Perceived risk of infection and attitudes toward risk groups: determinants of nurses' behavioral intentions regarding AIDS patients

Influence of Risk Perception on Task and Contextual Performance: A Case of Work-Related Musculoskeletal Disorders in Nurses

Assessing the risk perception of workers can be very informative in predicting their behavioral outcomes, including task and contextual performance. Yet, research to assess the effect of risk perception on task performance and contextual performance remains scarce. Thus, this study explored the effect of risk perception of work-related musculoskeletal disorders on task and contextual performance in nurses. This study further examined safety behavior as a mediator of these relationships. Using structural equation modeling, the researchers examined these relationships by employing a cross-sectional survey with a quantitative approach. The data was collected via questionnaires from 382 nurses who work in three major hospitals in Accra Metropolis, Ghana. The results showed that nurses' risk perception positively influenced their task and contextual performance, and that safety behavior partially mediated the effects of risk perception on task and contextual performance. This study offers a theoretical framework and empirical evidence for the concept of risk perception and its association with safety behavior, task, and contextual performance. To the best of our knowledge, this is the first study to assess the relationships that exist among these variables. Thus, future studies are needed to verify the causality of the relationships.

Combating HIV stigma in low- and middle-income healthcare settings: a scoping review

INTRODUCTION

Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research.

METHODS

We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews.

RESULTS AND DISCUSSION

Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings.

CONCLUSIONS

Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

Stigma: Its impact on professional responses to the needs of marginalised groups

The stigma associated with drug-use, prostitution and mental and physical illness is not just an experience, it is an active and dynamic process which is often perpetrated by professional responses. Stigma is a complex social phenomenon which resists simple definition. This paper examines the concept of stigma in relation to deviance and explores the notion of a trajectory from one to the other. It highlights the influence of public perceptions of deviance on drug abuse and explores the particular implications for female drug-users. By considering how the actions of health professionals may be reinforcing deviant labels, it emphasises the urgent need for educational interventions. Health professionals need to understand the sociological basis of stigma to create a consciousness of their own professional action. They are in a unique position to intervene and cut across this trajectory to promote awareness and change.

Knowledge and perceptions of HIV/AIDS among Cameroonian nursing students

The HIV/AIDS pandemic impacts people throughout the world and is complicated by fear, prejudice, and stigma. Nurses play a major role in the health care delivery systems, yet in many parts of the world with high HIV sero-prevalence rates, nurses lack sufficient training and education to provide care to patients with HIV/AIDS. In an effort to build capacity and improve knowledge, attitudes and beliefs regarding care of patients with HIV/AIDS, a 4-day workshop was provided by American nursing students for Cameroonian nursing students. The training program included HIV epidemiology, disease management, and natural course of the disease, testing, legal and ethical issues, and infection control practices. Pre- and post-test scores were calculated using a series of surveys that measured HIV-related knowledge, attitudes, and beliefs. Results indicated that these measures of HIV-related perceptions improved due to the train-the-trainer workshop.

Regional differences in HIV prevalence and individual attitudes among service providers in China

We examined the relationships between a region's HIV prevalence and HIV-related knowledge, perceived risk of HIV infection, perceived institutional support for HIV care, and avoidance attitude toward persons living with HIV (PLH) among service providers in China. Data were collected from 40 county-level hospitals in two provinces, including 1760 service providers. Multi-sample standardization and decomposition analysis was performed for HIV knowledge, perceived risk, institutional support, and avoidance attitude toward PLH. After adjusting for potential confounders, service providers from the province with higher HIV prevalence perceived a higher risk of contracting HIV at work, recognized more institutional support for HIV care, and reported a lower level of avoidance attitude toward PLH compared to those from the province with lower HIV prevalence. After confounding factors were standardized across provinces, occupational exposure experience was determined to be the strongest influence on the discrepancy of avoidance attitudes in the two provinces. Regional contextual factors could shape individual providers' attitudes and beliefs and impact the quality of care. Stigma reduction interventions need to be culturally tailored and region-specific.

Caring, chaos and the vulnerable family: experiences in caring for newborns of drug-dependent parents

BACKGROUND

Infants exposed to intrauterine drugs present a number of challenging features with which the new mother is faced. They can be irritable, unresponsive, and unpredictable. Available treatments require specialised neonatal care for the first four to six weeks of life; a critical time for the parent-infant attachment relationship to develop. Neonatal nurses have the opportunity to promote this development and ameliorate the effect of other developmental risk factors the baby is likely to experience.

