Satisfaction with nursing care: a comparison of patients with HIV/AIDS, non-HIV/AIDS infectious diseases, and medical diagnoses

Can socio-economic differences explain low expectation of health services among HIV patients compared to non-HIV counterparts?

Background

The health service of China has encountered significant challenges due to inequalities in socio-economic determinants of health. HIV patients are known to suffer from social stigma, and may receive inadequate responsiveness from health providers. Before assessing the responsiveness they receive, it is important to know their expectations. We aimed to compare levels of expectation towards the healthcare service among HIV and non-HIV patients with adjustment for socio-economic factors.

Methods

A cross-sectional study was conducted during January and February, 2015 among two consecutive groups of HIV positive and non-HIV patients in two hospitals in Kunming, China. Patients’ expectation towards eight domains of health system responsiveness was measured using 40 vignettes; five per domain. Each vignette was ranked from 1 “very good” to 5 “very bad”, and the responses were summed to obtain a total score for each domain. Differences in total scores were compared between the two groups and adjusted for other factors using multiple linear regression.

Results

The three domains with the highest scores, reflecting high expectation, were prompt attention, basic amenities and choice. Adjusted for other factors, HIV patients had significantly lower levels of expectation in all domains compared to the non-HIV group. Age was associated with the basic amenities domain, with young adults having higher expectations than other age groups. Minority ethnic groups had lower expectation towards dignity, prompt attention and autonomy domains compared to Han ethnicity. Those who lived in a home with 2–4 family members had higher expectations towards confidentiality than those who lived alone.

Conclusion

Patients with HIV have significantly lower levels of expectations even after adjusting for socio-economic factors. Assessment of health system responsiveness based on their judgments above may give biased results toward favorable service quality.

Providers' HIV-related avoidance attitude and patient satisfaction

OBJECTIVES

This article explores the associations between medical care providers' attitudes towards patients living with HIV (PLH) and the service satisfaction reported from general patients.

METHODS

Data were collected from 40 county-level hospitals in China, including 1760 service providers and 1000 patients receiving medical services from the hospitals. Provider and patient assessments were conducted by self-administered questionnaires and face-to-face interviews, respectively. Random-effect regression models were used to examine relationships between the providers' avoidance attitudes and patient satisfaction at the hospital level while taking into account variations in demographics and professional experience within each hospital.

RESULTS AND CONCLUSIONS

Service providers' avoidance attitudes towards PLH were negatively associated with general patients' satisfaction with service providers at the hospital level. The relationship was strong and significant whether or not adjustments were made for background characteristics. Medical care providers' stigmatizing attitudes towards PLH could be a reflection of the providers' general outlook with all patients. This study underscores a broader focus for HIV-related stigma reduction interventions in medical settings at both individual and institutional levels, targeting attitudes towards both patients with HIV/AIDS and the general patient population.

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.

How caring for persons with HIV/AIDS affects rural nurses

Prior research findings about caregiving for persons with HIV/AIDS indicate that caregiving impacts nurses in three separate domains: personal self as a nurse in practice; interactions with the nurse's family members, friends, and colleagues; and interactions with persons with HIV/AIDS. However the impact caregiving for persons with HIV/AIDS has on rural nurses has not been extensively explored. A qualitative study of rural registered nurses' experiences of caring for persons with HIV/AIDS was conducted to determine how caregiving affects registered nurses in rural areas. Content analysis was used to analyze rural registered nurses' written comments about their experiences of caring for persons with HIV/AIDS. Themes identified from the nurses' accounts of instances of caregiving were the perceived risk of acquiring the virus, a lack of concern about HIV/AIDS, and a need for ongoing continued education about the care of persons with HIV/AIDS.

HIV/AIDS Patient Satisfaction With Hospitalization in the Era of Highly Active Antiretroviral Therapy

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

Challenges to HIV service provision: the commonalities for nurses and social workers

Interdisciplinary collaboration can be enhanced through an understanding of the challenges and needs associated with service provision. This study explores the experiences of 192 service providers, with additional comparisons of nurses and social workers. Service providers reported fear of contracting HIV, feeling helpless, problems getting up-to-date information, grief and inadequate referral resources. Except for many more nurses expressing worry about contracting HIV, nurses and social workers shared many of the same problems. In addition, both groups were concerned with the comprehensive health needs of people living with HIV/AIDS. Moreover, they demonstrated shared professional values such as the importance of self-awareness and professional knowledge, positive and non-judgemental attitudes, and non-discriminatory treatment of client groups. This commonality makes nurses and social workers natural allies in responding to the many challenges associated with HIV service provision. Study findings support collaboration in the areas of service delivery, policy development, advocacy and professional development.

