Knowledge and attitude of nurses caring for patients with HIV/AIDS in Uganda

Bachelor of Nursing students' HIV and AIDS knowledge in KwaZulu-Natal province: An evaluation study

BACKGROUND

 Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) education and training in nursing suffer from various inadequacies and lack any real formalisation in their governance. As a result, Bachelor of Nursing students find themselves challenged in providing effective HIV and AIDS healthcare management, largely because of the deficit in training identified. An HIV and AIDS education intervention programme was introduced at a selected KwaZulu-Natal university to assist in bridging the perceived knowledge gap. This article communicates programme evaluation findings.

OBJECTIVES

 The aim of this article was to determine levels of HIV knowledge achieved following an HIV education intervention programme.

METHODS

 A pure, descriptive quantitative research design was employed, using total population sampling (N = 133). A modified G3658-11 Collecting Evaluation Data: End-of-Session Questionnaire, developed by the University of Wisconsin-Extension, was administered for data collection.

RESULTS

 Females predominated in the study, and most participants were African with 1 to 3 years of education programme exposure. Perceived HIV knowledge increase was evident: pathophysiology (n = 93, 70.2%); immunology (n = 97, 72.9%); transmission (n = 116, 87.5%); diagnosis (n = 109, 81.8%); prevention strategies (n = 118, 88.4%); staging and monitoring (n = 106, 80%); pre- and post-test counselling (n = 104, 78%).

CONCLUSION

 Pre- and ongoing in-service HIV and AIDS training can improve perceived HIV knowledge levels for both nursing students and professionals. Mandatory HIV and AIDS healthcare management training is therefore recommended in planning for its effective impartation by nursing educators.

Healthcare providers' understanding of HIV serodiscordance in South Africa and Uganda: implications for HIV prevention in sub-Saharan Africa

HIV transmission within stable heterosexual HIV serodiscordant couples accounts for almost half the new incident infections in South Africa and Uganda. Advances in HIV prevention provide opportunities to reduce transmission risk within serodiscordant partnerships (e.g., antiretroviral treatment (ART), pre-exposure prophylaxis (PrEP), medical male circumcision, and couples-based HIV counselling and testing). These interventions require a clinical encounter with a provider who recognises prevention opportunities within these partnerships. We explored healthcare provider understanding of HIV serodiscordance in a reproductive counselling study with providers in eThekwini district, South Africa, and Mbarara district, Uganda. In eThekwini, in-depth interviews (29) and focus group discussions (2) were conducted with 42 providers (counsellors, nurses and doctors) from public sector clinics. In Mbarara, in-depth interviews were conducted with 38 providers (medical officers, clinical officers, nurses, peer counsellors and village health workers). Thematic analysis was conducted using NVivo software. In eThekwini, many providers assumed HIV seroconcordance among client partners and had difficulty articulating how serodiscordance occurs. Mbarara providers had a better understanding of HIV serodiscordance. In the two countries, providers who understood HIV serodiscordance were better able to describe useful HIV-prevention strategies. Healthcare providers require training and support to better understand the prevalence and mechanisms of HIV serodiscordance to implement HIV-prevention strategies for HIV serodiscordant couples.

Addressing Physical Health Needs of Individuals With Schizophrenia Using Orem's Theory

People with schizophrenia have increased morbidity and mortality rates associated with poor physical health that requires a holistic and comprehensive nursing approach. Dorothy Orem's self-care deficit nursing theory (SCDNT) has made a substantive contribution to nursing by focusing on people as whole entities who engage with their environment to sustain health. We offer an expanded view of the SCDNT by showing how it is a useful framework for nurses to integrate interpretive, empirical, and critical theoretical perspectives for addressing both the physical and mental health needs for people with schizophrenia. Understanding patient needs through different theoretical lenses will help nurses integrate high-quality, evidence-based care with patients' realities, needs, and values while considering the influence of the broader sociopolitical context. We demonstrate how the SCDNT allows nurses incorporate a critical perspective for critiquing the influence of societal barriers on individual's health and advocate for initiatives to address the complex sociopolitical, economic, and contextual factors that affect the physical well-being of individuals with schizophrenia.

