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

Tuberculosis infection control measures at health care facilities offering HIV and tuberculosis services in India: A baseline assessment

BACKGROUND

Tuberculosis (TB) is one of world's oldest infectious disease and ranks alongside HIV as leading infectious killer. Tuberculosis infection control especially in HIV and TB care facilities has warranted attention after the recent health care-associated outbreaks in South Africa. The aim of this study was to describe the tuberculosis infection control measures implemented by HIV and TB care facilities in five high HIV burden provinces in India.

METHODS

Baseline assessment of 30 high burden Antiretroviral centers and TB facilities was conducted during Oct 2015-Dec 2015 by AIC trained staff using a structured format.

RESULTS

Thirty HIV and TB care facilities in five high HIV burden provinces were enrolled. Facility infrastructure and airborne infection control practices were highly varied between facilities. TB screening and fast tracking at ART centers is happening at majority of centers however inadequate TB infection control training, poor compliance to administrative and personal protective measures and lack of mechanism for health care workers surveillance need attention.

CONCLUSIONS

Local specific TB infection control interventions to be designed and implemented at HIV and TB care facilities including implementation of administrative, environmental and use of personal protective equipment's with the training of staff members. Health care workers surveillance needs to be prioritized considering the rising instances of tuberculosis among Health care workers.

Translation to practice: a randomised, controlled study of an evidence-based booklet for breast-care nurses in the United Kingdom

BACKGROUND

In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs).

AIM

To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK.

METHOD

A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis.

RESULTS

A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue.

DISCUSSION

The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience.

CONCLUSIONS

This practical approach to research dissemination could be replicated and applied to other groups of nurses.

A Structured Interview Approach to Evaluate HIV Training for Medical Care Providers

HIV/AIDS education trainings and self-reported changes in provider behavior resulting from the trainings were evaluated in a structured interview with 24 health care providers. The participants were asked to provide concrete examples of behavior changes related to eight specific areas in the provision of HIV/AIDS medical care. The structured interview process also served as an effective needs assessment of future training topics and of the modalities desired by the providers. The authors' results suggest that by carrying out a structured interview of training attendees, training programs can be more precisely evaluated, and strengths and gaps in overall HIV/AIDS provider education can be better identified and addressed.

Continuing education at the cutting edge: promoting transformative knowledge translation

As the evidence-based practice movement gains momentum, continuing education practitioners increasingly confront the challenge of developing and conducting opportunities for achieving research uptake. Recent thinking invites new approaches to continuing education for health professionals, with due consideration of what knowledge merits uptake by practitioners, who should play what role in the knowledge transfer process, and what educational approach should be used. This article presents an innovative theory-based strategy that encompasses this new perspective. Through a facilitated experience of perspective transformation, clinicians are engaged in an on-the-job process of developing a deeply felt interest in research findings relevant to everyday practice, as well as ownership of that knowledge and its application. The strategy becomes a sustainable, integrated part of clinical practice, fitting naturally within its dynamic, unique environment, context, and climate and overcoming the barrier of time. Clinician experience of a top-down push toward prescribed practice change is avoided. With an expanded role encompassing facilitation of active learning partnerships for practice change, the continuing educator fosters a learning organization culture across the institution. The resultant role changes and leadership and accountability issues are elaborated.

Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran

OBJECTIVE

To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran.

METHOD

In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups - surgeons, surgical residents, physicians and medical residents - were assessed using a questionnaire.

RESULTS

Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r=0.397, p=0.030 and r=0.554, p=0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r=0.399, p=0.029) relationship between attitude and practice was found in surgical residents.

CONCLUSION

Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.

HIV care: continuing medical education and consultation needs of nurses, physicians, and pharmacists

This article explores the impact of provider characteristics on their HIV-related continuing medical education (CE) attendance, consultation needs, satisfaction with skills, and willingness to provide care. A total of 731 users (52% physicians, 26% nurses, 11% pharmacists, and 10% nurse practitioners and physician assistants) of an HIV consultation were surveyed by mail (76% response). Significant differences in provider variables were found to be related to HIV experience and profession. Experienced providers reported more CE, more satisfaction with skills, lower consultation needs, more consultations sought, and more willingness to take new patients than other providers. "Unwillingness" was commonly explained by concerns over quality of care or staying up-to-date. Relative to physicians, nurses had more CE hours, were more dissatisfied with their skills, and had greater consultation needs. Although all providers had high consultation or CE needs in some areas, accessibility to such programs is particularly important for low-volume providers.

Using nursing research projects to meet Magnet Recognition Program standards

The American Nurses Credentialing Center Magnet Recognition Program recognizes facilities that demonstrate excellence in nursing services, development of a professional milieu and growth and development of the nursing staff. The Magnet program is based on the American Nurses Association's which serves as the evaluation framework for determination of Magnet recognition. The role of research and its impact on nursing practice is an important criterion. The authors describe how one medical center successfully used ongoing nursing research projects to highlight how the institution met the Magnet standards.

Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program

The study assessed the impact of health care provider HIV/AIDS education and training on patient care from nine Special Projects of National Significance. Telephone interviews were conducted with 218 health care providers within 8 months, on average, following completion of training. Respondents provided examples of how the SPNS trainings affected their provision of patient/client care. Transcribed comments reflecting change in patient/client care were classified by independent coders under 1 of 10 broad practice change categories. Eighty-two percent of the trainees identified at least one instance of change in patient/client care as a function of their training experience. Self-reported findings included changes in the number/types of patients seen, interpersonal interactions with patients/clients, HIV testing and counseling practices, patient/family education, infection control, advocacy, referrals and collaboration, documentation, and other service changes.

Evaluation of a human immunodeficiency virus rule out tuberculosis critical pathway as an intervention to decrease nosocomial transmission of tuberculosis in the inpatient setting

Nosocomial transmission of Mycobacterium tuberculosis (TB) is a recognized risk in health care settings, and is a particular concern in settings where human immunodeficiency virus (HIV)-infected persons receive care. TB control guidelines have been effective in prevention of nosocomial TB outbreaks and protection of patients and health care workers. In 1993 a South Florida academic medical center noted an increase in TB cases, particularly in HIV-infected persons who had been inpatients. A multidisciplinary team developed an HIV Rule Out TB Critical Pathway as an intervention to deter nosocomial transmission of TB. The pathway was implemented in 1995 on the Special Immunology/Infectious Disease (SI/ID) inpatient unit. This paper describes an evaluation study conducted to determine the effectiveness of the pathway as an intervention to deter nosocomial TB in relation to two areas: (1) early identification of HIV-infected patients with potential TB, followed by immediate placement in respiratory isolation and (2) protection of SI/ID unit personnel from occupational TB exposure. A retrospective review was conducted in June 1999 on the medical records of all patients who had been placed on the HIV Rule Out TB Critical Pathway from 1995-1998. A review was also done of the medical center's confirmed TB cases, and employee health records for tuberculin skin testing (TST) of employees during this time period. The review demonstrated that all HIV-infected patients with confirmed TB had been identified, placed on the pathway and admitted to respiratory isolation at the onset of hospital admission, deterring the potential for a nosocomial TB outbreak. However, in 1998 two SI/ID staff converted from a nonreactive to a reactive TST. Although the pathway was only partially successful in TB protection for staff members, other factors may have caused the TST conversions. A study recommendation is that institutions develop an HIV Rule Out TB Critical Pathway, along with a Rule Out TB Pathway for patients who are not HIV-infected but present with symptoms that may be indicative of TB infection.

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.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

BACKGROUND

Educational meetings and printed educational materials are the two most common types of continuing education for health professionals. An important aim of continuing education is to improve professional practice so that patients can receive improved health care.

OBJECTIVES

To assess the effects of educational meetings on professional practice and health care outcomes.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE (from 1966), the Research and Development Resource Base in Continuing Medical Education in January 1999 and reference lists of articles.

SELECTION CRITERIA

Randomised trials or well designed quasi-experimental studies examining the effect of continuing education meetings (including lectures, workshops, and courses) on the clinical practice of health professionals or health care outcomes.

DATA COLLECTION AND ANALYSIS

Two reviewers independently applied inclusion criteria, assessed the quality of each study, and extracted study data. We attempted to collect missing data from investigators. We conducted both qualitative and quantitative analyses.

MAIN RESULTS

Thirty-two studies were included with a total of 36 comparisons. The studies involved from 13 to 411 health professionals (total N= 2995) and were judged to be of moderate or high quality, although methods were generally poorly reported. There was substantial variation in the complexity of the targeted behaviours, baseline compliance, the characteristics of the interventions and the results. The heterogeneity of the results was best explained by differences in the interventions. For 10 comparisons of interactive workshops, there were moderate or moderately large effects in six (all of which were statistically significant) and small effects in four (one of which was statistically significant). For interventions that combined workshops and didactic presentations, there were moderate or moderately large effects in 12 comparisons (eleven of which were statistically significant) and small effects in seven comparisons (one of which was statistically significant). In seven comparisons of didactic presentations, there were no statistically significant effects, with the exception of one out of four outcome measures in one study.

REVIEWER'S CONCLUSIONS

Interactive workshops can result in moderately large changes in professional practice. Didactic sessions alone are unlikely to change professional practice.