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Turkish nursing students' attitudes about patients living with HIV/AIDS
Article in Sexuality and Disability · December 2012
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O R I G I N A L P A P E R
Turkish Nursing Students’ Attitudes About Patients
Living With HIV/AIDS
Evs¸en Nazik•Sevban Arslan•Funda O¨ zdemir•Serap Apay
Published online: 27 September 2012
Ó Springer Science+Business Media New York 2012
Abstract The study was conducted to identify attitudes towards patients living with HIV/ AIDS of nursing students in Turkey. The descriptive study was conducted in the Adana Health School of C¸ ukurova University in Adana, Turkey. The study comprised 311 nursing students. The data were collected via AIDS Attitudes Scale (AAS). The data were eval-uated using SPSS software, using percentage, analysis of variance, t test and Kruskal– Wallis test. Total AAS score of the students was found as 48.67 ± 13.77. The mean domain scores of AIDS Attitude Scale were 19.39 ± 5.66 for Contagion Subscale, 13.28 ± 4.41 for Negative Emotions Subscale and 16.00 ± 6.88 for Professional Resis-tance Subscale. It was determined in this study that negative attitudes exist towards people with HIV/AIDS among nursing students. These findings were interpreted to suggest that further AIDS education among nursing students is necessary.
Keywords Attitude AIDS AIDS attitudes scale Nursing students Turkey
Introduction
HIV/AIDS is considered as one of the most devastating disease of the recent decade due to its high morbidity, mortality and economic impact. The first AIDS case was reported in Turkey in 1985. The history of reported AIDS cases in Turkey started with 2 patients and AIDS cases increased each year. According to the statistics of the Turkish Ministry of
E. Nazik (&) S. Arslan
Department of Nursing, C¸ ukurova University Adana Health School, Adana, Turkey e-mail: eceevsen_61@hotmail.com
F. O¨ zdemir
Department of Nursing, Ankara University Health Sciences Faculty, Adana, Turkey S. Apay
Health, a total of 4,525 persons living with HIV/AIDS were notified from 1985 to December 2010 [1].
Nurses and nursing students as healthcare providers have critically important roles in HIV/AIDS treatment and educational programs [2]. In general, nursing students, exposed to an occupational risk of HIV infection due to direct contact with blood and bodily fluids during clinical practice attitudes, have been reported to tend to have negative attitudes towards patients with HIV [3–6]. There are many factors associated with negative HIV-related attitudes, such as a low knowledge level, fear of the possibility of becoming infected and death [2]. In some studies, it was found that fear was one of the major causes of negative attitudes among nursing students [5–7]. Madumo and Peu [8] found that South African nursing students were fearful of contracting HIV from patients in hospitals. Similarly in a German study, half of the nursing students were afraid of contacting HIV from nursing people with HIV/AIDS [9]. In Turkey, fear of being infected, feelings of pity and empathy were the feelings most commonly indicated by the students [4].
Researches has suggested that nurses’ attitudes towards AIDS patients have a significant influence on AIDS patients [10]. It is a generally accepted concept that knowledge based nursing practice could lead to more positive outcomes [11]. The quality of health care for AIDS patients’ needs to be improved by properly educated health care providers [12]. The purpose of this study was to identify the attitudes of nursing students related to patients living with HIV/AIDS.
Methods Design
A cross-sectional design was employed in this descriptive study. The subjects were stu-dents from the Nursing Department, Adana Health School of C¸ ukurova University, Adana. In total there were 468 students (female and male) in the Nursing Department during 2010–2011 academic year. A total of 311 nursing students, who were present at the school at time of the study, were asked to anonymously complete the questionnaire.
Measures
The used instrument was the AIDS Attitude Scale (AAS), a 15 item instrument developed for medical and nursing students by Bliwise et al. [13]. The AIDS Attitude Scale was adapted to Turkish society, whose validity was tested by C¸ imen et al. [14]. The AAS yields a total score as well as three subscale scores. These are: Fear of Contagion, Negative Emotions and Professional Resistance. Students were asked to indicate the extent to which they agreed or disagreed with each of the items on a six-point Likert scale with endpoints that were labeled strongly agree and strongly disagree.
In this study, the responses of the nursing students were collapsed into two categories for analysis. Responses on the scale from 1 to 3 were placed together to indicate dis-agreement with each of the 15 items of the AAS, and these were compared to responses of 4–6, which indicated agreement.
The instrument used in this study has been found to be reliable and valid. In the present study, the Cronbach’s alpha value for the AIDS Attitude Scale was 0.802.
Procedure
The aim of the study and the contents of the questionnaire were explained to each subject, and voluntary participation was requested. Oral consent to participate in this study was obtained. Questionnaire forms were completed by the students in their class in about 10 min. Official permission was granted by the institutions at which the study was conducted. Ethical Consideration
This study was approved by the institutional review board of Nursing Department, Adana Health School, C¸ ukurova University. In order to obtain student’s verbal consent, all par-ticipants were informed of the purpose of the study, ensured that the collected information would be used solely for scientific purposes, would be kept confidential and not shared by others except the researchers.
Statistical Analysis
The data were analyzed using SPSS for Windows version 13.0. Analysis of variance (ANOVA), t test, Kruskal–Wallis were utilized in statistical analysis. In all analyses, the usual significance level was P \ 0.05.
Results
The mean scores of the nursing students for the total AAS and AAS subscales were shown in Table2. The mean domain scores of AIDS Attitude Scale were 48.67 ± 13.77 for the total AAS Score, 19.39 ± 5.66 for Contagion Subscale, 13.28 ± 4.41 for Negative Emotions Subscale and 16.00 ± 6.88 for Professional Resistance Subscale (Table1).
On the Contagion Subscale, 76.2 % of the nursing students said that I would be willing to eat in a restaurant where I know the chef has AIDS and 55.6 % of the nursing students said that AIDS makes my job a high risk occupation. 40.8 % of students thought that even following strict infection control measure, it is likely that I would become infected with HIV, if I were working with AIDS patients over a long period of time (Table2).
On the Professional Resistance subscale, 40.8 % of the sample said that they would prefer not to work with AIDS patients if given a choice, and 34.4 % agreed that specialists might be trained to best deal with AIDS patients. Yet only 20.9 % indicated that they would consider switching positions if it became necessary to work with AIDS patients (Table2).
On the Negative Emotions Subscale, 58.5 % of the nursing students said that I often have tender, concerned feelings for people with AIDS and 32.5 % nursing students found it Table 1 The mean scores of the nursing students for AIDS attitude scale
Scores Mean ± SD Lower score Upper score
AIDS attitude scale 48.67 ± 13.77 15 90
Contagion subscale 19.39 ± 5.66 5 30
Negative emotions subscale 13.28 ± 4.41 4 24
hard to be sympathetic to AIDS patients; 58.5 % nursing students often have tender, concerned feelings for people with AIDS (Table2).
Comparison of demographic characteristics in nursing students and scores of AIDS Attitude Scale are presedent in Table3. Grade 4 students were significantly more negative than Grade 1 students in their total AAS score (grade 1 = 47.90 ± 14.55, grade 4 = 51.54 ± 11.63). When students in their professional versus school grade were com-pared, the analysis indicated that Grade 4 students scored (17.67 ± 6.42) higher on the Professional Resistance Subscale. The younger students (53.21 ± 17.03) were signifi-cantly more negative than older students (49.09 ± 13.96) in their total AAS score. A statistically significant difference was not detected between the grade, age and sex of students and AIDS Attitude Scale and the subscales of AIDS Attitude Scale (P [ 0.05). Only, a statistically significant difference was detected between the grade of students and Professional Resistance Subscale (P \ 0.05) (Table3).
Discussion
This study showed that nursing students had a mean attitude score of 48.67 ± 13.77 for the AAS. The mean scores for AAS subscales (Fear of Contagion, Negative Emotions, Pro-fessional Resistance) and the total AAS of the nursing students were found highly. High of Table 2 Percentages of nursing students in agreement with items from the AIDS attitude scale
AIDS attitude scale Agree
%
Disagree % Contagion subscale
AIDS makes my job a high risk occupation 55.6 44.4
Despite all I know about how AIDS is transmitted. I’m still afraid of catching it 56.3 43.7 I would not want my child to go to school with a child with AIDS 54.0 46.0 I would be willing to eat in a restaurant where I know the chef has AIDS 76.2 23.8 Even following strict infection control measure, it is likely that I would become
infected with HIV, if I were working with AIDS patients over a long period of time
40.8 59.2
Professional resistance subscale
I would rather work with a better class of people than AIDS patients 25.1 74.9 I would prefer to refer persons with AIDS to my professional colleagues 10.6 89.4
Given a choice. I would prefer not to work with AIDS patients 40.8 59.2
I would consider changing my professional specialty/position if it became necessary to work with AIDS patients
20.9 79.1
It is best to train a few specialists who would be responsible for the treatment of AIDS patients
34.4 65.6
I don’t want those at higher risk for AIDS such as IV drug users and homosexuals, as patients
32.2 67.8
Negative emotions subscale
I sometimes find it hard to be sympathetic to AIDS patients 32.5 67.5
I would feel resentful of AIDS patients accounted for a significant part of my caseload 39.5 60.5
I often have tender, concerned feelings for people with AIDS 58.5 41.5
I feel angry about the risk of AIDS which homosexuals have imposed on the straight community
47.3 52.7
AIDS Attidue Scale show that Turkish nursing students had negative attidue towards AIDS patient and they showed resistance to the professional experiences and said the fear of contagion. Similary, The mean scores of the nursing students for AAS were found 48.8 ± 12.5 and 46.0 ± 12 by C¸ imen et al. [14], Akansel et al. [15]. However, Krupat, Weston, and Messier found that the mean scores of the nursing students for AAS were found 37.02 ± 11.97 [16].
In this study, there was a negative attitude towards HIV/AIDS. There was a similarity between UK and Turkish samples [4,5]. Bektas¸ et al. found that nursing students who had previous experience in caring for an AIDS patient and had known someone with HIV/ AIDS were willing to care for people living with HIV. Earl and Penny’s study, nursing students demonstrated judgmental attitudes toward patients with HIV/AIDS. Valimaki et al’s study [17] found a general willingness on the part of students to provide care for patients with HIV/AIDS. In contrast to these studies, in Germany, Lohrmann et al. (2000) and in UK, Stewart (1999) found that nursing students generally had positive attidues [9,
18]. Negative attitudes appear to have been shaped by knowledge shortcomings, personal values, and perceived risk of contracting HIV/AIDS from patients. It is also possible that negative attitudes might have resulted from messages in the media, which high risk, socially unacceptable behaviors, and from the fact that Turkey’s media put too much emphasis on risk of infection.
In this study, nursing students had fears of contracting HIV/AIDS. Similarly, Bektas¸ ve Kulakac¸ [4] found that one of the reasons for students’ unwillingness to care for people Table 3 Comparison of demographic characteristics in nursing students and sub-scale item
Demographic characteristics N % Total AAS Mean ± SD Fear of contagion Mean ± SD Negative emotions Mean ± SD Professional resistance Mean ± SD Grade 1 149 47.9 47.90 ± 14.55 19.03 ± 6.11 13.28 ± 4.77 15.60 ± 7.12 2 61 19.6 51.84 ± 14.04 19.98 ± 5.59 14.02 ± 4.40 17.84 ± 6.79 3 77 24.8 46.75 ± 12.23 19.25 ± 5.10 12.70 ± 3.94 14.81 ± 6.35 4 24 7.7 51.54 ± 11.63 20.54 ± 4.60 13.33 ± 3.38 17.67 ± 6.42 KW = 6.863 KW = 1.922 KW = 2.627 KW = 10.203 Df = 3 Df = 3 Df = 3 Df = 3 P[ 0.05 P[ 0.05 P[ 0.05 P\ 0.05 Age 17 14 4.5 53.21 ± 17.03 21.21 ± 6.74 14.57 ± 6.14 17.43 ± 7.41 18 60 19.3 47.48 ± 13.20 19.08 ± 5.33 13.02 ± 4.17 16.10 ± 6.92 19 78 25.1 47.91 ± 13.23 19.08 ± 5.33 13.23 ± 4.25 15.60 ± 6.56 20 and older 159 51.1 49.09 ± 13.96 19.77 ± 5.50 13.30 ± 4.43 16.03 ± 7.02 F = .785 F = 1.459 F = 0.473 F = 0.291 P[ 0.05 P[ 0.05 P[ 0.05 P[ 0.05 Sex Female 213 68.5 48.46 ± 12.97 19.48 ± 5.42 13.22 ± 4.14 15.77 ± 6.76 Male 98 31.5 49.12 ± 15.43 19.19 ± 6.17 13.42 ± 4.96 16.51 ± 7.15 t = 0.391 t = 0. 412 t = 0.367 t = 0. 887 P[ 0.05 P[ 0.05 P[ 0.05 P[ 0.05
living with HIV was linked to the fear of contracting HIV/AIDS. Madumo and Peu [8] found that nursing students were fearful of contracting HIV from patients in hospitals. Ngan et al. [19] found that 48 % of the student sample was concerned that they might contract HIV when performing basic nursing tasks. Fear of contracting HIV/AIDS was cited as the main reason for this attitude, with 33 % of nursing students being fearful of contagion [6]. This finding is consistent with the results of several other studies among other groups of health professionals. These indicate that greater clinical experience and better knowledge are associated with more positive attitudes and lowered personal con-cerns in treating AIDS patients. Among nursing students in the United States of America and Canada, one of the major causes of fear, negative attitudes and reluctance to care for people with HIV/AIDS was identified as lack of education [5, 7]. These findings are supported by studies conducted in Turkey [4], South Africa [8], Germany [9], Jordan [20] and China [21].
Conclusion
The evidence has shown that negative attitudes exist towards people with HIV/AIDS among nursing students studying at an Turkey university. This finding has important implications for nursing education. These attitudes can result in reluctance to provide care and negatively impact on the quality of care provided to people living with HIV/AIDS. Nursing schools have an obligation to prepare students who have sufficient knowledge of HIV/AIDS and universal precautions, to reduce student fears of contracting the disease and increase their willingness to provide care to people living with HIV/AIDS. Nurse educators should ensure that education on all aspects of HIV/AIDS is explicitly included in the curriculum and that the teaching reflects the needs of learners. Further research to examine why students from the countries/regions have less positive attitudes towards caring for people with HIV/AIDS should be undertaken.
Acknowledgments The authors grateful to all the students who participated in this study. Conflicts of interest None.
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