Nursing Care of AIDS Patients in Uganda

This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.

Knowledge and Attitudes toward HIV, Hepatitis B Virus, and Hepatitis C Virus Infection among Health-care Workers in Malawi

Objective:

The highest prevalence of HIV infection occurs in Sub-Saharan Africa and hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence are the second highest in Sub-Saharan Africa including Malawi. Health-care workers (HCWs) play an important role in the prevention of, response to, and management of these infectious diseases. There is, however, no published research about the level of knowledge and attitudes toward HIV, HBV, and HCV infection among Malawian HCWs. The purpose of this study was to explore and determine the knowledge of and attitudes toward HIV, HBV, and HCV among a targeted population of Malawian HCWs.

Methods:

A cross-sectional community-based participatory research with 194 HCWs was completed employing health survey method. The project was a collaborative effort between nursing faculties in the USA and Malawian. A one-way analysis of variance (ANOVA) with the Bonferroni adjustment for multiple comparisons was used to assess the differences in knowledge and attitude among three subgroups of HCWs.

Results:

Of 194 of Malawian HCWs surveyed, 41% were support staff, 37% were nursing students, and 22% were health-care professionals. Both health-care professionals and support staff had high knowledge scores related to HIV/AIDS, and their attitudes were mainly positive. However, a series of one-way ANOVAs revealed significant differences in knowledge and attitude toward HIV/AIDs, HBV, and HCV among HCWs (P < 0.01). The majority had less knowledge about HBV and HCV and more negative attitudes toward hepatitis.

Conclusions:

This study highlights the ongoing need for reducing negative attitudes toward HIV, HBV, and HCV; and providing health education among HCWs, especially focusing on HBV and HCV prevention. The findings of the research project can be used to develop interventions addressing low HBV- and HCV-related knowledge and attitudes.

Turkish and American Undergraduate Students' Attitudes Toward HIV/AIDS Patients: A Comparative Study

BACKGROUND

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a complex healthcare problem. Research has demonstrated that negative attitudes affect healthcare provision.

AIMS

The purpose of this study was to compare nursing students' attitudes using the AIDS Attitude Scale (AAS).

SETTINGS

A descriptive, cross-sectional study was conducted in nursing schools in Istanbul, Turkey, and in Upstate New York (NY).

PARTICIPANTS

Baccalaureate nursing students (n = 613) from both countries completed the questionnaire.

METHODS

Demographic data, overall AAS attitudes, and attitudes within each subscale were compared. Analyses included frequency and percentages of the grouped variables, arithmetic means and standard deviations, t-test for independent samples, and multiple analysis of variance.

RESULTS

Upstate NY students' mean total AAS scores were significantly more positive toward HIV+ patients than Turkish students'. Scores for Professional Resistance and Emotions subscales were significantly more positive for the Upstate NY students, but Fear of Contagion was not. Upstate NY students had more negative attitudes in the contexts of job risk and eating in a restaurant where the chef has AIDS; more professional resistance to referring patients and training specialists for HIV/AIDS patients; and lower tender feelings for people with HIV/AIDS (p < .01 for each).

CONCLUSIONS

Improvement in students' attitudes is beneficial for promoting nonjudgmental, compassionate care for the HIV+ population.

Attitudes towards HIV/AIDS patients and empathic tendencies: a study of Turkish undergraduate nursing students

BACKGROUND

Studies indicate that the attitudes of nurses, nursing students, and other health care professionals towards Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) patients are affected by cultural differences and the fear of HIV/AIDS infection, resulting in both negative attitudes and reluctance to care for these patients. Empathy is critical for all health professionals in the delivery of effective care. Research indicates that as empathic tendencies develop, so do better communication skills, better attitudes, and better quality of care.

