A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety‐related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross‐sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7‐point scales. Results Approval of patients' safety‐related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues.     

Symptom management in HIV/AIDS: advancing the conceptualization

For people living with HIV, symptoms related to the disease, comorbidities, and treatment side effects make symptom management essential. Poorly managed symptoms result in reduced medication adherence, disease progression, and lower quality of life. The Self-regulatory HIV/AIDS Symptom Management Model is a conceptual model that describes how persons living with HIV/AIDS manage their symptoms. The model links symptom experience, symptom management, social support, adherence, and health-related quality of life. It can assist nurses, through a multidimensional approach to illness management, to enhance symptom assessment, better understand factors influencing symptom experience, and to improve symptom management among people living with HIV/AIDS.     

Mediation analysis of health‐related quality of life among people living with HIV infection in China

The effects of stigma, social support, and depressive symptoms on health‐related quality of life are well documented in the literature, but how these psychological factors interact with each other, and the combined effects when taken together on the health‐related quality of life for people living with HIV, remain unclear. This cross‐sectional study investigated 114 people living with HIV who were taking antiretroviral medication using the HIV/AIDS‐related Stigma Scale (Chinese version), the Social Support Rating Scale, the Center for Epidemiological Studies Depression Scale, and the Medical Outcomes Study–HIV health survey. Multiple linear regression analyses were used to examine the mediation effect of the psychosocial factors on health‐related quality of life. Results showed that stigma and social support did not have direct effects, but indirect effects on health‐related quality of life through a full mediation effect of depressive symptoms. The results indicate that interventions targeting depression might be the most effective approach to improving health‐related quality of life among people living with HIV who are taking antiretroviral medication in China.     

Telephone support for Canadian nurses in HIV/AIDS care.

An assessment study was conducted with Canadian nurses (N = 177) in HIV/AIDS care to determine how social support influences the relationship between job stress and health (job satisfaction and burnout). The assessment study revealed that social support and coping both moderate the effects of these stressors on nurses' health and functioning outcomes (i.e., job satisfaction and burnout). Accordingly, the follow-up study tested the effectiveness of an intervention designed to enhance social support, promote the use of certain coping strategies for managing occupational stress, and prevent burnout in nurses. Telephone support groups, co-led by an expert facilitator and an expert AIDS nurse, were tested in a demonstration project for nurses in HIV/AIDS care (n = 30). The nurse participants reported that the intervention enhanced their coping, confidence, relationships, client care, and connections to the HIV/AIDS nursing community.     

基于社区的HIV/AIDS患者心理支持模式的研究

目的探讨基于社区HIV/AIDS患者心理支持模式。方法建立以社区为基础,由心理学专家、社区志愿者、社区医生、社区护士、患者家属等组成的心理支持团队,通过心理咨询、健康教育、反歧视宣传、同伴交流等活动,为HIV/AIDS患者提供心理关爱和情感支持。结果基于社区的心理支持模式,能有效地帮助HIV/AIDS患者走出心理困境、降低焦虑抑郁程度、提高生活满意度。采用患者单一条目自我评分法,心理支持前后焦虑抑郁和生活满意度的差异有统计学意义(P0.01)。结论建立以社区为基础的心理支持模式有着传统心理支持不可比拟的优势,对充分发挥社区在艾滋病防治方面的功能及动员社会力量控制艾滋病的传播有重要的现实意义。     

Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS.

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health. The similarity in functional health status and depression between user groups, despite high users' poorer health and greater social vulnerability, supports client reports that services have reduced client isolation and improved health-related quality of life. Finally, high users had lower expenditures for government-provided health and social services overall, particularly HIV specialists and AIDS medication, but significantly more expenditures for emergency room services and complementary therapies. The results suggest community-based services can enhance health-related quality of life for persons living with HIV/AIDS by increasing providers' capacity to identify and address client depression and its consequences.     

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.     

HIV/AIDS patient satisfaction with hospitalization in the era of highly active antiretroviral therapy.

The purpose of this study was to investigate how HIV/AIDS patients evaluate hospitalizations and to contrast such evaluations with those of inpatients who were diagnosed with pneumonia or pleurisy. In all, 302 satisfaction survey records collected in 2002 from patients of U.S. hospitals were analyzed. Potential confounding variables were kept constant or statistically controlled. Patients with HIV/AIDS rated their care lower than patients with pneumonia or pleurisy. The survey section, Tests and Treatments, yielded a significant effect of diagnosis. In addition, there was a significant effect of diagnosis for two survey items: skill of the person who took your blood, and skill of the person who started the intravenous line. Results were discussed in terms of caregiver attitudes toward HIV/AIDS patients, and implications for nursing care were drawn.     

Rural nursing students' knowledge, attitudes, and beliefs about HIV/AIDS: a research brief.

