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.     

Systematized HIV/AIDS education for student nurses at the University of Ibadan, Nigeria: impact on knowledge, attitudes and compliance with universal precautions

This paper reports the findings of a study which examines changes in a group of Bachelor of Science (BSc) nursing students' perceptions, knowledge of and attitudes towards human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), accruing from attempts at a systematized education for the cohort. Based upon a 3-month study of 141 registered nurses enrolled in a BSc nursing programme at the University of Ibadan, Nigeria, it investigates alterations in knowledge and attitudes resulting from intense instruction on HIV/AIDS, AIDS patient care, and compliance with universal precautions. With regard to knowledge enhancement and attitudinal transformation, the research reveals that a number of positive changes occurred over the period of the study. Not only were the nurses better informed about AIDS than previously, but their attitudes towards the disease and patient care had become considerably more liberal, as well as their disposition to comply with universal precautions. The conclusion emphasizes that it is very important for education about HIV/AIDS to be incorporated within current undergraduate and in-service training programmes for Nigerian nurses.     

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.     

Nursing students' attitudes towards HIV/AIDS patients in Finland, Estonia and Lithuania

This paper presents baseline data on attitudes towards HIV/AIDS patients and homophobic levels among nursing students in three Baltic Sea countries: Finland, Estonia and Lithuania. The aim is to describe and compare nursing students' attitudes in these three countries and to explore how attitudes towards HIV/AIDS correlate with background variables. The total sample comprised 471 nursing students. The respondents demonstrated average attitude scores towards patients with HIV/AIDS and rather positive attitudes towards homosexually oriented patients. Significant country differences were found, with Finnish nursing students showing the most positive attitudes towards HIV/AIDS patients and homosexually oriented patients. Previous experience of HIV/AIDS patients was the single factor with the greatest positive impact on nursing students' attitudes. Nursing students' willingness to provide care for an HIV/AIDS patient was associated with a positive attitude towards these patients. Length of employment experience correlated negatively with general attitude, and older nursing students with more work experience showed a more negative attitude towards homosexual patients. Proper education to achieve a sound knowledge base and good nursing skills promotes a more positive attitude to HIV/AIDS. It is important that nursing students are sensitive and show respect for the patient's human dignity. There is need for greater harmonization of education in the three countries.     

An investigation into whether nursing students alter their attitudes and knowledge levels regarding HIV infection and AIDS following a 3-year programme leading to registration as a qualified nurse

The purpose of this study was to examine whether a 3-year programme of nursing studies enabled nursing students to graduate from the course with greater knowledge and more positive attitudes towards HIV infection and AIDS than when they began the course. Students on a maths and information technology course were used as controls. The study involved the use of a questionnaire which gathered information about students' experience, knowledge, attitudes and moral judgement regarding HIV infection and AIDS. The experimental hypothesis stated that nursing students show a greater increase in knowledge and positive attitude change towards HIV infection and AIDS than maths students. The results showed significant differences between third year nursing students' knowledge about HIV and AIDS when compared with other groups but it was noted that knowledge levels for all groups was quite low. There was no difference between first and third year nursing students' attitudes and moral judgement about HIV and AIDS but there was a significant difference between nursing students and maths students. It was suggested that there is a need to modify nurse education programmes in order to have greater impact on this topic area.     

实习护生对艾滋病相关知识掌握情况的调查分析

目的 了解实习护生对艾滋病相关知识掌握情况及影响因素,为有针对性开展健康教育提供依据.方法 用整群抽样法,以班级为单位抽取共计544例实习护生,采取不记名独立填写的方式进行艾滋病认知、态度问卷调查.结果 实习护生对艾滋病知识处于中等水平,平均得分(9.49±3.16)分,对主要传播途径认识正确率为81.40%;对高危行为和安全套等知识掌握仅有42.28%.实习护生对待艾滋病的态度呈中等水平,平均得分(172.11±14.37)分.艾滋病知识水平、态度水平的影响因素为学历、民族以及知识得分.结论 实习护生对艾滋病知识掌握不够,态度有待提高.对实习护生开展健康教育不仅要注重提高知识水平,更要加大对艾滋病的态度及高危行为的教育力度.     

Nursing students' knowledge and practice of infection control precautions: an educational intervention

Title.  Nursing students' knowledge and practice of infection control precautions: aneducational intervention.
Aim.  This paper is a report of the effectiveness of a purpose-designed education program in improving undergraduate nursing students' understanding and practice of infection control precautions.
Background.  The severe acute respiratory syndrome outbreak in 2003 highlighted that healthcare workers were under-prepared for such an epidemic. While many in-service education sessions were arranged by institutions in response to the outbreak, preservice nursing education has overlooked preparation for handling such infectious disease epidemics.
Method.  A quasi-experimental design was used and a 16-hour, purpose-designed infection control education programme was implemented for preservice nursing students in southern Taiwan. Self-administered questionnaires were distributed at three time points during the period September 2005 to April 2006 to examine the sustainability and effectiveness of the intervention.
Results.  A total of 175 preservice nursing students participated in the study. Following the education programme, students in the intervention group showed a statistically significant improvement across time in their knowledge of these precautions [ F _{(2, 180)} = 13·53, P  <   0·001] and confidence in resolving infection-related issues [ F _{(1·79, 168·95)} = 3·24] when compared with those in the control group.
Conclusion.  To improve nursing students' capacity in responding to infectious epidemics, an educational programme that integrates the theme of infection precautions, learning theory and teaching strategies is recommended for all nursing institutes.     

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

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

An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people

Objectives.  This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people.
Background.  With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent.
Design.  A pre- and post-test design was used to conduct the study.
Methods.  Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing ( n  = 130) and one year later ( n  = 94) following a series of visits to a well-older person in the community.
Results.  Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students.
Conclusions.  The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis.
Relevance to clinical practice.  Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge.     

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.     

HIV/AIDS and its impact on student nurses

This article describes components surrounding British nursing students' (n=138) knowledge base, attitudes towards HIV/AIDS, homophobia level, willingness to care for individuals with HIV/AIDS and attitudes to sexual risk behaviours. The data were collected by questionnaire and analysed by statistical methods. Out of the 33 knowledge questions, the mean value of correct answers was 22.2 (Min 13, Max 29, SD 3.27). Students who had taken care of people with AIDS and who were willing to take care of these people showed more positive attitudes to the disease and people with AIDS. Older age and reluctance to care for a person with AIDS were associated with a high level of homophobic attitudes. Students demonstrated a positive approach to carrying out general nursing tasks for a person with HIV/AIDS. Having been asked to care or having cared for a patient with HIV/AIDS, and being single were associated with a higher level of willingness to care for these patients. Female sex, older age and having children were associated with more cautious attitudes to sexual risk behaviours. The results underline the importance of providing education about HIV/AIDS and supporting student nurses who are afraid they might contract the disease in nursing tasks.     

Integrating HIV/AIDS policies and curricular content into baccalaureate nursing programs.

A model used by one school of nursing to implement HIV/AIDS policies, sequenced instructional opportunities, and a research-based evaluation process is described. In the evaluation phase, a study was undertaken to measure students' retention of HIV/AIDS knowledge and their application of universal precautions (U.P.). Findings revealed that 59% of junior baccalaureate nursing students and 75% of seniors retained knowledge about HIV/AIDS and U.P. Seniors indicated that in their role as nursing student or technician/extern, supplies and equipment were readily available and that they had sufficient time to implement U.P. However, only 64% admitted to following correct procedures, even though 96% acknowledged feeling confident in their ability to do so. Knowledge about HIV/AIDS and consistent application of U.P. protects nursing students, prevents legal problems, and promotes the quality of patient care.     

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 knowledge and self-efficacy among Nepalese adolescents: a peer education program

The purposes of this study were to develop and test the effectiveness of an HIV/AIDS peer education program in improving Nepalese adolescents HIV/AIDS knowledge and self-efficacy in one of the schools in Nepal. A modified format of the program "Teens for AIDS Prevention" (TAP) was used in this study. A quasi-experimental design was used to test the effectiveness of the peer education program. A convenience sample of 121 ninth grade Nepalese students from an urban high school participated at baseline. The final paired sample included 118 students. The results demonstrated a significant positive relationship between HIV/AIDS knowledge and self-efficacy. Nepalese adolescents' HIV/AIDS knowledge and self-efficacy improved after the peer education intervention. Therefore, school personnel, health care providers, and government and nongovernment organizations should consider developing and implementing school-based HIV prevention programs such as the peer education program.     

544名实习护生艾滋病知识及态度的调查

目的了解实习护生对艾滋病相关知识、态度及相关影响因素,为有针对性地在实习护生中开展健康教育,进行艾滋病流行的干预提供依据。方法用整群抽样法,以班级为单位抽取共计558例实习护生,采取不记名自填问卷的方式进行艾滋病认知、态度问卷调查。结果实习护生对艾滋病知识处于中等水平,得分（9.49±3.16）分;对传播途径认识错误方面,62.5%认为感染HIV的孕妇分娩的婴儿也是HIV感染者、55.3%认为共用浴盆、游泳池传染HIV;在对高危行为认识错误中,44.3%认为肛交不传播,40%认为多个性伴侣不易传播;实习护生对待艾滋病的态度不容乐观,呈中等水平,得分（172.11±14.37）分。结论实习护生对艾滋病知识掌握不够,态度有待提高。对实习护生开展健康教育不仅要注重知识水平的提高,态度及高危行为的教育也很重要。     

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 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.