Individual determinants associated with utilisation of sexual and reproductive health care services for HIV and AIDS prevention by male adolescents

BACKGROUND

 Adolescent sexual and reproductive health is one of the essential health care programmes in the world. However, adolescents still face numerous challenges in the area of sexual and reproductive health, which hinder their utilisation of available Sexual and Reproductive HealthCare Services (SRHCS). Male adolescents face further obstacles in accessing and utilising sexual reproductive health services owing to the influence of social constructions of masculinity, which has a bearing on how they view sexual and reproductive health services and their use.

OBJECTIVES

 The aim of this study was to investigate individual determinants associated with utilisation of SRHCS for HIV and AIDS prevention by male adolescents.

METHOD

 An exploratory, descriptive and contextual qualitative design was used and semi-structured interviews with 20 purposively selected male adolescents aged 18-24 years living in the South African seat of government were conducted. Data were analysed using Tesch's approach of data analysis.

RESULTS

 Knowledge of existing services was described as a significant individual determinant of utilisation of SRHCS. This was linked to the quality of SRHCS and violation of human rights of male adolescents.

CONCLUSION

 The study recommends the development of a strategy that will enhance and promote the utilisation of SRHCS by male adolescents.

[Patients and caregivers in the treatment of addictions]

Since the 1980s, risk and harm reduction has been a public health issue in the area of addictions. A new approach has been adopted with drug users, who are considered as patients like any other and players in their own health care. The therapeutic alliance with the caregiver is therefore essential.

Nurse led home-based care for people with HIV/AIDS

BACKGROUND

Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS.

METHODS

The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals.

RESULTS

Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms.

CONCLUSIONS

Nurse-led home-based interventions could help adherence to antiretroviral therapy and improve mental health. Further larger scale studies are needed, looking in more detail at improving medical care for HIV, especially related to screening and management of opportunistic infections and co-morbidities.

Quality of life of people living with HIV/AIDS: temporal, socio-demographic and perceived health relationship

OBJECTIVE

to analyze the quality of life of people living with HIV/AIDS and its relationship with sociodemographic variables, health satisfaction and time since diagnosis.

METHOD

quantitative, cross-sectional study with a sample of 100 HIV positive people monitored in a specialized service in southeastern Brazil. Sociodemographic and health forms were applied, followed by the WHOQOL-HIV BREF, a short form instrument validated to evaluate the quality of life. Descriptive and inferential statistical analysis was performed.

RESULTS

the perception of quality of life was intermediate in all quality of life domains. A relationship was identified between greater satisfaction with health and better quality of life, as well as statistically significant differences among the dimensions of quality of life according to gender, employment status, family income, personal income, religious beliefs and time since diagnosis.

CONCLUSIONS

the time since the diagnosis of HIV infection enables reconfigurations in the perception of quality of life, while spirituality and social relationships can assist in coping with living with this disease.

Administering Medical Procedures to Patients Living With AIDS: How Comfortable Are Physicians?

Background: Feeling of comfort is important for efficient and compassionate care. This study aimed to determine physicians’ level of comfort in administering common medical procedures to patients living with AIDS and to identify the demographic variables that may influence level of comfort. Methods: Residents and house officers (n = 211) in 2 Nigerian teaching hospitals were surveyed by a questionnaire that elicited demographic information and information on physicians’ level of comfort in administering medical procedures. Results: Overall, physicians were very uncomfortable with mouth-to-mouth resuscitation. Invasive procedures evoked a lower level of comfort than noninvasive procedures. Knowing a person living with AIDS influenced the comfort level. Older age and professed willingness to treat persons with AIDS were associated with a higher comfort level. Conclusions: This study reinforced the need to address idiosyncrasies as they relate to the AIDS epidemic and to emphasize ethics and altruistic feelings of responsibility to care for those in need.