OBJECTIVES

The aim of this study was to explore neonatal nurses' experiences of providing care to drug-exposed newborns and their parents throughout treatment for neonatal abstinence syndrome (NAS).

DESIGN, SETTING AND PARTICIPANTS

This study used interpretive methods by conducting group interviews with eight neonatal nurses in each of four Special Care Nursery Units in South-East Queensland, Australia.

RESULTS

Barriers to promoting the parent-infant attachment relationship were found to be both attitudinal and organisational. These barriers were significant, and were seen to impact negatively on optimal care delivery to this vulnerable population.

CONCLUSIONS

Unfortunately, the results of this study indicated that management of these babies and their parents is compromised by a range of attitudinal and organisational factors. There is a need to address these barriers to optimise care delivery and improve the way in which neonatal nurses impact on parent-infant relationships.

Factors affecting perceived risk of contracting severe acute respiratory syndrome among academic physicians

SARS disproportionately affects healthcare providers. A physician survey was administered within three hospitals providing care to SARS patients. Knowing a colleague who contracted SARS and previous occupational exposure to infectious agents were significantly predictive of greater perceived risk, whereas perceived effectiveness of precautions and provision of direct care were not.

A study of attitudes toward sexuality issues among health care students in australia

SUMMARY This study examined the attitudes of 1132 higher education students enrolled in health profession education degree programs. Students were asked to indicate their anticipated level of comfort in a variety of interactions including working with a lesbian client or a homosexual male, and asking a client about his or her sexual orientation. Students also indicated whether they perceived their degree program had dealt adequately with these issues. High levels of discomfort were identified in our large sample of students. Approximately 30% of the sample indicated they would be uncomfortable working with a lesbian client and 27% of the sample indicated that they would feel uncomfortable if working with a male homosexual client. There were significant differences for these two items depending on the student's gender. Female students indicated significantly higher levels of comfort in dealing with homosexual male clients than did their male counterparts. Male students indicated significantly greater comfort in dealing with lesbian clients. More than half of our sample indicated that they would not be comfortable asking about a client's sexual orientation. Over 75% of senior-year students believed that their degree program had not adequately dealt with these issues. The impact of homophobia and discomfort on the quality of care health professionals provide for lesbian and gay clients and the role of educational strategies to reduce this are discussed.

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.

Predictors of rural critical care nurses' willingness to care for people with AIDS

The purpose of this study was to examine the relationship between rural critical care nurses' attitudes about acquired immunedeficiency syndrome (AIDS) and people with AIDS (PWAs), and their willingness to provide care to AIDS patients. Sixty-one critical care nurses in nine rural counties in the northeastern USA completed a mailed questionnaire as part of a larger study of 957 rural nurses. A bivariate logistic regression analysis revealed a relationship between willingness to provide care and positive attitudes about homosexuality, nursing care concerns, and professional-societal concerns. However, a multivariate logistic regression indicated that the most significant factors influencing rural critical care nurses' willingness to care were their feelings of not being prepared to care for people with AIDS, and their anxiety and fears about contracting the disease from their patients. These findings add insight into the care of critically ill AIDS patients and support the need for continuing educational efforts in rural areas of the USA to address critical care nurses' concerns.

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.

Personal and social determinants of rural nurses' willingness to care for persons with AIDS

The purpose of this study was to investigate the individual and social determinants of rural nurses' willingness to care for people with AIDS (PWAs). Willingness to care was viewed as a function of nurses' personal attitudes about AIDS care and PWAs; the influence of normative (significant others), comparative (the nursing profession), and generalized (the rural community) reference group norms on these attitudes; and how much importance respondents placed on membership in these reference groups. Responses to a mailed questionnaire from 615 rural nurses were analyzed. Individual determinants were nurses' feelings of preparedness and favorable attitudes about their personal safety when administering care. Social determinants were the degree of upset of respondents' significant others about their caring for AIDS patients and favorable attitudes of the respondents about professional and social concerns related to AIDS.

Orthodox Christian beliefs and homophobia in baccalaureate nursing students

Religion is an important factor in attitudes formed about groups, specifically homosexuals. Nursing education does little to inhibit homophobia in students. Sophomore (n = 87) and senior (n = 87) nursing students completed a demographic questionnaire, the Index of Homophobia (IHP), the Christian Orthodoxy Scale, and the Intrinsic Religious Motivation Scale. Half the students had IHP scores indicative of high-grade nonhomophobia. IHP scores and frequency of church attendance were significantly correlated, as were Christian orthodoxy and homophobia scores. Intrinsic religious motivation and homophobia were inversely related. Implications include the need to provide opportunities for students to discuss religion and attitudes toward homosexuals.

