Nurses' attitudes about acquired immunodeficiency syndrome care: what research tells us

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.

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.

Experiences of AIDS-dedicated nurses in alleviating the stress of AIDS caregiving

From the beginning of the AIDS epidemic, there have been individuals dedicated to the care of patients with AIDS. However, there has been little research regarding their perceptions and experiences of AIDS caregiving and the strategies they use to alleviate the stress and promote their willingness to care. Based on the experiences of 12 nurses at one hospital, who had chosen to work on an AIDS-dedicated unit, this exploratory study, conducted in 1998, explored the following: the physical, emotional or spiritual risks and stresses associated with AIDS caregiving; factors that provide resistance to the stresses of AIDS caregiving and promote a willingness to care; and strategies recommended by AIDS-dedicated nurses in caring for patients with AIDS. The data reveal important themes related to the physical stress of AIDS caregiving, specifically being aware of risks, but not paralysed by fear, and bombardment of the senses. The coping strategies of nurses included taking the risk in their stride, reframing the risk, and protecting oneself. The emotional stress of AIDS caregiving included witnessing suffering, experiencing unresolved grief, accepting diversity, being emotionally connected, distress from the dismantling of the AIDS unit and work demands, and declining team spirit. Coping strategies included balancing personal and professional life, releasing pain, respecting yet controlling feelings, managing demands, and asking for help. Nurses maintained their spiritual perspective. They experienced through AIDS caregiving a greater sense of shared humanity and a new perspective of life. Findings indicate that AIDS-dedicated nurses use many coping strategies. The experiences of these nurses can assist clinicians, educators and administrators in supporting nurses' caregiving and promoting the quality of care offered to patients with AIDS.

Nurse practitioner, nurse midwife and physician assistant attitudes and care practices related to persons with HIV/AIDS

Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.

The expressed needs of a group of HIV-infected gay men subsequent to hospital care

A qualitative study was conducted to explore how a group of HIV-infected gay men experienced their encounters with the health care community and to develop a theoretical understanding of the care given from the patient's perspective. Ten HIV-infected gay men were recruited from an outpatient clinic in a city in the southeastern part of the United States. Collection and analysis of data was conducted with a qualitative approach using a constant comparative method. The themes summarizing the findings were integration, recognition, security, availability of facilities, and confirmation. These themes contain both negative and positive experiences and conceptualize different needs from a patient's perspective. The role of the nurses' attitudes to and perceptions of gay HIV-infected men was emphasized.

Fear of contagion: a response to stress?

Most of the research on nurses' responses to people affected by AIDS has comprised atheoretical surveys or cross-sectional correlation studies. A decade ago, Meisenhelder and LaCharite were among the first to propose a theoretical explanation for these responses, including implications for altering them. They posited that "fear of contagion [is] an affective response of the stress-coping process ... [and] highlighted origins of the fear, behavioral manifestations, and avenues for exploration to decrease this perceived threat." This article reexamines the interpretation of the empirical data on which their proposition rested, places that data in the context of other research about the nurses' AIDS-care attitudes, including Meisenhelder's own subsequent research, and discusses the model's utility for anticipating and influencing nurses' behavioral response to HIV-affected populations.

A case for theory triangulation

Although theory triangulation has not received much attention in the nursing literature, its deliberate, strategic use can be an invaluable guide to reviewing literature and designing research. It can enlarge the framing of questions for orderly data collection and analysis, and can lay out a route for rational, coherent study-clustering. An example is presented that triangulates two nursing theories to address a frequently studied problem--nurses' attitudes about AIDS care. The absence of firm theoretical footing in exploring this problem has limited the application of a large, continuously growing body of empirical data. Triangulation is suggested to organize these data, to clarify apparently inconsistent findings, and to guide research. The example demonstrates how the exploration of related questions not addressed by a single theory may be aided by searching for linkages among mid-range theories, including theories from other disciplines.