Knowledge and Attitudes About AIDS Among Canadian Nursing Students: Educational Implications

Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review

TITLE

Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review.

AIM

This paper is a report of a literature review conducted to examine current research studies into attitudes of nursing students towards caring for people with HIV/AIDS and to identify factors that influenced those attitudes to inform current nursing practice and to develop nursing education regarding care provided to people with HIV/AIDS.

BACKGROUND

Attitudes of nurses towards people living with HIV/AIDS have long been scrutinized. Studies show that some nurses have negative attitudes and are reluctant to provide care to people with HIV/AIDS, resulting in poorer quality nursing support being provided. Attitudes of nursing students towards caring for people with HIV/AIDS is thus of vital importance since they become the future practising nurses.

DATA SOURCES

Eight electronic data bases were searched from 1996-2008.

REVIEW METHODS

Criteria used for study selection were: attitudes of nursing students towards caring for people with HIV/AIDS, primary research studies, published in English language in peer reviewed journals from 1996 to June 2008. Sixteen studies were identified for inclusion in this thematic review.

RESULTS

The following themes were identified: education and knowledge of HIV/AIDS; fear of contracting HIV/AIDS; reluctance to care for people with HIV/AIDS; homophobia; and stigma associated with HIV/AIDS.

CONCLUSION

There is reluctance on the part of some nursing students in specific regions of the world to provide care for people with HIV/AIDS. Educational programmes based on research evidence must play a leading role in developing strategies to help nursing students understand and overcome such attitudes.

Attitudes towards disability in an undergraduate nursing curriculum: a literature review

In the process of introducing a new disability unit into an undergraduate nursing curriculum in a New Zealand educational setting, the opportunity arose to conduct a small study comparing the attitudes of student nurses towards people with disabilities. This paper discusses the literature reviewed, which formed the basis for the study. A range of perspectives and research was identified that explored societal and nurses' attitudes, disability studies in undergraduate nursing curricula, the impact of nurses' attitudes on patient care, and interventions for changing those attitudes. Effective nursing care can be severely compromised through negative attitudes, and concerns are expressed at the lack of attention given to this issue in nursing curricula generally. The literature showed that combining educational approaches with opportunities for student nurses to interact with disabled people provides the most effective means for student nurses to develop positive attitudes towards disabled people. The goal for nurse educators is to ensure the inclusion of disability studies as a core component in undergraduate nursing education.

Students' knowledge, attitudes, and beliefs about AIDS: a cross-cultural study

This exploratory, comparative study was conducted to assess and compare the knowledge, attitudes, and beliefs toward AIDS between a group of Jordanian and a group of American students. A convenience sample consisting of 126 senior BSN (bachelor's of nursing) students, 63 from a university in Jordan and 63 from a university in Michigan, was selected for this study. A self-administered structured questionnaire was utilized. The questionnaire consisted of three parts: knowledge, attitudes, and beliefs toward AIDS in both cultures. Descriptive and inferential statistical analyses were used. The results indicated that the American students' responses concerning knowledge of HIV/AIDS were significantly greater (M = 73%) in comparison with Jordanian students' (M = 52%). The American students also reported more positive attitudes toward AIDS than those of their Jordanian counterparts. In terms of prevention of the spread of HIV/AIDS, more American students (82.5%) approved of the use of condoms as a precautionary measure toward the spread of the disease when compared to Jordanian students.

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS cases

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS case This study describes German nursing students' (n=180) knowledge and attitudes relating to HIV/AIDS, their homophobia level, willingness to care for people with AIDS, and their approach to possible sexual risk behaviours. A questionnaire was used to collect the data (response rate 97.8%). The results indicated that the nursing students had a rather high knowledge level concerning AIDS. However, there were gaps of knowledge, such as regarding AIDS immunopathology or the symptoms of the disease. Single nursing students and those having cared for a person with AIDS had a more thorough knowledge about the disease. In general, the attitudes towards AIDS and people with AIDS were tolerant and positive, and homophobia was only found with a small minority. Students having positive attitudes towards people with HIV/AIDS had less homophobia compared to those having negative attitudes towards persons suffering from AIDS. Those with positive attitudes were more willing to care for patients with HIV/AIDS, while those with a high homophobia level were less willing to do so. In addition, students having a high AIDS knowledge level tended less towards negative attitudes and homophobia than those with a low level of knowledge. The implications of the research for nursing education will be discussed.

Low versus high prevalence of AIDS: effect on nursing students' attitudes and knowledge

The purpose of this study was to compare AIDS knowledge and attitudes of baccalaureate nursing students living in a state with a high prevalence of AIDS and those who resided in a state with a low prevalence of AIDS. Students from the high-prevalence state had significantly higher AIDS knowledge scores than did students from the low-prevalence state. However, overall, respondents from the low-prevalence state viewed the person living with AIDS with more accepting attitudes than did the respondents from the high-prevalence state. Students in the high-prevalence state interacted with persons living with AIDS (PLWA) primarily through professional contact. In contrast, students in the low-prevalence state identified both personal and professional contact with PLWA as their most significant interactions. Personal experience of nursing students appears to be a key to decreasing stigmatization of PLWA.

