Care of HIV-infected patients: nurses' concerns, opinions, and precautions

COVID-19 Response Unites Perioperative Teams at a Recently Merged Health Care System

Advocate Aurora Health, located in the north‐central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level‐of‐care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.

Nurses' Body Fluid Exposure Reporting, HIV Testing, and Hepatitis B Vaccination Rates

The purpose of this study was to investigate whether mandatory universal precautions changed nurses' body fluid exposure and reporting rates, hepatitis B vaccination rates, and human immunodeficiency virus (HIV) testing rates. Random cross-sectional surveys of nurses in Tennessee were conducted in 1991 and 1993 (n = 145 in 1991; n = 143 in 1993). The questionnaire in both surveys included frequency of body fluid exposures and reporting in the past year, and whether or not the respondent had received the hepatitis B vaccine or had been HIV tested. Findings indicated that self reported needlestick injuries decreased by 69%, and other sharps injuries decreased by 81%. Only 4.1% of all exposure incidents reported on this anonymous survey were reported to employee health officials, as required. Body fluid exposure incidents were the most common form of exposure (81%) and the most underreported. Hepatitis B vaccinations significantly increased (61.4% to 82.5%), with a nonsignificant increase in HIV testing (47.2% to 55.6%) from 1991 to 1993. Findings of this study suggest that the universal precautions regulatory mandate has been effective in increasing nurses' compliance to universal precautions. Body fluid contacts were significantly underreported and showed no decrease between 1991 and 1993.

How caring for persons with HIV/AIDS affects rural nurses

Prior research findings about caregiving for persons with HIV/AIDS indicate that caregiving impacts nurses in three separate domains: personal self as a nurse in practice; interactions with the nurse's family members, friends, and colleagues; and interactions with persons with HIV/AIDS. However the impact caregiving for persons with HIV/AIDS has on rural nurses has not been extensively explored. A qualitative study of rural registered nurses' experiences of caring for persons with HIV/AIDS was conducted to determine how caregiving affects registered nurses in rural areas. Content analysis was used to analyze rural registered nurses' written comments about their experiences of caring for persons with HIV/AIDS. Themes identified from the nurses' accounts of instances of caregiving were the perceived risk of acquiring the virus, a lack of concern about HIV/AIDS, and a need for ongoing continued education about the care of persons with HIV/AIDS.

Managing AIDS stigma

According to anecdotal reports, AIDS stigma and discrimination continue to influence people living with and affected by HIV disease as well as their health care providers, particularly in southern Africa where the burden of AIDS is so significant. Stigma is perceived as a major limiting factor in primary and secondary HIV/AIDS prevention and care. It reportedly interferes with voluntary testing and counselling, and with accessing care and treatments, thereby increasing suffering and shortening lives. Many health care workers in southern Africa have come to the conclusion that unless stigma is conquered, the illness will not be defeated. While there is substantial anecdotal evidence of the impact of stigma on AIDS care, very little rigorous research has been conducted. This article explores three questions: What is AIDS stigma? What is the impact of AIDS stigma? How can health care providers help to manage AIDS stigma?

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.

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.

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

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

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

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

Universal precautions compliance and exposure frequency to patient body fluids in nurses employed by urban and rural health care agencies

Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodeficiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self-reported universal precautions knowledge, precautions, and practice barriers. No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P < 0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.

Attitudes of health care providers and students towards tattooed people

Attitudes of health care providers and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.

Satisfaction with nursing care: a comparison of patients with HIV/AIDS, non-HIV/AIDS infectious diseases, and medical diagnoses

The purpose of this study was to describe patients' perceptions of nursing care and compare those perceptions based on patients' diagnoses (HIV/AIDS, non-HIV/AIDS infectious diseases, and medical diagnoses). One hundred forty-two patients on five units in a major medical center were surveyed using the Patient Satisfaction Instrument. In addition, 126 staff nurses completed the AIDS Vulnerability Survey. Results of data analysis indicated a statistically significant difference in patient satisfaction with nursing care among patients in the medical group compared to patients in the HIV/AIDS group, with the medical group being more satisfied with their nursing care. Further, there was a statistically significant difference across units between nurses' knowledge, attitude, and fear. In spite of their knowledge base related to HIV/AIDS, nurses felt vulnerable when providing care to this population, thus perpetuating fear and negative attitudes. Additional research into the dynamics of these relationships is imperative as we continue to see increases in the number of patients with HIV/AIDS.

