HIV Issues for Rural Hospitals in U.S. Frontier Areas

A Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals' experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection. Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV-infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV-positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV-positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in-house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Contributing Factors to Fear of HIV Contagion in Registered Nurses

This study tested the relationships of homophobia, fear of the unknown, fear of death, and fear of punishment as predictors of fear of HIV contagion. Knowledge of transmission and emotional involvement with a person at risk for HIV were hypothesized as decreasing fear among 114 randomly-selected RNs. Results supported significant relationships for all predictors except fear of death. Homophobia, lack of knowledge, lack of emotional involvement, and fear of the unknown predicted 57 percent of the variance in fear of contagion .     

Evaluation of a School-Based Train-the-Trainer Intervention Program to Teach First Aid and Risk Reduction Among High School Students

BACKGROUND: Farming is a hazardous occupation posing health risks from agricultural exposures for the farm owner and family members. First Aid for Rural Medical Emergencies (F.A.R.M.E.) was developed to support a train-the-trainer (TTT) program to prepare high school students to teach first aid skills and risk reduction through peer interaction. This study was designed to evaluate the educational effectiveness for first aid skill development and awareness of safety issues and injury prevention impacting agricultural communities. METHODS: Forty-three agricultural science students from a rural high school participated in the study. A quasi-experimental design was used to evaluate knowledge acquisition and anticipatory action among groups: those participating in training and a comparison group with no training. The intervention group included 27 participants trained as first aid peer instructors using the F.A.R.M.E. manual, return demonstration, case scenario facilitation training, and teaching evaluation sessions. The effectiveness of the program was evaluated using triangulated data. Independent t test analyses were conducted on post-test scores to evaluate the knowledge acquisition and anticipatory action scores between groups. Focus group sessions assessed attitudes, experiences, and values held following the intervention of teaching peers. RESULTS: Results indicate that the intervention group scored significantly higher on anticipatory action (t = 2.23, p = .03) but not knowledge acquisition (t = 1.37, p = .18). Focus group data suggest that the TTT format bolstered confidence in teaching, confirmed that teens enjoy learning from teens, and fostered pride in team work. CONCLUSIONS: The F.A.R.M.E. TTT resulted in a theory and evidence-based intervention that can be implemented in a school setting to promote knowledge and skill acquisition of first aid and injury prevention among rural high school students.