Rogerian science: opening new frontiers of nursing knowledge through its application in quantitative research

This article discusses the theoretical and methodological considerations in selecting Rogers' science of unitary human beings as a framework for quantitative research. It elucidates how Rogerian science guided the research process in selected nursing studies.

Nurses' willingness to care for AIDS patients and spirituality, social support, and death anxiety

OBJECTIVE

Use Rogers' (1992) framework of the science of unitary human beings to examine relationships among spirituality, perceived social support, death anxiety, and nurses' willingness to care for AIDS patients.

DESIGN

Descriptive, correlational.

POPULATION, SAMPLE, SETTING

Population, female RNs in the New York City Metropolitan area who care for patients with AIDS. Convenience sample of 220 RNs who worked in eight hospitals either on AIDS-dedicated units (n = 88), or medical-surgical scatterbed units (n = 132) with a daily AIDS patient census of between 5% to 50%. Data were collected in 1992.

MEASURES

Spiritual Orientation Inventory, the Personal Resource Questionnaire-85, the Templer Death Anxiety Scale, and the Willingness to Care for AIDS Patients Instrument.

METHODS

Pearson product-moment correlations and hierarchical multiple regression analyses to test hypotheses.

FINDINGS

Willingness to care for AIDS patients was positively correlated with spirituality and perceived social support, and negatively correlated with death anxiety. Death anxiety moderated the relationship between spirituality and willingness to care. In total, 17% of the variance in nurses' willingness to care for AIDS patients was explained. Additional regression analyses indicated that group membership as either an AIDS-dedicated nurse or medical-surgical nurse did not moderate or change hypothesized relationships.

CONCLUSION

Because group membership explained 22% of the variance in willingness to care, the data indicate that group culture or professional identity should be further examined as predictors of nurses' willingness to care for AIDS patients.

CLINICAL IMPLICATIONS

Social support at work from administrators and colleagues, as well as the support from patients themselves is important to nurses and should be fostered.

Attitudes of baccalaureate nursing students toward persons with acquired immunodeficiency syndrome according to mode of human immunodeficiency virus transmission

The purpose of this descriptive correlational study was to (1) examine differences in baccalaureate nursing students' attitudes toward persons living with acquired immunodeficiency syndrome (AIDS) (PLWAs) according to mode of transmission and (2) identify demographic and academic variables influencing baccalaureate nursing students' attitudes toward PLWAs. Two hundred forty-six students from five geographically dispersed baccalaureate programs returned a completed demographic data sheet, AIDS Knowledge Scale, and AIDS Attitude Scale. The AIDS Attitude Scale, based on Goffman's theory of stigma, assesses stigmatizing attitudes, perceptions of deservedness of care, and attitudes of respect and regard for PLWAs according to five modes of human immunodeficiency virus transmission. The findings of this study demonstrated overall that baccalaureate students were the most stigmatizing toward persons who had developed AIDS through injecting drugs followed by sexual contact (both homosexual and heterosexual) and least stigmatizing toward PLWAs who contracted the virus through maternal transmission or a blood transfusion. Perhaps the PLWA who contracted AIDS through either maternal transmission or a blood transfusion was viewed as an "innocent victim" of the disease, whereas PLWAs who contracted the virus through either shared needles or sexual transmission were viewed as having acquired the infection through the results of their actions. The demographic characteristics of the respondents did not influence AIDS attitudes.

Correlates of Death Anxiety in Nurses who Provide Aids Care

Within Martha E. Rogers' framework of the science of unitary human beings [1–3], a descriptive, correlational study was done to examine the relationships among spirituality, perceived social support, and death anxiety in nurses who provide AIDS care. Death anxiety was also examined as a predictor of nurses' willingness to care for AIDS patients. A convenience sample of 220 female RNs who provided AIDS care completed the Templer Death Anxiety Scale, the Spiritual Orientation Inventory, the Personal Resource Questionnaire-85, and the Willingness to Care for AIDS Patients Instrument. Multiple regression analyses indicated that death anxiety was significantly correlated with spirituality and nurses' willingness to care for patients with AIDS, yet no significant relationship was found between death anxiety and perceived social support. Analyses further revealed that despite high levels of death anxiety, the majority of nurses had a positive perception of death. Several personal, professional, and employment characteristics were associated with death anxiety in nurses who provide AIDS care. Methodological implications are discussed.

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.

Predictors of Taiwanese nurses' intention to care for patients who are HIV positive

The purpose of this research was to explore the knowledge of, attitudes toward, and intention to care for HIV-positive patients among 223 Taiwanese nurses. They worked in many different settings and had a variety of levels of exposure to HIV-positive patients. The findings of this research revealed that most Taiwanese nurses lacked sufficient knowledge to prevent themselves from becoming infected in the workplace. Their attitude about giving care to HIV-positive patients was generally negative; most nurses stated that they did not intend to care for these patients. A regression analysis revealed that knowledge was not a significant predictor of intention. Attitudes about societal treatment of HIV-positive people and nursing care were significant predictors of intention. Implications for practice and education of Taiwanese nurses are discussed.