OBJECTIVES

The purpose of this study was to examine the relationships among demographic factors, familiarity with HIV/AIDS, attitudes towards HIV/AIDS, and empathic tendencies in a Turkish sample of nursing students.

DESIGN AND METHODS

Using a non-experimental, correlational design, data on demographics, HIV/AIDS Attitude Scale (AAS) and the Scale of Empathic Tendency (SET) were collected.

PARTICIPANTS

The study sample consisted of 614 undergraduate nursing students in two universities located in different geographic regions of Turkey.

RESULTS

The results of this study indicated that attitudes and empathic tendencies are related to knowledge and exposure to patients. As well, those students with more positive attitudes had higher empathic tendencies towards HIV/AIDS patients.

CONCLUSIONS

It is important to adopt strategies to improve the empathic tendencies and attitudes of nursing students. These strategic changes would increase the quality of care provided to all patients.

Infection control and practice of standard precautions among healthcare workers in northern Nigeria

Background:

Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids.

Aims:

This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria.

Settings and Design:

Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common.

Materials and Methods:

This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009.

Statistical analysis used:

To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors.

Results:

A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients’ care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (χ² = 3.96, P = 0.03), public healthcare providers when compared to private health workers (χ² = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (χ² = 14.64, P = 0.001) and urban areas when compared to rural areas (χ² = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28).

Conclusions:

This study implies that inadequate workers’ knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.

Determinants of clinician knowledge on aging and HIV/AIDS: a survey of practitioners and policy makers in Kampala District, Uganda

Objective

The HIV/AIDS epidemic has evolved with an increasing burden in older adults. We assessed for knowledge about aging and HIV/AIDS, among clinicians in Kampala district, Uganda.

Methods

A cross-sectional survey of 301 clinicians complemented by 9 key-informant interviews between May and October 2011. Data was analyzed by multivariable logistic regression for potential determinants of clinician knowledge about HIV/AIDS in older adults, estimating their adjusted Odds Ratios (aOR) and 95% confidence intervals (95% CI) using Stata 11.2 software.

Results

Two-hundred and sixty-two questionnaires (87.7%) were returned. Respondents had a median age of 30 years (IQR 27–34) and 57.8% were general medical doctors. The mean knowledge score was 49% (range 8.8%–79.4%). Questions related to co-morbidities in HIV/AIDS (non-AIDS related cancers and systemic diseases) and chronic antiretroviral treatment toxicities (metabolic disorders) accounted for significantly lower scores (mean, 41.7%, 95% CI: 39.3%–44%) compared to HIV/AIDS epidemiology and prevention (mean, 65.7%, 95% CI: 63.7%–67.7%). Determinants of clinician knowledge in the multivariable analysis included (category, aOR, 95% CI): clinician age (30–39 years; 3.28∶1.65–9.75), number of persons with HIV/AIDS seen in the past year (less than 50; 0.34∶0.14–0.86) and clinical profession (clinical nurse practitioner; 0.31∶0.11–0.83). Having diploma level education had a marginal association with lower knowledge about HIV and aging (p = 0.09).

Conclusion

Our study identified gaps and determinants of knowledge about HIV/AIDS in older adults among clinicians in Kampala district, Uganda. Clinicians in low and middle income countries could benefit from targeted training in chronic care for older adults with HIV/AIDS and long-term complications of antiretroviral treatment.

Turkish school teachers' knowledge and attitudes toward HIV/AIDS

Aim

To assess Turkish school teachers’ knowledge, attitudes, and misconceptions of HIV/AIDS.

Methods

This cross-sectional descriptive study was conducted in Sivas, Middle Anatolian province of Turkey, from January to May 2009. We selected and interviewed 898 teachers using a simple systematic sampling method.

Results

All respondents heard about AIDS. Most knew that it could be transmitted by infected blood (98.0%) and sexual contact (93.4%) and some (33.2%) thought that it could be transmitted by mosquitoes. Although the majority of them strongly agreed or agreed with the statement that “people with AIDS should be helped, supported and treated” (98.0%), about 40% and 70% of them, respectively, agreed or strongly agreed with the statement that infected people should be quarantined. Young teachers with a higher level of knowledge about HIV/AIDS had more positive attitudes.