Stigma Associated With Ghanaian Caregivers of AIDS Patients

This study explores the experiences of informal caregivers of AIDS patients in Accra, the capital city of Ghana. Fifteen interviews were completed in 2002 with 11 informal caregivers, including wives, mothers, boyfriends, daughters, sons and brothers of AIDS patients. Three major themes emerge in the analysis of the interviews with caregivers: stigma, caregiver burden, and caregiver commitment. In this article, the authors focus on the theme of stigma by documenting its presence and highlighting its impact on caregiving activities. Caregivers go to great effort to not only “hide” their patients but also their care giving activities, resulting in the social isolation of both patients and their caregivers. Many caregivers live in secrecy, not sharing their family member’s diagnosis with extended family members. As a result, they receive limited support from the extended family. Stigma results in negative attitudes of neighbors, relatives, and health care workers toward caregivers and their patients.

Nursing Care of AIDS Patients in Uganda

This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.

How Much Should We Expect? Family Caregiving of AIDS Patients in Rural Uganda

The aim of this study was to measure the burden of care for family caregivers of AIDS patients. A cross-sectional exploratory design was used to describe the care experiences of family caregivers of AIDS care recipients. A questionnaire was used to interview 120 family caregivers of AIDS patients from four rural areas in western Uganda. The questions asked were related to 12 domains of family caregiving. Care burden scores of caregivers were calculated. It was found that care burden scores were high in all domains except those regarding relationships within the families and substance abuse. Serious work overload and low health status were reported. The high burden of caregiving puts family caregivers at risk for decreased health status and increased social isolation and depression.

Moments That Last Forever

This is the story of how Nurse Barbara Allen, one of the authors, met the spiritual needs of her patient, Kenny, through prayer as part of his end-of-life care. While prayer may not be a nurse's priority, it may be essential for some patients and their families, especially when death is near (1). Furthermore, the Joint Commission (2) and the American Nurses Credentialing Center (3), which provides Magnet certification, have both encouraged nurses to address the spiritual needs of patients and their families. Barbara's prayer was appropriate because it was focused on Kenny's needs and beliefs, not hers. Being coercive and evangelizing and proselytizing is never appropriate for nurses (1). However, Barbara's story shows how when we stop to pray and be with patients in the moment, we can change ourselves and our patients forever. This is Barbara's story:

Work-family and family-work conflicts amongst African nurses caring for patients with AIDS

BACKGROUND

South African nursing environments are marked by various incapacitating stressors. This study explores work-family (W-F) and family-work (F-W) conflicts as aspects of stress amongst nurses working with patients who have AIDS.

OBJECTIVES

The study sought to determine the value of W-F and F-W conflicts as predictors of work and family satisfaction, as well as turnover intentions and the moderating role of supervisor and significant other support, amongst nurses caring for patients with AIDS in public hospitals within the Capricorn and Mopani districts, Limpopo Province.

METHODS

The study used a cross-sectional design, with data collected at one point only. Ninety-one nursing staff provided the data for the study by completing structured, self-administered surveys. Analysis involved computing correlations of all study variables. Thereafter, associated variables were used as predictors. In each predictive analysis, the nurses' stress served as a control variable, W-F and F-W conflicts were the independent variables and significant others and supervisor supports were moderators. Interaction terms were derived from independent and moderator variables.

RESULTS

Although the findings of the study were not generally supportive of the hypotheses advanced, they nevertheless showed, amongst other findings, that F-W conflict predicted work satisfaction whilst W-F conflict predicted turnover intentions. Moreover, significant other support had a direct effect on family satisfaction whilst supervisor support moderated reports of W-F conflict and experiences of work satisfaction.

CONCLUSIONS

The study showed that inter-role models that appear to be established in the context of developed societies require some further investigations in South Africa.

Effect of Uoncept Mapping in Improving Nursing Students' Knowledge and Attitudes Related to Care of HIV/AIDS Patients

This one group pre- and post-test study evaluated the effectiveness of concept mapping and lecture method of teaching among 73 under graduate nursing students. One group was exposed to concept mapping technique and the other group was exposed to lecture method of teaching about HIV/AIDS. Findings indicated a statistically significant increase in the knowledge and attitude of students towards HIV/ AIDS among students exposed to concept mapping than students who underwent lecture method. The results of this study indicated that moden teaching strategies may enhance learning among nursing students. However further evaluation is needed.

