Acquired Immune Deficiency Syndrome (AIDS), Research Paper Example

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

Researches nowadays focus on diseases such as acquired immune deficiency syndrome (AIDS) severe acute respiratory syndrome (SARS) and Avian influenza. The challenges faced in doing research with such diseases suggest that nowadays, diseases are global phenomenon’s that would cause new problems transported to the world rapidly (Halberg, 2006).
The HIV virus has been known to have taken its toll on numerous people in the world. The World Health Association (WHO) suggests that 6800 people worldwide are affected with HIV virus and approximately 5700 die because of the lack of access to HIV prevention programs such as treatment and care services. There have been only a few research that focuses on adapting education intervention programs to target the behaviors that are associated with HIV and these include increasing the engagement of nurses in HIV health care’s and supportive services (Mockien, et al. 2010).

It is said that the way to support the willingness of nurses to care for patients affected with HIV is the implementation of continuing education. It was discusses by Slaten et al. (2000) the impacts of seven training workshop sessions of positive impact on the willingness of nurses to take care of HIV patients. It is also discussed that these training programs must consist of various teaching methods that allow debate and dialogue in terms of nurses’ willingness to take care of HIV patients (Wu et al. 2002). This notion that an intervention will pave the way for the increase of nurses’ willingness to care for patients with HIV is the reason why the research was conducted. The study aims to describe the intervention program impact of nurses who were willing to care for HIV-positive people in Lithuania.

Sampling and Method

The research sampled 185 nurses who worked in a medical surgical and gynecological unit and health care centers in the same hospital. The design used was a controlled trial design (CTD). The nine biggest nurses in Lithuania hospitals were chosen as the place to gather the samples for the study and three hospitals were randomly selected from these choices. 240 random nurses from the hospitals were invited to take part in the study. A random controlled trial design was used with a pre-test evaluation and three-month follow up evaluation. A power analysis for one-way ANOVA was used by the researchers to determine the number of participants needed in the study. The analysis determined 55 participants to be part of each group, but due to the anticipation of possible dropouts, the researchers increased the size. First group, the EG1, was the first educational intervention with a two-day workshop and written material which comprises 8o participants. The EG2 consisted of 8o participants along with the control group (CG).

Two different materials for interventions were utilized which included a thirteen hour and two day workshop and 20 pages written material were distributed. The areas of the written material encompass the history, epidemiology, prevention, HIV treatment, transmission and counseling patients positive with HIV. The intervention program included different types such as group discussions, lectures, film viewing, and discussions with HIV inflicted patients. For the second intervention, a 20 page article was provided which included a statistics of the HIV situation in Lithuania and the world that came from the experimental group 1 were provided to the EG2. Total participants of EG2 received 22 pages of written materials in total and the control group nurses received no lectures or any written material.

Data Analysis

The data analysis was conducted using different statistical measures performed with the uses of the SPSS 12.0 software. Demographic variables and items that concern the perception related to the willingness of nurses to care for HIV patients were examined with the use of descriptive analysis. To compare the groups, Student’s t, ANOVA, Kruskal-Wallis, and Mann-Whitney was utilized while the Cronbach’s alpha was used to evaluate the internal consistency of the scales. Values less than p=0.05 were considered statistically significant. Participants were all females with ages ranging from 23-67 years old. The nurses in the first group were the youngest with a statistical significant difference of p=0.016. They had no children and were more University leveled qualifications with p=0.001. The nurses in the first group had also the least experience. The results suggest that the workshops and written materials distributed alone played no impact to the willingness of nurses to take care of patients with HIV but the nurses from all the groups had the willingness to care for these patients even before the intervention programs were implemented. The changes of the willingness was found in EG1among those that received the workshop but the score with mean 1.47 and SD 0.66 was found to have no statistical

Results

The results have found that the willingness of nurses in EG1 increase after the intervention and was more willing to take care of the dirty nursing activities such as shave, empty urinary bags and administer blood transfusion. In EG2 and the CG, there have been no statistically significant changes found in the willingness of the nurses. For the background factor, participants were asked to answer at least one general question that concerns the willingness to take care of the patients with HIV, and it is found that 68% of EG1with n=43, 89% of EG2 with n=56 and 93% of CG, n=55 were reported to have the unwillingness to take care of patients with HIV.