Conclusion

This study provided basic information on school teachers’ AIDS knowledge and attitudes and showed that various misconceptions of HIV transmission were a matter of concern. A considerable number of respondents with undesirable attitudes toward HIV/AIDS indicates the need for education of teachers on the subject.

Changes in clients' care ratings after HIV prevention training of hospital workers in Malawi

OBJECTIVE

To examine the changes in clients' health-care ratings before and after hospital workers received an HIV prevention intervention in Malawi, which increased the workers' personal and work-related HIV prevention knowledge, attitudes and preventive behaviors.

DESIGN

Pre- and post-intervention client surveys.

SETTING

A large urban referral hospital in Malawi.

PARTICIPANTS

Clients at purposefully selected inpatient and outpatient units on designated days (baseline, n = 310 clients; final, n = 683).

INTERVENTION

Ten-session peer-group intervention for health workers focused on HIV transmission, personal and work-related prevention, treating clients and families respectfully and incorporating HIV-related teaching.

MAIN OUTCOME MEASURES

Brief face-to-face clients' interview obtaining ratings of confidentiality of HIV, whether HIV-related teaching occurred and ratings of service quality.

RESULTS

Compared with baseline, at the final survey, clients reported higher confidence about confidentiality of clients' HIV status (83 vs. 75%, P < 0.01) and more clients reported that a health worker talked to them about HIV and AIDS (37 versus 28%, P < 0.01). More clients rated overall health services as 'very good' (five-item mean rating, 68 versus 59%, P < 0.01) and this was true for both inpatients and outpatients examined separately. However, there was no improvement in ratings of the courtesy of laboratory or pharmacy workers or of the adequacy of treatment instructions in the pharmacy.

CONCLUSIONS

HIV prevention training for health workers can have positive effects on clients' ratings of services, including HIV-related confidentiality and teaching, and should be scaled-up throughout Malawi and in other similar countries. Hospitals need to improve laboratory and pharmacy services.

Undergraduate nursing student's attitudes towards caring for people with HIV/AIDS

The aim of this quantitative study was to determine the attitudes of Australian nursing students towards caring for people with HIV/AIDS. This research study was conducted among second year undergraduate nursing students at a university in South Australia, during August 2007. The survey tool consisted of six demographic questions and the AIDS Attitude Scale. This questionnaire was completed by 396 students, giving a response rate of 94.7%. The vast majority (95.7%) of students participating in this study demonstrated very positive attitudes towards caring for people with HIV/AIDS and only 4.3% demonstrated negative attitudes. No statistically significant differences were found in attitude score based on participants' age, gender, previous HIV/AIDS education, previous nursing experience or previous experience of caring for someone with HIV/AIDS. A statistically significant difference in AIDS attitude score was found in relation to participants' country/region of citizenship, with nursing students from China, East Asia, South East Asia, and Central Asia and Middle East having more negative attitudes than students from other countries/regions. As an increasing number of nursing students have been recruited to Australia from these countries/regions, nurse educators need to be aware of such differences when planning and delivering HIV/AIDS educational programs in tertiary institutions.

Decentralization of access to antiretroviral therapy in Cameroon: correlates of HIV physicians' knowledge in HIV care

BACKGROUND

Good knowledge in HIV care among physicians is a necessary prerequisite to effective antiretroviral therapy (ART) scaling-up in Sub-Saharan Africa.

METHODS

Between September 2006 and March 2007, a 27-item knowledge questionnaire was proposed to all HIV physicians working in 27 hospitals throughout six provinces of Cameroon. Physicians' responses were compared between the three levels of decentralization of the Cameroonian healthcare delivery system (χ(2) and Fisher tests). Correct responses were summed to build a knowledge score. Factors significantly associated with a higher score were identified using linear regression.

