Fear of contagion and AIDS: nurses' perception of risk

Anxiety and Insomnia Mediate the Association of Fear of Infection and Fatigue: A Cross-Sectional Survey of Nurses Deployed to a COVID-19 Epicenter in China

Background

This study aimed to test the mediating role of anxiety and insomnia in the association between fear of infection and fatigue.

Methods

A cross-sectional questionnaire survey was conducted on the nurses deployed to Heihe. A serial multiple mediation model was established to determine the role of anxiety and insomnia in the association between fear of infection and fatigue.

Findings

Over half (53.0%) of the study participants reported experiencing fear of infection despite stringent personal protection measures. The scores of anxiety (11.87±5.19), insomnia (16.33±5.95), and fatigue (45.94±12.93) were moderately correlated, with a Pearson correlation coefficient ranging from 0.501 to 0.579. Anxiety, either alone or in combination with insomnia, mediated the association between fear of infection and fatigue.

Conclusion

The findings suggest that anxiety and insomnia play a mediating role in the relationship between fear of infection and fatigue. These results emphasize the importance of implementing targeted mental health interventions and work arrangements to address the well-being of healthcare professionals.

Spanish nurses' experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal

AIMS AND OBJETIVES

Explore nurses' experiences and perception of risk regarding the use of personal protective equipment during the first wave of the pandemic in Spain.

BACKGROUND

The contribution of our study is to use qualitative methods to understand nurses' experiences and perceptions of the risk of the contagion linked to the shortage of PPE during the first wave of the pandemic, whose explosive start strained health systems around the globe.

DESIGN

Qualitative descriptive design according to the Rapid Research Evaluation and Appraisal model.

METHODS

Semi-structured videoconference interviews were conducted to explore the experiences of 29 nurses including staff nurses, nursing supervisors and nursing directors from hospital and community services of the Spanish health system. Interviews lasted 30-45 min and were conducted in May 2020. We carried out a thematic analysis using Dedoose. The COREQ checklist was used to report findings.

RESULTS

We identified the following themes and subthemes: 1. Experiences with personal protective equipment: scarcity, inequality, reutilization, self-protection, delegation of responsibility, and gap between protocols and reality; 2. Perception of the risk of contagion: lack of credibility, lack of trust, lack of support, and meeting subjective needs.

CONCLUSIONS

The scarcity of personal protective equipment and inequality in its distribution led nurses to take initiatives to feel more protected. Mid-ranking supervisors were caught between the responsibility of monitoring and rationing personal protective equipment and providing the necessary protection to nurses. The disjuncture between protocols and the available supply of personal protective equipment caused confusion. Lack of credibility, lack of trust and lack of support from management influenced participants' perception of the risk of contagion. Mid-ranking supervisors were often responsible for trying to alleviate fear among nursing staff.

RELEVANCE TO CLINICAL PRACTICE

Understanding the factors involved in risk perception can be helpful to decision-makers who help protect nurses in clinical practice. These results can help administrators and policymakers because they point to the need for nurses to feel that their departments and centers look after their safety at work. Transparent communication and emotional support may contribute to their well-being in the face of risk.

Keeping secrets, disclosing health information: an institutional ethnography of the social organisation of perinatal care for women living with HIV in Canada

This paper describes findings from an institutional ethnography that arose out of the concerns of women living with HIV in Ontario, Canada, regarding the disclosure of their HIV status while accessing perinatal care. The enquiry traces the connections between women's experiences of perinatal care, the activities of healthcare providers delivering such care and the ruling relations that organise women's experiences and healthcare providers' activities. Focusing on HIV disclosure as a concern expressed by women, the findings make visible the day-to-day, routinised practices of healthcare providers working in perinatal care for women living with HIV, as well as the ideological discourses of 'fear of contagion' and 'AIDS hysteria' that contributed to producing the kinds of care experiences that were articulated by women. Opportunities to strengthen perinatal care policies and practices for women living with HIV are discussed.