Using a wheelchair activity as a learning experience for student nurses

An experiential activity was conducted as part of a nursing course at a university in the Midwest to determine whether simulating a physical disability by using a wheelchair could be a valuable educational strategy. The goal was to increase nursing students' awareness of disability, sensitivity to people with disabilities, and understanding of the importance of self-efficacy, as well as to enhance their learning about the research process, which was one of the course objectives. While the results of this activity were not statistically significant, the content analysis of the qualitative data showed an effect on the experimental group. This analysis suggested that the enactment was a beneficial learning experience that increased nursing students' depth of understanding about what life is like for a disabled person in a wheelchair.

An educational program's effects on students' attitudes toward people with disabilities: a 1-year follow-up

The purpose of the study described here was to examine the attitudes of nursing students toward people with disabilities 1 year after the students had participated in an educational program on caring for such people. The program provided (a) information about this care, (b) simulated experiences related to different aspects of care, and (c) contact with disabled people as well as with rehabilitation health professionals. The study also examined how students' attitudes were influenced by the students' age, the number of years they had spent in the nursing program, their degree of experience in caring for people with disabilities, and their amount of personal interaction with disabled people. The Attitudes Towards Disabled Persons (ATDP) scale was administered to 67 nursing students before they completed the workshop. The participants were tested again 1 year later, thereby providing a matched group for examining attitude changes over time. The participants' attitudes were significantly more positive at the follow-up. At the 1-year follow-up, the ATDP scores of the intervention group were also compared with those of a second group of nursing students (n = 170) who had not participated in the educational program. The findings suggested that completion of the educational program was an important influence on students' development of positive attitudes toward people with disabilities.

The effect of prior experience in a rehabilitation setting on students' attitudes toward the disabled

The attitudes and reactions of rehabilitation nurses and nursing students toward patients with disabilities are important to the patients' adjustment and care over time. The purpose of this research study was to examine the effect of prior work experience and clinical experience in a rehabilitation setting on students' attitudes toward the disabled. The study involved the administration of Yuker, Block, and Young's (1966) Attitudes Toward Disabled Persons Scale (ATDP). Nursing students (N = 225) appropriately completed the ATDP before and 1 month after attending an educational workshop on care of people with disabilities. Prior work experience with such people was found to have a significant impact on student attitudes. Subjects with prior work experience in a rehabilitation setting had significantly higher scores on the ATDP, indicating more positive attitudes toward people with disabilities, than did subjects without this experience. Students who had clinical experience in a rehabilitation setting had higher scores on the ATDP than students without it, but the difference was not statistically significant.

Effects of an Educational Intervention on Students' Attitudes Toward the Disabled

The purposes of this study were to determine if the attitudes of nursing students toward the disabled would improve following participation in a one-day educational conference on care of the physically disabled and to identify variables influencing these attitudes. Nursing students completed Yuker and Block's Attitudes Toward Disabled Persons scale (ATDP) (1986) prior to and one month following the conference. T test indicated that subjects had significantly higher ATDP scores following the rehabilitation conference (p = < .0001). Subjects with prior work experience with the disabled had significantly higher scores on the ATDP, indicating more positive attitudes toward the disabled.

Structured Controversy Versus Lecture on Nursing Students' Beliefs About and Attitude Toward Providing Care for Persons with AIDS

Like many nurses in clinical practice, a small sample of RN-to-BSN nursing students reported their negative attitude toward providing care for persons with AIDS (PWA). Structured controversy is an interactive educational approach that may promote positive attitudes. This experimental study compared the effectiveness of structured controversy with lecture on BSN students' beliefs about and attitude toward providing care for PWA. A questionnaire, based on Ajzen and Fishbein's (1980) theory of reasoned action, was completed by 51 BSN students following an AIDS class session, and by nursing faculty. When compared with students who had listened to the lecture, students who had participated in structured controversy were more positive in general, and were significantly more positive on individual attitude and belief items. Faculty perceptions of these nursing students' beliefs and attitudes were less positive than the students' actual beliefs and attitudes.

Degree of Comfort in Providing Care to PWAs: Effect of a Workshop for Baccalaureate Nursing Students

A low-incidence area of HIV/AIDS was the site for this study, which examined baccalaureate nursing students' degree of comfort in providing basic nursing care to people with AIDS (PWAs), and determined the effect of a National Institutes of Health (NIH)-sponsored one-day workshop on HIV/AIDS on this degree of comfort. The pretest-posttest study revealed no statistically significant decrease after the workshop in the amount of discomfort associated with providing basic nursing care to PWAs. However, there were changes in the ranking of nursing procedures following the workshop. Included is a discussion of the workshop's effect on students' comfort level and implications for nurse educators. Ideas for related studies in the area of HIV health care are explored.