Limitations

It is suggested, even by Halberg (2009) that although it may seem problematic to carry out research interventions regarding evidence-based nursing and the causality may not be explained by certain conclusions, it is important to implement this in order to advance nursing knowledge. Lithuania was regarded as the country with low-prevalence of HIV that is why there is also low awareness regarding the situation. That is why the study was conducted in order to help address this. Although the results for the present study conducted were statistically grounded, it is important to consider that there may be limitations in terms of the methods used. First, the intervention programs had limitation because the aim of this study was supposed to ascertain and determine the intervention programs that would increase the willingness of the nurses.

There may be a biased seen because before the interventions were implemented, a group was already reported to show signs of willingness towards caring for these patients. There may be a need to gather samples of participants who had low willingness in order to efficiently validate if significant changes were made. Second, the intervention implemented such as distributing materials related to HIV is to be considered weak since no significant changes were made. It is also suggested that doing this may not contribute to the goal in increasing nurse willingness. But considering that there was a difference made by the intervention materials such as increasing the willingness of nurses to do dirty nurse activities for these patients, it supports the notion that educational awareness does a play to help understand HIV situations and change the attitudes of health professionals into giving them extra care and attention.

Paper II: The Nurses’ experience Of Possible HIV infection After Injury And/or Exposure On duty

Understanding and Summarizing the Contents

The research entitled “The Nurses’ Experience of Possible HIV Infection After Injury and/or Exposure on Duty” was authored by Roets, L. and Ziady, L. who were both faculty members of Health Sciences at the School of Nursing in the University of Free State. It was published on Curationis in the year 2008. The paper talked about the experiences of medical practitioners, particularly, the nurses who had been into possible exposure to HIV infection throughout their hospital duties or injuries. The authors stated that the South African Nurses faced problem with their probable exposure to HIV. It was found out on the report from the hospital that approximately 0.8% of the staffers were vulnerable to the infection every month.

The authors employed qualitative research wherein a descriptive study was performed to describe and assess the singular experience of a nurse after his/her exposure to probable incurable infection called HIV. The description was based on the partakers’ experience and not on the interpretations of the researcher. A participatory research approach was also adopted as a research technique wherein in-depth interviews were made to come up with direct quotations and conversations that both served as foundation for this study. The authors divided the in-depth interviews into two parts, wherein the first part occurred immediately after the exposure to the infection and the second part was three months post-exposure. The questions on the interview dealt with the experience of nurses during the possible exposure.

The participants in the study were all nurse staffs from the selected hospital that had been exposed to HIV during their duties or through injuries. The exposure was due to either splash accidents or needle-stick. The participants that were interviewed were exposed during period between March 1 and 3 in the year 2004. In October 2004, the participants were interviewed again after they underwent the necessary treatment and counseling. The authors indicated that the participants that were included in the study met the following criteria: (1) Africans and English Speaking nurses from the chosen hospital that were exposed to probable HIV infection during their duty, (2) participants were required to be under the surveillance list of the hospital, (3) the exposure occurred during the nurses’ official duty periods at the hospital, (4) the nurses that were exposed were registered to the South African Nursing Council including those licensed nurses and student nurses, (5) the researcher had included the first twelve months of the six months of surveillance period for each exposed nurses.

The authors described their participants to be between the age eighteen and fifty-seven years of age with clinical experiences ranging from four weeks to thirty nine years, or fifteen years on the average. Among the twelve participants, eight were registered professionals, one was a registered enrolled nurse, and three were student nurses (first and third year). Seven out of twelve participants were exposed through sharp and needle injuries whereas five of them were exposed to body fluid or infected blood.

To ensure that all the participants were negative prior to exposure, all the positive for HIV were before the occurrence of exposure or injury were excluded on the study. The authors also adopted Polit and Beck’s (2004) data saturation in measuring the size of the unit. This was done by saturating data during repetitions of descriptions without collecting new data. The authors indicated that the saturation was attained after eight months and covered twelve participants. The authors also adopted the method of exploratory interview (Brink, 1996; Burns and Gove, 2005; Polit and Beck, 2004) on two exposed nurses to get an assurance that the necessary information would be attained. The authors indicated that the advantages of performing an exploratory interview include: (1) testing the research question whether it would get the desired response or not, (2) fixing the probable problems that may result from the interview method or vagueness of the questions, and (3) practicing the procedure.

It was stated that the first part of the interview was conducted in the infection control office of the selected hospital and lasted for 45 minutes to one hour. The second interview was appointed during the initial. The analysis and interpretation of the gathered data were performed using the Tesch’s model. This is a model for analysis that involved categorizing words and phrases from the participants. The authors adopted the works of Tesch (1990) and Pope (2000) wherein data analysis began during the interview. The experiences of the participants were divided into emotional and physical experiences.

The measures that were used in the study involved the skills of the authors as skilled counselors as based on the requirements set by Rogerian client-centered approach to interrogating. According to Okum (1997) and Burns and Grove (2005), it only involved acceptance and reflection from the interviewee. The authors also asserted that as infection control consultant and registered professional nurse; they both own the required interrogating skills and meet the standards for trustworthiness including (1) transferability, (2) credibility, (3) conformability, and (4) dependability.

Upon accomplishing the interviews, the authors found out that the participants were experiencing a stage of grieving response. They also found out that the participants were all provided with immediate physical and emotional assistances that were both satisfactory and sufficient. After three months, the participants continued to practice the more cautious behaviors during the procedures that involved HIV patients or paraphernalia. Recommendations in the study included (1) 24 hour crisis management, (2) immediate support from trained and well-skilled professionals after the exposure, and (3) buddy system comprising of an exposed staff.

Strengths

The strengths of the study include the back-ups provided by the available related literatures. Just like in the cases of adopting a research design called qualitative phenomenological descriptive study by (Burns and Groove, 2005) that helped the authors to come up with data that were purely based on responses and neither from their opinions nor side comments. In addition, the saturation of data was implemented from Babbie’s (2004) study which indicated that saturation is done to avoid biases on the responses of the participants. This related study was helpful due to the fact that the research focused on qualitative nature and statistical treatment was not available for validation thus further measures should be performed to avoid biases and fragility on the results.

The study was also well-researched in terms of research techniques and research design. The authors considered all the possible methods that are applicable to the study they were conducting. They also utilized related studies that were both related and non-related to the field of nursing. The words pertaining to emotional experiences were also well-defined. These definitions helped the audience to fully understand the experiences of the participants.

Limitations

The study was only limited to one hospital in Southern Africa and covered only twelve participants from the nurse staffs of the chosen medical institution. The study did not include other medical practitioners that may also be possibly exposed to the infection; only nurses that are both registered professionally, enrolled and training were included as participants. Those that were exposed during their duties were the only ones who were considered to become part of the study. Those who were previously exposed prior to the study were excluded to avoid conflicts on the results. Only the qualitative nature of data was considered including the physical and emotional experiences of the participants. The respondents were African and American speaking staffs; however their nationalities were not mentioned on the description. The types of exposure that were considered were from sharp objects such as needed and splash liquid such as fluid or blood from the infected patients. The interviews were conducted only twice, thus there were 24 interviews conducted for the twelve participants.

Weaknesses

One of the weaknesses of the study is that it only covered twelve participants from a single hospital. Unlike the population adopted by one of the references on the study, Ayas et al. (2006) covered the National Prospective Cohort Study 2737, wherein approximately 18,447 trainees of the United States post-graduate programs for residency during the duration between July 2002 and May 2003 were held as participants. Ayas et al. (2006) included the monthly surveys that covered the schedules and occurrences of the exposure. This big population is more ideal in getting more accurate resources and same responses especially when conducting participative research method. Another weakness of the study is that the authors did not indicate the total number of nurse staffs that were currently employed in the hospital. This might have helped the authors to get the average number of nurses that were exposed to HIV at particular time duration. In spite of the fact that the research focused on the qualitative nature of the event, it would be recommended to at least know the percentage of the occurrence to come up with better conclusions and recommendation.

Likewise, the reference that was adopted by the authors that discussed the exposure of health workers to HIV infection covered four hospitals from the year February 1995 to May 2001 (Winuk, 2003). In spite of the fact that the study only covered seventeen participants, Winuk (2003) extended the duration of the study as well as the locations for the research to provide more accurate and non-fragile results.

