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.     

AIDS, nursing, and physician-assisted suicide: Part 1.

Nurses who work in HIV/AIDS care often hold conflicting views about appropriate nursing roles in relation to physician-assisted suicide. Regardless of whether the individual nurse supports or opposes physician-assisted suicide, nurses in HIV/AIDS care need to have a broad knowledge base of the legal and ethical issues related to physician-assisted suicide. This article's main purpose is to provide nurses with the knowledge base they need to assist them in their work in clinical practice, education, policy development, and research.     

AIDS, nursing, and physician-assisted suicide: Part 2.

Nurses who work in HIV/AIDS care often hold conflicting views from each other about appropriate nursing roles in relation to physician-assisted suicide. Regardless of whether the individual nurse supports or opposes physician-assisted suicide, nurses in HIV/AIDS care need to have a broad knowledge base of the legal and ethical issues related to physician-assisted suicide. This article has as its major purpose to provide nurses with the knowledge base they need to assist them in their work in clinical practice, education, policy development, and research.     

Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review

Title.  Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review.
Aim. This paper is a report of a literature review conducted to examine current research studies into attitudes of nursing students towards caring for people with HIV/AIDS and to identify factors that influenced those attitudes to inform current nursing practice and to develop nursing education regarding care provided to people with HIV/AIDS.
Background. Attitudes of nurses towards people living with HIV/AIDS have long been scrutinized. Studies show that some nurses have negative attitudes and are reluctant to provide care to people with HIV/AIDS, resulting in poorer quality nursing support being provided. Attitudes of nursing students towards caring for people with HIV/AIDS is thus of vital importance since they become the future practising nurses.
Data sources.  Eight electronic data bases were searched from 1996–2008.
Review methods.  Criteria used for study selection were: attitudes of nursing students towards caring for people with HIV/AIDS, primary research studies, published in English language in peer reviewed journals from 1996 to June 2008. Sixteen studies were identified for inclusion in this thematic review.
Results.  The following themes were identified: education and knowledge of HIV/AIDS; fear of contracting HIV/AIDS; reluctance to care for people with HIV/AIDS; homophobia; and stigma associated with HIV/AIDS.
Conclusion. There is reluctance on the part of some nursing students in specific regions of the world to provide care for people with HIV/AIDS. Educational programmes based on research evidence must play a leading role in developing strategies to help nursing students understand and overcome such attitudes.     

新疆艾滋病高发地区护理人员艾滋病相关知识、态度调查

目的：了解新疆艾滋病重点疫送护理人员对艾滋病知识的掌握程度和对艾滋病所持有的态度,为进一步开展有针对性的培训工作提供依据。方法;采用自行设计的艾滋病知识、态度问卷以方便抽样的方法,对5个高发区的500名护理人员以匿名形式进行问卷调查。结果：护理人：员艾滋病知识总体知晓率均高于70.00％,但对不同知识回答正确率不同,对艾滋病患者／感染者持同情态度的占64．6％,不同层次的护理人员在知识、态度等方面存在差异。结论;对护理人员进行持续、全面、深入的培训是有必要的,特别要加大少数民族、低年资、低学历等护理人员的培训力度。并应既系统又有侧重点地进行。     

Effectiveness of an HIV/AIDS educational programme for Chinese nurses

AIM: This paper reports a study examining the effect of a multifaceted HIV/AIDS educational intervention on the knowledge, attitudes and willingness of Chinese nurses in caring for patients with human immunodeficiency virus. BACKGROUND: The expanding HIV/AIDS epidemic challenges nurses to increase their knowledge about this devastating illness to provide effective HIV/AIDS prevention and care to their patients. HIV/AIDS educational interventions, which were developed for North American and European nurses, have not been studied among nurses in other societies. METHODS: The study employed a pretest, post-test experimental design with 208 nurses from seven Chinese provinces. The intervention consisted of a 5-day workshop comprising didactic lectures interspersed with activities designed to elicit discussion of participants' values and personal feelings about HIV/AIDS. Bloom's Taxonomy and principles of good HIV/AIDS educational practice guided the educational intervention. Outcome variables were HIV/AIDS knowledge, attitude toward patients with HIV/AIDS (including empathy for and desire to avoid these patients) and willingness to provide nursing care to these patients. The data were collected in 2003. FINDINGS: At baseline, HIV/AIDS knowledge was not high and attitudes and willingness to care were neutral. Knowledge, attitudes toward patients with HIV/AIDS and willingness to provide nursing care to these patients were each improved at the conclusion of the workshop (P<0.001). CONCLUSIONS: As the HIV/AIDS epidemic expands, nurses will be called upon to deliver competent, compassionate and comprehensive care to patients and their significant others. Intensive, interactive HIV/AIDS professional workshops can contribute to the national effort by increasing knowledge and improving attitudes towards and willingness to provide nursing care for patients with HIV/AIDS.     

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.     

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS cases

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS case This study describes German nursing students' (n=180) knowledge and attitudes relating to HIV/AIDS, their homophobia level, willingness to care for people with AIDS, and their approach to possible sexual risk behaviours. A questionnaire was used to collect the data (response rate 97.8%). The results indicated that the nursing students had a rather high knowledge level concerning AIDS. However, there were gaps of knowledge, such as regarding AIDS immunopathology or the symptoms of the disease. Single nursing students and those having cared for a person with AIDS had a more thorough knowledge about the disease. In general, the attitudes towards AIDS and people with AIDS were tolerant and positive, and homophobia was only found with a small minority. Students having positive attitudes towards people with HIV/AIDS had less homophobia compared to those having negative attitudes towards persons suffering from AIDS. Those with positive attitudes were more willing to care for patients with HIV/AIDS, while those with a high homophobia level were less willing to do so. In addition, students having a high AIDS knowledge level tended less towards negative attitudes and homophobia than those with a low level of knowledge. The implications of the research for nursing education will be discussed.     

Context-based advocacy for HIV-positive women making reproductive decisions.

As the number of HIV-positive women of childbearing age continues to rise, and treatments available to manage HIV become more accessible, the issue of HIV-positive women's reproductive decision making is gaining importance for nurses in AIDS care. Nurses and other health professionals care for these women as they decide whether to bear children. The decision whether to have children is complex and influenced by a number of individual and societal factors, creating an ethical tension between the interests of HIV-positive women and those of society. This article proposes a six-step, context-based advocacy process for nurses and other health professionals who interact with HIV-positive women of childbearing age. The advocacy process described is grounded in a review of literature on HIV/AIDS, factors influencing HIV-positive women's reproductive choices, and nursing advocacy. The proposed advocacy process enables nurses to support women's self-determination and decision making in a way that is informative and empowering.     

HIV/AIDS knowledge, attitudes and beliefs among Nepalese adolescents

AIM: This paper reports an exploration of Nepalese adolescents' knowledge, attitudes and beliefs of HIV/AIDS. BACKGROUND: Nepal is confronted with an increasing incidence of HIV/AIDS among adolescents and young adults. A priority of nurses and other health professionals in Nepal is the prevention of the spread of HIV infection. The first step in prevention is assessing the HIV/AIDS knowledge, attitudes and beliefs of adolescents. METHODS: A cross-sectional correlational design was carried out in 2003 in a private school in Kathmandu, Nepal. A total of 150 adolescents participated in the study. Two instruments were used: a demographic questionnaire and the Youth Survey, which included questions on knowledge, attitudes and beliefs. FINDINGS: The majority of the adolescents had a moderate level of overall HIV/AIDS knowledge, but lacked knowledge in the areas of mode of transmission and prevention of HIV/AIDS. Approximately 79% thought that AIDS was a big problem and 67% were afraid of getting AIDS. However, only 16.7% reported that they were likely to get AIDS, and 18.7% did not perceive living in Kathmandu as a risk for HIV/AIDS. CONCLUSION: The findings of this study will help policymakers and healthcare professionals develop a culturally sensitive and needs specific educational programme for urban Nepalese adolescents. The findings may also have lessons for public health and school nurses working in similar contexts. Nurses, and more specifically public health nurses in Nepal, need to play an active role in the development and implementation of educational programs on HIV/AIDS. Research needs to be done in rural as well as urban areas of Nepal on adolescents' HIV/AIDS knowledge, attitudes and beliefs.     

Perceived risk of infection and attitudes toward risk groups: determinants of nurses' behavioral intentions regarding AIDS patients.

The relationship of perceived occupational risk of AIDS and attitudes toward AIDS risk groups to behavioral intentions regarding the care of AIDS patients was examined among nurses (N = 496) residing in a selected area of New Jersey, a state with a relatively high number of reported AIDS cases. Hierarchical multiple regression analyses on anonymous mail survey responses revealed that, controlling for AIDS knowledge and years of education, nurses who perceived that caring for AIDS patients increased their risk of HIV infection scored higher on an index of intentions to avoid AIDS patient care. In addition, nurses who expressed more negative attitudes toward intravenous drug users or homosexuals were more likely to report similar intentions to avoid AIDS patient care. The implications of these findings for efforts to increase nurses' ability and willingness to provide quality care to persons with AIDS are discussed.     

HIV and AIDS: a survey of nurse education in the United Kingdom

A survey conducted throughout the United Kingdom examined the current provision being made to train nurses to care safely and sensitively for patients with HIV and AIDS Problems relating to intolerance and prejudice are still commonly encountered The study recommends that HIV and AIDS should be set into a wider context of sexuality, death and infection control rather than singled out for special attention Nurses, both students and qualified staff, need to gain insight into their own values and prejudices if these are not to inhibit the giving of good quality care Teaching in this subject area requires special skills and there is concern that nursing is not equipped to deal with it The involvement of clinical specialists in educating nurses is perceived to have a strongly positive effect, helping to bridge a credibility gap and compensating for the lack of clinical experience amongst the teachers Providing opportunities for nurses to meet with people whose lives have been profoundly affected by the virus is also a powerful form of learning There is, however, a great need for support in this stressful area of practice     

Acquired immunodeficiency syndrome: the nurse's legal duty to serve.

Some nurses are reluctant to care for human immunodeficiency virus (HIV)-infected clients because of fear of contagion and discomfort in caring for people with alternate life-styles. Various federal, state, and local antidiscrimination statutes limit the right of the nurse to refuse to care for people with acquired immunodeficiency syndrome (AIDS) or HIV infection. Other constraints are employment contracts, ethical codes of professional organizations, and regulations of state licensing boards. Nurses have rights as well as responsibilities in caring for AIDS or HIV-infected patients. They also have a professional responsibility to institute measures that minimize the need for litigation and ensure access to health care for everyone.     

Ethical issues in providing nursing care to human immunodeficiency virus-infected populations

During the past few years, an incredible body of knowledge about HIV infection and all of its ramifications has been accumulated. As we consider whether or not our conduct toward persons who are HIV infected is right, however, many unanswered questions still exist. All health care professionals must be involved in reflection, re-examination of values, and ethical analysis of our behaviors. Nurses have an obligation to be informed about HIV infection, its clinical manifestations, treatments, and the care of affected persons. We must help our patients to know their needs and their options. We must listen to them. We must advocate for them. It has been said that nurses caring for patients with AIDS require two dominant characteristics: courage and impartiality. They need courage to face risks and impartiality to temper prejudice. In addition to these characteristics, nurses need a strong sense of caring, compassion for fellow human beings, and a conviction that they can make a difference in promoting a person's welfare and preserving his or her dignity.     

The Jamaican adolescent: an assessment of knowledge and attitudes regarding HIV/AIDS

PURPOSE: The purpose of this study was to assess the knowledge and attitudes of adolescent Jamaicans in a church youth group, regarding HIV/AIDS. METHODS: A convenience sample of 45 adolescents from a Jamaican youth group completed a modified version of the AIDS Attitude Scale (AAS). The subjects were assessed for having empathy or avoidance towards people with HIV/AIDS. A focus group discussion after completion of the AAS provided information about the participants' knowledge regarding HIV transmission and self-protection. FINDINGS: The adolescents' responses on the AAS indicated strong empathy (4.66) and an overall supportive attitude (+1.77) for people with HIV/AIDS. While the adolescents incorrectly felt that HIV/AIDS was being spread mainly by homosexual encounters in their country, other responses regarding mode of transmission were quite accurate. Since these adolescents were practicing abstinence and the avoidance of drugs and alcohol, they weren't worried about protecting themselves from the transmission of HIV; however, when asked what they would tell their friends outside of the church about HIV protection, most subjects were able to provide accurate information. CONCLUSIONS: These findings indicate that Jamaican adolescents actively committed to the teachings of the church are generally knowledgeable about HIV/AIDS and supportive of people with HIV/AIDS. Nurses and other health care professionals working with members of the church youth groups to develop peer educator programs, would have effective role models to help influence the sexual behaviors of their adolescents.     

AIDS: what are nurses' concerns?

The purpose of this research was to study nurses' knowledge about and attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and the relationship of these factors with demographic and professional characteristics. Data were gathered by questionnaires mailed to a random sample of Registered Nurses in Erie County, NY. Results indicated that many of the nurses surveyed are fearful of contracting AIDS and do not have confidence in their ability to meet the intense physical and psychological needs of patients with this illness. Further, the data suggest that caring for individuals with AIDS may be complicated by the fact that a large proportion of these patients are homosexuals who are terminally ill. The findings lead to the conclusion that targeted intervention strategies are necessary to prepare nurses to met the emerging needs of the escalating AIDS epidemic and to help assure that quality of care will be maximized.     

Nurses' knowledge and attitudes to HIV/AIDS—An international comparison between Finland,Estonia and Lithuania

Suominen T, Koponen N, Mockiene V, Raid U, Istomina N, Vänskä M‐L, Blek‐Vehkaluoto M, Välimäki M. International Journal of Nursing Practice 2010; 16 : 138–147
Nurses' knowledge and attitudes to HIV/AIDS—An international comparison between Finland, Estonia and Lithuania This paper presents baseline data on nurses' knowledge of and attitudes to HIV/AIDS in three countries: Finland, Estonia and Lithuania. The prevalence of HIV/AIDS is steadily increasing in Finland, Estonia and Lithuania. At the same time, labour mobility and also nursing mobility between these countries increases. Previous international studies have shown that lack of knowledge and negative attitudes continue to exist. A total of 681 registered nurses from one Finnish (n = 322), one Estonian (n = 191) and one Lithuanian (n = 168) hospital were surveyed in spring 2006. The questionnaire was originally developed by Held in 1993 and modified for this study. The questionnaire has three scales: demographic and other background variable, nurses' knowledge related to HIV/AIDS, and nurses' attitudes towards people with HIV/AIDS and towards the disease itself. Across the whole sample respondents showed average levels of HIV/AIDS knowledge and attitudes towards people with HIV/AIDS. Years of work experience correlated negatively with the knowledge and attitude levels. A significant correlation was found between the level of knowledge and attitudes. Significant differences were found between countries, Finnish nurses showing the highest knowledge levels and most positive attitudes towards patients with HIV/AIDS. Factors positively influencing levels of knowledge and attitudes were education, previous experience of providing care to HIV/AIDS patient or knowing someone with the infection, and willingness to provide care to HIV/AIDS patients. Supplementary education is needed to strengthen nurses' knowledge. It is important to recognize that there might be differences in knowledge and attitudes between neighbour countries. This needs to be taken into account when planning education for degrees and for further nursing education.