RESULTS

In total, 93 physicians filled in the questionnaire. Level of knowledge was globally good (median score 23), with no significant difference between the three levels of decentralization. Gaps in knowledge were observed regarding the use of cotrimoxazole and the follow-up of ART-treated patients. Main factors independently associated with a higher knowledge score included training, involvement in therapeutic committees, satisfactory collaboration with other practitioners and establishment of strong relationships between patients and patients' associations.

CONCLUSIONS

Overall knowledge in HIV care is good among HIV physicians working at all three levels of decentralization of healthcare in Cameroon. However, a national training policy should be set up to improve knowledge and practices in both ART follow-up and specific situations such as paediatric HIV. Collaboration between caregivers and external resources involved in HIV care should also be encouraged.

Improving universal precautions and client teaching for rural health workers: a peer-group intervention

Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.

Peer group intervention reduces personal HIV risk for Malawian health workers

PURPOSE

To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi.

DESIGN

Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection.

METHODS

The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences.

FINDINGS

Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors.

CONCLUSION

The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention.

CLINICAL RELEVANCE

Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.

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.

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.

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.

High HIV knowledge relates to low stigma in pharmacists and university health science students in Guyana, South America

OBJECTIVES

The objective of this study was to investigate HIV knowledge and its relation to HIV stigma among health science students and pharmacists in Guyana, South America. This study also evaluated how the Public Health Strengthening in Guyana Project's (PHSGP) HIV/AIDS/STI educational initiatives influenced HIV knowledge levels among health science students at the University of Guyana.

METHODS

A total of 119 individuals, consisting of pharmacists (n=42) and health science students (n=77) participated in this cross-sectional study. All participants completed validated measures of HIV knowledge and HIV stigma.

RESULTS

Overall, health science students scored high on knowledge about HIV risk factors and modes of HIV infection, but were less knowledgeable about more complex HIV treatment issues such as adherence and drug resistance. Students who had received educational HIV training had significantly higher levels of HIV knowledge than those who had not received training. Pharmacists had excellent knowledge regarding HIV risk factors and modes of infection, but had some important gaps in knowledge regarding the importance of HIV medication adherence and drug resistance. Overall, low levels of HIV stigma were endorsed, and those with higher HIV knowledge reported lower HIV stigma.

CONCLUSIONS

Although the HIV curriculum has enhanced HIV knowledge, gaps in HIV knowledge remain, such as complex HIV treatment issues. The results of this study are discussed within the context of the challenges of HIV capacity building in resource-poor countries.

The Pregnant Women with HIV Attitude Scale: development and initial psychometric evaluation

AIM

This paper is a report of the development and initial psychometric evaluation of the Pregnant Women with HIV Attitude Scale.

BACKGROUND

Previous research has identified that attitudes toward persons with HIV/AIDS have been judgmental and could affect clinical care and outcomes. Stigma towards persons with HIV has persisted as a barrier to nursing care globally. Women are more vulnerable during pregnancy. An instrument to specifically measure obstetric care provider's attitudes toward this population is needed to target identified gaps in providing respectful care.

METHODS

Existing literature and instruments were analysed and two existing measures, the Attitudes about People with HIV Scale and the Attitudes toward Women with HIV Scale, were combined to create an initial item pool to address attitudes toward HIV-positive pregnant women. The data were collected in 2003 with obstetric nurses attending a national conference in the United States of America (N = 210). Content validity was used for item pool development and principal component analysis and analysis of variance were used to determine construct validity. Reliability was analysed using Cronbach's Alpha.

RESULTS

The new measure demonstrated high internal consistency (alpha estimates = 0.89). Principal component analysis yielded a two-component structure that accounted for 45% of the total variance: Mothering-Choice (alpha estimates = 0.89) and Sympathy-Rights (alpha estimates = 0.72).

CONCLUSION

These data provided initial evidence of the psychometric properties of the Pregnant Women with HIV Attitude Scale. Further analysis is required of the validity of the constructs of this scale and its reliability with various obstetric care providers.

