Title of paper: KNOWLEDGE AND ATTITUDES OF NURSING STUDENTS OF MUHIMBILI UNIVERSITY COLEGE OF HEALTH SCIENCES REGARDING HIV INFECTION AND AIDS, 2004.
INTRODUCTION:
The degree of nursing care provision to HIV infected patients is dependent upon the knowledge and attitude of the nursing personnel towards HIV infection and AIDS (1,2,3,4,5). Inadequate knowledge has been associated with fear, inappropriate attitudes and poor handling of HIV infected patients, leading onto provision sub-standard nursing care (1). A necessary step in improving nursing care of patients would be to provide nurse with the necessary knowledge regarding HIV infection.
HIV emerged in this country in 1983 and has been since taught in nursing schools regarding its transmission, prevention and nursing care, Despite these efforts, the knowledge and attitudes of the nurses has not been determined.
This study aim to investigate the knowledge and attitudes of certificate create and diploma nursing students of Muhimbili Medical Centre (MMC) in Dar es Salaam regarding HIV infection and AIDS, identifying in the process, areas which need to be changed or emphasized for provision, of better nursing care of HIV –infected and AIDS patients, and with minimal occupational risk of acquiring HIV infection.
MATERIALS AND METHODS:
Study design and setting
This cross-sectional study was conducted at the Nursing School Of Muhimbili University Colege of Health Sciences at Muhimbili National Hospital in Dar es Salaam, Tanzania. The Muhimbili National Hospital is the largest referral hospital in the country and incorporates the Muhimbili University College of Health Sciences (MUCHS) which is the National Medical School.
Subjects
Participants were certificate and diploma nursing students who were in different years of the study. Both courses run of four years. