Knowledge and attitudes of health care staff about HIV infection in a health district with low HIV prevalence

The level of awareness of HIV related problems and their implications for health workers were investigated in Oxford, where the problem of HIV infection has not reached the levels of other metropolitan areas. Four hundred nurses and doctors in Oxford were surveyed to ascertain their knowledge about HIV infection, their attitudes to care of HIV patients, and to examine the relationship between knowledge and attitudes. The response rate was 64%. Professional groups differed in their knowledge and attitudes, and staff lacked some basic information about HIV transmission and safety relevant to hospital care. Accurate knowledge about HIV infection and positive attitudes to the care of HIV patients were highly correlated. However, anxiety about HIV infection, which could interfere with the optimum care of patients, affected one quarter of staff surveyed. Implications for staff training are discussed.     

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.     

Factors associated with hospital workers' reactions to the treatment of persons with AIDS

This article reports on how the increasing number of AIDS patients is having a significant impact on the delivery of healthcare services. Healthcare workers need to learn how to provide medical care for persons with AIDS as well as how to interact with and relate to them. Workers who have accurate information regarding the transmission of AIDS report more positive responses. In addition to didactic educational efforts hospital workers need explicit education on the psychosocial issues related to AIDS including such issues as fears of contagion, homosexuality, and death anxiety. Ethnic and cultural differences of both the AIDS population and healthcare workers must be addressed to relieve feelings of risk, stress, and discomfort. Each healthcare setting must determine the most effective means to educate all levels of staff on a continual basis.     

Critical care nurses' attitudes toward, concerns about, and knowledge of the acquired immunodeficiency syndrome

Two samples of critical care nurses (from a secular teaching hospital and a religious-affiliated community hospital, respectively) were compared on their attitudes, concerns, and knowledge regarding the acquired immunodeficiency syndrome (AIDS). Nurses from the teaching hospital had significantly (p = 0.003) more favorable attitudes toward patients with AIDS than did the community hospital nurses. Modal response in each group for perceived risk of acquiring AIDS from patients was 1 chance in 10,000. If given a choice, a sizable percentage in both the teaching (45%) and the community hospital (65%) groups would refuse to care for patients with AIDS. Those indicating preference for refusing showed significantly higher levels of concern and significantly less favorable attitudes than the others. Knowledge about AIDS was high, with means in each group exceeding 14 out of 16 possible points. Implications for nursing practice are discussed.     

艾滋病定点治疗单位医务工作者的职业防护情况

目的了解艾滋病定点治疗单位医务工作者的职业防护情况,探讨对临床医务工作者进行艾滋病防护知识干预的有效方法,为艾滋病临床职业防护提供依据。方法采用问卷调查法,分别对医务人员进行干预前、后艾滋病职业防护知识、行为、态度调查。结果干预前、后分别调查医务人员165人、152人。医师对艾滋病职业防护相关知识认识的知晓率为82．6％,护士的知晓率为60．5％;对较深层次的问题认识度不够,艾滋病病毒主要存在哪些液体中的知晓率为33．3％,“窗口期”知晓率为24．8％,职业暴露后需及时采用的防护措施知晓率为21．2％,干预前职业暴露概率为13．5％,介入防护知识培训干预后职业暴露概率为3．4％,差异有统计学意义（P〈0．05）。结论加强艾滋病职业防护知识的教育与培训,能够提高职业防护能力,保障医务人员的职业安全,预防艾滋病医院感染。     

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.     

Medical personnel knowledge and stigmatic attitude toward HIV patients in a high-income country

ABSTRACT

Negative attitudes of health care workers (HCW) toward people living with HIV (PLWH) impact patients’ care, quality-of-life, therapy adherence, and retention in care. Few publications address stigma and discrimination among HCWs in high income countries. This study aims to provide a better understanding of HCW knowledge and attitudes toward caring for PLWH, how this relates to discriminatory tendencies and professional contacts, and proposes effective strategies to reduce negative attitudes and stigmas among health care providers in a tertiary hospital in Israel. Of 321 health care personnel who responded to an electronic questionnaire, HCWs had a good level of general knowledge regarding HIV. A lack of knowledge was noted regarding antiretroviral therapy influences, HIV transmission from mother to child, and HIV risks and transmission. Cultural diversity was also noted. This study supports the need to implement a training program for HCWs on HIV-related stigma-reduction.     

Knowledge and attitudes of health care workers about AIDS and HIV infection before and after distribution of an educational booklet

Hospital workers (509) in a health authority were surveyed, and asked if they were in contact with HIV positive or AIDS patients; about their perception of risk; of their knowledge about and attitudes towards HIV and AIDS problems at work; and their desire for more information about AIDS and HIV. Overall scores for level of knowledge and attitudes were calculated; clinical workers scored better than non-clinical workers. Following the first survey, an information booklet was distributed to all health authority staff and after distribution, 232 staff were surveyed again. In this group (the follow-up group), there was a reduction in perceived risk, an improvement in the level of knowledge and in attitudes, and a reduction in the desire for further information. The group who initially had the least level of knowledge and most unfavourable attitudes (non-clinical workers) were the group who improved most.     

The roles of labor migrants' wives in HIV/AIDS risk and prevention in Tajikistan

This study aimed to build formative knowledge regarding labor migrants' wives' knowledge, attitudes, and behaviors regarding HIV/AIDS risk and protection that would inform developing innovative HIV prevention strategies. This was a collaborative ethnography in Tajikistan that included minimally structured interviews and focused field observations with 30 Tajik wives in Dushanbe married to Tajik male migrant workers currently working in Moscow. The results documented the wives' concerns over their husbands' safety in Moscow and the difficulties of living without husbands. In a male-dominated society, gender norms limit the wives' abilities to protect themselves and their husbands from HIV/AIDS. They have some awareness of HIV/AIDS, but limited abilities to speak about sexual activity, HIV/AIDS, condoms, and HIV testing. Wives do not use condoms with their husbands and depend upon their husband's role as their protector. Wives often turn for support to their "circle of friends" or to a primary care nurse for support, but seldom do these relationships focus on preventing HIV/AIDS. To respond to HIV/AIDS risks amongst the wives of Tajik male migrant workers in Moscow, preventive interventions could build upon migrants' wives' role as the primary family caregiver and their existing sources of social support from women's circles and nurses. The overall intervention strategy could be to expand their role as family caregivers to include HIV/AIDS protection, through enhancing their HIV/AIDS knowledge and prevention skills and negotiation strategies with their husbands.     

Diffusion of HIV/AIDS knowledge, positive attitudes, and behaviors through training of health professionals in China.

A study evaluated a training-of-trainers strategy to update HIV/AIDS knowledge and improve attitudes and behavior among health professionals and the public. A survey was carried out among health workers and villagers. An initial workshop was given to 55 staff from several health institutions. Trainees were provided limited funds to conduct secondary workshops at local levels. They were requested to diffuse knowledge to patients during routine health visits. A follow-up survey was conducted 18 months later in counties in which workshops were not held. Knowledge, attitudes, and behavior were compared both at the baseline and follow-up surveys, and before and after the intervention. Nearly 95% (94.8%, or 13,782) of health workers in Fuyang Prefecture were trained secondarily at local levels. Knowledge was significantly higher in intervention (88.5-99.8%) compared with nonintervention (37.4-53.7%) counties, and after intervention (22.2-66.6%), respectively (p < .01). Attitudes toward people with HIV/AIDS improved significantly in intervention counties. Condom use during last sexual intercourse increased from 11.0% to 33.5% in health workers (p < .01) and from 8.7% to 18.5% among villagers (p <.01). The strategy wascost effective for improving knowledge and attitudes and promoting condom use.     

Infection control knowledge, attitude, and practice among Nepalese health care workers

This study was designed to assess the knowledge, attitudes, and infection control practices among Nepalese health care workers (HCWs). The study comprised a questionnaire survey of 324 staff from acute care hospitals in Kathmandu, Nepal. A total of 158 doctors and 166 nurses participated, 27% of whom had received infection control training. Only 16%, 14%, and 0.3% of the respondents achieved maximum scores for knowledge, attitude, and practice items, respectively. Staff had good knowledge and positive attitude toward most aspects of infection control, although only half had heard of methicillin-resistant Staphylococcus aureus. Logistic regression revealed that profession, age, and having studied abroad significantly predicted markers of infection control knowledge, attitudes, and practice. This is the first survey of infection control practice among Nepalese HCWs and provides useful baseline data by professional group. There is ample opportunity for improvement in current practice, which should be recognized by hospital managers and Nepalese health authorities.     

