If we have learnt anything in the previous couple of years, it is that nurses are tenacious, skilled, resourceful, compassionate and competent. During the pandemic, they found themselves redeployed to areas of nursing in which they had not undertaken work for many years. This included HIV specialist nurses being deployed to intensive care units, COVID-assigned wards and other departments supporting the directly affected workforce. As the NHS tried to return to a semblance of normality, HIV nurses noticed that many of their clinics had changed and they had lost touch with clients who had previously engaged with their care, and they saw the number of individuals seeking HIV testing fall below pre-pandemic levels.
The ‘all-hands-on-deck’ approach during the pandemic was understandable. We were dealing with a virus that we were learning about daily and that was having devastating effects on many who came into contact with it. The virus had a disproportional impact on individuals living in populations already marginalised, and a language of blame resurfaced for those who did not adhere to guidelines on isolation or engage with preventive measures such as vaccines. For many HIV nurses, this was reminiscent of the imagery, memories and experiences of the early days of HIV.
Nurses reported that changes to their roles or services had occurred while they had been redeployed. Some saw roles expand, while others saw their roles change completely. Some services were joined with other services, and some were merged into larger services. However, at the root of the changes, the redesign of services and the attempts to track down clients and re-engage them with care, were nurses. Working with other members of the multidisciplinary team, they took control of their clinics and visits, used their skills and knowledge to communicate with those who had disengaged to re-start their journey of care, and implemented new ways of working with the introduction of injectable antiretroviral therapy (ART).
In this supplement, the importance of nurses' abilities to engage with clients is displayed in two pertinent articles. Nurwijayanti et al (see page S12) explore the synergistic effect of ART adherence and viral load suppression on the quality of life of people with HIV in Indonesia. In their study, clients reported better quality of life if they engaged with care, adhered to their treatment regimens and were able to suppress their viral load. Foote (see page S4) looks at the challenging process of supporting clients who choose to not engage with treatment, using case studies to explore the issues. This can be a challenge for nurses who know that ART can prolong life, but who understand the need to respect a client's choice to opt out of treatment.
Supporting clients through their engagement with care is an essential aspect of the nurse's role, but nurses are not always kind and compassionate to themselves when making challenging decisions, and enduring the pressures placed on their service and the NHS. Croston and Rutter (see page S20) introduce their work involving compassion-focused therapy, to enable nurses to improve their self-compassion, thereby promoting compassion satisfaction and preventing compassion fatigue.
As we start a new calendar year we, as nurses, are aware of the demands the NHS is facing. We have lived through the pandemic and withstood the pressures placed on us, and can now begin to look ahead. The difficulties we have faced and overcome over the past few years will not prevent us from striving to improve the experiences of those we care for. It is something we should be very proud of, but it is important to remember to take care of ourselves too.