The authors also based the recommendation from their references. Although citing the literature may be helpful, it would have been better if the authors have come up with their own recommendations as based on their observations and acquired data. There was also no further explanation on the exclusion of positive for HIV staff prior to the conduction of the study. The authors did not mention how they found out about the infection and how the staff became infected. In addition, the authors did not indicate the qualifications of the two staffs that were subjected to exploratory interview. The authors did not mention whether the two staffs were included on the twelve official participants or not.

With all these weaknesses, it is therefore asserted that the study was not written well. Some ideas were vague and only based on existing literatures. The interview parts of the research also did not indicate the percentage of the responses. For instance, the authors only stated “others” and “some participants”. These descriptions contributed to the vagueness of the report because it did not deliver a clear report on the number of participants who, for instance, underwent the denial stage or otherwise. In addition, being a registered professional nurse as well as an infection control consultant do not give an individual the right to claim that he has the necessary interrogating skills and that he meets the criteria for trustworthiness. It would have been better if the authors were accompanied by a psychologist or someone who is more skilled and knowledgeable when it comes to interviewing.

Lastly, the concluding remarks that were included by the authors saying, “This is the reality with which nurses in most health care institutions in Southern Africa are confronted everyday” are not validated yet due to the fact that the authors only covered one hospital for this study. This is a very small fraction of the total number of hospitals in Southern Africa. Although the remarks may also be true, the authors should have recommended further studies to be conducted on more hospitals to support their research.

Implications to Nursing

The implications of this study to nursing have already been delivered by previous studies; however, this helped the audience understand more the experiences of the participants rather than focusing on the technical aspects after the exposure. This can help medical institutions to provide better training to their staffs to avoid these accidents. These trainings should include dealing with work under pressure so that unnecessary accidents may be prevented. This is also a good start for those who are planning to conduct researches that would focus on qualitative data instead of quantitative. Further researches on hospitals with better facilities can be performed to do comparisons of the results. The comparison and assessment of the occurrences can help the authorities formulate better recommendations to ensure the safety of both patients and medical practitioners.

References

Ayas, Nt; Barger, Lk; Cade, Be; Hashimoto, Dm; Rosner, B;Cronin, Jw; Speizer, Fe; Czeisler,Ca; Extended work duration and the risk of self-reported percutaneous injury in items. JAMA.Vol. 296 No. 9

Babbie, E 2004. The practice of socialreseareh. 10″” edition. Belmont: Thomson Wadsworth.

Burns, N &Grove, Sk 2005. Thepraetice of nursing research – conduct, critique and utilization. 5*edition. StLouis: Elsevier Saunders Company.

Okun, Bf 1997. Effective helping -interviewing and counseling techniques.5* edition. Pacific Grove: Brooks / Cole Publishing Company

Polit, Df & Beck, Ct 2004. Nursing research: principles and methods. 7″‘edition. Philadelphia: Lippincott Williams and Wilkins

Wnuk, Am 2003. Occupational exposure to HIV infection in health care workers. HIV AIDS REVIEW. 2003; 2(3/4): 140-143. www.msi.com.pl/pub/hiv/vol 2/no 3-4/5689.pdf

Hallberg, I.R., 2009. Moving nursing research forward towards a stronger impact on health care practice? International Journal of Nursing Studies 46 (4), 407–412.

Mockiene, V., Suominen, T., Välimäki, M., Razbadauskas, A., Caplinskas, S., Martinkenas, A., 2011. The impact of an intervention to change nurses’ knowledge and HIV/AIDS related attitudes in Lithuania: a randomized controlled trial. Journal of the Association of Nurses in AIDS Care 22 (2), 140–149.

Slaten, E., Ingmundson, P., Amodei, N., Salazar, C., Martinez, C., Taliaferro, D., 2000. Training mental health professionals on ethical issues and HIV/AIDS. Sociological Practice: A Journal of Clinical and Applied Sociology 2 (4), 303–314.

Wu, Z., Detels, R., Ji, G., Xu, C., Rou, K., Ding, H., Li, V., 2002. Diffusion of HIV/AIDS knowledge, positive attitudes, and behaviours through training of health professionals in China. AIDS Education and Prevention 14 (5), 379–390.