某高速公路筑路工人艾滋病知识 态度及行为干预效果评价

目的评价应用健康干预工具包,对在建高速公路筑路工人进行艾滋病(AIDS)知识、态度及行为干预的效果。方法将艾滋病相关知识融入各种游戏中,组成一套互动式的健康干预工具包,使用该工具包对筑路工人开展干预活动,调查分析干预前后目标人群艾滋病相关知识、态度及行为情况。结果筑路工人艾滋病知识总知晓率由干预前的60.0%提高到干预后的75.2%(P<0.05),总体正性态度率由干预前的51.5%提高到干预后的64.7%(P<0.05)。结论应用艾滋病防治干预包对目标人群进行系列干预,可提高目标人群艾滋病相关知识知晓和正性态度。     

Patient education model for increasing handwashing compliance.

BACKGROUND: A review of the literature on handwashing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding handwashing compliance. The primary objective of this project was to conduct a prospective control study of the effect of patient handwashing education on staff compliance with handwashing. METHOD: A prospective, controlled, 6-week intervention/control study was performed in 4 community hospitals in South Jersey. Each hospital served as its own control. Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their hands. Soap usage and handwashing was calculated by bed-days. Patient follow-up was conducted through telephone interviews 2 weeks after discharge. RESULTS: The patient handwashing education model increased soap usage by health care workers an average of 34% (P =.021); this increase was consistent across hospitals regardless of the initial soap usage rates. Of the patients interviewed, 81% read the materials provided, 57% asked health care workers whether they had washed their hands, and 81% of this 57% said they received positive responses. CONCLUSIONS: For the first time, our findings document that education of patients regarding their role in monitoring handwashing compliance among health care workers can increase soap usage and handwashing and provide sustainable reinforcement of handwashing principles for health care workers.     

Effects of subject variables on attitude change and knowledge acquisition in an AIDS education program.

The need for improved knowledge and attitudes about HIV infection and HIV-infected clients has been documented, as has the effectiveness of AIDS education programs in affecting change in these characteristics of health care workers. Analyzing a sample of 336 health care providers, the current study assessed the impact of subject variables on knowledge and attitude change for health care providers after educational programs of 4 to 8 hours. Results indicated that several subject characteristics were significantly related to pretest levels of attitudes and knowledge. However, these same subject variables did not affect the degree of change on the attitude and knowledge scales. The importance of AIDS educators understanding the impact of subject variables on change is discussed.     

Influenza vaccination of health care workers: policies and practices of hospitals in a community setting

BACKGROUND: The Advisory Committee on Immunization Practices has long recommended that health care workers receive annual influenza vaccinations to prevent transmission of disease to vulnerable patients, but HCW vaccination rates remain low, and there is little information about hospital policies promoting employee vaccination. METHODS: Our objective was to collect information about and compare hospital influenza vaccination policies and practices regarding health care workers in the metropolitan Atlanta community and identify relationships between policies and practices and employee coverage rates. Senior staff of infection control and of employee health programs at 12 hospitals in the metropolitan Atlanta community completed an in-person interview using a structured guide. RESULTS: All study hospitals provided vaccine free of charge to employees in on-site clinics. Seven of the 9 hospitals clustered between 34% and 47% of their employees vaccinated, with an average of 41%. The hospitals that included flexibility and better accessibility, such as providing vaccination carts and adding more hours of vaccine availability, had somewhat higher hospital employee vaccination rates. Personal contact in the form of educational presentations appears to have more influence on employee decisions than distributing printed educational materials. CONCLUSION: Hospitals in the Atlanta community had several similar policies and practices to improve immunization coverage of their staff. Human interactions with employees as well as ease of vaccine access may be more successful at increasing coverage rates than mass approaches such as posters or flyers.     

The corporate organization of hospital work: balancing professional and administrative responsibilities.

The development of the hospital into a corporation has influenced the care of patients and the work of the professional staff. As a corporate enterprise, the modern hospital has a private agenda aimed at increasing growth and efficiency with an emphasis on technical services, professionals as employees, and patients as customers. These changes have resulted in a decrease in trustee and professional authority and an increase in administrative control. This shift in the control structure has continued in response to the need for accounting and regulation of services and in response to demands for increased growth and efficiency made by an increasingly competitive market environment. Strategies for the reorganization of hospital staff aimed at improving both inpatient and outpatient care are reviewed. The reorganization of the institution and staff, using either a staff group-practice corporation or an administrative staff model, is proposed. Clinicians have new responsibilities for developing collective arrangements for institutional governance, for allocating institutional resources, for providing public accountability regarding the use of these resources, and for defining the missions of care.     

