KNOWLEDGE AND PRACTICE OF REGISTERED NURSES TOWARDS THE CARE OF HIV/AIDS PATIENTS IN GENERAL HOSPITAL GBAGADA, LAGOS STATE, NIGERIA

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ABSTRACT

This study investigated the “Knowledge, Attitude, and Practice of registered Nurses towards the care of HIV/AIDS patients in Kosofe Local Government area of Lagos state. A descriptive research method was adopted for the study. The population for the study consisted of  all registered Nurses in General Hospital Gbagada  in kosofe Local Government Area of Lagos state. Simple random   sampling technique was adopted to select 70 registered Nurses in General Hospital Gbagada in kosofe Local Government Area of Lagos state who were randomly selected. A self -developed questionnaire of 30 items was used to collect information from the respondents. The face and content validity was ascertained by the supervisor and reliability coefficient was determined (r=0.73). The data generated were analyzed using Mean, Standard Deviation, Simple Percentage, Pearson Product Moment correlation and One-way Anova statistical tools. Three hypotheses were tested at 0.05 level of significance using (Chi square) testing program. The study revealed the following results: From the findings of the study, it was concluded that Lack of knowledge about ways of HIV/AIDS transmission in the workplace will have a significant effect on the knowledge, attitude, and practice of nurses towards the care of HIV/AIDS patients. Fear of contagion in the workplace will have a significant effect on the knowledge, attitude, and practice of nurses towards the care of HIV/AIDS patients. Lack of proper equipment/personal protective equipments in the workplace will have a significant effect on the knowledge, attitude, and practice of nurses towards the care of HIV/AIDS patients.  In the light of the study`s results, the researcher presented a number of recommendations,  A law should be enacted and properly enforced for the proper screening of donated blood before transfusion. Hospital management must reconsider the implications of dismissing or forcing HIV/AIDS health workers to resign from their jobs, especially when infection is work-related. The recognition and full utilization of professional nursing skills by administrative and governmental bodies is required. Nurses should participate in planning and policy-making at all levels in the health service by establishing interdisciplinary teams to coordinate the educational and supportive responsibilities for providing high-quality care to HIV/AIDS patients. These teams will formulate, plan and implement in-service training for all ranks of nurses, as suggested MacNeil (2012).  All nurses caring for HIV/AIDS patients should be given incentives to motivate them. A large number of nurses in Nigeria are leaving nursing for jobs with higher salaries, less stress and more respect in other fields. Both public and private agencies should be encouraged to establish support groups for HIV/AIDS patients. Evidence suggests that social support can act as a buffer against stress, cushioning its impact. It also has a direct, positive effect on psychological well-being (House et al. 2012). Since the fear of HIV/AIDS is associated with occupational hazards, it is important for health staff to make use of universally accepted precautionary measures (Centers for Disease Control 2014). Care of HIV/AIDS patients can be properly provided in hospitals. The practice of hospitals forcibly discharging HIV/AIDS patients is an affront to basic human rights and must cease. The Federal Government of Nigeria must provide the resources to treat all HIV/AIDS cases. 7.Recommendations to improve care to PLWHAs include training providers in infection prevention strategies, ensuring availability of protective wear, and effectively implementing non-discrimination policies for all patients. Communicative forums to address provider concerns relating to fear and risks of infection may also improve the quality of HIV/AIDS-related care.

 

 

 

 

TABLE OF CONTENTS:

Title Page

Certification                                                                                      

Dedication                                                                                         

Acknowledgement                            

Abstract                              

Table of contents  

 

CHAPTER ONE: INTRODUCTION.

 Background to the study                                                               

 Statement of the problem      

 Purpose of the study                                                                      

 Research questions                                                        

 Research hypothesis            

 Significance of the study                        

 Delimitation of the study                                                              

 Limitation of the study                                                      

 Operational definition of key terms        

 

CHAPTER TWO: LITERATURE REVIEW.

Concept of HIV/AIDS

Historical Perspective of HIV/AIDS

Knowledge of Nurses towards ways  of HIV/AIDS transmission.

The need for HIV/AIDS Education

Practices of Nurses towards HIV/AIDS Patients.

HIV/AIDS  in Nigeria.

Effects of HIV/AIDS

The Roles of Nurses in care of HIV/AIDS Patients.

Concept of Nursing.

Attitude of Nurses towards the care of HIV/AIDS Patients.

