HIV-positive women and minority patients' satisfaction with inpatient hospital care

Although patient satisfaction has been examined in relation to HIV services for ambulatory and managed care, less is known about perceptions of hospital care, particularly for HIV-positive women and minorities. The purpose of this study was to examine HIV-positive women and minority patients' satisfaction with hospital care. The study was part of a larger funded study that explored potential health care disparities for HIV-positive women and minority persons in the era of HIV combination drug therapy. A convenience sample of 50 HIV-positive persons was recruited from four medical centers/hospitals in a South Florida community. The multi-ethnic sample included 31 women and 19 men. The survey tool used was Cleary's HIV-Infected Patient's In-Hospital Questionnaire. Findings revealed that participants were generally satisfied with their hospital care. Physicians, nurses, and the hospital environment received satisfactory ratings. However, several problem areas were identified, including pain management and education on side effects of HIV medications, indicating the need for interventions to improve care. Experimental AIDS drugs were discussed with less than half of the participants, suggesting that HIV-positive women and minority patients may not have equal access to clinical drug trials. Further research is also needed to determine whether attitudes conveyed by health care providers influence HIV-positive patients to be wary of advance directives. The competence of nurses experienced in acute-care nursing of persons with HIV/AIDS was an important factor in patient satisfaction. A lack of experienced acute-care AIDS nurses may ultimately lead to a decrease in HIV-positive patients' satisfaction with hospital care.     

Unique educational program in critical care medicine for the general internist

Objective: To determine the effect of a unique educational program in critical care medicine on the attitudes, knowledge, and skills of general internists who care for critically ill patients. Design: Comparison of objective assessments and self-assessments obtained before and after the one-year educational program. Setting/participants: Eighteen general internists practicing in a 350-bed university-affiliated community teaching hospital. Results: After the program, the internists felt significantly more competent in, knowledgeable about, comfortable with, and satisfied with caring for critically ill patients than they did when completing the precourse self-assessments (p<0.05). Participants felt particularly more comfortable with managing ventilator patients and leading the advanced cardiac life-support team (p<0.05). Comfort levels for other commonly performed critical care procedures did not vary. No significant change in knowledge test scores was noted from before to after the one-year program (61% vs 60%). Residents and nurses rated the internists’ overall ability in critical care medicine to be the same as that of senior medical residents. They also favorably rated the internists on humanism, teaching skills, and interpersonal interactions. Residents also appreciated the decrease in their night call because of the program. Conclusions: This unique educational program increased comfort and satisfaction of general internists caring for critically ill patients. The program was well accepted by residents and nurses because of favorable interaction with the internists and a decrease in resident night-call responsibility. This curriculum is recommended to other teaching hospitals. Presented at the 14th annual meeting of the Society of General Internal Medicine, May 2, 1991, Seattle, Washington.     

Attitudes toward the care of patients with acquired immunodeficiency syndrome. A survey of community internists

Community physicians may play an increasing role in treating patients with acquired immunodeficiency syndrome (AIDS) because of the shift away from inpatient care. At a community hospital in New York, NY, we surveyed 230 attending physicians in a department of medicine to determine their attitudes toward the care of patients with AIDS. Factor analysis produced three clusters of attitudes termed antipathy, liability, and isolation. These factors, together with physicians' "knowledge" and background, were analyzed as predictors of treating patients with AIDS. While antipathy, isolation, and fear of acquiring AIDS were not predictors, liability scores were inversely correlated with the likelihood of treating the disease (r = -.18). Liability was influenced by patients' attitudes toward AIDS. Primary care physicians had higher liability and isolation scores than subspecialists and were more likely to see support groups, guaranteed funding, and education as incentives to treat patients with AIDS. Further study is needed to target measures that support primary care physicians in their care of patients with this disease.     

