Rural nurses' use of universal precautions in relation to perceived knowledge of patient's HIV status

Universal precautions

The purpose of this literature review is to consider key themes from empirical research relating to the knowledge and compliance of universal precautions amongst healthcare practitioners. Utilising international studies, strategies to improve universal precautions are analysed. The review identifies areas of limited knowledge, synthesises existing research and suggests aspects of universal precautions that need to be studied further.

A literature search of studies listed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was conducted from 1990–2003, using a number of key words. Review, analysis and synthesis of selected studies were performed.

The findings of this review showed that universal precautions are considered an effective means of protecting patients and staff and controlling infection. The consensus from this body of evidence is that, globally, knowledge of universal precautions is inadequate and compliance low. Studies from many countries have shown that specific intervention strategies, such as education, are influential in improving knowledge and compliance.

This review concludes that it is imperative that future research examines how the attitudes and beliefs of practitioners can be influenced and changed to reenforce adherence to universal precautions within the clinical practice setting. There remains a lack of evidence on the long-term benefits of practice interventions to improve compliance, and what specific barriers are influential in affecting how healthcare practitioners adopt universal precautions more effectively in their practice.

A systematic review of the knowledge, attitudes and practice of trained nurses towards patients with HIV/AIDS

EXECUTIVE SUMMARY

Background Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is a global health problem. Stigmatization and blame which are associated with the disease have made efforts to control the pandemic challenging. With discoveries of anti-retroviral drugs, HIV/AIDS patients are expected to live longer. Therefore, nurses being frontline workers are expected to nurse them in different clinical settings. Some studies have found that nurses hold discriminatory attitudes when caring for HIV/AIDS patients, have gaps in their knowledge and differing practicesObjective The objective of this review was to synthesize the evidence on the knowledge, attitudes and practice of trained nurses towards HIV/AIDS patients.

INCLUSION CRITERIA

Types of participants Studies that included trained nurses, specifically Registered Nurses (RN) and Enrolled nurses (EN).Types of interventions Studies that evaluated knowledge, attitudes and practice of trained nurses towards HIV/AIDS patients.Types of measured outcomes Studies that included outcome measures of knowledge, attitudes or practices of trained nurses towards HIV/AIDS patients.Types of studies Cohort studies, cross-sectional studies, case control studies and descriptive studies were considered for inclusionSearch strategy A three-step search strategy was utilised. Search was limited to English language studies published between January 1990 till December 2010.Assessment of methodological quality The reviewers used the JBI Critical AppraisalChecklists to assess methodological quality.Data extraction Data were extracted using the JBI Data Extraction Form for experimental/observational studies.Data synthesis Meta-analyses was not performed. Findings are presented in a narrative summary.Results Thirty-three studies were included for this systematic review. All studies were descriptive studies. The results showed that the knowledge, attitude and practices of nurses varied. In general studies showed that: nurses' knowledge of HIV/AIDS was satisfactory but knowledge deficits are prevalent in certain areas; nurses also had positive attitudes, but still held fears; nurse showed more prejudice towards HIV/AIDS patients in the high risk groups; practiced of universal precaution was irregular; and nurses also changed their practice behaviours after knowing the patient is HIV positive.Conclusion Knowledge, attitude and practices of nurses varied worldwide. The level of knowledge is satisfactory but gaps in knowledge exist. Nurses have positive attitudes but is affected by the ways which a person acquired HIV/AIDS. Strong stigmatization is still prevalent towards high risk groups. The use of universal precaution also needs to be address. More well established questionnaire should be used to measure practice towards HIV/AIDS patients.Implications for practice Institutions need to: develop strategies to assist nurses to overcome fears, create self-awareness with regards to their attitude; relook into programmes to address knowledge deficits; make trainings available to keep nurses up-to-date; make protective barriers available for nurses readily; put universal precaution policy in place; look into universal precaution education.Implications for research Research should focused on using well established questionnaire to measure nurses' practices; the relationship between knowledge, attitude and practices; factors affecting the use of universal precautions in different settings; comparison between nurses' knowledge, attitudes and practices towards HIV/AIDS with other infectious diseases; develop and test education program for nurses.

Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China

This study identified the prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among rural obstetrics and gynaecology workers in two poor counties in Anhui, China. A cross-sectional survey was conducted using a self-administered anonymous semi-structured questionnaire. The study population included all health workers in the departments of obstetrics and gynaecology in township hospitals and county health facilities. Among the 137 participants, the rate of non-compliance with glove utilization was 61%, the rate of non-compliance with hand hygiene was 40%, and the rate of non-compliance with both was 67%. 'Unnecessary and inconvenient' accounted for 66% of the reasons for not always using gloves and 71% for not always washing hands. 'Short of gloves or water' accounted for 15% and 22% of reasons, respectively. Two variables were associated with non-compliance: county [odds ratio (OR)=11.56, P<0.001] and knowledge (OR=0.10, P=0.033). After removing county from the regression model, institutional level (OR=2.34, P=0.059), institutional support (OR=3.85, P=0.009) and knowledge (OR=0.05, P=0.007) were associated with non-compliance. The prevalence of non-compliance with glove utilization and hand hygiene was high. The risk factors for non-compliance were institutional level, institutional support and knowledge. These variables incorporated both subjective and objective reasons for non-compliance.

Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines

BACKGROUND

Traditional infection control policies have focused on engineering controls, specific protocols, and personal protective equipment (PPE). In light of the variable success in protecting health care workers (HCWs) from Severe Acute Respiratory Syndrome (SARS) in 2003, organizational and individual factors related to self-protective behavior in health care settings may also play an important role.

METHODS

A critical review of the literature was conducted, directed at understanding what organizational and individual factors are important in protecting HCWs from infectious diseases at work.

RESULTS

Organizational factors, such as a positive safety climate, have been associated with increased HCW adherence to universal precautions. There is some evidence that appropriate training of HCWs could be effective in changing HCW behavior if appropriate follow-up is applied. Very little research into these factors has been conducted with regard to preventing exposures to respiratory tract pathogens, but there was evidence from the SARS outbreaks that training programs and the availability of adequate PPE were associated with a decrease risk of infection.

CONCLUSION

Variations in organizational and individual factors can explain much of the variations in self-protective behavior in health care settings. It is likely that these factors were also important determinants during the SARS outbreaks, but they have not been extensively studied.

Profiles of rural nurses' use of personal protective equipment: a cluster analysis

This study examined the relationship between profiles of rural registered nurses' levels of compliance with the use of personal protective equipment and HIV-related attitudes. Survey data were collected from 395 practicing registered nurses in nine rural counties in New York and Pennsylvania. Cluster analysis grouped respondents according to their use of protective equipment by patient HIV status. Seven profiles were identified from the resulting 13 clusters. Profiles were named according to the characteristics of the protective equipment usage that were most evident in each profile. Usage levels included minimal users, appropriate users, anticipatory users, glove users, discriminate users, maximal users, and optimal users. Of these, three were classified as compliant, one as undercompliant, and three as overcompliant. Selective compliance (changing usage in response to patients' HIV status) was characteristic of five profiles. Knowledge that patients were HIV-positive accounted for overcompliance and selective compliance and was related to nurses' HIV attitudes. Undercompliance was related to care of patients who were HIV-negative or unknown. Rural nurses' use of personal protective equipment is not homogenous but discrete and idiosyncratic. This analysis expands current knowledge and redefines nursing practice of standard precautions.

Undertaking research for the benefit of the rural community

This paper discusses the importance of disseminating clinical research findings to improve nursing practice and, ultimately, the health of rural Australia. It is argued that nursing in all settings must be practised within the context of changing healthcare trends. Currently, these changes include the restructuring of health services toward a greater emphasis on community-based services, a redirection of the focus of care toward population health rather than hospital-based service provision, multidisciplinary clinical decision-making with the community as partner, and the need for all health professionals to maintain fiscal and clinical accountability. To chart the process and outcomes of care in these changing circumstances requires ongoing, systematic research. The global movement toward evidence-based healthcare practice is thus timely and necessary. In order to provide a foundation for evidence-based practice that will demonstrate quality, efficiency, effectiveness and community acceptability, employers must address both infrastructure and educational needs. Educators must be responsive to changes in the organisation and finding of care. Also both groups must work collaboratively toward ensuring dissemination of research information that will make a difference to patient and community outcomes. The key to success is ongoing communication between employers, educators, practitioners in the field, community members and professional organisations so that research findings can be analysed in simple language that increases utility and that provides a forum for valuing information from all sources.