Perception of risk towards HIV/AIDS Patients.

Universal precaution towards care of HIV/AIDS Patients.

Understanding of nurses towards care of HIV/AIDS Patients.

Fear of infection towards HIV/AIDS Patients.

Summary.

 

CHAPTER THREE: RESEARCH METHODOLOGY

Research design                                                                                          

Population of the study              

Sample and Sampling techniques             

Research instrument                                         

Validity of the Research instrument                                             

 Reliability of the Research instrument            

 Method of data collection                                                            

Method of data analysis                                                                 

Pilot study                                                                                       

 

CHAPTER FOUR: PRESENTATION AND DATA ANALYSIS

Introduction          

Demographic data     

Analysis of Research Questions                                    

Testing of Hypothesis     

Summary of findings

Discussion of Findings                                                

                                                                                   

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

Introduction                                                                                     

Summary                                                                                           

Conclusion                                                                                        

Recommendations                       

Suggestion for further studies                                  

References                                                                                        

Appendix 1                                                          

Appendix 2 

                                                                                                 

 





 CHAPTER ONE

INTRODUCTION

1.1  Background to the Study

The Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic have become one of the most important public health problems in recent years. HIV/AIDS influence all aspects of human life such as physical, social, emotional and spiritual. HIV/AIDS decrease life expectancy for infected individuals, creating confusion in health systems, and helping to monetary insecurity (Sowell 2004). In the world, HIV epidemic is steady remained, also with high proportion of new HIV infected individuals and AIDS deaths. Globally, between 30 to 36 million individuals were infected with HIV (UNAIDS 2008). Increasing number of people suffering from HIV/AIDS has influenced healthcare sectors. Nurses play critical role in caring for the HIV positive patient. Health professionals refused to face the HIV/AIDS patient because they have fear of contagion at workplaces. Irrational and discriminatory treatment of HIV/AIDS patient is the result of health professionals fear (Eisenberg 1986; Adebajo et al. 2003). Unfortunately, most of health professionals have this kind of perspective and practice about people living with HIV/AIDS (PLWHA) (Aghamoalemi et al. 2009). Nurses must be aware of the facts and realities about HIV/AIDS.

Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are the major challenges to healthcare oriented research today. In the 30 years since HIV/AIDS was first discovered, the disease has become a devastating pandemic; more than 60 million people have been infected with the virus and nearly 30 million people have died of HIV-related causes. The risk of contracting HIV/AIDS is quite high among healthcare workers. Every day thousands of healthcare workers around the world undergo accidental exposures to blood-borne pathogens. It is probably the grimmest and causes the highest level of concern amongst healthcare workers in many countries.  Internationally, studies evaluating knowledge, attitudes and practices of health care providers toward HIV/AIDS patients have suggested that current negative attitudes of health care workers toward people with HIV —compounded by fear of infection in the workplace, perceptions of risk, lack of understanding of HIV and inconsistent universal precautions adherence perpetuate the prevalence and manifestation of stigma toward this population.  Nurses are the primary level caregivers playing very important roles in patient care. Therefore their knowledge, attitude, and practice as it relates to patient care are of immense importance to cut down transmission rates, prevent infection, aids early detection, and reduce social stigmatization of HIV/AIDS patients. Though the topic has been dealt with by various authors, published literature in this part of the country are scarce. In this context, this study Will be undertaken to assess the knowledge in the field of virology, modes of transmission, prevention, and- practice of nurses regarding HIV/AIDS patients care.

Nurses provide direct patient care in healthcare delivery systems. In countries where there is a high rate of HIV/AIDS nurses are exposed to blood and body fluids containing the HIV virus. AIDS is now one of the top five killer diseases in the world. At the end of the last century over 33.6 million people were infected with HIV/AIDS   Infection rates continue to rise worldwide, reflecting the acute need for more and better prepared nursing personnel. When nurses are taught the principles of managing HIV/AIDS patients the risk of contracting HIV is minimal. When there is a shortage of nurses, those who provide care are overwhelmed, stressed, and have a tendency to overlook precautionary measures used when providing care to HIV/AIDS patients, thus exposing themselves to the risk to contract HIV/AIDS. Some countries healthcare systems are lacking funds necessary to provide protective equipment and cleaning materials necessary to safely provide care to HIV/AIDS patients. Factors such as nurse shortages, lack of proper equipment, and stress in the workplace create a negative atmosphere towards the HIV/AIDS patient. Some of the nurses ignore the calls for help of HIV/AIDS thus neglecting their duty to care. Other nurses seem to have a negative attitude and behaviour towards HIV/AIDS patients. A negative attitude combined with rigid beliefs and misinformation about HIV/AIDS can significantly affect a nurse’s ability to provide effective, safe care to HIV/AIDS patients.