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.

Pride and prejudice

Nurses have been at the heart of services for people with HIV and AIDS for 30 years. In this article nurses reveal what it was like to care for patients in the early 1980s, when a positive diagnosis of HIV was effectively a death sentence. They describe the progress since then and the challenges they face today.

[A needs assessment of nursing staff AIDS care knowledge needs]

BACKGROUND

The number of HIV infections in Taiwan has been increasingly linear in recent years. At the close of April 2009, Taiwan registered 17, 979 AIDS infections. The average annual infection rate has grown an average 18% during the most recent five year period. Apart from medical problems, the social and psychological problems associated with AIDS are becoming increasingly complicated both in Taiwan and globally with the increasing number of HIV infections. Identifying the knowledge needs of nursing staff members for providing appropriate nursing care to HIV/AIDS patients is important to planning effective in-service nursing education programs. Quality of both patient care and professional development can be promoted.

PURPOSE

This study investigated the HIV/AIDS educational needs of nursing staffs and variations in care knowledge needs by individual background. Results provide a reference for in-service education program planners.

METHODS

This was a descriptive and correlational study design that used self-structured questionnaires to conduct a cross-sectional survey. A total of 556 structural questionnaires were distributed and 546 completed questionnaires were returned (response rate = 98.2%) and used in data analysis.

RESULTS

The average knowledge need score for nursing staffs with regard to HIV/AIDS patient care was > 4 points. The highest three mean scores were (in rank order): follow-up treatment for victims after sexual assault, prevention of injury (e.g., sharp objects, exposure to infected body fluids) and subsequent management, and nursing care of opportunistic infection. The lowest three mean scores were (in rank order): HIV epidemiology, Taiwan HIV policies and regulations, and HIV transmission routes. Nurses who were older, married, or held senior nurse positions had more knowledge needs.

CONCLUSION

This study can be a reference for prioritizing the arrangement of in-service HIV/AIDS care education and for formulating hospital policies related to HIV/AIDS patients. Prevention of injury and subsequent management of patients with opportunistic infections should be made mandatory in all health care provider courses. Also, enhancing promotion of safety needles can help reduce needle stick risks for clinical staff.

Nurses' willingness to take care of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)--does a teaching intervention make a difference?

The aim of this study is to describe the impact of an education intervention programme on nurses' willingness to care for HIV-positive people in Lithuania.

METHODS

The study utilizes a randomized controlled trial design (RCT). The total sample comprises 185 nurses working in medical, surgical and gynaecological units, and primary health care centres from the same hospital areas in three Lithuanian hospitals. The data were analyzed using SPSS 12.0 and descriptive statistics.

FINDINGS

Our educational intervention did not have an impact on the nurses' willingness to take care of people living with HIV (PLHIV), as their level of willingness was high already before the education intervention.

CONCLUSIONS

Further research on this issue is needed to try to understand the forces acting on our nursing staff in order to ensure appropriate care for PLHIV.

Families suffering with HIV/AIDS: what family nursing interventions are useful to promote healing?

The purpose of this clinical research project was to examine the usefulness of a family nursing intervention program offered to families experiencing illness suffering related to HIV/AIDS. The interventions were based on the Family Caregiving Model and the Illness Beliefs Model. Sixteen Thai families with one or more family members living with HIV/AIDS were offered three to four family clinical sessions by an advanced practice family nurse. The audiotaped family clinical sessions and field notes were analyzed using thematic analysis. The outcomes reported by families included a competence to manage illness care of family members experiencing HIV/AIDS, new meaning and purpose, improved family interaction, embraced facilitating beliefs and changed constraining beliefs, and a recognition of the family's strengths.

Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS

BACKGROUND

Home-based care (HBC), to promote quality-of-life and limit hospital care, is used in many countries, especially where public health services are overburdened.

OBJECTIVES

This review assessed the effects of HBC on morbidity and mortality in those with HIV/AIDS.

SEARCH STRATEGY

Randomised and controlled clinical trials of HBC including all forms of treatment, care and support offered in the home were included. A highly sensitive search strategy was used to search CENTRAL, MEDLINE, EMBASE, AIDSearch, CINAHL, PsycINFO/LIT. Risk of bias of all trials was assessed.

SELECTION CRITERIA

All randomised and controlled clinical trials were included of HIV/AIDS positive individuals, adults and children, of any gender, and from any setting. Home-based care, provided by family, lay and/or professional people, including all forms of treatment, care and support offered in the HIV/AIDS positive person's home as compared to hospital or institutional based care

DATA COLLECTION AND ANALYSIS

Titles, abstracts and descriptor terms of the electronic search results were screened independently by two authors for relevance based on the types of participants, interventions, and study design. Full text articles were obtained of all selected abstracts and an eligibility form was used to determine final study selection. Data extraction and assessment of risk of bias were done independently. Narrative synthesis of results were done. Relevant effect measures and the 95% confidence intervals were reported.

MAIN RESULTS

Ten studies randomised individuals and trial sizes varied from n=31 to n=549. One study randomised 392 households and enrolled a total of 509 persons with HIV and 1,521 HIV-negative household members. Two ongoing studies were identified. Intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence and difference in pharmacy drug refill (1 study). Another study, comparing proportion of participants with greater than 90% adherence, found statistically significant differences over time but no significant change in CD4 counts and viral loads. A third study found significant differences in HIV stigma, worry and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning. Comprehensive case management by trans-professional teams compared to usual care by primary care nurses had no significant difference in quality-of-life after 6-months of follow-up (n=57) and average length of time on service (n=549). Home total parenteral nutrition had no significant impact on overall survival and rate of re-hospitalisation. Two trials comparing computers with brochures/nothing/standard medical care found no significant effect on health status, and decision-making confidence and skill, but a reduction in social isolation after controlling for depression. Two trials evaluating home exercise programmes found opposing results. Home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa.

AUTHORS' CONCLUSIONS

Studies were generally small and very few studies were done in developing countries. There was a lack of studies truly looking at the effect of home based care itself or looking at significant end points (death and progression to AIDS). However, the range of interventions and HBC models evaluated can assist in making evidence-based decisions about HIV care and support.

Impact of intervention programs on nurses' knowledge, attitudes, and willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome: a descriptive review

OBJECTIVE

This paper reviews the current literature on intervention programs designed to improve nurses' knowledge and attitudes to human immunodeficiency virus/acquired immunodeficiency syndrome and their willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome. It also explores the impact of these intervention programs.

MATERIALS AND METHODS

The MEDLINE and Pubmed, Science Direct, Cochrane Library, EbscoHost, ERIC databases were searched for relevant English-language citations between 1997 and 2007 using the following search terms: human immunodeficiency virus/acquired immunodeficiency syndrome, nurse, intervention, teaching, education, knowledge, attitude, and willingness. Relevant articles were retrieved, reviewed, and assessed. A total of 16 articles were considered appropriate and selected for content analysis.

RESULTS

We identified articles that reported on intervention programs to improve nurses' knowledge and attitudes and their willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Eight of the intervention studies included lectures among their methods of educational intervention. The nurse sample sizes (n) ranged from 12 to 552. Many of the studies involved one experimental/intervention group and one control group. The intervention programs varied in terms of their methodological rigor. Almost all reported one or more statistically significant effects.

CONCLUSIONS

The review highlights the need for well-designed, methodologically sound research on outcomes of nursing education. Future studies should examine not only the short-term effectiveness of intervention programs in terms of changing attitudes and increasing willingness to care, but also their impact in the longer term.

The effectiveness of web-based and face-to-face continuing education methods on nurses' knowledge about AIDS: a comparative study

BACKGROUND

Information about web-based education outcomes in comparison with a face-to-face format can help researchers and tutors prepare and deliver future web-based or face-to-face courses more efficiently. The aim of this study was to compare the effectiveness of web-based and face-to-face continuing education methods in improving nurses' knowledge about AIDS.

METHODS

A quasi-experimental method was used with a pre-test and post-test design. In this study 140 nurses with BSc degrees were chosen through a random sampling method and divided into a web-based and a face-to-face group by random allocation. For the former group the intervention consisted of a web-based course on AIDS; the latter received a 3-hour lecture course on the same subject. At the beginning and end of the course in both groups, the nurses' knowledge was measured by a questionnaire. Pre- and post-test scores were compared within and between the groups.

RESULTS

The results show that there was no significant difference between the groups in either the pre-test (t(138) = -1.7, p = 0.096) nor the post-test (t(138) = -1.4, p = 0.163) scores in the knowledge test. However, there was a significant difference in the pre-test and post-test scores within each group (web-based, t(69) = 26, p < .001; face-to-face, t(69) = 24.3, p < .001).

CONCLUSION

The web-based method seems to be as effective as the face-to-face method in the continuing education of nurses. Therefore, the web-based method is recommended, as complementary to the face-to-face method, for designing and delivering some topics of continuing education programs for nurses.

Vulnerabilities and caregiving in an ethnically diverse HIV-infected population

The current study aimed to identify the primary informal caregivers of a group of urban HIV+ adults (n = 250) and to determine relationships between demographic, medical, and substance use characteristics and caregivers types. Reported caregiver types included 36.8% familial, 22.4% significant other, and 22.8% institutional or other caregiver relationships. The remaining 18% of the sample reported having no individual that rendered informal care. Factors associated with the absence of an informal caregiver included African American race and low education. Hispanic participants reported the highest frequency of family caregivers while participants with a history of substance disorder were less likely to identify a significant other as a caregiver. This study demonstrates the evolving nature of informal caregiving in HIV, race- and education-related disparities in the absence of primary caregivers, and the importance of sociocultural and demographic factors in the study of HIV caregiving.

[HIV/AIDS children living in shelters under the perspective of humanistic nursing]

This article views the life of HIV/AIDS children in shelters under the perspective of the Humanistic Nursing Theory. This is a qualitative study with an existential-phenomenological-humanistic approach based on the Nursology of Paterson and Zderad. The scenario was a shelter for HIV/AIDS children located in the state of Rio Grande do Sul, Brazil. Information was collected using phenomenological interview carried out with three children with AIDS. This article presents part of the interpretation of the obtained information centered in two meaning units. The results provided an understanding of the child's play as way of feeling better in the environment of the shelter because the child perceives himself/herself as part of that environment with others. It also gives visibility to children with HIV/AIDS in shelters, and highlights the importance of including this theme in undergraduate courses, training health professionals in humanistic care, and managers to develop specific public policies for this population.

[Applying the family adjustment and adaptation response model to care of an AIDS patient's family]

Discrimination against AIDS patients occurs in our society, not only influencing the patients but also restricting their usage of social resources. We report on a 31-year-old AIDS patient facing a family crisis because of an imbalance between the meanings, demands, and capabilities of his family. In this paper, we have applied the family adjustment and adaptation response (FAAR) model to assess this family, and identified three health problems, including (1) poor communication among family members, (2) deficiency in disease-related knowledge and skill, and (3) dysfunctional processing among the family. Throughout the care, we adopted a family-centered belief to communicate with the family to resolve their misunderstandings. We provided the family with information related to the disease to reduce their stress arising from caring for the patient. We also helped the family to utilize social resources by coordinating multi-disciplinary care. The family successfully restored a balance between meanings, demands, and capabilities. If we can apply this model clinically to understand the capabilities, demands and meanings of family existence as well as to help family members to develop their capabilities, reduce demands and recognize the positive meanings of family, we can help AIDS patients and their families to achieve positive adaptation.

Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in Africa

Most people with HIV have disclosed their status to someone, often with mixed results. Most health literature seems to favor disclosure by persons living with acquired immunodeficiency syndrome (AIDS), but it could be that to disclose is not always a good thing. We used a descriptive, qualitative research design to explore the experience of human immunodeficiency virus (HIV) and AIDS stigma of people living with HIV or AIDS and nurses involved in their care in Africa. Focus group discussions were held with respondents. We asked them to relate incidents that they themselves observed, and those that they themselves experienced in the community and in families. Thirty-nine focus groups were conducted in five countries in both urban and rural settings. This article is limited to a discussion of data related to the theme of disclosure only. The sub-themes of disclosure were experiences before the disclosure, the process of disclosure, and responses during and after disclosure.

[The experience of parents caring for adult children with HIV/AIDS]

Antiretroviral treatment dramatically reduces mortality and prolongs the life expectancy of HIV/AIDS patients in Taiwan. The stigma attached to AIDS, and conflicts within the family result in family stress and emotional distress. Consequently, parents of adult children with HIV/AIDS endure perpetual distress while caring for their adult children. The purpose of this study is to elucidate the experiences of seven parents caring for children over 18 years of age with HIV/AIDS. Hermeneutic phenomenological methodology was applied to reveal the trajectory of parents' caring experiences and to discover the hidden meanings of the phenomena. Data were collected using semi-structured in-depth interviews lasting from 1.5 to three hours. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using thematic analysis with the concept of the hermeneutic circle. Four essential themes emerged, and were identified and clarified. The parents' caring experiences were: (1) We didn't expect our children's controversial illness, so we pretend to ignore the taboo; (2) We are suffering from shame, and our daily lives and interaction with others have changed; (3) We provide advice frequently to protect our children from pain, and try our best to take care of them in order to bring them better fortune; and (4) We feel helpless in the face of predestined causality, and wish we could bear the burden of sin for our children. Unconditional love and endless responsibility, furthermore, were the essential experiences of these parents. Our findings highlight the importance of patient-center nursing care for HIV/AIDS patients and for healthcare professionals to assist HIV affected families on related family stress throughout the illness trajectory.

[Casa Siloé: the history of an NGO for children with HIV/AIDS]

Casa Siloé (Siloam House) is a Catholic support house that shelters children with human immunodeficiency virus or acquired immunodeficiency syndrome. The article presents a history of the institution and discusses its work. A qualitative approach was used, relying on oral history techniques and documental analysis. Eight key informants were interviewed: the president of the institution, two coordinators who worked at the home, a member of the supporting foundation, a volunteer social worker, a member of the state NGO/AIDS forum, a physician, and a psychologist from the state public service. Topics addressed include the Catholic Church and AIDS, community mobilization, the Casa Siloé, the State and civil society, and project evaluation and outlook.

HIV-related traumatic stress symptoms in AIDS caregiving family dyads

This study assesses HIV-related traumatic stress symptoms in 135 AIDS caregiving family dyads in which the caregiver is a midlife or older mother or wife, and the care-recipient is her HIV-infected adult son or husband. Symptoms of HIV-related traumatic stress can be reliably measured in these dyads, with both caregivers and care-recipients reporting avoidant and intrusive thoughts. Among care-recipients, high symptoms are associated with high daily living assistance requirements, low dyadic adjustment, and high constriction of social activities. Among caregivers, high symptoms of traumatic stress are associated with being HIV positive, feeling overloaded by caregiving demands, and perceiving high levels of HIV stigma. Caregiving mothers and wives may feel traumatized 'courtesy' of their loved one's HIV infection, the caregiving scenario, or the resultant caregiving stress.

