Health care professional education and AIDS

The pandemic of AIDS and related infections due to the human immunodeficiency virus (HIV) has associated issues which present specific needs for health care professional education. These include (a) the spectrum of an evolving incurable infectious disease epidemic with new concepts in pathobiology and treatment; (b) specific phobias generated by the pandemic, including fear of the risk (albeit low) of occupational transmission, phobia of death and dying young, homonegativism and substance abuse phobia, fear of helplessness, and transference and countertransference issues; (c) the traditional role of health professionals as health information resources in the face of newly generated clinical and biopsychosocial information, which is often skewed by media presentation and patient consumerism; and (d) occupational stress associated with (a), (b), and (c) and the potential for practice “burnout.” These problems are addressed by specific health professional education in traditional and novel forms. Before- and after-AIDS-HIV education knowledge and attitude assessment and AIDS-HIV knowledge documentation will improve health professional and community response to the epidemic, optimize patient care and related interactions, and decrease nosocomial transmission of HIV.     

Health care professional education and AIDS

Abstract

The pandemic of AIDS and related infections due to the human immunodeficiency virus (HIV) has associated issues which present specific needs for health care professional education. These include (a) the spectrum of an evolving incurable infectious disease epidemic with new concepts in pathobiology and treatment; (b) specific phobias generated by the pandemic, including fear of the risk (albeit low) of occupational transmission, phobia of death and dying young, homonegativism and substance abuse phobia, fear of helplessness, and transference and countertransference issues; (c) the traditional role of health professionals as health information resources in the face of newly generated clinical and biopsychosocial information, which is often skewed by media presentation and patient consumerism; and (d) occupational stress associated with (a), (b), and (c) and the potential for practice “burnout.” These problems are addressed by specific health professional education in traditional and novel forms. Before- and after-AIDS-HIV education knowledge and attitude assessment and AIDS-HIV knowledge documentation will improve health professional and community response to the epidemic, optimize patient care and related interactions, and decrease nosocomial transmission of HIV.     

HIV and occupational health.

Although the occupational risks of HIV transmission in health care are minimal and levels of knowledge among health professionals are high, HIV-related anxiety is pervasive among workers in health care services. Occupational health and safety law is often used to justify unnecessarily rigorous precautions or discrimination. It is the psychological and cultural impact of HIV rather than its medical dimension that causes these concerns. Resolution of HIV-related anxiety and conflict requires that issues beyond infection control are addressed. Irrational fear, anxiety and prejudice are not less common among health professionals than in the community generally; they require attention in HIV-related educational programs.     

Acquired immunodeficiency syndrome. The impact on professional nursing practice

The epidemic of human immunodeficiency virus (HIV) infection and all of its consequences has had a significant impact on our society and on the delivery of health care. This article explores the impact that HIV infection and AIDS has had on professional nursing practice. The risk of occupational exposure, the question of obligation to care, the need for reexamination of values, philosophy of nursing, and some of the ethical issues, the need for learning and relearning, and the need for supporting each other as individuals, co-workers, and co-professionals are discussed.     

Nurses' health education program in India increases HIV knowledge and reduces fear.

Few health care facilities are adequately prepared to manage and care for HIV/AIDS patients in India. Nurses play a critical role in patient care but are often ill-equipped to deal with their own fears of occupational risk and handle the clinical aspects of HIV/AIDS care, leading to stigma and discrimination toward HIV-positive patients. The authors examine the impact of a 4-day HIV/AIDS health education program on knowledge and attitudes of nurses in a government hospital. This education program was developed using a training of trainers model and qualitative research. A total of 21 master trainers underwent 6 days of training and began training of 552 hospital nurses (in 2004-2005). Using a pretest-posttest design, the authors assessed changes in knowledge and attitudes of 371 trained nurses. Significant improvements were seen in nurses' HIV/AIDS knowledge in all areas including care, treatment, and issues of confidentiality and consent. Fear of interaction with people living with HIV/AIDS was reduced significantly. The short course was successful in increasing nurses' knowledge in all aspects. There is great potential to expand this stigma-reduction intervention to other public and private hospitals.     

Knowledge about, and attitudes to, HIV/AIDS among students in a Sydney nursing college.

The purpose of this study was to assess nursing students' knowledge about HIV infection and AIDS. 231 nursing students at a nursing college in Sydney were invited, and agreed, to participate. They were surveyed on knowledge about transmission, precautions to take when providing nursing care and epidemiology, general attitudes to HIV/AIDS, attitudes to patient-care, risk of infection at work and homosexuality. Two knowledge and four attitude scales were constructed. The students showed a fairly high level of knowledge: a mean percentage score of 78 on the transmission scale and 80 on the precaution scale. They also had some misconceptions about transmission routes. A majority (72%) had favourable attitudes to AIDS patient care; a minority (22%) had a clear fear of contagion through occupational exposure; 26% had negative attitudes to homosexuality. Nursing students with AIDS-care experience had significantly more positive attitudes than those who had no such experience. Knowledge and attitudes were positively correlated (correlation range 0.24-0.46). It is suggested that training programmes include experiential learning to address fear, discomfort and anxieties about HIV/AIDS.     

AIDS: current implications and impact on nursing

The pandemic proportions of human immunodeficiency virus (HIV) have already begun impacting health care in the United States. It is safe to say that in the near future nursing will have to formulate an aggressive response to this situation. This article addresses the origins of HIV and the resulting acquired immunodeficiency syndrome (AIDS) and discusses the impact on nursing. It also suggests ways in which nursing as a profession can respond to the epidemic of HIV and the fear which surrounds it.     

AANA journal course: update for nurse anesthetists--managing human immunodeficiency virus and acquired immune deficiency syndrome during anesthesia care.

The human immunodeficiency virus (HIV) and its advanced progression to acquired immune deficiency syndrome (AIDS) has had a greater impact on our society than any other disease entity during this century. Throughout the past decade the prevalence of HIV disease has grown to pandemic proportions throughout many regions of the world. The infectious and often fatal nature of HIV has made AIDS the most threatening epidemic currently facing modern medicine. A myriad of fears concerns, challenges, and frustration face all healthcare providers whose awareness and impact on practice is continuously challenged. Every nurse anesthetist is responsible for maintaining the ability to both prevent HIV disease transmission and appropriately care for HIV-infected patients during anesthesia care. Experience throughout the past decade of a continuously increasing prevalence of both HIV and AIDS has provided a wealth of information and knowledge that continues to enhance patient care. The following AANA Journal Course will present a current overview of HIV disease and considerations for providing quality anesthesia care while preventing disease transmission.     

Ethical Dilemmas and AIDS: Nursing Issues Regarding Rights and Obligations

Nurses and other health professionals deal with many ethical dilemmas daily. The AIDS epidemic has generated enormous controversy affecting the care and treatment of persons with HIV infections. As the epidemic spreads, the ethical issues become more apparent. The AIDS situation highlights the precarious balance between individual rights and the public welfare, patients' rights, and the rights of nurses and their professional obligations. Ethical questions have also been raised concerning equal rights to healthcare resources. The AIDS epidemic has caused hysteria among members of our society, including some people in the nursing profession. Implications for nursing practice and education are outlined to help nurses to make ethical rather than emotional decisions.     

Ethical issues.

The HIV virus and the associated worldwide pandemic pose enormous biomedical, clinical, and social dilemmas for health care providers, biomedical researchers, policy analysts, and the public at large 10 years after its discovery. Many of these dilemmas and challenges are captured in the difficult ethical issues the HIV epidemic has highlighted for primary care physicians. Given the vanishingly small risk to primary care providers of acquiring HIV infection in office practice and the rapidly increasing prevalence of the virus, a clear ethical obligation to care for HIV-infected patients exists for primary care physicians. Primary care providers should be sensitive to the potentially sensitive nature of patient risk status and HIV testing results and balance confidentiality in the medical record with the "need to know" the patient's clinical status by other health care professionals. Every attempt should be made by the primary care provider to encourage HIV-infected patients to act responsibly toward their intimate sexual partners and inform them of their HIV status to take appropriate precautions against acquiring the virus. Primary care providers should also model responsible shared decision making and goal setting with HIV-infected patients early in the course of the disease, laying the foundation for subsequent decision making later in the course of the illness. Finally, considerable controversy exists about the responsibilities of HIV-infected providers to inform patients of their status; professional and public policy in this area is in rapid flux. Undoubtedly, the HIV epidemic will continue to challenge us and force careful examination of many of the critical dilemmas in modern biomedical ethics.     

Knowledge and attitudes of Ugandan midwives regarding HIV.

In Uganda, 60% of HIV-infected adults are women of childbearing age. Considering this, midwives in Uganda play a pivotal role in reducing HIV transmission and providing high quality care to the many women and families affected by the disease. In this pilot study, investigators described the knowledge and attitudes of Uganda's private midwives regarding HIV. Overall knowledge levels were reported to be low, and the majority of participants reported overwhelming fear of contracting the disease from practice. Despite these challenges, the midwives' attitudes regarding HIV were positive. The results of this study support previous results. Additional studies focusing on midwives and traditional birth attendants in Uganda are warranted. The initiation of HIV continuing education programs and professional support for Ugandan midwives is also recommended.     

AIDS and the minority health care worker

1. Large groups of health care workers, many of whom are among ethnic minorities with potential for occupational exposure to HIV/HBV, are generally underserved in training on prevention of occupational transmission of the viruses. 2. The inadequacy of training for indirect client care personnel appears to be one of the primary reasons for high rates of needlestick injuries and exposure to blood. 3. Training in appropriate infection control techniques can help reduce the uneasiness and fear among health care workers over occupationally-related HIV/HBV transmission.     

Pandemic influenza: are we prepared to face our obligations?

After decades of low personal risk for contracting lethal diseases, physicians are suddenly facing the possibility of a substantial increase in occupational risk during an influenza pandemic. If they are not confronted before the onset of an influenza pandemic, feelings of unease and fear or ignorance about physicians' professional obligations could profoundly hinder individual physicians in fulfilling their professional duties. Such feelings could therefore undermine institutional and societal preparations. In their review published in Critical Care, Anantham and coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies, such as an influenza pandemic.     

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS‐related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross‐sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in‐depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0·05), but less HIV/AIDS training when compared to PHC nurses (P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0·01) and training (P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.     

A strategy for educating health care providers about AIDS: the California Nurses Association's AIDS Train the Trainer Program

The AIDS epidemic is increasing the demand on all levels of health care staff to provide care compassionately and safely to people with AIDS and HIV infection. Only appropriate, ongoing education of all health care workers will maintain an effective health care system as the number of cases rises. However, the fear engendered by the word AIDS can be a serious deterrent to effective care. Adult learning principles and fear reduction techniques provide the foundation for AIDS education. A train the trainer approach provides immediate AIDS expertise to health care providers within their institution or department. With adequate resources and training, health care professionals who are already in the workplace are in the best position to quell hysteria, educate health care workers about appropriate protective measures, and ensure that humane, compassionate care is provided to persons with AIDS and HIV infection.     

Role perceptions of occupational therapists providing support and education for caregivers of persons with dementia.

OBJECTIVE: This pilot study explored occupational therapists' perceptions of their roles as interventionists providing education and support for caregivers of persons with dementia. The intervention was provided in caregivers' homes as part of a larger funded study. METHOD: Interviews were conducted with four occupational therapists to elicit their reflections on practice and their views on occupational therapy services on the basis of their experiences providing support and education for caregivers in the funded study. RESULTS: Key themes consisted of the contrasts between the therapists' roles in the study and their customary practices and the professional and personal impact of their role in the study. Their recommendations for occupational therapy services emphasized the need to (a) collaborate with patients, families, and other health care staff members to solve problems; (b) acknowledge others as experts; (c) include family perspectives; and (d) fully address the needs of patients and families in their home environments. CONCLUSION: Providing support and education for caregivers in the community can be a major transition for therapists accustomed to practicing in more traditional settings. Additional research is needed to explore the ways in which specific practice contexts influence delivery of occupational therapy services.     

Fear of contagion: a stress response to acquired immunodeficiency syndrome

The threat of acquired immunodeficiency syndrome (AIDS) has triggered an affective stress response to illness: fear of contagion, an anxious response to the perceived threat of catching a disease. Three behaviors characterize this fear: avoidance, extreme precautions, and verbal expressions of fear regarding the disease. Despite the scientific evidence for the low risk of occupational exposure to this infection, many health care workers appear to demonstrate highly fearful behavior. Social and cultural values, which attach a deep symbolic meaning to AIDS, combine with misperceptions about transmission to create this stress response. This article suggests education on cross-cultural, sexual, and death-related issues, as well as factural information on AIDS to decrease this fear. Implications for nursing research are included.     

Changing times: trials and tribulations of the move to Master's entry-level education in Canada

BACKGROUND: Most health care professions are reviewing issues related to the changing nature of professional education and practice. Social work, physical therapy, speech-language pathology, audiology, and recently occupational therapy, have raised the entry-level training requirements to the graduate level to enhance formal education programs. PURPOSE AND SCOPE: In the past few years, this trend has generated considerable debate and discussion within the occupational therapy profession both in Canada and internationally. In November, 2001 the Canadian Association of Occupational Therapists (CAOT) announced that Canadian universities must convert to entry-level Master's programs by 2008 to receive re-accreditation (CAOT, 2002a). This paper describes the historical evolution of Canadian occupational therapy education, outlines several issues within occupational therapy that are impacting the move, and discusses benefits and challenges to Master's level training. PRACTICE IMPLICATIONS: Recommendations are presented for the development of Master's entry-level occupational therapy training programs in Canada.     

Knowledge and attitude of nurses caring for patients with HIV/AIDS in Uganda.

Nurses working in a regional hospital represent the largest group of health care workers in Uganda. Four hundred seventy-seven nurses and midwives completed the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) knowledge and attitude surveys (86% response rate). Approximately 95% (n = 452) had provided care to HIV/AIDS patients; yet 86% (n = 388) believed resources to obtain HIV/AIDS information were inadequate. Fear of contagion was great (47%, n = 232). HIV/AIDS knowledge gaps included "precaution and transmission" (64.7%) and "agent and immunology" (53.4%). Knowledgeable respondents had less fear of contagion. Positive attitudes toward patients with HIV/AIDS were displayed despite fear of contagion.