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.     

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.     

HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa

AIM: The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa. BACKGROUND: The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients. METHOD: A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003. FINDINGS: Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment. CONCLUSIONS: Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.     

Knowledge and Attitudes of Jordanian Nurses towards Patients with HIV/AIDS: Findings from a Nationwide Survey

This study explored the knowledge and attitudes of Jordanian nurses toward patients with HIV/AIDS, particularly in regards to their sources of information and education. This survey utilized a cross-sectional design. A self-administered questionnaire developed by Eckstein was used in collecting the data. A total of 922 nurses completed the questionnaire. Overall, Jordanian nurses expressed negative attitudes toward patients with HIV/AIDS, and their level of HIV/AIDS knowledge was weak. Weak knowledge level was recorded among nurses in the following subsections: agent and immunology; course and manifestation; transmission and incidence; and precaution and prevention. Only in one subsection (risk group), did nurses show a good level of knowledge about HIV/AIDS. More than two-thirds of nurses (84%) refused to provide care to patients who tested positive for HIV/AIDS. Most of the nurse participants believed that currently provided HIV/AIDS information resources were inadequate (81.4 %). The majority of nurses were interested in support groups for staff nurses (96.5%). The major source of HIV/AIDS information obtained by Jordanian nurses was through Internet web sites (52.7%). The majority of nurses (96.2%) ranked their fear of getting AIDS from their nursing practice as overwhelming. The total attitude of participants towards patients with HIV/AIDS in all five subsections (i.e., fear of contagion, social stigma, fatal outcome of the disease, direct care, and education and counseling) was negative (84.3%). Accurate knowledge about HIV/AIDS along with an in-depth understanding of patients’ needs can help alleviate much of the fear, anxiety, and stigma associated with caring for patients with HIV/AIDS.     

Knowledge and attitudes of Jordanian nurses towards patients with HIV/AIDS: findings from a nationwide survey

This study explored the knowledge and attitudes of Jordanian nurses toward patients with HIV/AIDS, particularly in regards to their sources of information and education. This survey utilized a cross-sectional design. A self-administered questionnaire developed by Eckstein was used in collecting the data. A total of 922 nurses completed the questionnaire. Overall, Jordanian nurses expressed negative attitudes toward patients with HIV/AIDS, and their level of HIV/AIDS knowledge was weak. Weak knowledge level was recorded among nurses in the following subsections: agent and immunology; course and manifestation; transmission and incidence; and precaution and prevention. Only in one subsection (risk group), did nurses show a good level of knowledge about HIV/AIDS. More than two-thirds of nurses (84%) refused to provide care to patients who tested positive for HIV/AIDS. Most of the nurse participants believed that currently provided HIV/AIDS information resources were inadequate (81.4 %). The majority of nurses were interested in support groups for staff nurses (96.5%). The major source of HIV/AIDS information obtained by Jordanian nurses was through Internet web sites (52.7%). The majority of nurses (96.2%) ranked their fear of getting AIDS from their nursing practice as overwhelming. The total attitude of participants towards patients with HIV/AIDS in all five subsections (i.e., fear of contagion, social stigma, fatal outcome of the disease, direct care, and education and counseling) was negative (84.3%). Accurate knowledge about HIV/AIDS along with an in-depth understanding of patients? needs can help alleviate much of the fear, anxiety, and stigma associated with caring 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.     

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.     

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.     

Educational intervention with international nurses and changes in knowledge, attitudes and willingness to provide care to patients with HIV/AIDS

This paper reports the findings of a study which examines the relationship between the use of an educational intervention with nurses from several Asian countries and changes in knowledge, attitudes and willingness to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). A pre-test and post-test questionnaire was used to collect the data. The results indicate, that whilst there was an improvement in knowledge following the educational intervention, there is a need for further improvement in the knowledge levels of the nurses. The method of contracting the virus is less influential in shaping students' attitudes towards people with HIV/AIDS. Fear of contagion is evident; this increases when more invasive clinical procedures are being carried out. What is also evident is that multiple levels of infection control protocols are used with patients. Fear of contagion is also apparent in the participants' willingness to work with colleagues and patients with HIV/AIDS. While the participants stated that they were more willing to work with colleagues and patients with HIV/AIDS following the educational intervention, they said that they would continue to take additional precautions for fear of contracting HIV in the workplace. The conclusion emphasizes that it is important for education about HIV/AIDS to be incorporated within current undergraduate and in-service programmes.     