A cross-sectional analysis of variables impacting on AIDS-related knowledge, attitudes, and behaviors among employees of a Minnesota teaching hospital

We examined variables that were correlated with the AIDS-related knowledge, attitudes, and behaviors among employees of a 455-bed acute-care Minnesota teaching hospital and its associated clinics, located in a low-prevalence area for HIV infection. In August 1987, an anonymous questionnaire was sent via interdepartmental mail to all employees (2,980), including 270 physicians. The four-page survey obtained demographic information and measured 14 variables, including degree of homosexual bias, degree of homophobia, and AIDS-related knowledge, behaviors, attitudes, and anxiety level. Responses were obtained from 2,351 (79%) of the employees. By multivariate analysis, the following variables were highly correlated with positive behaviors and attitudes toward AIDS patients (p less than .0001): lower homophobia scores, higher AIDS knowledge scores, expressed confidence in AIDS-related medical information, and a greater number of previous contacts with AIDS patients. Those with a family member or close friend with AIDS also showed more positive attitudes and behaviors (p less than .02). Level of education was correlated with knowledge about AIDS (p less than .0001) but was not correlated (p greater than .05) with more positive behaviors or attitudes inrelation to AIDS patients. Educational efforts should attempt to improve hospital employees' knowledge about AIDS and their confidence in AIDS-related medical information. Efforts to address homophobia should also be considered.     

Effects of internal medicine residency training in AIDS care in Taiwan

Having contact and interacting with HIV/AIDS patients has long been recognized as a means for improving AIDS-related knowledge and attitudes among physicians and hence for increasing their intention to provide AIDS care. To investigate the impact of one-month residency training in an AIDS inpatient unit on internal medicine residents, this quasi-experimental, pre-post, two-group study, conducted from April 2000 to April 2001, used questionnaires. At follow-up, residents who received training in the AIDS unit (experimental group) were significantly more knowledgeable about HIV/AIDS, had more positive attitudes and greater intention to care for HIV-infected patients than residents who did not receive this training (control group). Results suggest that a one-month AIDS residency training intervention can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.     

Knowledge of AIDS among hospital workers: behavioral correlates and consequences

Incidents of suboptimal care being rendered to AIDS patients have been documented. Using a voluntary anonymous questionnaire, we surveyed the employees of a large urban hospital in order to evaluate the knowledge, attitudes and professional behavior of the staff regarding AIDS. Responses were obtained from 1194 (60%) of the staff. Poor knowledge of the transmission of AIDS was documented, with 50% of workers stating that AIDS can be spread through ordinary non-sexual contact and 23% through the air by a cough or a sneeze. One-third of employees believed that they should be able to refuse to care for patients with AIDS. Extreme anxiety in dealing with AIDS patients was noted by 25% of employees, and only 16% of the employees would volunteer to work on an AIDS ward. Knowledge regarding AIDS was demonstrated to be a predictor of positive attitudes, appropriate professional behavior and lower anxiety in dealing with AIDS patients. The goal of hospital education programs on AIDS must be to ensure the incorporation of accurate information into the belief system of workers.     

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus

Discrimination against persons living with HIV/AIDS in hospital settings has been documented. This study examined the attitude of health care workers (HCWs) to nurses, doctors and patients infected with HIV. A total of 345 respondents selected by multistage sampling techniques were surveyed, using a semi-structured questionnaire, which explored respondents' attitude to HIV-infected patients and colleagues with HIV/AIDS. HCWs were unwilling to accept that medical procedures be carried out on them by HIVinfected doctors and nurses, with almost 80% refusing surgery or assistance at surgery on them by an HIV-infected doctor or nurse. They were also significantly more unwilling to accept that medical procedures be carried out on them by an infected colleague, compared with their carrying out the same procedure on an HIV-infected patient. Thus, HCWs seemed to believe that the risk of contracting HIV was higher if an infected HCW were to perform medical procedures on them, and fear of contracting HIV seemed to be the driving force for their negative attitudes. Education on occupational risks of HIV, provision of a safe working environment with enforcement of universal precautions, as well as provision of post-exposure prophylaxis are suggested as ways to enable HCWs to change their attitudes.     

Physicians’ and nurses’ attitudes toward withholding treatment in a community hospital

Physician and nurse attitudes regarding aggressiveness of patient care were prospectively surveyed by questionnaire in a small rural community hospital. All patient admissions during one year, excluding routine obstetrical cases, were surveyed. Physicians and nurses used a simple continuous scale to indicate care level (1 = comfort care to 5 = full care). Nurses were more willing than physicians to limit care efforts for patients (mean scores of 4.35 vs 4.79, respectively). Both physicians and nurses indicated nearly identical factors important in making decisions to limit full resuscitative efforts: quality of life, nature of underlying illness, and age. A significant communication gap existed between nurses and physicians regarding aggressiveness of care: physicians indicated communication with nursing staff in 564 cases; nurses acknowledged this in only 56 of these same cases. These data suggest that current policies regarding do not resuscitate (DNR) orders should be broadened to include guidelines for less than full aggressive patient care. These policies should ensure adequate, documented communication between professional staff, patients, and others significantly involved with patient care decisions.     

2001 SGIM annual meeting schedule

OBJECTIVE: The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN: This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING: A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS: All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS: Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk-cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidence interval (CI) +/- $489) less than expected among teaching-unit patients and $4,153 (95% CI +/- $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI +/- $307) per hospitalization for teaching-unit patients and $451 (95% CI +/- $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI +/- $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI +/- $437). CONCLUSIONS: Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability.     

AIDS education for hospital workers in Manila: effects on knowledge, attitudes, and infection control practices.

OBJECTIVE: To evaluate an AIDS education intervention for health workers in Metro Manila hospitals. METHODS: A randomized controlled education program consisting of lectures, role-plays, posters and pamphlets was delivered to physicians, nurses, laboratory technologists and orderlies in Manila hospitals. Knowledge, attitudes and infection control practices were measured before, immediately after, and 2 months after the intervention. RESULTS: Baseline survey among 641 hospital workers revealed poor knowledge, negative attitudes towards AIDS patients, and inappropriate infection control practices. Immediately after the intervention, there was significant improvement in (1) knowledge scores (8.7-11.2 in the intervention group versus 8.5-9.5 in the control group; range, 0-14), (2) attitude scores (54.4-60.6 versus 54.6-56.8; range, 22-88), and (3) needle-recapping practices (14-43% versus 39-43%) (all P values < 0.001). After 2 months, attitude scores in the experimental group fell to the same level as those of the control group, while improvements in knowledge and needle recapping were largely maintained. Role-playing was considered by the participants to be the most effective component of the intervention. CONCLUSIONS: These results suggest that AIDS training for hospital workers in the Philippines and in similar countries is necessary and can be effective. Ideally, such training should include role-playing and should be ongoing in order to sustain the effect.     

Quantitative analysis of burnout and its associated factors in AIDS nursing

A study was conducted to examine burnout and associated factors in the nursing care of AIDS patients in the hospital setting. Oncology nurses served as a comparison group and 64 subjects completed the Maslach Burnout Inventory. Although nurses working in the area of Oncology suffered burnout with greater frequency, nurses working in the area of AIDS showed greater intensity of burnout after adjustment for frequency of burnout. The study identified hospital differences in burnout scores, lending support to the environmental model of burnout proposed by Maslach. Male nurses were as likely to suffer burnout as female nurses. Having previously worked in other stressful areas did not influence burnout scores. On the other hand nurses who had worked in a particular unit for a greater length of time were more likely to suffer burnout, and age significantly influenced burnout inversely.     

A national study of AIDS and residency training: experiences, concerns, and consequences

OBJECTIVE: To examine residents' experiences in the care of patients with the acquired immunodeficiency syndrome (AIDS), and to examine factors that may influence their attitudes about such care. DESIGN: Cross-sectional, self-administered questionnaire survey conducted in 1989. PARTICIPANTS: All senior internal medicine and family medicine residents in ten geographically representative states who were identified through the 1986 National Residency Matching Program. MEASUREMENTS AND MAIN RESULTS: Seventy-four percent of residents reported that patients with AIDS accounted for 5% or more of general medicine admissions, and 50% of residents reported that they were currently following one or more human immunodeficiency virus (HIV)-infected patients in their continuity clinics. Among residents who had provided ambulatory care to patients with AIDS, 77% felt that it was an excellent educational experience, and among those who planned to do general primary care in their future practices, 74% planned on providing primary care to patients with AIDS. However, 61% expressed concerns about the adequacy of their training in AIDS ambulatory care. A greater amount of contact with outpatients who had AIDS, but not with inpatients who had AIDS, was associated with residents' intending to provide AIDS primary care in their future practices. Among all residents, 23% reported that, if given a choice, they would not provide care to any patients with AIDS, and 23% reported that they would not work in an area with a high prevalence of AIDS because of concern about contracting the syndrome. Nine percent of residents reported that they had been exposed to a blood-contaminated needlestick from an HIV-seropositive patient. CONCLUSIONS: Although most residents have substantial contact with inpatients and outpatients with AIDS, most still find their education in AIDS ambulatory care to be deficient. A minority of residents would prefer not to care for patients with AIDS. Residency curricula should include training and experience in ambulatory AIDS care, explicitly address negative attitudes toward caring for patients with AIDS, and include programs to reduce needlestick exposures.     

Assessing occupational exposure as risk for tuberculous infection at a teaching hospital in S?o Paulo, Brazil.

OBJECTIVE: To determine the risk for TB infection among nurses exposed to TB patients and non-exposed employees, and to evaluate associated aspects to initiate TB prevention in a teaching hospital in Brazil. DESIGN: A cross-sectional tuberculin skin test (TST) survey and assessment questionnaire of 169 nurses exposed to patients (exposed group [EG]) and 164 administrative employees (comparative group [CG]). RESULTS: The prevalence of positive TST was 59.7% in the EG and 53.7% in the CG (P = 0.26). Univariate analysis revealed, in the CG, association of TST positivity with BCG scar (P = 0.002), and, in the EG, with male sex (P = 0.02) and working at that hospital for >2 years (P < 0.001). On multivariate analysis, male sex (P = 0.0444), working at the institution for >2 years (P < 0.0001) and BCG scar (P = 0.0004) were associated with positive TST, while occupational exposure was not. CONCLUSIONS: The results suggest that all health care workers should be evaluated in an institutional TB prevention programme because community exposure to TB and BCG vaccination may have influenced TST positivity in the studied population.     

Evidence-based medicine knowledge,attitudes, and skills of community faculty

CONTEXT: As medical schools turn to community physicians for ambulatory care teaching, assessing the preparation of these faculty in principles of evidence-based medicine (EBM) becomes important. OBJECTIVE: To determine the knowledge and attitudes of community faculty concerning EBM and their use of EBM in patient care and teaching. DESIGN: Cross-sectional survey conducted from January to March of 2000. SETTING: A clinical campus of a state medical school; a midwestern city of a half-million people with demographics close to national means. MAIN OUTCOME MEASURES: Comparisons of community faculty with full-time faculty in perceived importance and understanding of EBM (5-point scale), knowledge of EBM, and use of EBM in patient care and teaching. MAIN RESULTS: Responses were obtained from 63% (177) of eligible community faculty and 71% (22) of full-time faculty. Community faculty considered EBM skills to be less important for daily practice than did full-time faculty (3.1 vs 4.0; P < .01). Primary care community faculty were less confident of their EBM knowledge than were subspecialty community or full-time faculty (2.9 vs 3.3 vs 3.6; P < .01). Objective measures of EBM knowledge showed primary care and subspecialty community faculty about equal and significantly below full-time faculty (P < .01). Thirty-three percent of community faculty versus 5% of full-time faculty do not incorporate EBM principles into their teaching (P < .01). CONCLUSIONS: Community faculty are not as equipped or motivated to incorporate EBM into their clinical teaching as are full-time faculty. Faculty development programs for community faculty should feature how to use and teach basic EBM concepts.     

Correlates of attitudes toward homosexuality and intention to care for homosexual people among psychiatric nurses in southern Taiwan

This study examined the association between attitudes toward homosexual individuals and intention to provide care and demographic and occupational factors, sexual orientation, knowledge about homosexuality, and experiences of contact with homosexual people among psychiatric nurses in southern Taiwan. In total, 133 psychiatric nurses from a medical center, three regional teaching hospitals, and one psychiatric hospital in southern Taiwan were recruited into this study. Their attitudes toward homosexual people as recorded on the Attitudes Toward Homosexuality Questionnaire, intention to provide care to homosexual individuals, and related factors were examined. The results revealed that psychiatric nurses who had a bachelor's or master's degree, higher level of knowledge about homosexuality, and friends or relatives with a homosexual orientation had a more positive attitude toward homosexuality. These psychiatric nurses, with more positive attitudes, and who worked in the medical center or regional teaching hospitals had a higher intention to care for homosexual people. The factors related to attitudes toward homosexuality and intention to care for homosexual people identified in this study should be taken into consideration when intervening in psychiatric nurses' attitudes toward homosexuality and intention to care for homosexual people.     

Applying theory of planned behavior to predict nurses' intention and volunteering to care for SARS patients in southern Taiwan

Severe acute respiratory syndrome (SARS) spread worldwide after an outbreak in Guangdong Province, China, in mid-November 2002. Health care workers were at highest risk of infection. The purpose of this study, which was based on Ajzen's theory of planned behavior (TPB), was to determine the extent to which personal attitudes, subjective norms, and perceived control influence nurses' intention and volunteering to care for SARS patients. After the SARS outbreak, a total of 750 staff nurses (response rate 90%) at one hospital completed a questionnaire assessing their intention to provide care to SARS patients. Overall, 42.7% of nurses had a positive intention to provide care to SARS patients, and 25.4% of nurses would volunteer to care for SARS patients. Four factors explaining 35% of the variance in nurses' intention to care for SARS patients were self-efficacy (beta = 0.39, p < 0.001), attitude (beta = 0.25, p < 0.001), years of working in the study hospital (beta = -0.15, p < 0.001), and receiving resources from the hospital (beta = 0.13, p < 0.001). Two factors explaining 15% of the variance in nurses' volunteering to care for SARS patients were intention (beta = 0.31, p < 0.001) and attitude (beta = 0.15, p < 0.001). The final model shows that the variables of the TPB contributed significantly to the explanation of a portion of variance in nurses' intention and volunteering to care for SARS patients. The results are helpful for human resources managers facing a new contagious disease.     

SURVEY OF KNOWLEDGE OF STAFF ABOUT URINARY INCONTINENCE

Urinary incontinence is a common, distressing and costly condition afflicting up to 25% of hospitalized patients and 60% of nursing home patients most of whom are elderly. It is important for nurses and doctors to have a good knowledge base and positive attitudes in order for them to deal optimally with this condition. A survey of 106 nurses and doctors was conducted in a large general acute teaching hospital. The survey assessed both attitudes and knowledge to various aspects of the causes, investigation and management of incontinence. It was found that (1) most staff had little teaching on this subject, (2) most staff had a poor knowledge base as to causes, investigation and management, (3) about 40% of nurses felt urinary incontinence was an attention seeking act, (4) State enrolled nurses who had the greatest contact with such patients had the poorest knowledge base. The results of this survey support the need for more undergraduate and inservice training, and particularly for the appointment of hospital based Clinical Nurse Specialists, with expertise in continence management.     

Parents and AIDS education.

The objective of this research was to study parents' attitudes toward AIDS education in schools. Questionnaires were mailed to employees in an industrial plant and a hospital in a city of 150,000 in Ontario, Canada. Two hundred and sixteen questionnaires from parents with children in schools were analyzed. Two thirds of the parents agreed that AIDS education should discourage premarital sex; whereas, 88% believed that AIDS education should teach about condoms. Pearson correlations and multiple regression were used to analyze hypotheses that tested attitudes toward AIDS education in the schools. Two predictor variables--attitude toward premarital intercourse and fear of casual contact of AIDS--were significantly correlated with all three measures of attitudes toward AIDS education in the schools. Church attendance and knowledge of AIDS were related to both attitudes toward discouraging premarital sex and teaching about condoms. Three multiple regression models were constructed to predict attitudes toward AIDS education in the schools. The final models accounted for between 11% and 33% of the variance.