Aids Education Needs Assessment: A Comparative Study of Jail and Prison Correctional Officers

To ascertain HIV/AIDS knowledge levels and the education needs of correctional officers in jails and state prisons in northwest Florida, a needs assessment instrument was administered in the workplace. State law requirements mandating annual HIV/AIDS training for correctional officers led to a hypothesis that state prison correctional officers would have greater knowledge levels than jail correctional officers, who do not have regularly scheduled training as there is no mandated program on the local level. On the whole, knowledge levels were good in both groups, with prison correctional officers scoring better than correctional officers in the jails on most items. However, statistical and item analyses of responses suggest that both groups generally are unable to consistently distinguish between various behavioral risk situations, at times rating similar risk situations very differently. This research is consistent with other studies whose results suggest that designs for educational programs intended for adults should employ an adult learning theory framework. Education better tailored to the environment and to the age and learning requirements of participants increases the probability that learners will be prepared to make effective decisions in the workplace.

Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.

Emotional and behavioral consequences of bioterrorism: planning a public health response

Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.

HIV/AIDS and health care workers: contact with patients and attitudes towards them

Data on a range of variables associated with contact with patients with HIV/AIDS and attitudes towards them were collected from 174 Scottish health care workers. Measures of attitudes and contact (overall, social and physical) were derived from the scales devised by Pleck et al. (1988). The measure of overall contact was not significantly related to attitudes, but those with predominantly social contact with patients with HIV/AIDS had more positive attitudes towards them. This relationship was moderated by occupational characteristics, concern about working with people of unknown HIV status and neuroticism. With all these variables controlled, including social contact, those who had not received in-service training relating to HIV/AIDS had more negative attitudes. The results are discussed with regard to the measurement of social contact with patients, salient beliefs, the occupational characteristics associated with attitudes, and in-service education.

Primary health care in the era of HIV/AIDS. some implications for health systems reform

In this article it is argued that the current emphasis on third generation reforms to health systems places at risk the empowering comprehensive agenda of second generation reforms. Using the HIV/AIDS epidemic in South Africa as an exemplar, the authors demonstrate the importance of retaining this agenda. They suggest that the emphasis on 'packaged' priority programmes with measurable outcomes, which characterizes third generation reforms, needs to be accompanied by the reorientation of primary health care providers towards an empowering comprehensive approach to care. In addition, using psychodynamic principles, they also show how certain aspects of the health care system need restructuring to provide containment and support for such care.

Psychological stress among hospital doctors caring for HIV patients in the late nineties

To assess stress and satisfaction related to HIV medical work and its impact on psychological wellbeing, a cross-sectional study was undertaken among the population of doctors caring for HIV/AIDS patients in French hospitals. They were sent a questionnaire on demographic and professional characteristics along with three additional scales: the Consultants Mental Health Questionnaire with three components - stress, satisfaction and responses to job stress; the Maslach Burnout Inventory; and the GHQ-12 (General Health Questionnaire). A total of 670 physicians responded anonymously (65.4% participation). For 45% of respondents, HIV/AIDS represented less than 25% of their activity. Three dimensions were extracted by multivariate analysis from the stress scale (overload, social relationships at work, patients/family distress) and four dimensions from the satisfaction scale (work content, patients/family, peer recognition, work environment). Length of time working in HIV/AIDS, and proportion of clinical work in HIV/AIDS were not related to either stress or satisfaction. Only participation in NGOs increased the level of stress. Stress was not related to time spent in clinical work, neither to HIV work. Satisfaction derived from work decreases with time in direct contact with patients and is mainly related to the position in hospital. Eleven per cent sought help from professionals for psychological problems. Stress derived from patients suffering was not related to any psychological outcomes. Work overload and stress derived from social relationships at work are the main predictors of psychological distress, emotional exhaustion and depersonalization, while the moderator effect of satisfaction is weak. In the late nineties, the amount of HIV work did not appear as a specific feature of hospital medical work.

Influence of a Persuasive Strategy on Nursing Students' Beliefs and Attitudes Toward Provision of Care to People Living With HIV/AIDS

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.

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.

Measuring the stress associated with caring for clients with HIV/AIDS

The AIDS-stress scale (Pleck et al., 1988) provides measures of the sources of stress faced by health care workers caring for people with AIDS. The aim of the study was to consider the utility of the scale as a means of identifying groups of health care workers who would benefit from intervention. Data were collected from a sample of Scottish health care workers (n = 140), all with known contact with clients with HIV or AIDS within the year prior to data collection. Three factors were derived from the AIDS-stress scale: 'lack of knowledge', 'discomfort' and 'work load'. Each showed a different pattern of association with occupational, training and attitudinal measures. The factor scores had some degree of concurrent validity and were not, in the main, associated with the desire to give socially desirable responses. The results were discussed in relation to appropriate interventions.

Health care workers and HIV/AIDS: a critical review of the literature

This paper reviews the extensive literature which looks at the impact of HIV/AIDS on health care workers (HCWs). The knowledge and attitudes of HCWs toward people with HIV/AIDS and other relevant attitudes, for example those regarding male homosexuality have been widely studied whereas attitudes to intravenous drug use are perhaps under-investigated. Three major themes of the literature are examined. These are fear of infection, beliefs about the right to refuse care and the stresses associated with caring for HIV positive people. A number of educational interventions which attempt to change HCWs attitudes and beliefs are reviewed. Some notable gaps in the literature are identified. Neglected areas include attitudes to women, people of colour and consideration of the organizational and societal factors mediating the impact of HIV upon healthcare workers. Limitations of the research techniques used are identified and future implications for health care workers are considered.

Infection control and human immunodeficiency virus: perceptions of risk among nurses and hospital domestic workers

In December 1993 the first case of patient-to-patient transmission of human immunodeficiency virus (HIV), at a doctor's surgery in New South Wales, was documented. In an environment of heightened anxiety about HIV transmission and the adequacy of infection-control measures taken by health providers, it is important to explore perceptions of occupational risk of exposure to infection among hospital workers, reasons why hospital domestic workers sometimes depart from standard procedure in infection control, and how they regard the patients who have infectious diseases. In this study, at an infectious diseases hospital where there is an acute awareness of such issues, nurses had accurate knowledge about control of infection, including HIV, but had limited trust of that knowledge. They gave rationales for why they sometimes departed from infection-control procedures. They had low levels of fear of homosexuals and of acquired immune deficiency syndrome. The hospital domestic workers had lower levels of accurate knowledge about infection control, including HIV, and less trust of that knowledge and of protection by health provider from occupational exposure to infection. They had low levels of fear of homosexuals and HIV. Both groups sought regular, small-group, interactive education programs on infection control and HIV to allow them to discuss their concerns. Participatory education of workers should include eliciting concerns of participants, and should discuss concerns regarding administrators' and educators' interests in their safety and wellbeing.

Responding to a challenge: nursing care and AIDS

Those providing nursing services have been at the forefront in responding to the AIDS epidemic. This paper poses the question as to what extent AIDS work makes unique demands of nursing staff. It explores the implications of AIDS-related nursing work and considers these within the broader context of the role of nurses and their work environment. Although intense, many of the demands of AIDS-related work are also features of nursing in other contexts. There is thus potential to draw on already formulated training responses and to contribute significantly to ongoing debates about nursing and nurse education.

The impact of working with people with HIV/AIDS: a review of the literature

This review describes and discusses research on the experiences of professionals and volunteers who work face-to-face with people with HIV/AIDS. Although there is a rapidly growing body of research which examines the attitudes and experiences of staff involved in HIV/AIDS service provision, this work has, as yet, failed to produce a comprehensive picture of the ways in which the demands of HIV/AIDS-related work differ from those of other fields of work. Because studies have differed considerably, both in terms of focus and methods, few systematic comparisons between the experiences of different professional groups have been made. Research must have a comparative focus if we are to begin to distinguish those demands which are unique to HIV/AIDS from those to which satisfactory responses may have already been developed in parallel fields of work. Much of the work to date has assumed that the demands inherent in AIDS work are self-evident, but has failed to contextualize AIDS work in relation to other fields of service provision, the personal circumstances and career paths of workers, and the organizational structure within which work takes place. The studies have provided very little information about the process of adaptation to AIDS work and the rewards which may offset some of the stresses and demands of the work. This review attempts to provide a comprehensive overview of the research which has been carried out in relation to workers in different locations responding to different epidemic patterns and demands on services. It also attempts to contextualize the demands of HIV/AIDS-related work by comparing the demands and responses reported with regard to other types of work and makes recommendations for future research.

