining a mortgage if she has this test. The blood sample taken by the midwife is sent to a laboratory for analysis for hemoglobin content, rubella antibodies, and syphilis. At the same time a small amount of blood from this sample is placed in an unnamed test tube which is then sent to a central laboratory to be tested for HIV. The midwife is completely unaware that this has occurred so cannot inform Amanda.
The next time that Amanda visits the antenatal clinic the other blood results are returned to her and, as they are normal, she continues with her pregnancy uneventfully. Unknown to her the anonymous blood sample has been tested and found to be HIV antibody positive and this is recorded at the national surveillance centre, where data on HIV and acquired immuno-deficiency syndrome (AIDS) and other infectious diseases are collected. The information accompanying this sample includes Amanda's age range (i.e. between 35 and 40 years), her gender and the geographical origin of the sample. In this case the epidemiologist will not have information about the means by which HIV was contracted. The data will provide information about the trends of HIV among pregnant women who attend antenatal clinics over a five-year period. Amanda's pregnancy