某在建高速公路沿线女性性工作者艾滋病知识态度和行为干预效果评价

目的评价应用健康干预工具包,对在建高速公路沿线女性性工作者进行艾滋病知识、态度及行为的干预的效果。方法随机抽取在建高速公路周边的120名女性性服务工作者作为研究对象,采用世界银行提供、湖北省疾病预防控制中心翻译调整的健康干预工具包,对女性性工作者进行系列干预,比较干预前后艾滋病知识、态度和行为的变化。结果高速公路沿线女性性工作者艾滋病相关知识总知晓率,由干预前的59.4%提高到干预后的78.2%(P<0.05);愿意照顾患艾滋病家人的比例,由56.0%提高到干预后的83.8%(P<0.05)。在商业性行为中,最近一个月与所有客人发生性行为时总是使用安全套的比例,由35.2%提高到干预后的61.6%(P<0.05)。结论采用健康干预工具包对目标人群进行系列干预,可在一定程度上提高女性性工作者的艾滋病防治知识、正性态度和安全套使用行为。     

山东省泰安市路边店从业人员艾滋病KAP调查分析

目的 了解交通干道路边饭店、旅馆从业人员有关艾滋病KAP状况,探索适合该人群的健康教育方式。方法 采用匿名答卷的方式对艾滋病有关问题进行调查。结果 被调查者对艾滋病不同问题的正确回答率存在着明显差别,最高达91.87％,最低仅为32.52％;75.88％的人认为AIDS可怕,50％左右的人认为AIDS无法预防,并对病人持歧视态度;被调查者有关AIDS知识,主要来源于书籍、新闻媒介和医务人员;73.44％的人愿意获取更多的知识。结论 目前,路边店从业人员艾滋病基本知识较缺乏。需根据该人群特点,采取适宜的宣传方式开展艾滋病宣传教育。     

“We write as little as we have to”: charting practices and documenting disclosure in response to HIV criminalization in Canada

The criminalization of HIV nondisclosure is reshaping the landscape of support and care for people living with HIV/AIDS (PLWHA). Focusing on Canada, this article examines how criminalization is reshaping the relationships between frontline AIDS Service Organization (ASO) workers and their HIV-positive service users. Using data gleaned through semi-structured interviews with N?=?62 frontline ASO staff members across Canada that were coded using thematic analysis, we describe how ASO workers are rethinking and altering their notetaking practices in light of fears about criminalization and how their charts may be used by legal actors. Specifically, we identified three main themes. First, awareness that their notes can be subpoenaed and used against their clients in criminal proceedings is leading ASO staff to keep less detailed records of their conversations with PLWHA, although there were variations by the type of position held. Participants with professional obligations (doctors, nurses, social workers) reported that they continue to keep more detailed charting records than other frontline ASO staff (peer counselors, educators, etc.). Second, participants acknowledged that criminalization threatens the trust dynamic in the therapeutic relationship and that by taking less detailed notes they risk the quality of care provided. Third, we found that evolving knowledge about risk and responsibility in light of criminalization is impacting the type of counsel ASO workers offer to PLWHA regarding how to document disclosure. The article concludes by reflecting on the challenges associated with navigating the “medico-legal borderland”, as ASO staff balance their commitments to serving PLWHA with the realities created by the harsh climate of criminalization. Greater political attention should be paid to the risks that criminalization poses to frontline HIV support work and efforts to support PLWHA, who already face significant stigma, without the additional stigma of the criminal label.     

社区卫生服务机构艾滋病防治工作人员的艾滋病知识和歧视态度及相关影响因素的研究

目的了解社区卫生服务机构艾滋病防治工作人员,对艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）的歧视情况及影响因素。方法采用自填式调查问卷,对8个城市40家社区卫生服务机构361名工作人员进行调查。调查内容包括工作人员的一般情况、对HIV/AIDS病人的态度和开展艾防工作意愿等。结果 292人（80.9%）表示能像对待其他患者一样对待HIV/AIDS病人,或者可以为他们提供医疗卫生服务,没有歧视。多因素Logistic回归分析显示,近一年接受培训的天数（3-6天、7-14天和15天以上）、支持社区开展艾滋病防治工作的工作人员对HIV/AIDS病人歧视有显著性差异,比值比（OR）[95%可信区间（CI）]分别为3.96（1.10,14.25）、4.93（1.27,19.19）、10.33（1.86,57.42）、0.25（0.12,0.52）。结论社区卫生服务机构工作人员对HIV/AIDS病人依然存在歧视,当地卫生行政部门和疾控机构需要加强对社区医生的艾滋病防治知识、技能和职业暴露预防的培训,同时要提高其工作待遇,稳定基层防艾队伍。