Safe working practices and HIV infection: knowledge, attitudes, perception of risk, and policy in hospital

OBJECTIVES--To assess the knowledge, attitudes, and perceptions of risk of occupational HIV transmission in hospital in relation to existing guidelines. DESIGN--Cross sectional anonymous questionnaire survey of all occupational groups. SETTING--One large inner city teaching hospital. SUBJECTS--All 1530 staff working in the hospital in October 1991 and 22 managers. MAIN MEASURES--Knowledge of safe working practices and hospital guidelines; attitudes towards patients with AIDS; perception of risk of occupational transmission of HIV; availability of guidelines. RESULTS--The response rate in the questionnaire survey was 63% (958/1530). Although staff across all occupational groups knew of the potential risk of infection from needlestick injury (98%, 904/922), significantly more non-clinical staff (ambulance, catering, and domestic staff) than clinical staff (doctors, nurses, and paramedics) thought HIV could be transmitted by giving blood (38%, 153/404 v 12%, 40/346; chi 2 = 66.1 p < 0.001); one in ten clinical staff believed this. Except for midwives, half of staff in most occupational groups and 19% (17/91) of doctors and 22% (28/125) of nurses thought gloves should be worn in all contacts with people with AIDS. Most staff (62%, 593/958), including 38% (36/94) of doctors and 52% (67/128) of nurses thought patients should be routinely tested on admission, 17% of doctors and 19% of nurses thought they should be isolated in hospital. One in three staff perceived themselves at risk of HIV. Midwives, nurses, and theatre technicians were most aware of guidelines for safe working compared with only half of doctors, ambulance, and paramedical staff and no incinerator staff. CONCLUSIONS--Policy guidelines for safe working practices for patients with HIV infection and AIDS need to be disseminated across all occupational groups to reduce negative staff attitudes, improve knowledge of occupational transmission, establish an appropriate perception of risk, and create a supportive and caring hospital environment for people with HIV. IMPLICATIONS--Managers need to disseminate policy guidelines and information to all staff on an ongoing basis.

Anxiety and perception of risk of HIV and hepatitis B infection among health-care workers reporting accidental exposures to blood and other body fluids

We noticed considerable variation in anxiety among staff reporting blood exposure incidents and therefore undertook a study to investigate this. We studied 100 consecutive staff reporting blood or other body fluid exposures to the Occupational Health Unit. The nurse seeing the staff member administered a questionnaire about worries related to the incident, knowledge of HIV and hepatitis B transmission risks, perception of risk from the particular incident and predicted reaction of others that would be told. Level of anxiety was recorded on a visual analogue scale. Staff were then given information and counselling as usual, and asked to re-attend after a week, when the questionnaire was repeated. We found that the initial level of anxiety was not related to knowledge of HIV or hepatitis B transmission risks, but was related to perception of risk from the incident and to predicted reaction of others that would be told. The eight staff involved in exposures to known HIV-infected blood were not more anxious than the remainder. There was a reduction in anxiety between visits, which was significantly greater in women, in those who had a non-parental exposure and in those where the source patient was known. Knowledge of transmission risks also improved significantly between visits. This study underlines the importance of adequate counselling of staff who have suffered blood exposures.

HIV-related knowledge and attitudes among medical students in China

A modified version of the 'WHO/KABP Questionnaire for Students' was administered to 302 students at a medical university in China. The instrument included items to assess the students' demographic background, knowledge of AIDS/HIV, attitudes about AIDS, as well as towards people infected with HIV, those groups commonly labelled as 'high risk' and toward sources of information. The average score on the knowledge scale was 80% correct. There was a substantial disparity in knowledge between how HIV is transmitted and how HIV is not transmitted--90% of the former items were answered correctly, while only 72% of the latter were answered correctly. Over 40% of the sample blamed prostitutes for AIDS in China, whereas 22% blamed drug addicts and 6% blamed homosexuals. Two-thirds of the sample indicated that they thought people with AIDS got what they deserve. About one-third of the sample supported quarantine measures as well as keeping infected students out of classrooms. Nearly half of the sample indicated that they did not trust any of the official sources of health information we asked about and 27% said that they thought the government was concealing information about AIDS.

Recurrent themes of concern in groups for health care professionals

This paper reports of recurrent themes of concern about AIDS expressed by health care professionals participating in small group sessions. Three dominant themes emerged: fear of contagion, homophobia, and attachment and loss. For each of these themes the possible meanings are explored. Fear of contagion was the dominant theme and is discussed as both a possible expression of displaced homophobia and a 'catastrophic' risk factor (extreme negative consequence). The need of health care professionals to see themselves as 'different' from the person with AIDS is also discussed. Professionals also discussed the emotional burden of caring for young patients often similar in age to themselves. It is suggested that hospital policy makers need to accept the reality of staff concerns and provide adequate forums for expression of concerns since without an opportunity for thoughtful discussion, health care professionals may espouse the 'correct' position and attitude, but believe and practise something else.