Techniques for reversing the failure of empathy towards AIDS patients

Fear of contagion: a response to stress?

Most of the research on nurses' responses to people affected by AIDS has comprised atheoretical surveys or cross-sectional correlation studies. A decade ago, Meisenhelder and LaCharite were among the first to propose a theoretical explanation for these responses, including implications for altering them. They posited that "fear of contagion [is] an affective response of the stress-coping process ... [and] highlighted origins of the fear, behavioral manifestations, and avenues for exploration to decrease this perceived threat." This article reexamines the interpretation of the empirical data on which their proposition rested, places that data in the context of other research about the nurses' AIDS-care attitudes, including Meisenhelder's own subsequent research, and discusses the model's utility for anticipating and influencing nurses' behavioral response to HIV-affected populations.

The effects of an HIV/AIDS educational programme on the anxiety level of nursing students

Acquired immunodeficiency syndrome (AIDS) is a serious disease that has special concern for the health care provider. AIDS has continued to grow despite control efforts. As the disease infectivity period remains lengthy, and the heterosexual population is affected to a greater degree, the level of anxiety has also risen despite educational endeavours. Many fears and anxieties have been associated with AIDS patients by health care workers. The reduction of stress, perceived risk and discomfort following educational efforts have been supported in past research. Educational programmes will need to be given for current health care workers at all levels as well as nursing students. Future nurses must be prepared to meet this challenge. This study was conducted using a convenience sample of nursing students at a university in western United States. Its purpose was to assess any changes that occurred in state anxiety following an educational presentation. Spielberger's State-Trait Anxiety Inventory was used as the measurement instrument. Some anxiety levels were significantly reduced.

A case for theory triangulation

Although theory triangulation has not received much attention in the nursing literature, its deliberate, strategic use can be an invaluable guide to reviewing literature and designing research. It can enlarge the framing of questions for orderly data collection and analysis, and can lay out a route for rational, coherent study-clustering. An example is presented that triangulates two nursing theories to address a frequently studied problem--nurses' attitudes about AIDS care. The absence of firm theoretical footing in exploring this problem has limited the application of a large, continuously growing body of empirical data. Triangulation is suggested to organize these data, to clarify apparently inconsistent findings, and to guide research. The example demonstrates how the exploration of related questions not addressed by a single theory may be aided by searching for linkages among mid-range theories, including theories from other disciplines.

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.

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-related knowledge and attitudes among medical students in China

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

Predicting dentists' perceived occupational risk for HIV infection

This study posed two questions: what is the level of perceived occupational risk among American general practice dentists (GPDs)? What factors influence perception of occupational risk for HIV infection among GPDs? In data obtained from a national mail survey of 1351 GPDs (response rate, 88%) 31% of American GPDs expressed disagreement with the statement that HIV+ individuals can be safely treated in their office settings. Of the 16 variables entered into a multiple regression equation, 9 variables had a statistically significant influence on dentists' assessment of occupational risk. In order of their influence they were (1) concern re the economic viability of the practice, (2) ethical obligation to treat patients at risk, (3) certainty of having treated patients with HIV infection, (4) risk attributed to four accidental occupational exposures, (5) concern re treatment of homosexuals, (6) relevant continuing education exposure, (7) personal worry re transmission of HIV infection from patients, (8) implementation of infection control behaviors, (9) number of patients seen per week. Statistically nonsignificant predictors of interest included age, knowledge level re HIV transmission routes, practice location in a high prevalence area, and perceived effectiveness of infection control behaviors. Results argue for intervention programs with less focus on delivery of factual information regarding the transmission of the disease and the effectiveness of infection control techniques, and more emphasis on the themes of practice economic viability, professional ethics, and structured educational encounters involving dentists' knowing exposure to HIV-infected patients.

Recurrent themes of concern in groups for health care professionals

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

Fear of contagion and AIDS: nurses' perception of risk

Nurses' fear of contagion when caring for persons with AIDS remains high despite increased levels of knowledge. This paper examines the multiple factors that contribute to nurses' perception of risk within the workplace. The authors suggests that constructs from theories such as decision making, psychoanalysis and cognitive psychology can provide insight into the assessment of risk. Findings from a recent survey of nurses are used to illustrate the complex nature of fear of contagion. Understanding this complexity may be an essential first step in order to provide opportunities for resolution of fears and modification of behaviors.