Knowledge and attitudes of nursing students toward patients living with HIV/AIDS (PLHIV): A Turkish perspective

The aim of this study was to assess the knowledge and attitudes towards HIV/AIDS of nursing students in Turkey. HIV/AIDS has become one of the most serious health problems in the world. It is important to understand nursing students' knowledge and attitudes towards people living with HIV (PLHIV) because the educational preparation of nurses has been known to affect the attitudes of the nurse and the effectiveness of the care provided to PLHIV. The study was conducted with 227 nursing students from the School of Health in Antalya, Turkey during the calendar year 2005/2006. Qualitative and quantitative methods were both used to collect data for the study. Analysis of variance, t-test, Mann-Whitney U-test, Kruskal-Wallis and inductive methods were used in data analysis. The majority of nursing students in this study had a moderate level of HIV/AIDS knowledge. Students correctly answered 64.4% of HIV/AIDS-related questions in the questionnaire (Mean 28.99; SD 7.03 out of 45 points). Scores increased parallel with student grade (F=26.925; p=0.000) and age (chi2 (K-W)=35.117; p=0.000). Fear of being infected and feelings of pity and empathy were the feelings most commonly indicated by the students. Students who had previous experience in caring for an AIDS patient and had known someone with HIV/AIDS were willing to care for PLHIV. Results underline the need to strengthen education on all aspects of HIV/AIDS. To improve nursing students willingness to care for PLHIV, particular emphasis should be placed on the training of nursing students as skilled nursing staff with humane attitudes towards PLHIV.

Factors associated with the self-reported health status of female caregivers of AIDS patients

A cross-sectional study was conducted on women who were family caregivers of spouses with AIDS, living in the Bumbu Zone, Kinshasa, Democratic Republic of Congo. Eighty caregivers were randomly selected from a client visitation list of the home-based care program for AIDS patients. A semistructured questionnaire was used in face-to-face interviews. A self-reported health status score was calculated using five items from the questionnaire. The self-reported health of female caregivers indicates poor health. Lower caregiver health is associated with lower income, rented accommodation, little support, and stigmatization of the caregiver by relatives.

The processes by which persons with HIV-related peripheral neuropathy manage their symptoms: a qualitative study

A variety of peripheral neuropathies occur throughout the course of HIV infection, with the most common peripheral nerve disorder of late HIV infection being distal symmetrical peripheral neuropathy (DSPN). Current management strategies often fail to achieve satisfactory pain relief. This study was designed to explore the everyday life experiences related to DSPN in persons with AIDS (PWAs) and the behaviors they initiate to alleviate the symptoms. A qualitative study using a grounded theory approach was used to better understand the impact DSPN has on PWAs. Many interventions were attempted and were ineffective; the effective ones were highly individualized. Emerging themes in the delimiting debilitation continuum included isolating the symptom cluster, inventing and testing interventions, and assimilating the annoyance. Results indicated a need for better DSPN assessment by nurses and teaching strategy development to manage the symptoms, and development of strategies to combat functional DSPN disabilities.

Developing a nursing database system in Kenya

OBJECTIVE

To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya.

PRINCIPAL FINDINGS

Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.

CONCLUSIONS

The Kenya nursing database is a first step toward facilitating evidence-based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

The behavioral assessment scale: a measure of community living skills

This study reports the development of a community living skills measure of long-term care AIDS residents. Community living skills impact numbers and types of care providers needed. The Behavioral Assessment Scale (BAS) used multiple sources of validity evidence to ensure community living skills construct representation. The BAS was piloted in four diverse long-term care facilities. Nurses rated residents using the BAS and the Nurse Perception Scale (NPS)-another community living skills measure. Researchers rated residents' community living skills through medical record notations (Interdisciplinary Notation Scale [INS]). Reliability coefficients over .6 (p < .001) were reported for the BAS in both the total sample and the individual samples. Evidence-based validity of the BAS was obtained via coefficients from the total sample (.422 [BAS and INS] and .526 [BAS and NPS], with p < .001 for both relationships), Cronbach's alpha (.851 for all community living skills tools), analysis of variance, and regression results. The BAS was substantiated for long-term care practice with AIDS residents.