"I have lost sexual interest …"-challenges of balancing personal and professional lives among nurses caring for people living with HIV and AIDS in Limpopo, South Africa

As part of a capacity-building research project, this study examined the extent to which caring for people living with HIV and AIDS (PLWHA) affects both professional and personal relationships of nurse caregivers. The data were collected using focus group interviews with 17 female nurses at two Limpopo hospitals. The PEN-3 cultural model was used as a theoretical framework for exploring how nurses balance job demands with family responsibilities. The results generated three themes: the multiple identities nurses experience within their family and professional lives; nurse attitudes related to patient gender; and stigma experienced by nurses who care for PLWHA. Caring for PLWHA influences nurses' personal and professional lives by interfering with their perceptions and emotions as they relate to spousal, parental, and gendered relationships. The findings offer insight into factors requiring consideration when designing interventions to help nurses cope with the stress associated with caring for PLWHA while simultaneously managing family responsibilities.

Moral distress among Ugandan nurses providing HIV care: a critical ethnography

BACKGROUND

The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa.

AIM

To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people.

METHOD

A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions.

RESULTS

Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients' wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues.

CONCLUSIONS

The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.

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.

Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi

Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.

Impacts of a peer-group intervention on HIV-related knowledge, attitudes, and personal behaviors for urban hospital workers in Malawi

This report describes the effects of a peer-group intervention on Malawian urban hospital workers' HIV-related personal knowledge, attitudes, and behaviors. More than 850 clinical and nonclinical hospital workers received the intervention. Evaluation used independent surveys of a sample of workers at baseline (N = 366) and postintervention (N = 561). Compared with the baseline survey, after the intervention, workers had higher knowledge of HIV transmission and prevention; more positive attitudes including more hope, less stigmatization of persons with HIV, more positive attitudes toward HIV testing and condom use, and higher self-efficacy for practicing safer sex and for community prevention; more reported recent personal HIV tests, more discussion of safer sex with partners, and more reported community HIV prevention activities. However, health workers' risky sexual behaviors did not differ at baseline and postintervention. The intervention should be strengthened to support more sexual risk reduction and be made available to all health workers in Malawi.

The impact of HIV education on the lives of Ugandan nurses and nurse-midwives

In this ethnography, I explored the impact of an HIV/AIDS education program on the lives of 24 Ugandan nurses and nurse-midwives. Nurses who previously had viewed themselves simply as providers of advice and sympathy now saw themselves as more holistic, collaborative caregivers. They voiced an increased awareness of their role as leaders and advocates in the community with respect to policy. The education program had positive and synergistic effects on the nurses' professional practice, communication and problem-solving skills, confidence, and engagement in political and social change activities.

Knowledge, attitude and willingness of Nigerian physiotherapists to provide care for patients living with Acquired Immunodeficiency Syndrome

BACKGROUND AND PURPOSE

Adequate knowledge, positive attitude, and willingness to provide services are important factors in rendering competent and compassionate care to patients living with Acquired Immunodeficiency Syndrome (AIDS). Inadequate knowledge and poor attitude could exclude the application of the principles of logic and scientific methods to the practice of physiotherapy, and could result in fragmented care, with a potentially negative impact on treatment outcome and patient satisfaction. The purpose of this study was (1) to investigate the Nigerian physiotherapists' global knowledge, attitude and willingness to provide care for patients living with AIDS (PLWA), and to (2) determine the relationship between socio-demographic variables and previous encounter with PLWA, and physiotherapists' knowledge, attitude and willingness to care for AIDS survivors.

METHODS

Using a 90-item two-part questionnaire that elicited sociodemographic and previous AIDS encounter information, and also assessed knowledge, attitude and willingness to provide care to PLWA, physiotherapists (N = 131) practicing in Nigeria were surveyed.