Acquired immunodeficiency syndrome: the nurse's legal duty to serve

Some nurses are reluctant to care for human immunodeficiency virus (HIV)-infected clients because of fear of contagion and discomfort in caring for people with alternate life-styles. Various federal, state, and local antidiscrimination statutes limit the right of the nurse to refuse to care for people with acquired immunodeficiency syndrome (AIDS) or HIV infection. Other constraints are employment contracts, ethical codes of professional organizations, and regulations of state licensing boards. Nurses have rights as well as responsibilities in caring for AIDS or HIV-infected patients. They also have a professional responsibility to institute measures that minimize the need for litigation and ensure access to health care for everyone.

An AIDS educational program for third-year medical students

Medical student training now involves an increasing number of patients with HIV infection and AIDS. Thus far educational efforts to change attitudes and behaviors toward AIDS patients have not been successful. Education that only involves the presentation of information appears to be insufficient to alter fearful and prejudicial attitudes toward such patients. Using four different teaching modules (open discussion, role play, and two videotapes) we demonstrated a positive change in students' anticipation of how they would respond to a question or a statement from a non-AIDS patient or a patient with AIDS. There were significant changes in the students' response to AIDS patients on the Understanding, Probing, Focusing, and Judgmental scales of the Medical Helping Relationship Inventory. This initial work suggests that educators can have a positive effect on students' attitudes. Techniques that traverse the emotional barriers students erect to protect themselves from the painful feelings stimulated by working with AIDS appear to be useful.

Medical students' attitudes toward AIDS, homosexual, and intravenous drug-abusing patients: a re-evaluation in New York City

After completing their clinical rotations, 69% of the third-year medical school class at Columbia University responded to a survey based on one originally used by Kelly et al. at the University of Mississippi, to determine their attitudes toward acquired immunodeficiency syndrome (AIDS) patients, homosexual men, and intravenous drug abusers (IVDAs). Results of this study were compared to the findings of Kelly et al. to determine how, if at all, geographic and environmental exposures affected student attitudes. Unlike the University of Mississippi students, who exhibited a highly negative and prejudiced view of homosexuals and patients with AIDS, Columbia students displayed no evidence of negative attitude toward homosexuals and a much less harsh judgment of AIDS patients. They, however, did have dramatically negative attitudes toward IVDAs; 78.4% stated that they strongly disliked and would avoid this group of patients. There is a complex multi-variable environmental effect on students' attitudes during medical school. It is not possible to generalize attitudes from one medical school to another. The necessity of incorporating activities into student education to evaluate and to reduce prejudice is discussed.

The limitations of generic AIDS educational programs for the health professions

Three major trends are driving the widespread need for continuing education in AIDS. First, with the spread of AIDS, increasing numbers of health care professionals are becoming involved in the care and treatment of AIDS, ARC and HIV positive individuals. Second, as the disease spreads beyond current AIDS epicenters, more persons with minimal information are required to have a baseline working knowledge of AIDS. Finally, the reluctance of many health care professionals to care for HIV-positive individuals, along with already existing staff shortages, limits access to care and makes the provision of responsive educational programs even more important. Generic programs to educate health professionals frequently lack sufficient specificity and sensitivity to address the needs of health professionals with varying levels of knowledge and role responsibility. This paper briefly summarizes the literature on the similarities and differences in knowledge and attitudes across and within professional groups. In addition, it presents specific research designed to provide initial direction for considering the circumstances under which health professionals, particularly nurses and physicians, may or may not profit from generic programs aimed at mixed levels and types of health care provider.

Health Care Workers' Anxieties and Fears Concerning AIDS: A Literature Review

Acquired immunodeficiency syndrome (AIDS) is a serious illness and a public health crisis that merits the concern of everyone. Three key features make AIDS difficult to control. The first feature is that the disease is predominantly spread sexually. The second feature is that a period of infectivity may last from months to years, and the infected individual may not be aware that he or she is infected. The last feature is that AIDS also may be spread by percutaneous and perinatal transmission. Whatever success public education may have in changing sexual behavior, it will not be seen for several years, and the number of AIDS cases will continue to grow. The following literature review leads to a prediction that education will have a profound impact on the anxiety connected with providing care for AIDS patients. Education is a powerful tool that can be used by health care workers to change how AIDS is perceived. Health care workers must become aware of their misconceptions, fears, and anxieties about this disease and afflicted individuals.