Nurses' compliance with universal precautions before and after implementation of OSHA regulations

The principal objective of this study was to investigate whether or not nurses' compliance with universal precautions procedures improved after the mandatory Occupational Safety and Health Administration regulations were implemented in 1992. Two random samples of registered nurses and licensed practical nurses registered in Tennessee responded to survey questionnaires measuring universal precautions compliance and practice barriers to compliance in 1991 and 1993 (n = 306). The 1993 sample of nurses reported significantly greater compliance with universal precautions (p < 0.001) than the 1991 sample. The most noteworthy improvement between the 1991 and the 1993 groups was a significant increase in compliance for patients described as HIV/HBV-status unknown and HIV/HBV-negative (p < 0.001). Practice barriers hindering compliance with universal precautions decreased significantly (p < 0.001) in the 1991-1993 time frame. Problematic practice barriers identified in both groups were needle recapping, preference for isolation door signs, and concerns about offending patients and visitors.

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.

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.

Managing occupational HIV exposures: a Canadian study

The findings reported in this paper are part of a larger study that explored how nurses cope with the risk of acquiring HIV infection while caring for persons with AIDS (PWAs). The data were collected through in-depth interviews with 13 nurses who cared for PWAs in a large Western Canadian hospital. Seven of these nurses perceived that they had been exposed to HIV-infected blood or body fluids. This paper describes how these seven nurses coped with actual exposures to HIV-infected blood or body fluids. Data were analyzed using the methodology of grounded theory. Nurses' coping efforts after exposure were grouped into four categories: minimizing the effect of exposures, reducing a sense of vulnerability, selective disclosure to others, and assigning meaning. Nurses minimized the physical effects of exposure through measures such as 'bleeding' the needlestick injury and immersing the affected area in bleach solution. Nurses reduced their sense of vulnerability by assessing the possibility of harm, avoiding situations that aroused fear, and confronting the decision for HIV testing. Nurses limited their disclosures to co-workers to avoid rejection and to preserve professional self-esteem. Disclousre to significant others was influenced primarily by the support nurses perceived they would receive. Finally, nurses attempted to assign meaning to the exposure by determining why the event occurred and by evaluating the implications it has had on their lives. The article concludes with implications for nursing practice.

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.

Contributing factors to fear of HIV contagion in registered nurses

This study tested the relationships of homophobia, fear of the unknown, fear of death, and fear of punishment as predictors of fear of HIV contagion. Knowledge of transmission and emotional involvement with a person at risk for HIV were hypothesized as decreasing fear among 114 randomly-selected RNs. Results supported significant relationships for all predictors except fear of death. Homophobia, lack of knowledge, lack of emotional involvement, and fear of the unknown predicted 57 percent of the variance in fear of contagion.

The impact of HIV-positive diagnosis on the individual, Part 1: Stigma, rejection, and loneliness

The growing incidence of HIV infection and AIDS has generated panic, fear, anxiety, and negative attitudes among the general public. As an illness, HIV infection and AIDS have become the new sources of stigma. This article explores the stigma, rejection, and loneliness of 25 individuals with known HIV-infection/AIDS, who were interviewed using a set of open-ended questions. The results indicated that the HIV-positive diagnosis had a profound impact on the individual's psychosocial aspects of life, particularly interactions with others. Most of those infected by the virus were lonely, had to cope with stigmatization, and suffered disruption of family and peer relationships. They were confronted with prolonged uncertainty about their lives and experienced intense, constant fear of disclosure of their illness and of being rejected by society, yet they were not always able to discuss these fears and anxieties openly with friends or family.

A Psychoeducational Model for Changing Nurses' AIDS Knowledge, Attitudes, and Practices

A review of the research literature over the last five years reveals that nurses' knowledge of the human immunodeficiency virus (HIV) has improved dramatically. However, attitudes and fears about HIV and acquired immunodeficiency syndrome (AIDS) have not changed commensurately with nurses' knowledge. Also, there is evidence that nurses' clinical practice is not always safe. This paper summarizes the research literature and proposes a three-tiered psychoeducational model for changing knowledge and clinical skills, knowledge and attitudes, and attitudes alone. These approaches include information and demonstration, expression of attitudes and fears, role-playing, group discussions, practice in designing policies, and exposure to various sociocultural groups, to persons with HIV, and to religious, legal, and ethical spokespersons.

Stigma, AIDS and quality of nursing care: state of the science

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed.

An update on nursing research and HIV infection

More than 16,000 citations related to AIDS and HIV infection between May 1987 and June 1990 (38 months) were surveyed to summarize nursing research related to HIV infection; 731 nonresearch and 54 research articles, averaging about 20/month, were found. However, only 20 of the research articles addressed the five topic areas set as priority by the National Center for Nursing Research Priority Expert Panel (physiological and psychosocial aspects of care, prevention of transmission, care delivery systems, and applied ethics). There is a continued gap in the research literature related to the care aspects of HIV infection. This gap needs to be filled by nursing investigation.