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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