HIV/AIDS has a worldwide impact on families, friends, and communities and all are major players in the acceptance or denial of the patient with HIV/AIDS. Nurses are placed in a position where they are asked to provide direct care of the HIV/AIDS patient despite their personal convictions. How can the healthcare environment better prepare nurses to deal with the HIV/AIDS patient, not only in direct care issues, but with the global aspect of physical, emotional, and spiritual issues? Sometimes nurses are faced with making difficult decisions in rendering adequate healthcare to HIV/AIDS patients because of lack of resources. Sometimes policy guidelines and lack of support at the institutional level place a difficult burden on the nurse. Burnout in the workplace occurs in many subsets of healthcare workers. Those who work in the environments of high stress and fatigue, i.e. ICU nurses, Burns unit nurses, display a high incidence of burnout. Nurses providing care to HIV/AIDS patients are exposed to similar factors and experience burnout.

HIV/AIDS-related stigma has been recognized as one of the largest challenges to improving HIV/AIDS care around the world. Studies suggest that provider stigma may be affecting the quality of care and patient decisions to seek health care services. This study conducted structured interviews with 204 health care providers in three public hospitals in Dar es Salaam, Tanzania, to evaluate the prevalence of stigma and discrimination among providers toward people living with HIV/AIDS (PLWHAs) and the factors associated with stigmatizing attitudes. Information on HIV/AIDS-related knowledge, perceived risk of infection, willingness to care, and availability of protective gear was also obtained.

Findings from the study show that providers were familiar with various modes of HIV transmission and presenting symptoms, but had knowledge gaps relating to virology and infection prevention. Over two-thirds perceived some risk of infection during casual contact with PLWHAs, and perceived risks of infection for specific medical procedures varied substantially. Some providers rated procedures as having “high” or “moderate” risk for HIV/AIDS infection, while others rated those procedures as having “low” or “no” associated risk. Most providers expressed at least one negative attitude towards PLWHAs, such as blame for infection, particularly if it was considered a result of sexual promiscuity.

There were few specific reports of discriminatory practices toward HIV/AIDS patients. However, when aggregated by type of discriminatory practices, the reported prevalence of discrimination increased, with the most common practices being selective use of universal precautions, denial of services, and substandard treatment. Forty-seven percent (47%) of the respondents said that peers or hospitals sometimes, frequently, or always engaged in at least one discriminatory practice against PLWHAs.

In summary analyses, multivariate regression models revealed that knowledge of HIV was inversely associated with negative attitudes toward PLWHAs (i.e., stigma), and providers who perceived high risk of HIV infection through casual contact had significantly more negative attitudes. Stigma was associated with providers’ selective use of universal precautions, which was associated with reports of peers’ discriminatory practices. Availability of protective wear, with the exception of gloves, was low in many wards, as were guidelines for management of care for people with HIV/AIDS.

While health personnel are willing to provide care to HIV/AIDS patients, this study shows that discriminatory behavior and stigma toward them do exist and may be attributable to poor HIV/AIDS-related knowledge and high perceived risk of infection. Communicative forums to address provider concerns and training in infection prevention and HIV may reduce health sector stigma and discrimination.


1.2       Statement of the Problem

As the impact of HIV/AIDS increases throughout the world, it becomes increasingly important to examine the nurse’s knowledge, attitude and practice of care of HIV/AIDS patients.  Seventy percent of all new HIV infections take place in Africa (UNAIDS 2003) and there can be no doubt that HIV/AIDS is no longer only a public health challenge, and it is having a devastating impact on the continent. Poverty, lack of adequate facilities, inadequate education, cultural/social barriers and political inertia are but a few of the complex factors that facilities the spread of this disease which is undermining the hard-won economic and social gains that many African countries were able  to make in the last two to three decades (World Bank 2010). The impact of HIV/AIDS is pervasive and far-reaching, affecting individuals and communities not only psychologically but also economically and socially. Families lose their most productive members to the disease, leaving children and the elderly without means of support. The high cost of the disease wreaks havoc within communities where the already fragile structures are not capable of absorbing further strin. Nurses in outpatient department are seeing an increase in the number of patients who are HIV positive or who present with AIDS defining illness. We have preconception about nurse’s experiences of caring for patients with HIV/AIDS. For instance, fear of being infected during work and feeling of helplessness of not being able to provide good and adequate care is a major problem.


1.3       Purpose of Study

The purpose of this study was to:

1.      Assess the registered Nurses knowledge of HIV/AIDS in the areas of virology, presenting symptom, modes of transmission, prevention and treatment. 

2.      Determine the prevalence and associated factors of Nurses stigma, such as HIV knowledge, perceived risk of infection and other individual characteristics.

3.      Determine the prevalence and associated factors of Nurses HIV/AIDS related discrimination such as denial of services or substandard treatment.

 

1.4       Research Questions   

The following research questions were postulated to guide this study:

1.         Will insufficient knowledge about ways of HIV/AIDS transmission in the workplace affect the knowledge, and practice of nurses towards the care of HIV/AIDS patients?

2.         Will fear of contagion in the workplace affect the knowledge, and practice of nurses towards the care of HIV/AIDS patients?

3.         Will lack of proper equipment/personal protective equipment’s in the workplace   affect the knowledge, and practice of nurses towards the care of HIV/AIDS patients?

 

1.5       Hypotheses

The following research hypotheses were formulated and tested at 0.05 alpha level of significance:

H0:      Insufficient knowledge about ways of HIV/AIDS transmission in the workplace will have no significant effect on the knowledge, and practice of nurses towards the care of HIV/AIDS patients.

H1:      Insufficient knowledge about ways of HIV/AIDS transmission in the workplace will have significant effect mnnhnjk the knowledge, and practice of nurses towards the care of HIV/AIDS patients.

H0:      Fear of contagion in the workplace will have no significant effect on the knowledge, and practice of nurses towards the care of HIV/AIDS patients.

H2:      Fear of contagion in the workplace will have significant effect on the knowledge, and practice of nurses towards the care of HIV/AIDS patients.

H0:       Lack of proper equipment/personal protective equipments in the workplace will have no significant effect on the knowledge, and practice of nurses towards the care of HIV/AIDS patients.

H3:       Lack of proper equipment/personal protective equipments in the workplace will have significant effect on the knowledge, and practice of nurses towards the care of HIV/AIDS patients.


1.6       Significance of the Study

The findings of this study may be useful in the following ways:

1.      The study may help in adequate provision of personal protective equipment in health care services.

2.      Regular training for knowledge for Nurses.

3.      Release of incentives as a way of motivating nurses.

4.      Set guidelines for potentially changing negative perceptions.


1.7       Limitation of the Study

Some of the questionnaire was not properly filled and some also were not retrieved.


1.8       Delimitation

This study was delimited to:

1        Registered nurses in general Hospital Gbagada Lagos.

2        Descriptive survey research method.

3        A self developed structural questionnaire.

4        All hypotheses were  tested at 0.05 alpha levels.


1.9        Definitions of key Terms:

ATTITUDE: This is a tendency to hold certain beliefs about and to feel in certain ways towards persons, object or ideas.

ATTITUDE: the way a person views something or tends to behave towards it, often in an evaluative way.

KNOWLEDGE:  facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject:

KNOWLEDGE: Awareness or familiarity gained by experience of a fact or situation:

 HEALTH: A state of physical, mental, social and emotional well-being of an individual.

HEALTH:   the general condition of the body or mind with reference to soundness and vigor:

HEALTH: Soundness of body or mind; freedom from disease or ailment:

PRACTICE:   the actual application or use of an idea, belief, or method, as opposed to theories relating to it:

1.      the customary, habitual, or expected procedure or way of doing of something:

2.      repeated exercise in or performance of an activity or skill so as to acquire or maintain proficiency in it:

AIDS:        Acquired immunodeficiency syndrome

OPD  :      Outpatient department

PLWHA:  Person living with HIV/AIDS

PMTCT:   Prevention of mother-to-child transmission

UNAIDS: Joint United Nations Programme on HIV/AIDS

USAID:  United States Agency for International Development

VCT:       Voluntary counseling and testing

WHO:    World Health Organization 

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