Influence of a persuasive strategy on nursing students' beliefs and attitudes toward provision of care to people living with HIV/AIDS.

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.     

HIV/AIDS—knowledge,attitudes and education of nurses: a review of the research

• ? This paper provides a review of research relating to knowledge, attitudes and education of nurses in relation to HIV/AIDS.
• ? Early studies portrayed nurses (and other health-care workers) as fearful of AIDS, ill-informed, and negative and discriminatory in their attitudes towards people with HIV/AIDS. Several major surveys in the UK in the late 1980s produced broadly similar findings and, in the absence of more recent countering evidence, it cannot be assumed that there has been significant improvement.
• ? Research surveys of HIV/AIDS education provision for nurses are also reviewed. A recent survey of UK nursing colleges revealed weaknesses in provision, and a lack of training and confidence among nurse teachers. Although evaluation research has been scarce, some studies have demonstrated the beneficial effects of various forms of education on nurses' HIV/AIDS-related knowledge and attitudes, and these are also reviewed.
• ? Although early predictions of a rapidly escalating AIDS epidemic have proved to be exaggerated, at least in developed countries, it is vital that nurses do not become complacent. This review should encourage nurses, irrespective of clinical specialty, to reconsider their own knowledge and attitudes and to press for further HIV/AIDS education if they consider that it is still lacking.

     

People with HIV/AIDS: who cares?

People with HIV/AIDS: who cares? Studies have shown that some nurses, doctors and other carers have negative attitudes towards people with human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Some cope by avoiding working with such patients, while others just do the best they can. But does it matter? This paper describes a review of the literature on the impact of attitudes to care and the barriers affecting the quality of care for people with HIV/AIDS by professional health care workers and other carers. Most of the reports identified were based on attitude scales, mostly unique and often unvalidated. Attitudes of health care workers based in the community, and ‘house keeping’ staff such as porters, receptionists, etc., have been neglected areas of research. There is also little information about the culture of organizations and the attitudes of individuals with HIV/AIDS to care. Only three references were found in which both patients’ and carers’ attitudes to each other were considered and none of these looked at negative feelings and their impact. There is scope therefore to investigate the attitudes of patients and carers towards each other and how this can effect the quality of care. It is anticipated that the benefits of such investigations could lead to the development of educational strategies designed to improve the quality of patient care.     

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.     

Attitudes of nursing and auxiliary hospital staff toward HIV infection and AIDS in Spain.

The aim of this study was to determine the attitudes of health personnel staff concerning HIV and AIDS. Participants included nurses (n = 315) and nurses' aides (auxiliary staff) (n = 115) working from May to June 2002 in a Spanish hospital. A self-administered validated questionnaire about attitudes towards HIV and AIDS was used. The response was 74.9% (N = 430). The mean for the attitudes questionnaire was 79.7 (SD = 10.9), with a median of 80. The nurses had more positive attitudes than the auxiliary workers (80.9 vs. 76.5; t = 3.712; p<.001). Twenty percent (n = 63) of the nurses and 37.4% (n = 43) of the auxiliary workers (p<.001) reported a negative attitude. After a logistic regression analysis adjusting for age, sex, and occupations, the authors found that age and occupation were the variables with an independent effect on attitudes toward HIV.     

Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.     

Are You Positive?: AIDS, Attitudes and Physiotherapy

This study was conducted to find out the attitudes of chartered physiotherapists towards people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). A convenience sample of 144 chartered physiotherapists of all grades from nine institutions in the United Kingdom was used in the study. The physiotherapists were surveyed using a self-completion postal questionnaire. The attitude scores were generally high indicating positive attitudes towards people with HIV and AIDS. Statistical analysis using t-tests and ANOVA showed that women were found to have more positive attitudes than men. There were differing attitudes according to age, with those aged 40 plus having less positive attitudes than those aged 39 and under. Those respondents who had worked with people with HIV and AIDS had significantly more positive attitudes than those who had not worked with this client group. Surprisingly, there was no significant difference in attitudes between those who had had training in HIV and AIDS and those who had not. Finally, whether the region was one of high or low prevalence had an effect on attitudes, with those in high prevalence areas having significantly more positive attitudes. The level of significance used in this study was p = > 0.05.