RESULTS

Overall, the physiotherapists showed unsatisfactory knowledge about AIDS, harbored negative attitude towards PLWA, and some were unwilling to provide care for PLWA. Previous experience caring for PLWA influenced their attitude, and modest but positive relationships were found between knowledge and attitude and between attitude and willingness.

CONCLUSION

The study underscores the need to address Nigerian physiotherapists' working knowledge deficits and negative attitudes to PLWA. A comprehensive AIDS education that would assist clinicians in exploring their attitude, stereotype and bias against PLWA is warranted.

The Iranian female high school students' attitude towards people with HIV/AIDS: a cross-sectional study

BACKGROUND

Acquired Immunodeficiency Syndrome (AIDS) has become an important public health hazard in Iran. It is believed that AIDS-related knowledge does not necessarily translate into behavior modification. Hence, it has been suggested that culturally appropriate educational campaigns should be implemented to obtain satisfactory outcomes. Here, we evaluated the female high school students' attitude towards HIV/AIDS in Tabriz, Iran to assess the cultural needs for the related educational programs and to discover sources of information about AIDS.

RESULTS

Anonymous, self-administered questionnaires were filled by the young female students. Among 300 students, 91% agreed that being an HIV carrier should not be an obstacle to obtaining education and employment. Moreover, 72.5% of the students declared that the community should be informed of HIV-positive people. In addition, one-tenth declared that they would feel extremely uncomfortable towards their HIV infected classmate. In addition, only 16% of the students stated that they would continue to shop at HIV infected grocer's store. The mass media and the experts were the major source and the most reliable source of information about AIDS, respectively.

CONCLUSION

Tabrizian female students have overall negative attitudes towards HIV/AIDS. HIV/AIDS related educational campaigns should target the students, society and the families with emphasizing the leading roles of health staff.

Knowledge and attitudes of Ugandan midwives regarding HIV

In Uganda, 60% of HIV-infected adults are women of childbearing age. Considering this, midwives in Uganda play a pivotal role in reducing HIV transmission and providing high quality care to the many women and families affected by the disease. In this pilot study, investigators described the knowledge and attitudes of Uganda's private midwives regarding HIV. Overall knowledge levels were reported to be low, and the majority of participants reported overwhelming fear of contracting the disease from practice. Despite these challenges, the midwives' attitudes regarding HIV were positive. The results of this study support previous results. Additional studies focusing on midwives and traditional birth attendants in Uganda are warranted. The initiation of HIV continuing education programs and professional support for Ugandan midwives is also recommended.

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.

'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

Background

Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff.

Methods

A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews.

Results

HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences.

Conclusion

HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.

Knowledge, attitude, and willingness of Nigerian physiotherapy students to provide care for patients living with acquired immunodeficiency syndrome

In the current AIDS pandemics, equipping health professional students with adequate knowledge and positive attitude is necessary to produce graduates who can deliver appropriate intervention to patients infected with HIV or who have developed AIDS. The purpose of this study was 1) to investigate the Nigerian physiotherapy students' knowledge, attitude, and their willingness to provide care for patients living with AIDS (PWA) and to 2) determine the sociodemographic variables that could influence the students' attitude and willingness to provide care for PWA. Physiotherapy students (N = 104) in four training programs in Nigeria were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information, and Part II assessed knowledge, attitude, and willingness to provide care to PWA. Nigerian students showed unsatisfactory knowledge, harbored negative attitude, and many of them were unwilling to render care for PWA. Religious affiliation, training programs, long-term career goals, and previous instructions on AIDS influenced the students' attitude. The study identified the need for a comprehensive AIDS curriculum and recommend that all programs in Nigeria include clinical clerkship, small group discussions, and seminars on ethical and medico-legal issues on AIDS in their curriculum.

Identifying what rural health workers in Malawi need to become HIV prevention leaders

Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.

Understanding paradigms used for nursing research

AIMS

The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge.

BACKGROUND

Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry.

METHODS

We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution.

FINDINGS

A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies.

CONCLUSION

Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline.