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International Journal of Health Sciences & Research (www.ijhsr.org) 233
Vol.7; Issue: 2; February 2017
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article
Awareness Regarding the Care of Patients with HIV/AIDS among the
Nurses Working at BPKIHS, Nepal
Erina Shrestha1
, Pushpa Parajuli2
, Dr Ram Sharan Mehta2
, Gayanand Mandal3
1
Senior Instructor, 2
Professor, 3
Additional Professor,
Department of Medical Surgical Nursing, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Corresponding Author: Erina Shrestha
Received: 02/01/2017 Revised: 17/01/2017 Accepted: 23/01/2017
ABSTRACT
Background: Nurses play a critical role in caring the HIV positive patient. A knowledge deficit about
HIV/AIDS nursing care could logically affect outcomes of care for these patients. Negative attitudes
and behaviors related to HIV/AIDS might deter those in particular risk groups, the individuals with
the disease, their family members and the society from providing support and treatment.
Objective: This study attempts to determine the knowledge and attitude regarding the care of
HIV/AIDS patient, to find out the association between knowledge and practice with the selected
variables and to find the correlation of knowledge with practice.
Method: A descriptive cross-sectional study was conducted among 207 nurses working at BPKIHS,
Dharan. Stratified random sampling based on population proportionate method was adopted. Data
were collected using a semi-structured self-administered questionnaire. Data were analyzed using
descriptive and inferential statistics at level of significance 0.05.
Result: The study showed moderately adequate knowledge among majority (92.3%) of the nurses.
More than half (50.7%) of the nurses had favorable attitude towards the care of patient with
HIV/AIDS. There was no significant association between the knowledge and attitude with the socio-
demographic variable, training and experience of care of HIV/AIDS patient. Knowledge regarding the
care of patient with HIV/AIDS has significant positive correlation with attitude.
Conclusion: The study revealed that the majority of the nurses have moderately adequate knowledge
regarding the care of patient with HIV/AIDS and most of the nurses have favorable attitude towards
the care of patient with HIV/AIDS. It is therefore pertinent that all health care providers have access
to up-to-date information on all aspects of HIV/AIDS so that they can provide quality care and
services without stigmatizing and without being judgmental.
Key words: Attitude, awareness, HIV/AIDS, knowledge, nurses.
INTRODUCTION
Since the first case of HIV
recognized in the United States in 1981,
HIV has spread rapidly throughout the
world. [1]
Today, more than 30 years later,
there are approximately 35 million people
currently living with HIV and nearly 39
million people have died of AIDS related
causes since the beginning of the epidemic.
[2]
Increasing number of people
suffering from HIV/AIDS has influenced
healthcare sectors. [3]
With a sudden rise in
the HIV infection, especially in the
economically productive age groups, the
health care system has been confronted with
the challenging and complex task of taking
care of these patients. HIV has created its
own emotional stresses for the health care
sector. [4]
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 234
Vol.7; Issue: 2; February 2017
Health care providers, who are also
members of the general community, are
likely to elicit similar prejudicial and fearful
reactions to HIV/AIDS infected persons. [5]
Health professionals refuse to care for 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 professionalā€™s
fear. [3]
Unfortunately, most of health
professionals have this kind of perspective
and practice about PLWHA. The resultant
effects of such negative attitudes include
poor patient management, with people being
denied most needed treatment, care and
support. This in turn could affect their
morale, self-esteem and self- determination
to live quality lives devoid of stigma, fear,
repression and discrimination. [6]
Objective
To assess the knowledge and attitude
regarding care of patients with HIV/AIDS
among the nurses working at BPKIHS, to
find the association of knowledge and
practice with selected variables and to find
the correlation of knowledge with practice.
Significance of the study:
Infectious diseases like HIV/AIDS
are on the rise in developing countries like
Nepal which has influenced the health care
sectors. Nurses, who are the largest frontline
health care professionals, play a critical role
in caring the HIV positive patient. [7]
Maintaining the desired quality of life of
people with HIV/AIDS is possible mainly
through extensive, competent and
compassionate nursing care. [5]
A
knowledge deficit about HIV/AIDS nursing
care and negative attitudes and behaviors
related to HIV/AIDS might deter those in
particular risk groups, the individuals with
the disease, their family members and the
society from providing support and
treatment. [7]
MATERIALS AND METHODS
Research design: Descriptive cross
sectional study design was adopted for the
study.
Research Setting/Sample Area: The study
was conducted among the nurses working in
BPKIHS, a tertiary level medical institute in
Nepal.
Sample: Nurses including senior staff
nurse, staff nurse and ANM working in
BPKIHS who fulfill the inclusion criteria.
Sample size: The sample size was calculated
at the level of significance 95% and power
90% with the prevalence of attitude 47%. [3]
The sample size formula used in this study
was n=4pq/l2
and it was corrected for finite
population. Thus the final sample size was
207.
Sampling Technique: Stratified random
sampling method was adopted to collect the
data. A list of the wards was obtained with
the total number of working staffs of each
category. The number of sample was taken
from each strata of nurses based on
population proportionate random sampling
method.
Research instrument: A semi-structured
self-administered questionnaire was
developed based on the objectives of the
research. It consisted of three sections:
Section A consisted of questions related to
demographic factors and training and
experience of care of HIV/AIDS patient.
Section B consisted of knowledge regarding
the care of patients with HIV/AIDS based
on literature review and tool used by
Hasani. [8]
It consisted of 34 true/false
questionnaire and each statement answered
as true, false or donā€™t know. Each correct
answer was scored 1 and each incorrect
answer was scored 0 (donā€™t know answers
were treated as 0)
Section C consisted of HIV attitude
items used by Zadeh [3]
consisting of five
point Likert scale items that address the
attitude of nurses towards the care of patient
with HIV/AIDS. These items include five
scales as emotions toward people with
HIV/AIDS (6 items), caring of patients with
HIV (5 items), effectiveness of care (3
items), fear of contagion (3 items) and
readiness to care (3 items). Each item had a
5 point Likert scale ranging from 1 (strongly
disagree) to 5 (strongly agree) and negative
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 235
Vol.7; Issue: 2; February 2017
attitude scored reversely. The items on
attitude for each part had Cronbachā€™s alpha
coefficient of 0.68, 0.69, 0.73, 0.88 and 0.87
respectively. The reliability was tested
among the Iranian nurses.
Validity of the tool: Content validity of the
tool was established by the experts in
related fields. Based on their suggestions
necessary modifications were made. Pre-
testing of the tool was done among 10 % of
total subjects.
Procedure for data collection: Permission
from the concerned authority was obtained
to conduct the study. Informed verbal
consent was obtained from respondents
prior to the data collection. The respondents
were reassured that confidentiality will be
maintained throughout the study. Data was
collected by self-administered
questionnaire. The questionnaire was
distributed to the respondents by the
researcher herself and they were asked to
fill the questionnaire in the presence of the
researcher. The filled questionnaire was
collected after its completion. The
respondents were assured that
confidentiality of their information would
be maintained while reporting the data.
Statistical Analysis: Descriptive statistics
(mean, median, percentage, range, standard
deviation and interquartile range) was used
to describe the demographic and other
related variables. One way ā€˜ANOVAā€™ and
Independent ā€˜tā€™-test were used to find out
the association between the knowledge and
attitude score towards the care of patient
with HIV/AIDS and the selected variables.
Correlation was used to find out the
association between the attitude and its
domain with the knowledge.
RESULTS
More than three-fourth (76.8%) of
the respondents belonged to the age group
20-29 years. The age of the respondents
ranged from 20 to 50 years with the mean
age of 25.81 years and standard deviation of
4.77. More than half (51.2%) of the
respondents were working in the general
unit. Around 51% of the respondents were
unmarried, followed by married respondents
of 49.3%. Majority (80.6%) of the
respondents were educated up to the
certificate level and 9.7% each studied up to
the ANM level and the bachelor level.
Majority (82.1%) of the respondents was
designated as staff nurse and minimal
respondents (8.2%) were working as senior
staff nurse. Significant percentage (72.8%)
of the respondents had less than 5 years of
nursing experience. The experience of the
respondents ranged from 9 months to 25
years. The median duration of the nursing
experience of the respondents was 2.5 years
with the IQR of 2- 5 years.
Minimal percentage (6%) of the
respondents had received training in aspects
of HIV/AIDS, among which 25% of the
respondents had received training on VCT
and PMTCT. Significant percentage
(78.3%) of the respondents claimed that
they had previous experience of caring the
patients with HIV/AIDS. Among these
respondents more than one third (41.5%) of
the nurses had taken care of more than one
HIV/AIDS patient per month.
The study showed that the majority
(98.1%) of the respondents knew that
HIV/AIDS is caused by a Retro Virus.
Almost all (98.6%) of the respondents were
acquainted that intravenous drug abusers are
at risk for contracting HIV/AIDS.
Significant number (98.1%) of the
respondents knew that the sexual partners of
a person with HIV/AIDS should be blood
precautioned if hospitalized. Almost 90% of
the respondents denied that HIV can be
easily transmitted through saliva, sweat and
tears. Minimal percent (10.6%) of the
respondents knew that the risk of infection
with the HIV/AIDS virus after an accidental
needle stick is low. Less than one third
(23.7%) of the respondents denied that to
prevent accidental injury, contaminated
needles should be recapped immediately
after use on patients with HIV/AIDS. Only
around 25% of the respondents knew that
one should suspect the diagnosis of
HIV/AIDS in young persons who present
with Kaposiā€™s sarcoma.
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 236
Vol.7; Issue: 2; February 2017
The study reported that the
respondents had positive emotion towards
the people with HIV/AIDS. Majority
(94.6%) of the respondents disagreed that
the patients with HIV/AIDS should be
isolated from the society. Majority (90%)
agreed that they should be admitted to the
hospital. Majority of the respondents
showed positive attitude towards working
with the HIV/AIDS patient. Around 60% of
the respondents disagreed that the beds of
the HIV/AIDS patients should be marked.
Around 50% of the respondents disagreed
that that the patient status to be notified
without his/her consent. Majority of the
respondents had positive attitude towards
the effectiveness of care for HIV/AIDS
patient. Most of the respondents believed
that caring, educating, counseling and
treatment of patients with HIV may result in
improving own quality of life. There was
less fear of contagion among the
respondents. Majority of the respondents
were ready to take care of the HIV/AIDS
patient.
Table 1: Socio-demographic Characteristics of the Respondents n=207
Characteristics Category Frequency Percentage (%)
Age
(in years)
20-29 159 76.8
30-39 46 22.2
ā‰„40 2 1.0
Mean Ā±SD = 25.81Ā±4.77 (Range 20-50 years)
Working unit General 106 51.2
Critical 101 48.8
Marital status Unmarried 105 50.7
Married 102 49.3
Level of education Bachelor 9.7
PCL 80.6
ANM 9.7
Designation ANM 20 9.7
Staff nurse 170 82.1
Senior staff nurse 17 8.2
Years of Nursing experience <5 150 72.8
5 -10 24 11.7
>10 32 15.5
Median years of experience(IQR) = 2.5 years (2- 5)
Table 2: Training and Experience of Care of HIV/AIDS Patient n=207
Characteristics Category Frequency Percentage
Training received in
aspects of HIV/AIDS
Yes 6
No 94
*Type of training (n=12) VCT 3 25
PMTCT 3 25
STI 2 16.6
TB/HIV 2 16.6
ART 2 16.6
Infection prevention 1 8.3
Stigma 1 8.3
Previous experience of
care of HIV/AIDS
patient
No 45 21.7
Yes 162 78.3
Frequency of care
(n=162)
Rarely (ā‰¤ 1/ month) 56 27.1
Sometimes (>1/ month) 86 41.5
Often (>1/week) 10 4.8
Very often (>5/week) 10 4.8
*Multiple Responses
In the present study the mean
percent score of the knowledge was 64.71.
Majority (92.3%) of the respondents had
moderately adequate knowledge regarding
the care of patient with HIV/AIDS.
The present study showed that the
mean percent score of the attitude was
75.84%. Majority of the respondents
showed favorable attitude towards the care
of patient with HIV/AIDS.
The study reported that the
knowledge was not significantly associated
with any of the socio-demographic variable
and the training received and the previous
experience of care of HIV/AIDS patient.
Attitude also had no significant association
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 237
Vol.7; Issue: 2; February 2017
with the socio-demographic variables and
the training received and the previous
experience of care. Emotion towards
HIV/AIDS patient was significantly
associated with age, working unit, marital
status, education, designation, nursing
experience. Fear of contagion among the
respondents had significant association with
the age, working unit, designation and
nursing experience. Respondentā€™s
willingness to care was significantly
associated with the previous experience of
the care of HIV/AIDS patient.
Table 3: Knowledge Regarding Agent and Immunology of HIV/AIDS n=207
SN. Statement Correct
response
Frequency of
Correct response
Percentage
1 HIV/AIDS is caused by a retrovirus. T 203 98.1
2 Pneumocysticcarinii can cause HIV/AIDS. F 90 43.5
3 A person with antibody to the virus is protected against HIV/AIDS. F 148 71.5
4 The HIV/AIDS virus is very difficult to kill with disinfectant in the
environment.
F 126 60.9
5 Members of the high-risk groups for HIV/AIDS are permitted to donate blood
if they test negative for the antibody to the virus.
F 125 60.4
6 The incubation period for HIV/AIDS is 2-5 weeks. T 141 68.1
7 HIV/AIDS is characterized by a decrease in T4 lymphocytes, causing
impaired cell immunity.
T 142 68.6
8 The average length of time from the diagnosis of HIV/AIDS until death in 5
years.
F 152 73.4
9 Persons with HIV can be asymptomatic but still infectious. T 198 95.7
10 Opportunistic infection (such as Candida esophagitis) in a previously healthy
person is suggestive of HIV/AIDS.
T 88 42.5
11 One should suspect the diagnosis of HIV/AIDS in young persons who present
with Kaposiā€™s sarcoma.
T 53 25.6
12 The incubation period for HIV/AIDS is 2-5 weeks. T 141 68.1
13 HIV/AIDS can be transmitted by casual contact. F 180 87
14 HIV/AIDS has been transmitted to people receiving blood transfusion. T 177 85.5
15 HIV can be easily transmitted through saliva, sweat and tears. F 185 89.4
16 Following an accidental needle stick, there is a greater likelihood of infection
with hepatitis B virus than with HIV/AIDS.
T 116 56
17 It is possible to transmit the virus to family members of a nurse providing
care for patients with HIV/AIDS, even though the nurse is not infected.
F 138 66.7
18 The risk of transmission of the HIV/AIDS virus during mouth to mouth
resuscitation is extremely low.
T 131 63.3
19 HIV/AIDS can be transmitted by casual contact. F 180 87
20 Heterosexual women do not get HIV/AIDS. F 172 83.1
21 Intravenous drug abusers are considered to be at risk for contracting
HIV/AIDS.
T 204 98.6
22 The greatest risk of exposure to HIV/AIDS is caring for an incontinent
patient with HIV/AIDS.
F 164 79.2
23 The risk of infection with the HIV/AIDS virus after an accidental needle stick
is high.
F 22 10.6
24 The risk of infection with HIV/AIDS among nurses is high. F 49 23.7
25 Numerous cases of HIV/AIDS have been reported among nurses and
midwives.
F 77 37.2
26 An individual may be infected with HIV/AIDS virus even if he/she tests
negative for HIV/AIDS antibodies.
T 146 70.5
27 People with HIV/AIDS should have separate bathroom/toilet facilities. F 184 88.9
28 The sexual partners of a person with HIV/AIDS should be blood precaution if
hospitalized.
T 203 98.1
29 Gloves are not necessary when handling the specimen of a patient with
HIV/AIDS.
F 155 74.9
30 There are many more people infected with HIV than actual AIDS. T 157 75.8
31 Gloves and gowns are required for any contact with patients with HIV/AIDS. F 60 29
32 People with HIV/AIDS should have different waiting rooms before
admission to the ward.
F 115 55.6
33 It is appropriate to use blood precautions on anyone known to be from
HIV/AIDS high risk groups even though they do not have a diagnosis of
HIV/AIDS
T 201 97.1
34 To prevent accidental injury, contaminated needles should be recapped
immediately after use on patients with HIV/AIDS.
F 49 23.7
35 HIV-positive patients with a CD4 count <200 should be assessed for
antiretroviral treatment.
T 116 56
36 Adherence to antiretroviral treatment is essential to avoid the development of
drug resistance.
T 87 42
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 238
Vol.7; Issue: 2; February 2017
Table 4: Knowledge Regarding the Care of Patients with HIV/AIDS n=207
Knowledge Category Frequency Percentage
Category Based on exact
score
Based on percentage
score
Inadequate knowledge Below than mean-1.96SD <14.13 <41.55 13 6.3
Moderately adequate
knowledge
Between (mean-1.96SD) and
(mean+1.96SD)
14.13-29.87 41.55-87.87 191 92.3
Adequate knowledge Above than mean+1.96SD >29.87 >87.87 3 1.4
The study revealed the significantly
positive correlation of the knowledge
regarding the care of patient with
HIV/AIDS with the attitude towards the
care of patient with HIV/AIDS (p <0.001).
Knowledge also had significant positive
correlation with the emotion towards
HIV/AIDS patient (p= 0.003), working with
HIV/AIDS patient (p=0.042), effectiveness
of care (p= 0.010) and readiness to care (p
<0.001).
The study showed that the majority
of the respondents had moderately adequate
knowledge regarding the care of patients
with HIV/AIDS. More than half of the
respondents also had the positive attitude
towards the care of patient with HIV/AIDS.
Knowledge and Attitude was not associated
with any of the socio-demographic
variables. However, knowledge had the
significant positive correlation with the
attitude and the domains of the attitude as
emotion towards HIV/AIDS patient,
working with HIV/AIDS patient,
effectiveness of care and readiness to care.
Table 5: Attitude towards the Care of Patients with HIV/AIDS n=207
Character Category Frequency Percentage (%) MeanĀ± SD
Attitude towards the care of patients with HIV/AIDS Favorable attitude 105 50.7 75.84Ā±8.18
Unfavorable attitude 102 49.3
Table 6: Correlation between Knowledge Regarding the Care of Patients with HIV/AIDS and Attitude towards the Care of Patients
with HIV/AIDS and its Domain n= 207
Knowledge
regarding the care
of patients with
HIV/AIDS*
Domains of the attitude towards the care of patient with HIV/AIDS Attitude towards the
care of patient with
HIV/AIDS
Emotion towards
HIV/AIDS
patient
Working with
HIV/AIDS
patient
Effectiveness
of care
Fear of
contagion
Readiness to
care
r value P-
value
r
value
P-
value
r
value
P -
value
r
value
P-
value
r
value
P -
value
r value P- value
0.206 0.003 0.142 0.042 0.178 0.010 0.119 0.087 0.264 <0.001 0.329 <0.001
Note: *Pearson correlation
DISCUSSION AND CONCLUSION
While assessing the knowledge
majority of the respondents (98.1%) could
identify the causative agent of HIV/AIDS as
Retro Virus but only 43.5% i.e. less than
half of the respondents denied that
Pneumocystic carinii can cause HIV/AIDS.
Worse scenario was found in a study done
by Mulaudzi [9]
where only 21% of the
respondents knew that HIV is caused by
retro virus. Infections can be transmitted by
the infected individuals even when
symptoms of AIDS are not present. More
than 95% of the respondents in this study
were acquainted with this fact. However, in
a study conducted by Marranzano [10]
only
65% of the respondents accepted that
persons with HIV can be asymptomatic but
still infectious. Respondents in this study
might not have the knowledge about the
complications of the disease as only 25.6%
of the respondents answered correctly that
one should suspect the diagnosis of
HIV/AIDS in young persons who present
with Kaposiā€™s sarcoma. Casual contact such
as touching, hugging and kissing an infected
person with HIV/AIDS do not result in HIV
transmission. [5,11]
Supporting the fact, in the
present study 87% of the respondents
identified the statement that HIV/AIDS can
be transmitted by casual contact as the false
statement. Similar to the present study,
Sadon [11]
reported that 97% of the
respondents had knowledge that casual
contact would not transmit HIV. In a study
conducted by Achappa, [4]
very large
population of nurses believed that HIV
could be transmitted by sharing plates,
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 239
Vol.7; Issue: 2; February 2017
contact with urine and feces, saliva and tears
and sputum of the HIV positive patient.
Much better scenario was seen in the
present study where around 90% of the
respondents denied that HIV can be easily
transmitted through saliva, sweat and tears.
Despite the fact that the risk of a health care
provider contracting HIV is believed to be
almost zero when proper precautions are
used, studies showed that the nurses
continue to be concerned about the risk of
caring for patient with HIV/AIDS. [4]
In the
present study 80% of the respondents
believed that the greatest risk of exposure to
HIV/AIDS is caring for an incontinent
patient with HIV/AIDS. Although the
overall risk of occupational infection after a
needle stick injury with a needle containing
HIV infected blood is estimated to be 0.3%,
[13]
the respondents in the present study were
likely to be overestimating their risk of
occupational infection with HIV as the
majority (89.4%) had wrong belief that the
risk of infection with the HIV/AIDS virus
after an accidental needle stick is high.
More than three-fourth (76.3%) of
the respondents agreed that to prevent
accidental injury, contaminated needles
should be recapped immediately after use on
patients with HIV/AIDS which is consistent
with finding of the study done by Dellobelle
[14]
and Ehler. [15]
This shows the lack of
injection safety in developing countries. An
unsafe injection practice put not only
patients but also healthcare workers at risk;
attention should be given to the
occupational safety of health care workers.
[14]
With the mean score of 22 and SD
4.02, out of possible score of 34 (mean
percent scoreĀ±SD = 64.71Ā±11.82), nurses in
this study demonstrated a good knowledge
regarding the care of patient with
HIV/AIDS.
Around 67% of the respondents
disagreed that the patients with HIV/AIDS
are responsible for their illness. Similar to
the present finding a study conducted by
Mulaudzi [9]
reported that only 12.1% of the
respondents blamed the patient for their
status.
In the present study around 45% of
the respondents agreed that the people with
HIV/AIDS should be in separate ward in a
hospital. Similar finding was seen in the
study conducted by Achappa [4]
and Reis [16]
which showed that 46.1% and 59% of the
respondents respectively agreed that the
HIV positive needed to be nursed
separately. These findings highlight a lack
of understanding regarding the primary
principle underlying standard/universal
precautions i.e. the precautions to be applied
universally and not selectively. When
standard/universal precautions are applied
appropriately it is not necessary to isolate
HIV positive patients unless they have
tuberculosis or other opportunistic
infections that require isolation. [17]
More than half (59%) of the
respondents disagreed that the beds of
patients with HIV/AIDS be marked. A study
done by Achappa [4]
in India showed that
80.5% of the respondents thought that it was
appropriate to disclose the HIV status of the
patient to his relatives/sexual partner
without his/her consent. However in the
present study more than half (55%) of the
respondents disagreed that relatives/sexual
partner of patients with HIV/AIDS should
be notified of the patientā€™s status without
his/her consent. Around 65% of the
respondents agreed that medications to treat
opportunistic infections may prolong the life
of patient with HIV. This result is supported
by the study conducted by Aghamolaei [6]
in
which most of the participants believed that
caring, educating, counseling and treatment
of patients with HIV may result in
improving own quality of life. The present
study shows that more than three fourth
(76.9%) of the respondents were willing to
take care of patients with HIV/AIDS.
Similar finding was seen in a study
conducted by Achappa [4]
which reported
that only 5.4% of the respondents did not
prefer to care for the HIV positive patients.
The mean scores of attitude in
dimensions including emotion towards the
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 240
Vol.7; Issue: 2; February 2017
people with HIV/AIDS, working with
HIV/AIDS patient, effectiveness of care,
fear of contagion and readiness to care were
24.08, 17.90, 11.86, 10.87and 11.13
respectively. The study reveals favorable
attitude among the respondents showing
50.7% of the respondents scoring more than
60 percent. The mean score of attitude was
found to be 75.84 with standard deviation of
8.18. This result is supported by a study
conducted by Achappa [4]
which showed
positive attitude in caring the HIV patients.
Several other studies conducted among the
nurses showed the similar result. [4-6,9,14]
However a study conducted by Mo, [18]
Zadeh, [3]
Oyeyemi, [19]
Mahat [20]
and
Hassan [21]
had revealed the negative
attitude among the nurses.
In the present study respondents
with bachelor level of education had higher
mean percent knowledge score of 69.85.
Higher mean knowledge score was found
among the respondents those who had
received training (67.64) than those who
hadnā€™t received training (62.87). Knowledge
regarding the care of patient with
HIV/AIDS was not associated with the age,
working unit, marital status, level of
education, designation of the respondent,
nursing experience. Similar result was seen
in a study conducted by Dellobelle. [14]
Gulifeiya [22]
conducted a study in Malaysia
which showed no significant association of
the knowledge with the respondentā€™s socio-
demographic characteristics.
The present study shows no
statistically significant association of the
knowledge level of the nurses with previous
training and previous experience of care of
HIV/AIDS patient. However in a study
conducted by Zadeh [3]
significant
association of the level of knowledge with
the training program related to HIV/AIDS
and the previous experience of caring for
HIV/AIDS patients was found. A study by
Hasani [8]
showed that the respondents
participating in educational program had
over all higher scores of knowledge than the
nonparticipants. However the same study
revealed that knowledge was not associated
with the years of HIV patient caring.
In the present study no statistically
significant association was found between
the attitude towards the care of patient with
HIV/AIDS and age, working unit, marital
status, level of education, designation of the
respondent, nursing experience. The finding
was supported by a study conducted by
Zadeh [3]
which found no significant
association between the socio-demographic
variables and the attitude of the nurses.
In the present study, no statistically
significant association was found among the
attitude and the previous training in aspects
of HIV/AIDS and previous experience of
caring the HIV/AIDS patient. Contrary to
the present findings, a comparative study
done by Suominen [23]
explored that the
level of attitude was positively influenced
by the previous experience of providing care
to HIV/AIDS patient. A study conducted by
Oyeyemi [19]
showed that the attitude was
influenced by the prior education and
experience of taking care for HIV/AIDS
patient. Other studies by Gulifeiya [22]
and
Dellobelle [14]
showed that attitude of the
nurses towards HIV/AIDS patients was
significantly related to their training status.
The present study shows that
emotion towards HIV/AIDS patient was
significantly associated with age, working
unit, marital status, education, designation
and nursing experience. In this study fear of
contagion was associated with the age,
working unit, designation and nursing
experience. Respondents in the age group of
more than 40 years, designated as senior
staff nurse and more than 10 years of
experience had less fear of contagion. This
may be due to the maturity in their work and
experience of working which has led to less
fear of contagion. The present study reveals
that the respondentā€™s readiness to care was
significantly associated with their previous
experience of caring the HIV/AIDS patient.
The study reveals that knowledge
regarding the care of patient with
HIV/AIDS had significant positive
relationship with the attitude towards the
Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At
BPKIHS, Nepal
International Journal of Health Sciences & Research (www.ijhsr.org) 241
Vol.7; Issue: 2; February 2017
care of patient with HIV/AIDS. (r= 0.329,
p= <0.001). The positive linear correlation
affirms that better knowledge can lead to
positive attitude.
Similar finding was seen in a study
conducted by Zadeh [3]
in which the
knowledge score was significantly
positively correlated with attitude (r
=0.0253, p<0.05). However a study by
Oyeyemi [19]
showed no significant
correlation between scores on knowledge
and attitude.
The present study reported that the
knowledge score was significantly
positively correlated with domain emotion
(r= 0.206, p= 0.003), caring the HIV/AIDS
patient (r= 0.142, p= 0.042), effectiveness of
care (r= 0.178, p= 0.010) and readiness to
care (r= 0.264, p<0.001). The present study
showed no significant correlation of the
knowledge score with fear of contagion. It
reveals that there exist the fear of contagion
among the nurses regardless their level of
knowledge.
CONCLUSION
The study revealed that the majority
of the nurses have moderately adequate
knowledge regarding the care of patient
with HIV/AIDS and more than half of the
nurses have favorable attitude towards the
care of patient with HIV/AIDS. Knowledge
regarding the care of patient with
HIV/AIDS has significant positive
correlation with attitude and the domains
emotion towards HIV/AIDS patient,
working with HIV/AIDS patient,
effectiveness of care and readiness to care.
Knowledge, however, has no correlation
with the fear of contagion. It is concluded
from the study that the increase in
knowledge of the nurses leads to the
favorable attitude. It is therefore important
that all the nurses have access to up-to-date
information on all aspects of HIV/AIDS.
ACKNOWLEDGEMENT(S)
We would like to express our sincere gratitude to
BPKIHS and Nursing Service Administration for
providing us the opportunity and facilities to
conduct this research.
REFERENCES
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***********
How to cite this article: Shrestha E, Parajuli P, Mehta RS et al. Awareness regarding the care of
patients with HIV/AIDS among the nurses working at BPKIHS, Nepal. Int J Health Sci Res.
2017; 7(2):233-242.

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  • 1. International Journal of Health Sciences & Research (www.ijhsr.org) 233 Vol.7; Issue: 2; February 2017 International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at BPKIHS, Nepal Erina Shrestha1 , Pushpa Parajuli2 , Dr Ram Sharan Mehta2 , Gayanand Mandal3 1 Senior Instructor, 2 Professor, 3 Additional Professor, Department of Medical Surgical Nursing, BP Koirala Institute of Health Sciences, Dharan, Nepal. Corresponding Author: Erina Shrestha Received: 02/01/2017 Revised: 17/01/2017 Accepted: 23/01/2017 ABSTRACT Background: Nurses play a critical role in caring the HIV positive patient. A knowledge deficit about HIV/AIDS nursing care could logically affect outcomes of care for these patients. Negative attitudes and behaviors related to HIV/AIDS might deter those in particular risk groups, the individuals with the disease, their family members and the society from providing support and treatment. Objective: This study attempts to determine the knowledge and attitude regarding the care of HIV/AIDS patient, to find out the association between knowledge and practice with the selected variables and to find the correlation of knowledge with practice. Method: A descriptive cross-sectional study was conducted among 207 nurses working at BPKIHS, Dharan. Stratified random sampling based on population proportionate method was adopted. Data were collected using a semi-structured self-administered questionnaire. Data were analyzed using descriptive and inferential statistics at level of significance 0.05. Result: The study showed moderately adequate knowledge among majority (92.3%) of the nurses. More than half (50.7%) of the nurses had favorable attitude towards the care of patient with HIV/AIDS. There was no significant association between the knowledge and attitude with the socio- demographic variable, training and experience of care of HIV/AIDS patient. Knowledge regarding the care of patient with HIV/AIDS has significant positive correlation with attitude. Conclusion: The study revealed that the majority of the nurses have moderately adequate knowledge regarding the care of patient with HIV/AIDS and most of the nurses have favorable attitude towards the care of patient with HIV/AIDS. It is therefore pertinent that all health care providers have access to up-to-date information on all aspects of HIV/AIDS so that they can provide quality care and services without stigmatizing and without being judgmental. Key words: Attitude, awareness, HIV/AIDS, knowledge, nurses. INTRODUCTION Since the first case of HIV recognized in the United States in 1981, HIV has spread rapidly throughout the world. [1] Today, more than 30 years later, there are approximately 35 million people currently living with HIV and nearly 39 million people have died of AIDS related causes since the beginning of the epidemic. [2] Increasing number of people suffering from HIV/AIDS has influenced healthcare sectors. [3] With a sudden rise in the HIV infection, especially in the economically productive age groups, the health care system has been confronted with the challenging and complex task of taking care of these patients. HIV has created its own emotional stresses for the health care sector. [4]
  • 2. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 234 Vol.7; Issue: 2; February 2017 Health care providers, who are also members of the general community, are likely to elicit similar prejudicial and fearful reactions to HIV/AIDS infected persons. [5] Health professionals refuse to care for 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 professionalā€™s fear. [3] Unfortunately, most of health professionals have this kind of perspective and practice about PLWHA. The resultant effects of such negative attitudes include poor patient management, with people being denied most needed treatment, care and support. This in turn could affect their morale, self-esteem and self- determination to live quality lives devoid of stigma, fear, repression and discrimination. [6] Objective To assess the knowledge and attitude regarding care of patients with HIV/AIDS among the nurses working at BPKIHS, to find the association of knowledge and practice with selected variables and to find the correlation of knowledge with practice. Significance of the study: Infectious diseases like HIV/AIDS are on the rise in developing countries like Nepal which has influenced the health care sectors. Nurses, who are the largest frontline health care professionals, play a critical role in caring the HIV positive patient. [7] Maintaining the desired quality of life of people with HIV/AIDS is possible mainly through extensive, competent and compassionate nursing care. [5] A knowledge deficit about HIV/AIDS nursing care and negative attitudes and behaviors related to HIV/AIDS might deter those in particular risk groups, the individuals with the disease, their family members and the society from providing support and treatment. [7] MATERIALS AND METHODS Research design: Descriptive cross sectional study design was adopted for the study. Research Setting/Sample Area: The study was conducted among the nurses working in BPKIHS, a tertiary level medical institute in Nepal. Sample: Nurses including senior staff nurse, staff nurse and ANM working in BPKIHS who fulfill the inclusion criteria. Sample size: The sample size was calculated at the level of significance 95% and power 90% with the prevalence of attitude 47%. [3] The sample size formula used in this study was n=4pq/l2 and it was corrected for finite population. Thus the final sample size was 207. Sampling Technique: Stratified random sampling method was adopted to collect the data. A list of the wards was obtained with the total number of working staffs of each category. The number of sample was taken from each strata of nurses based on population proportionate random sampling method. Research instrument: A semi-structured self-administered questionnaire was developed based on the objectives of the research. It consisted of three sections: Section A consisted of questions related to demographic factors and training and experience of care of HIV/AIDS patient. Section B consisted of knowledge regarding the care of patients with HIV/AIDS based on literature review and tool used by Hasani. [8] It consisted of 34 true/false questionnaire and each statement answered as true, false or donā€™t know. Each correct answer was scored 1 and each incorrect answer was scored 0 (donā€™t know answers were treated as 0) Section C consisted of HIV attitude items used by Zadeh [3] consisting of five point Likert scale items that address the attitude of nurses towards the care of patient with HIV/AIDS. These items include five scales as emotions toward people with HIV/AIDS (6 items), caring of patients with HIV (5 items), effectiveness of care (3 items), fear of contagion (3 items) and readiness to care (3 items). Each item had a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) and negative
  • 3. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 235 Vol.7; Issue: 2; February 2017 attitude scored reversely. The items on attitude for each part had Cronbachā€™s alpha coefficient of 0.68, 0.69, 0.73, 0.88 and 0.87 respectively. The reliability was tested among the Iranian nurses. Validity of the tool: Content validity of the tool was established by the experts in related fields. Based on their suggestions necessary modifications were made. Pre- testing of the tool was done among 10 % of total subjects. Procedure for data collection: Permission from the concerned authority was obtained to conduct the study. Informed verbal consent was obtained from respondents prior to the data collection. The respondents were reassured that confidentiality will be maintained throughout the study. Data was collected by self-administered questionnaire. The questionnaire was distributed to the respondents by the researcher herself and they were asked to fill the questionnaire in the presence of the researcher. The filled questionnaire was collected after its completion. The respondents were assured that confidentiality of their information would be maintained while reporting the data. Statistical Analysis: Descriptive statistics (mean, median, percentage, range, standard deviation and interquartile range) was used to describe the demographic and other related variables. One way ā€˜ANOVAā€™ and Independent ā€˜tā€™-test were used to find out the association between the knowledge and attitude score towards the care of patient with HIV/AIDS and the selected variables. Correlation was used to find out the association between the attitude and its domain with the knowledge. RESULTS More than three-fourth (76.8%) of the respondents belonged to the age group 20-29 years. The age of the respondents ranged from 20 to 50 years with the mean age of 25.81 years and standard deviation of 4.77. More than half (51.2%) of the respondents were working in the general unit. Around 51% of the respondents were unmarried, followed by married respondents of 49.3%. Majority (80.6%) of the respondents were educated up to the certificate level and 9.7% each studied up to the ANM level and the bachelor level. Majority (82.1%) of the respondents was designated as staff nurse and minimal respondents (8.2%) were working as senior staff nurse. Significant percentage (72.8%) of the respondents had less than 5 years of nursing experience. The experience of the respondents ranged from 9 months to 25 years. The median duration of the nursing experience of the respondents was 2.5 years with the IQR of 2- 5 years. Minimal percentage (6%) of the respondents had received training in aspects of HIV/AIDS, among which 25% of the respondents had received training on VCT and PMTCT. Significant percentage (78.3%) of the respondents claimed that they had previous experience of caring the patients with HIV/AIDS. Among these respondents more than one third (41.5%) of the nurses had taken care of more than one HIV/AIDS patient per month. The study showed that the majority (98.1%) of the respondents knew that HIV/AIDS is caused by a Retro Virus. Almost all (98.6%) of the respondents were acquainted that intravenous drug abusers are at risk for contracting HIV/AIDS. Significant number (98.1%) of the respondents knew that the sexual partners of a person with HIV/AIDS should be blood precautioned if hospitalized. Almost 90% of the respondents denied that HIV can be easily transmitted through saliva, sweat and tears. Minimal percent (10.6%) of the respondents knew that the risk of infection with the HIV/AIDS virus after an accidental needle stick is low. Less than one third (23.7%) of the respondents denied that to prevent accidental injury, contaminated needles should be recapped immediately after use on patients with HIV/AIDS. Only around 25% of the respondents knew that one should suspect the diagnosis of HIV/AIDS in young persons who present with Kaposiā€™s sarcoma.
  • 4. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/AIDS among the Nurses Working at BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 236 Vol.7; Issue: 2; February 2017 The study reported that the respondents had positive emotion towards the people with HIV/AIDS. Majority (94.6%) of the respondents disagreed that the patients with HIV/AIDS should be isolated from the society. Majority (90%) agreed that they should be admitted to the hospital. Majority of the respondents showed positive attitude towards working with the HIV/AIDS patient. Around 60% of the respondents disagreed that the beds of the HIV/AIDS patients should be marked. Around 50% of the respondents disagreed that that the patient status to be notified without his/her consent. Majority of the respondents had positive attitude towards the effectiveness of care for HIV/AIDS patient. Most of the respondents believed that caring, educating, counseling and treatment of patients with HIV may result in improving own quality of life. There was less fear of contagion among the respondents. Majority of the respondents were ready to take care of the HIV/AIDS patient. Table 1: Socio-demographic Characteristics of the Respondents n=207 Characteristics Category Frequency Percentage (%) Age (in years) 20-29 159 76.8 30-39 46 22.2 ā‰„40 2 1.0 Mean Ā±SD = 25.81Ā±4.77 (Range 20-50 years) Working unit General 106 51.2 Critical 101 48.8 Marital status Unmarried 105 50.7 Married 102 49.3 Level of education Bachelor 9.7 PCL 80.6 ANM 9.7 Designation ANM 20 9.7 Staff nurse 170 82.1 Senior staff nurse 17 8.2 Years of Nursing experience <5 150 72.8 5 -10 24 11.7 >10 32 15.5 Median years of experience(IQR) = 2.5 years (2- 5) Table 2: Training and Experience of Care of HIV/AIDS Patient n=207 Characteristics Category Frequency Percentage Training received in aspects of HIV/AIDS Yes 6 No 94 *Type of training (n=12) VCT 3 25 PMTCT 3 25 STI 2 16.6 TB/HIV 2 16.6 ART 2 16.6 Infection prevention 1 8.3 Stigma 1 8.3 Previous experience of care of HIV/AIDS patient No 45 21.7 Yes 162 78.3 Frequency of care (n=162) Rarely (ā‰¤ 1/ month) 56 27.1 Sometimes (>1/ month) 86 41.5 Often (>1/week) 10 4.8 Very often (>5/week) 10 4.8 *Multiple Responses In the present study the mean percent score of the knowledge was 64.71. Majority (92.3%) of the respondents had moderately adequate knowledge regarding the care of patient with HIV/AIDS. The present study showed that the mean percent score of the attitude was 75.84%. Majority of the respondents showed favorable attitude towards the care of patient with HIV/AIDS. The study reported that the knowledge was not significantly associated with any of the socio-demographic variable and the training received and the previous experience of care of HIV/AIDS patient. Attitude also had no significant association
  • 5. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 237 Vol.7; Issue: 2; February 2017 with the socio-demographic variables and the training received and the previous experience of care. Emotion towards HIV/AIDS patient was significantly associated with age, working unit, marital status, education, designation, nursing experience. Fear of contagion among the respondents had significant association with the age, working unit, designation and nursing experience. Respondentā€™s willingness to care was significantly associated with the previous experience of the care of HIV/AIDS patient. Table 3: Knowledge Regarding Agent and Immunology of HIV/AIDS n=207 SN. Statement Correct response Frequency of Correct response Percentage 1 HIV/AIDS is caused by a retrovirus. T 203 98.1 2 Pneumocysticcarinii can cause HIV/AIDS. F 90 43.5 3 A person with antibody to the virus is protected against HIV/AIDS. F 148 71.5 4 The HIV/AIDS virus is very difficult to kill with disinfectant in the environment. F 126 60.9 5 Members of the high-risk groups for HIV/AIDS are permitted to donate blood if they test negative for the antibody to the virus. F 125 60.4 6 The incubation period for HIV/AIDS is 2-5 weeks. T 141 68.1 7 HIV/AIDS is characterized by a decrease in T4 lymphocytes, causing impaired cell immunity. T 142 68.6 8 The average length of time from the diagnosis of HIV/AIDS until death in 5 years. F 152 73.4 9 Persons with HIV can be asymptomatic but still infectious. T 198 95.7 10 Opportunistic infection (such as Candida esophagitis) in a previously healthy person is suggestive of HIV/AIDS. T 88 42.5 11 One should suspect the diagnosis of HIV/AIDS in young persons who present with Kaposiā€™s sarcoma. T 53 25.6 12 The incubation period for HIV/AIDS is 2-5 weeks. T 141 68.1 13 HIV/AIDS can be transmitted by casual contact. F 180 87 14 HIV/AIDS has been transmitted to people receiving blood transfusion. T 177 85.5 15 HIV can be easily transmitted through saliva, sweat and tears. F 185 89.4 16 Following an accidental needle stick, there is a greater likelihood of infection with hepatitis B virus than with HIV/AIDS. T 116 56 17 It is possible to transmit the virus to family members of a nurse providing care for patients with HIV/AIDS, even though the nurse is not infected. F 138 66.7 18 The risk of transmission of the HIV/AIDS virus during mouth to mouth resuscitation is extremely low. T 131 63.3 19 HIV/AIDS can be transmitted by casual contact. F 180 87 20 Heterosexual women do not get HIV/AIDS. F 172 83.1 21 Intravenous drug abusers are considered to be at risk for contracting HIV/AIDS. T 204 98.6 22 The greatest risk of exposure to HIV/AIDS is caring for an incontinent patient with HIV/AIDS. F 164 79.2 23 The risk of infection with the HIV/AIDS virus after an accidental needle stick is high. F 22 10.6 24 The risk of infection with HIV/AIDS among nurses is high. F 49 23.7 25 Numerous cases of HIV/AIDS have been reported among nurses and midwives. F 77 37.2 26 An individual may be infected with HIV/AIDS virus even if he/she tests negative for HIV/AIDS antibodies. T 146 70.5 27 People with HIV/AIDS should have separate bathroom/toilet facilities. F 184 88.9 28 The sexual partners of a person with HIV/AIDS should be blood precaution if hospitalized. T 203 98.1 29 Gloves are not necessary when handling the specimen of a patient with HIV/AIDS. F 155 74.9 30 There are many more people infected with HIV than actual AIDS. T 157 75.8 31 Gloves and gowns are required for any contact with patients with HIV/AIDS. F 60 29 32 People with HIV/AIDS should have different waiting rooms before admission to the ward. F 115 55.6 33 It is appropriate to use blood precautions on anyone known to be from HIV/AIDS high risk groups even though they do not have a diagnosis of HIV/AIDS T 201 97.1 34 To prevent accidental injury, contaminated needles should be recapped immediately after use on patients with HIV/AIDS. F 49 23.7 35 HIV-positive patients with a CD4 count <200 should be assessed for antiretroviral treatment. T 116 56 36 Adherence to antiretroviral treatment is essential to avoid the development of drug resistance. T 87 42
  • 6. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 238 Vol.7; Issue: 2; February 2017 Table 4: Knowledge Regarding the Care of Patients with HIV/AIDS n=207 Knowledge Category Frequency Percentage Category Based on exact score Based on percentage score Inadequate knowledge Below than mean-1.96SD <14.13 <41.55 13 6.3 Moderately adequate knowledge Between (mean-1.96SD) and (mean+1.96SD) 14.13-29.87 41.55-87.87 191 92.3 Adequate knowledge Above than mean+1.96SD >29.87 >87.87 3 1.4 The study revealed the significantly positive correlation of the knowledge regarding the care of patient with HIV/AIDS with the attitude towards the care of patient with HIV/AIDS (p <0.001). Knowledge also had significant positive correlation with the emotion towards HIV/AIDS patient (p= 0.003), working with HIV/AIDS patient (p=0.042), effectiveness of care (p= 0.010) and readiness to care (p <0.001). The study showed that the majority of the respondents had moderately adequate knowledge regarding the care of patients with HIV/AIDS. More than half of the respondents also had the positive attitude towards the care of patient with HIV/AIDS. Knowledge and Attitude was not associated with any of the socio-demographic variables. However, knowledge had the significant positive correlation with the attitude and the domains of the attitude as emotion towards HIV/AIDS patient, working with HIV/AIDS patient, effectiveness of care and readiness to care. Table 5: Attitude towards the Care of Patients with HIV/AIDS n=207 Character Category Frequency Percentage (%) MeanĀ± SD Attitude towards the care of patients with HIV/AIDS Favorable attitude 105 50.7 75.84Ā±8.18 Unfavorable attitude 102 49.3 Table 6: Correlation between Knowledge Regarding the Care of Patients with HIV/AIDS and Attitude towards the Care of Patients with HIV/AIDS and its Domain n= 207 Knowledge regarding the care of patients with HIV/AIDS* Domains of the attitude towards the care of patient with HIV/AIDS Attitude towards the care of patient with HIV/AIDS Emotion towards HIV/AIDS patient Working with HIV/AIDS patient Effectiveness of care Fear of contagion Readiness to care r value P- value r value P- value r value P - value r value P- value r value P - value r value P- value 0.206 0.003 0.142 0.042 0.178 0.010 0.119 0.087 0.264 <0.001 0.329 <0.001 Note: *Pearson correlation DISCUSSION AND CONCLUSION While assessing the knowledge majority of the respondents (98.1%) could identify the causative agent of HIV/AIDS as Retro Virus but only 43.5% i.e. less than half of the respondents denied that Pneumocystic carinii can cause HIV/AIDS. Worse scenario was found in a study done by Mulaudzi [9] where only 21% of the respondents knew that HIV is caused by retro virus. Infections can be transmitted by the infected individuals even when symptoms of AIDS are not present. More than 95% of the respondents in this study were acquainted with this fact. However, in a study conducted by Marranzano [10] only 65% of the respondents accepted that persons with HIV can be asymptomatic but still infectious. Respondents in this study might not have the knowledge about the complications of the disease as only 25.6% of the respondents answered correctly that one should suspect the diagnosis of HIV/AIDS in young persons who present with Kaposiā€™s sarcoma. Casual contact such as touching, hugging and kissing an infected person with HIV/AIDS do not result in HIV transmission. [5,11] Supporting the fact, in the present study 87% of the respondents identified the statement that HIV/AIDS can be transmitted by casual contact as the false statement. Similar to the present study, Sadon [11] reported that 97% of the respondents had knowledge that casual contact would not transmit HIV. In a study conducted by Achappa, [4] very large population of nurses believed that HIV could be transmitted by sharing plates,
  • 7. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 239 Vol.7; Issue: 2; February 2017 contact with urine and feces, saliva and tears and sputum of the HIV positive patient. Much better scenario was seen in the present study where around 90% of the respondents denied that HIV can be easily transmitted through saliva, sweat and tears. Despite the fact that the risk of a health care provider contracting HIV is believed to be almost zero when proper precautions are used, studies showed that the nurses continue to be concerned about the risk of caring for patient with HIV/AIDS. [4] In the present study 80% of the respondents believed that the greatest risk of exposure to HIV/AIDS is caring for an incontinent patient with HIV/AIDS. Although the overall risk of occupational infection after a needle stick injury with a needle containing HIV infected blood is estimated to be 0.3%, [13] the respondents in the present study were likely to be overestimating their risk of occupational infection with HIV as the majority (89.4%) had wrong belief that the risk of infection with the HIV/AIDS virus after an accidental needle stick is high. More than three-fourth (76.3%) of the respondents agreed that to prevent accidental injury, contaminated needles should be recapped immediately after use on patients with HIV/AIDS which is consistent with finding of the study done by Dellobelle [14] and Ehler. [15] This shows the lack of injection safety in developing countries. An unsafe injection practice put not only patients but also healthcare workers at risk; attention should be given to the occupational safety of health care workers. [14] With the mean score of 22 and SD 4.02, out of possible score of 34 (mean percent scoreĀ±SD = 64.71Ā±11.82), nurses in this study demonstrated a good knowledge regarding the care of patient with HIV/AIDS. Around 67% of the respondents disagreed that the patients with HIV/AIDS are responsible for their illness. Similar to the present finding a study conducted by Mulaudzi [9] reported that only 12.1% of the respondents blamed the patient for their status. In the present study around 45% of the respondents agreed that the people with HIV/AIDS should be in separate ward in a hospital. Similar finding was seen in the study conducted by Achappa [4] and Reis [16] which showed that 46.1% and 59% of the respondents respectively agreed that the HIV positive needed to be nursed separately. These findings highlight a lack of understanding regarding the primary principle underlying standard/universal precautions i.e. the precautions to be applied universally and not selectively. When standard/universal precautions are applied appropriately it is not necessary to isolate HIV positive patients unless they have tuberculosis or other opportunistic infections that require isolation. [17] More than half (59%) of the respondents disagreed that the beds of patients with HIV/AIDS be marked. A study done by Achappa [4] in India showed that 80.5% of the respondents thought that it was appropriate to disclose the HIV status of the patient to his relatives/sexual partner without his/her consent. However in the present study more than half (55%) of the respondents disagreed that relatives/sexual partner of patients with HIV/AIDS should be notified of the patientā€™s status without his/her consent. Around 65% of the respondents agreed that medications to treat opportunistic infections may prolong the life of patient with HIV. This result is supported by the study conducted by Aghamolaei [6] in which most of the participants believed that caring, educating, counseling and treatment of patients with HIV may result in improving own quality of life. The present study shows that more than three fourth (76.9%) of the respondents were willing to take care of patients with HIV/AIDS. Similar finding was seen in a study conducted by Achappa [4] which reported that only 5.4% of the respondents did not prefer to care for the HIV positive patients. The mean scores of attitude in dimensions including emotion towards the
  • 8. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 240 Vol.7; Issue: 2; February 2017 people with HIV/AIDS, working with HIV/AIDS patient, effectiveness of care, fear of contagion and readiness to care were 24.08, 17.90, 11.86, 10.87and 11.13 respectively. The study reveals favorable attitude among the respondents showing 50.7% of the respondents scoring more than 60 percent. The mean score of attitude was found to be 75.84 with standard deviation of 8.18. This result is supported by a study conducted by Achappa [4] which showed positive attitude in caring the HIV patients. Several other studies conducted among the nurses showed the similar result. [4-6,9,14] However a study conducted by Mo, [18] Zadeh, [3] Oyeyemi, [19] Mahat [20] and Hassan [21] had revealed the negative attitude among the nurses. In the present study respondents with bachelor level of education had higher mean percent knowledge score of 69.85. Higher mean knowledge score was found among the respondents those who had received training (67.64) than those who hadnā€™t received training (62.87). Knowledge regarding the care of patient with HIV/AIDS was not associated with the age, working unit, marital status, level of education, designation of the respondent, nursing experience. Similar result was seen in a study conducted by Dellobelle. [14] Gulifeiya [22] conducted a study in Malaysia which showed no significant association of the knowledge with the respondentā€™s socio- demographic characteristics. The present study shows no statistically significant association of the knowledge level of the nurses with previous training and previous experience of care of HIV/AIDS patient. However in a study conducted by Zadeh [3] significant association of the level of knowledge with the training program related to HIV/AIDS and the previous experience of caring for HIV/AIDS patients was found. A study by Hasani [8] showed that the respondents participating in educational program had over all higher scores of knowledge than the nonparticipants. However the same study revealed that knowledge was not associated with the years of HIV patient caring. In the present study no statistically significant association was found between the attitude towards the care of patient with HIV/AIDS and age, working unit, marital status, level of education, designation of the respondent, nursing experience. The finding was supported by a study conducted by Zadeh [3] which found no significant association between the socio-demographic variables and the attitude of the nurses. In the present study, no statistically significant association was found among the attitude and the previous training in aspects of HIV/AIDS and previous experience of caring the HIV/AIDS patient. Contrary to the present findings, a comparative study done by Suominen [23] explored that the level of attitude was positively influenced by the previous experience of providing care to HIV/AIDS patient. A study conducted by Oyeyemi [19] showed that the attitude was influenced by the prior education and experience of taking care for HIV/AIDS patient. Other studies by Gulifeiya [22] and Dellobelle [14] showed that attitude of the nurses towards HIV/AIDS patients was significantly related to their training status. The present study shows that emotion towards HIV/AIDS patient was significantly associated with age, working unit, marital status, education, designation and nursing experience. In this study fear of contagion was associated with the age, working unit, designation and nursing experience. Respondents in the age group of more than 40 years, designated as senior staff nurse and more than 10 years of experience had less fear of contagion. This may be due to the maturity in their work and experience of working which has led to less fear of contagion. The present study reveals that the respondentā€™s readiness to care was significantly associated with their previous experience of caring the HIV/AIDS patient. The study reveals that knowledge regarding the care of patient with HIV/AIDS had significant positive relationship with the attitude towards the
  • 9. Erina Shrestha et al. Awareness Regarding the Care of Patients with HIV/Aids among the Nurses Working At BPKIHS, Nepal International Journal of Health Sciences & Research (www.ijhsr.org) 241 Vol.7; Issue: 2; February 2017 care of patient with HIV/AIDS. (r= 0.329, p= <0.001). The positive linear correlation affirms that better knowledge can lead to positive attitude. Similar finding was seen in a study conducted by Zadeh [3] in which the knowledge score was significantly positively correlated with attitude (r =0.0253, p<0.05). However a study by Oyeyemi [19] showed no significant correlation between scores on knowledge and attitude. The present study reported that the knowledge score was significantly positively correlated with domain emotion (r= 0.206, p= 0.003), caring the HIV/AIDS patient (r= 0.142, p= 0.042), effectiveness of care (r= 0.178, p= 0.010) and readiness to care (r= 0.264, p<0.001). The present study showed no significant correlation of the knowledge score with fear of contagion. It reveals that there exist the fear of contagion among the nurses regardless their level of knowledge. CONCLUSION The study revealed that the majority of the nurses have moderately adequate knowledge regarding the care of patient with HIV/AIDS and more than half of the nurses have favorable attitude towards the care of patient with HIV/AIDS. Knowledge regarding the care of patient with HIV/AIDS has significant positive correlation with attitude and the domains emotion towards HIV/AIDS patient, working with HIV/AIDS patient, effectiveness of care and readiness to care. Knowledge, however, has no correlation with the fear of contagion. It is concluded from the study that the increase in knowledge of the nurses leads to the favorable attitude. It is therefore important that all the nurses have access to up-to-date information on all aspects of HIV/AIDS. ACKNOWLEDGEMENT(S) We would like to express our sincere gratitude to BPKIHS and Nursing Service Administration for providing us the opportunity and facilities to conduct this research. REFERENCES 1. Tan X, Pan J, Zhou D, Wang C, Xie C. HIV/AIDS knowledge, attitudes and behaviors assessment of Chinese students: A questionnaire study. International Journal of Environmental Research and Public Health. 2007;4(3):248-53 2. Statistics: Worldwide. Cited on: 14th August 2014. Available from: http://amfar.org/worldwide-aids-stats/ 3. Zadeh SRE, Far SB, Isa ZM. Knowledge and attitude related to caring for hiv/aids patients among nurses at Golestan hospital, Iran. Research Journal of Biological Sciences. 2011;6(9):446-52 4. Achappa B, Mahalingam S, Multani P, M P, Madi D, Unnikrishnan B et al. Knowledge, risk perceptions and attitudes of nurses towards HIV in a tertiary care hospital in Mangalore, India. Journal of Clinical and Diagnostic Research. 2012; 6(6):982-6 5. Amosu AM, Degun AM, Makinde CM, Thomas AM, Babalola AO. An assessment of specific knowledge and attitude of healthcare providers towards people living with HIV/AIDS in Ibadan, Nigeria. Annals of Biological Research. 2011;(2):255-64 6. Aghamolaei T, Tavafian S, Hasani L, Zare S. Attitudes of healthcare providers towards patients with HIV/AIDS in Bandar Abbas. Archives of Iranian Medicine. 2009;12(3):298-301 7. Kostak MA, Unsar S, Kurt S, Erol O. Attitudes of Turkish midwives and nurses working at hospitals towards people living with human immunodeficiency virus/acquired immune deficiency syndrome. International Journal of Nursing Practice. 2012;18:437-44 8. Hasani L, Aghamolaei T, Tavafian SS, Sabili A. Knowledge of Iranian nurses about HIV/AIDS: A cross sectional study from Bandar Abbas. Iranian Journal of Clinical Infectious Diseases. 2010;5(3):161-65 9. Mulaudzi MV, Pengpid S, Peltzer K. Nurseā€™s knowledge, attitudes and coping related to HIV and AIDS in a rural hospital in South Africa. Ethno Medicine. 2011;5(1):25-32 10. Marranzano M, Ragusa R, Platania M, Faro G, Coniglio MA. Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily.
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