HIV-positive women and minority patients' satisfaction with inpatient hospital care

Although patient satisfaction has been examined in relation to HIV services for ambulatory and managed care, less is known about perceptions of hospital care, particularly for HIV-positive women and minorities. The purpose of this study was to examine HIV-positive women and minority patients' satisfaction with hospital care. The study was part of a larger funded study that explored potential health care disparities for HIV-positive women and minority persons in the era of HIV combination drug therapy. A convenience sample of 50 HIV-positive persons was recruited from four medical centers/hospitals in a South Florida community. The multi-ethnic sample included 31 women and 19 men. The survey tool used was Cleary's HIV-Infected Patient's In-Hospital Questionnaire. Findings revealed that participants were generally satisfied with their hospital care. Physicians, nurses, and the hospital environment received satisfactory ratings. However, several problem areas were identified, including pain management and education on side effects of HIV medications, indicating the need for interventions to improve care. Experimental AIDS drugs were discussed with less than half of the participants, suggesting that HIV-positive women and minority patients may not have equal access to clinical drug trials. Further research is also needed to determine whether attitudes conveyed by health care providers influence HIV-positive patients to be wary of advance directives. The competence of nurses experienced in acute-care nursing of persons with HIV/AIDS was an important factor in patient satisfaction. A lack of experienced acute-care AIDS nurses may ultimately lead to a decrease in HIV-positive patients' satisfaction with hospital care.

Patients tell of their images, expectations, and experiences with physicians and nurses on an AIDS-designated unit

Throughout the 1980s and 1990s, there were only a few studies addressing the relationship of health care professionals and patients with AIDS from the patient's viewpoint. This descriptive, qualitative study explored patients' perceptions and experiences with physicians and nurses on an AIDS-designated unit in New York City. The data reveal patients' physical and emotional images and expectations of physicians and nurses. In meeting their needs, patients expect physicians and nurses to attend to their physical needs as the priority but do not expect them to address their emotional and social needs. Although patients appreciate recognition of their spiritual needs, they attempt to avoid discussions about religion. Patients characterized "special" and "difficult" physicians and nurses. Patients emphasized the importance of establishing a caring relationship through the professionals' therapeutic use of self. With knowledge of what is valued by patients in their relationship with physicians and nurses, health professionals have an opportunity to reflect on their own caregiving experiences and learn ways of enriching and supporting those relationships with the intent of improving the quality of care.

Predictors of quality of life in AIDS patients

BACKGROUND

While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life.

OBJECTIVE

This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS.

METHODS

A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently.

RESULTS

The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores.

CONCLUSIONS

The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.

Patient satisfaction: a key concept for evaluating and improving nursing services

AIMS

The main purpose of this review was to explore the meaning of patient satisfaction and present the theoretical background and the definitions which developed in nursing.

BACKGROUND

Today, there is an increasing interest in patient satisfaction which is considered a valid indicator of the quality of care.

ORIGINS OF INFORMATION

An extensive literature review was performed by using the MEDLINE database.

DATA ANALYSIS

Data was classified and analysed by using the content analysis approach.

KEY ISSUES

The principal finding of this review was the lack of attention to the meaning of patient satisfaction, the development of theoretical frameworks and the psychometric properties of the developed instruments.

CONCLUSIONS

Nurses need to develop valid and reliable instruments to measure patient satisfaction in order to improve the quality of care and make their work visible.

Knowledge, Perceptions, and Practice of Nurses Toward HIV+/AIDS Patients Diagnosed With Tuberculosis

BACKGROUND

Tuberculosis (TB) continues to be a major health problem in the United States. Nurses may be exposed to TB and not realize their risks for becoming infected. The presentation of HIV-associated TB is somewhat different from "standard TB."

PURPOSE

The purpose of this study was to determine if an educational program could improve nurses' attitudes, level of knowledge, and compliance with infection control standards for HIV/AIDS patients diagnosed with TB.

METHOD

Participants included 50 staff nurses. The experimental group (35) and control group (15) completed a knowledge test and an attitude survey. Researchers observed participants for compliance with infection control standards pretest and posttest.

RESULTS

Following an educational program, the experimental group demonstrated a greater knowledge of TB than the control group who did not participate in the educational program (F [1.47] = 14.43, p = .000). In addition, the experimental group had a greater improvement in their Nursing Intervention Observation Tool adherence to respiratory isolation and universal precaution protocols scores as compared to the control group (F [1.47] = 8.95, p = .004). However, there was not a tangible increase in knowledge level of AIDS, attitudes or concerns about caring for these patients.

CONCLUSION

This nursing research study supports the need for an ongoing educational program with continual monitoring of infection control practices to positively affect client and caregiver outcomes.