The purpose of this study was to explore rural student nurses' knowledge, attitudes, and beliefs about caring for people with HIV/AIDS. The results from this study were consistent with other past studies where judgmental attitudes toward patients with HIV/AIDS were demonstrated. Data indicate that nursing students' attitudes, beliefs, and knowledge about HIV/AIDS have not changed over the past decade. Based on these findings, many implications for nurse educators exist. Nurse educators need to examine approaches to teaching about HIV/AIDS that can increase knowledge and influence the actual treatment of individuals who have this disease. In addition, the focus for rural nursing programs should be on increasing the understanding of the impact of HIV/AIDS on rural communities and to help project future needs for HIV/AIDS-related services.     

Familial Hemolytic Jaundice Complicated by Acute Purulent Cholecystitis

Objective: Our aim was to explore how differing attitudes, expectations, and experiences among people with obesity (PwO) and healthcare providers (HCPs) might have an impact on effectively implementing current obesity treatment guidelines.

Methods: Online surveys were conducted among 3,008 adult PwO (BMI≥30 by self-reported height and weight) and 606 HCPs.

Results: PwO with weight loss ≥ 10% during the previous three years were more likely to have been diagnosed with obesity and to have discussed a weight loss plan with an HCP. However, only 21% believe HCPs have a responsibility to actively contribute to their obesity treatment. Further, HCPs tend not to effectively communicate the diagnosis of obesity, its nature as a serious and chronic disease, the full range of treatment options, and obesity’s implications for health and quality of life.

Regarding treatment goals, HCPs more often focus on BMI reduction, while PwO’s goals focus on improved functioning, energy, and appearance. HCPs also tend to underestimate their patients’ motivation to address their obesity. Twenty-eight percent of HCPs ‘completely agreed’ that losing weight was a high priority for PwO, whereas more than half of PwO ‘completely agreed’ that losing weight was a high priority for them. When asked how their HCP could better support them, PwO most often expressed a desire for helpful resources, as well as assistance with specific and realistic goal-setting to improve health.

Conclusions: HCPs can more effectively implement obesity treatment guidelines by more clearly and proactively communicating with PwO about their diagnosis, health implications of obesity, desired treatment goals, and the full range of treatment options. HCPs should understand that most PwO believe that managing their disease is solely their own responsibility. HCPs can also encourage more effective conversations by better appreciating their patients’ motivation and treatment goals.     

Attitudes of professionals, students and the general public to HIV/AIDS and people with HIV/AIDS: a review of the research

This paper provides a review relating to the attitudes of health care professionals, students and the general public to HIV/AIDS and people with HIV/AIDS. This is done by describing the literature on attitudes to HIV and AIDS in three fields of research: medicine/nursing, psychology and the social sciences. In addition, we look at the countries in which research has been conducted in these issues and at the variety of tools and methodological approaches used and at the participants studied. The review shows that, during the 1990s, the research interest in issues related to HIV/AIDS attitudes has rapidly increased. Most of the work on HIV and AIDS has been done in the United States, with the main focus on empirical research using questionnaires. The attention has mostly been on students and their attitudes to AIDS/HIV and sexual behaviour, but increasing interest has also been shown in the attitudes of health care personnel and students. As it seems that attitudes have been highly resistant to change, more consideration needs to be given to finding appropriate ways of educating the general public, students and health care professionals. A comprehensive analysis is also needed of the different tools used in measuring attitudes and in international comparisons of the attitudes of adolescents, health care professionals and students towards AIDS and AIDS patients.     

THE CONTRIBUTION OF RELIGIOUS AND EXISTENTIAL WELL-BEING TO DEPRESSION AMONG AFRICAN AMERICAN HETEROSEXUALS WITH HIV INFECTION

The AIDS crisis has challenged black churches to examine how to provide spiritual support to individuals who are living with HIV. The dilemmas facing some black churches have been specifically related to providing support without embracing homosexuality. The doctrine guiding some black churches has caused psychological discomfort for both homosexual and heterosexual HIV infected individuals because of the stigma associated with HIV. Previous research showed that heterosexuals reported more distress than homosexuals. The purpose of this study was to examine a subset of African Americans (n = 49) who were heterosexual. Data were drawn from a larger data set (N = 117) collected in California. All participants were HIV seropositive or had AIDS. A questionnaire examining existential and religious well-being, demographic variables, and depression was administered. Religious well-being and existential well-being together explained 32% of the variance in depression. Implications for mental health nurses are discussed.     

Health visitors' knowledge and attitudes relating to HIV and AIDS

Infection with human immunodeficiency virus (HIV) is increasing in the heterosexual community and people already affected by HIV are living longer. As a result, health visitors will be more involved in caring for people with HIV and acquired immune deficiency syndrome (AIDS). The aim of this study was to assess the knowledge level of health visitors about HIV infection and AIDS, and to identify some of the attitudes held by them concerning AIDS and the variety of symptoms that can occur in HIV positive individuals (AIDS related complex) before they have actually developed AIDS. The influence of AIDS-related education and the experience of caring for affected patients on health visitors' knowledge of the disease was assessed. The attitudes of carers towards these patients were also ascertained. All heath visitors (n = 88) working in the Merton and Sutton Community Healthcare Trust were invited to participate in a questionnaire survey. Fifty-five health visitors participated. Knowledge relating to HIV and AIDS was good, but the majority of respondents felt they did not have all the information they needed about HIV and AIDS. Almost one-quarter of respondents had cared for a client who was either HIV positive or had AIDS. Overall, the findings were quite encouraging. However, further education, training, and support were identified as necessary. These shortfalls need to be addressed in order to fully assist health visitors in their role of caring for clients and families affected by HIV and AIDS.     

The contribution of religious and existential well-being to depression among African American heterosexuals with HIV infection

The AIDS crisis has challenged black churches to examine how to provide spiritual support to individuals who are living with HIV. The dilemmas facing some black churches have been specifically related to providing support without embracing homosexuality. The doctrine guiding some black churches has caused psychological discomfort for both homosexual and heterosexual HIV infected individuals because of the stigma associated with HIV. Previous research showed that heterosexuals reported more distress than homosexuals. The purpose of this study was to examine a subset of African Americans (n = 49) who were heterosexual. Data were drawn from a larger data set (N = 117) collected in California. All participants were HIV seropositive or had AIDS. A questionnaire examining existential and religious well-being, demographic variables, and depression was administered. Religious well-being and existential well-being together explained 32% of the variance in depression. Implications for mental health nurses are discussed.     

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.     

HIV感染者/AIDS病人及其家属的生活质量调查及相关因素分析

目的调查分析HIV感染者/AIDS病人及其家属的生活质量及其相关因素,为建立HIV感染者/AIDS病人社区综合关怀支持模式、改善HIV感染者/AIDS病人及其家属的生活质量提供依据.方法选择四川省HIV感染率和AIDS患病率较高的两个县(资中县和凉山州昭觉县)作为目标社区,共计调查71名HIV感染者/AIDS病人及其162名家属和97名健康者,采用生活质量综合评定问卷(GQOLI-74)、社会支持评定量表(SSS)及自制的一般情况记录表收集相关资料,用SPSS统计软件进行统计分析.结果HIV感染者/AIDS病人及其家属的GQOLI-74总分及躯体功能、心理功能、社会功能和物质生活状态4个维度分均低于正常对照(分别为F=36.512、F=11.046、F=31.616、F=34.235、F=2.386,P值均＜0.01),HIV感染者/AIDS病人及其家属生活质量总分与疾病状况、社会支持存在明显相关性.结论HIV感染者/AIDS病人及其家属的生活质量均较低,这与疾病状况、社会支持等因素有关.     

Willingness to provide care and treatment for patients with HIV/AIDS

This paper is derived from the findings of a larger study which examinies nurses' and doctors' attitudes towards mainstreaming of hospital inpatient services for individuals with HIV/AIDS in general hospital wards. The aim of this paper is to discuss the factors which influence nurses' and doctors' willingness to provide care and treatment for patients with HIV/AIDS. Two methods of study are used in this researc — a survey questionnaire and semi-structured interviews. The findings of this study provide several themes abouth the positive attributes associated with caring for and treating patients with HIV/AIDS. These include: that caring for and treating is personally and professionally rewarding; the need to be non-judgemental and accepting of others; that previous work or social experience is related to willingness to work with patients; the influence of family and colleague support in the work environment; and having a duty of care.     

Experiences of patients with HIV/AIDS receiving mid- and long-term care in Japan: A qualitative study

PurposeIn the era of antiretroviral treatment (ART), treatment of HIV has become more manageable, and most patients with HIV benefit from long-term therapy in Japan. The aim of this qualitative study was to examine the experiences of patients with HIV/AIDS receiving mid- and long-term care in Japan.MethodsA qualitative study was performed using semi-structured interviews at an outpatient clinic of a university hospital in the Greater Tokyo area. A total of 31 Japanese patients with HIV who had been receiving treatment for at least a year were interviewed in Japanese. Data from these interviews were analyzed by ‘content analysis’ (Krippendorff, 1980).ResultsThe data were organized into the following seven themes: “feelings toward diagnosis of HIV infection”; “perceptions and behavior after diagnosis of HIV”; “attitudes toward HIV therapy”; “fear and hope for the future”; “feelings toward professional support”; “life changes after HIV therapy”; and “struggles in relationships with others”.ConclusionsSome participants accepted themselves as HIV-positive, some did not when they were diagnosis. This difference of reaction had effect on attitudes toward HIV therapy. But all participants continued mid- and long-treatments owing to feeling well and receiving support from professionals. Additionally, it found that patients were felt stigma of HIV-positive similarly to another Asian countries. Therefore, we should provide the entire Japanese society with knowledge about HIV/AIDS and be early and constant intervention by professional teams after being infected.     

Nurse practitioner, nurse midwife and physician assistant attitudes and care practices related to persons with HIV/AIDS

Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.