AIDS knowledge and attitudes of health-care workers in Mexico

AIDS threatens to spread rapidly in Mexico. In the present study, results of a survey of 204 Mexican employees in hospitals and doctors' offices indicated that those health-care workers were largely knowledgeable about the illness. A majority were willing to provide AIDS care, although they feared contagion. Multiple regression analyses indicated that (a) attitudes toward high-risk groups (intravenous drug users and homosexuals) and (b) fear of contagion were both related to intentions to provide care to AIDS patients.

Educational intervention with international nurses and changes in knowledge, attitudes and willingness to provide care to patients with HIV/AIDS

This paper reports the findings of a study which examines the relationship between the use of an educational intervention with nurses from several Asian countries and changes in knowledge, attitudes and willingness to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). A pre-test and post-test questionnaire was used to collect the data. The results indicate, that whilst there was an improvement in knowledge following the educational intervention, there is a need for further improvement in the knowledge levels of the nurses. The method of contracting the virus is less influential in shaping students' attitudes towards people with HIV/AIDS. Fear of contagion is evident; this increases when more invasive clinical procedures are being carried out. What is also evident is that multiple levels of infection control protocols are used with patients. Fear of contagion is also apparent in the participants' willingness to work with colleagues and patients with HIV/AIDS. While the participants stated that they were more willing to work with colleagues and patients with HIV/AIDS following the educational intervention, they said that they would continue to take additional precautions for fear of contracting HIV in the workplace. The conclusion emphasizes that it is important for education about HIV/AIDS to be incorporated within current undergraduate and in-service programmes.

Ethical issues experienced by HIV-infected African-American women

The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led to many ethical problems. Most studies have focused on the ethical issues faced by nurses who provide care to persons with AIDS (PWA), rather than the ethical issues faced by PWAs themselves. The purpose of this study, therefore, was to explore the ethical issues faced by five HIV/AIDS-infected African-American women. An analysis of interview data revealed that these women deal with four broad categories of ethical issues: diagnosis; disclosure; treatment by, and of, others; and future pregnancies. The results of this study provide an initial description of the ethical issues faced by HIV/AIDS-infected African-American women, and begin to lay the foundation necessary for nurses appropriately to facilitate and support their decisions.

[Between the fear of HIV contamination and the symbolic representations of AIDS: the specter of contemporary despair]

Lack of knowledge and misinformations on HIV/AIDS are predictors of emotional responses as fear of contagion, homophobia, avoidance and excessive precautions. Fear of contagion is an affective stress response to the neurocognitive activity that leads to a perceived threat of AIDS in connection with the symbolic meanings os illness. Focused interviews were conducted with an opportunistic sample of 31 young people to know the affective responses and behaviors after blood screening for HIV antibody testing. The findings confirm the relationship of symbolic representation of illness as mystery, death, punishment and sexuality to fear of contagion and mitic conception of AIDS.

Nurse practitioners' reactions to persons with HIV/AIDS: the role of patient contact and education

Attitudes about caring for patients with HIV/AIDS (PWAs) were investigated in a survey mailed to all nurse practitioners (NPs) in Georgia. There was a 53% response rate to the survey (286 of 539 questionnaires were returned). It was hypothesized that exposure to continuing education on HIV/AIDS and to HIV-positive patients would be associated with more positive attitudes and less extreme behavioral changes associated with fear of transmission. Factor analytic procedures were used to generate three scales: resentment of PWAs (RESENT), anxiety or fear about contact with PWAs (FEELINGS), and changes in personal life related to fear of transmission after contact with PWAs (CHANGE). Descriptive findings indicated that a significant minority of NPs were worried about risk, harbored some resentment toward PWAs, and had changed their behavior out of concern about the possible transmission of HIV. Differences of means and stepwise regression analyses (with several potentially confounding variables controlled) found exposure to continuing education associated with less fear and anxiety, less resentment, and less behavioral change. Exposure to HIV-positive patients was associated with less behavioral change, as predicted, but not with less fear/anxiety or resentment. The cross-sectional survey design limits the attribution of causality, but offers some support for the role of continuing education in improving attitudes toward PWAs.

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.

