[Innovative processes in ambulatory care--AIDS as a pilot project]

Flexibility in nursing practice and the willingness to be innovative are discussed, using the care of patients with AIDS as an example. When this new infectious disorder made its first appearance many countries tried to provide a patient-centred, community based service, in spite of the severity of the illness and the fact that it was usually lethal. A number of innovations were required to achieve this. The top priority was the provision of a community nursing service. This contribution consists of the analysis of the structure of provisions for care of patients with AIDS in the German Federal Republic (BRD). It deals with the reaction of the nursing services and asks to what extent the objectives have been achieved. Three different ways to adapt to the situation in the BRD are described and analysed. Data are based on qualitative interviews with members of the nursing service. It is shown that AIDS has led, in the BRD, to numerous innovations in community nursing care, the relevance of which far transcends the treatment of AIDS. In spite of this success, the care of patients is unsatisfactory. Many promising attempts to change came to grief as a result of resistance and obstacles to implementation. Others proved to be insufficiently robust or inappropriate in view of the multiplicity of problems encountered in AIDS. Reasons are to be found in the defective structure of the service, in the fact that management difficulties concerned with implementation of innovations were underestimated and that there is a "crisis" in nursing in the BRD. There have been criticisms for a long time, pointing out that the basic qualification is insufficient, that it does not prepare nurses adequately to deal with new social and health problems. If no change is introduced to training, community nursing is unlikely to be able to cope innovatively and flexibly with new challenges in the future.