Factors associated with student nurses' intent to provide physical and psychosocial care to persons with acquired immunodeficiency syndrome

This project examined the influence of selected factors on student nurses' intent to provide physical and psychosocial care to persons hospitalized with acquired immunodeficiency syndrome (AIDS). Respondents were 125 undergraduate upper division nursing majors attending a state-supported university. Questionnaires were distributed to student mailboxes and were returned anonymously through the United States Postal Service. All factors were correlated with intent to provide physical care and with intent to provide psychosocial care using Pearson product-moment correlation coefficients. For both intention scales, attitude toward a person with AIDS acquired through homosexual activity and attitude toward a person with AIDS acquired through sharing needles were positively related to intent to provide care. Homophobia, fear of AIDS, and perceived susceptibility toward acquiring human immunodeficiency virus from providing care were inversely related. These findings are useful for designing programs that promote the delivery of compassionate nursing care to persons with AIDS.

Nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome

The purpose of this study was to examine nurses' attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and factors that might be related to these attitudes. One hundred thirty-eight (138) registered nurses responded to an anonymous mail survey. The survey instrument assessed the subjects' attitudes toward caring for AIDS patients along five dimensions: (1) fears and concerns relating to caring for AIDS patients, (2) attitudes toward health care utilization by AIDS patients, (3) attitudes toward caring for terminally ill patients, (4) attitudes toward homosexuality, and (5) attitudes of significant others toward AIDS patients. The data obtained were analyzed using frequency distributions, independent t tests, and analysis of variance. Results of this study indicated that educational background is not related to nurses' attitudes toward caring for patients with AIDS; however, nurses who have had experience caring for patients with AIDS have more positive attitudes towards health care utilization by AIDS patients (P < .05) and more positive attitudes toward homosexuality (P < .04) than nurses who have not cared for AIDS patients.

Attitudes of pediatric nurses facing HIV risk

The purpose of this study was to examine health related attitudes, including willingness to provide care, of health care professionals toward HIV-infected patients. To control for attitudes toward people who may have engaged in high risk behaviors for HIV infection, such as intravenous drug use or homosexual behavior, attitudes of pediatric nurses were studied since children with HIV almost never acquire the infection through these behaviors. The research population consisted of 517 pediatric nurses (46% response rate) from twenty states, the District of Columbia and Puerto Rico. The major findings were that those pediatric nurses with more experience caring for HIV-infected patients were more willing to care for these patients, and respondents reported more favorable attitudes after caring for people infected with HIV. Very few nurses would refuse to care for these children, although most acknowledged moderate fear of acquiring HIV from their patients. The level of experience caring for people with HIV was uncorrelated with reported likelihood of incidents of occupational HIV exposure risk. Greater occupational exposure risk was associated with less positive attitudes and less willingness to provide care. Implications of this study include that attitudes, including willingness to provide care, are more favorable with less suspected risk of infection and after more experience with such patients. In this study, where the sample of clients was adjusted to remove other biases, health caregivers were generally positive toward caring for HIV-infected patients.

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

With the mounting incidence of human immunodeficiency virus infection not projected to peak until a decade into the next century, the question of nurses' willingness to engage in acquired immunodeficiency syndrome (AIDS) care remains important. Published data, however, do not support the frequently cited view that positive attitudes are exceptional. This analysis suggests reasons for misperceptions and also cautions that a continued focus on attitudes may not be useful unless we validate their influence on nursing action in clinical situations. Researchers must ask not only what differentiates the willing from the unwilling but also what alters the extent of nurses' willingness to engage. Even more important may be what influences how nurses engage, that is, what knowledge and skills they need to provide compassionate, effective care. The salience of these questions is especially apparent when we recognize how consistent the finding of positive AIDS-care attitudes has been through the last decade's plethora of studies. Without overlooking negative attitudes about, and some nurses' reluctance to participate in, AIDS care, research at this time should perhaps start with the premise that nurses want to nurse, and then focus on what they need to learn--cognitively, affectively, and technically--to do so competently and comfortably. In other words, the essential question is: What do nurses need to learn?

Community health nurses' HIV care behavior

The purpose of this study was to examine community health nurses' attitudes, subjective norms, and intentions to care for patients who are HIV positive using the theory of reasoned action. One hundred and forty-five participants completed a questionnaire developed according to guidelines described by Ajzen and Fishbein (1980). Consistent with the theory, nurses' attitudes and subjective norms were found to be significant predictors of intentions to care for persons who are HIV positive (R2 = .15). Personal beliefs found to discriminate between intenders and nonintenders were those related to possible consequences for self, family, and friends, but not to job-related consequences. In addition, qualitative data showed persistent concerns about occupational risk for contracting AIDS. Based on the results of this research, it is recommended that nurse educators in both clinical and academic settings target specific educational and training interventions to include transmission, prevention, and exploration of feelings, attitudes, beliefs, and behavioral intentions about HIV-related topics. Further theory-based research and testing of interventions to change community health nurses' attitudes and beliefs about HIV disease are advocated.

Factors influencing baccalaureate nursing students' attitudes towards persons living with AIDS

Using stigma theory described by Goffman (1963), a descriptive correlational study was conducted to identify factors that influence nursing students' attitudes toward persons living with AIDS (PLWAs). Two hundred ten baccalaureate nursing students completed a three-part questionnaire consisting of a demographic data sheet, AIDS Knowledge Scale (AKS), and AIDS Attitude Scale (AAS). The AKS, 15 true/false questions, covered general aspects of AIDS knowledge. Attitudes toward PLWAs were assessed using the AAS, a series of five vignettes each followed by a 16-item Likert scale. Stepwise multiple regression indicated that student status, AIDS knowledge, ideology, ethnicity, and age influenced nursing students' attitudes toward PLWA. Variables that did not enter the regression equation were years of work experience, gender, religion, type of significant interaction with PLWAs, and heart-changing experiences. Students who demonstrated the most stigmatizing attitudes were conservative, had more nursing education, less AIDS knowledge, or were noncaucasian.

Assessing HIV-related attitudes and orientations of male and female general dentists

This article examines differences between male and female general practitioners in private practice in New York City with regard to their attitudes and orientations toward treating HIV-infected patients. The survey asked about willingness to treat such patients and perceptions that might influence that willingness, particularly those related to safety and self-efficacy and risk of occupationally acquiring HIV. Possible explanations for gender-related differences are considered. Implications of these findings for the development of HIV-related continuing education programs are discussed.

HIV and the work intentions of public health nurses

Studies have examined the association between attitudes about the human immunodeficiency virus (HIV) and nurses' willingness or intentions to work with infected persons. However, the relationship between these intentions and perceived concern from nurses' family and friends, or factors of professional nursing experience is relatively unexplored. An anonymous questionnaire was completed by 311 public health nurses from areas with high and low prevalence of acquired immunodeficiency syndrome (AIDS) in North Carolina. Multiple regression analysis showed that nurses had stronger intentions to work with HIV-infected clients if they had more favorable attitudes about the disease, perceived significant others [corrected] to be supportive of such work, had stronger professional ties to public health, and had worked fewer years in public health. In addition, nurses from low AIDS-prevalence areas had stronger intentions to work with these clients if they had professional nursing care experience with them. These findings are consistent with the Theory of Reasoned Action, but also identify professional nursing experience as independently associated with behavioral intentions. This suggests that attitudinal, normative, and professional experiences are all important in examining nurses' intentions to work with clients infected with HIV.

Development of a measure of nurses' AIDS attitudes and conservative views

The literature concerning measurement of nurses' attitudes toward AIDS was reviewed. A short scale to measure nurses' attitudes toward AIDS was developed and evaluated. The instrument has three subscales on (a) willingness to care for those who are HIV positive, homosexuals, and intravenous drug users as patients, (b) attitudes toward homosexuals and intravenous drug users, and (c) general conservative views on religious, political, and family issues. The three subscales were supported by results of a factor analysis. Coefficient alpha ranged from .69 to .92.

Attitudes of practicing nurses as predictors of intended care behavior with persons who are HIV positive: testing the Ajzen-Fishbein Theory of Reasoned Action

The purpose of this descriptive correlational study was to examine practicing nurses' attitudes, subjective norms, and intentions to care for HIV positive patients, using the Theory of Reasoned Action. One hundred and forty-one subjects completed a questionnaire developed according to guidelines described by Ajzen and Fishbein (1980). Consistent with the theory, nurses' attitudes and subjective norms were found to be significant predictors of intentions to care for persons who are HIV positive (R2 = 0.27). Personal beliefs found to discriminate between intenders and nonintenders were those related to possible consequences for self, family, and friends, but not job-related consequences. Normative beliefs which discriminated between groups were also related to nonprofessional referents' expectations. In addition, qualitative data showed persistent concerns about occupational risk for contracting AIDS. Based on the results of this research, it is recommended that nurse educators in both clinical and academic settings, target specific educational/training interventions to include transmission, prevention, as well as exploration of feelings, attitudes, beliefs, and behavioral intentions about HIV-related topics. Further theory-based research and testing of interventions to change practicing nurses' attitudes and beliefs about HIV disease are advocated.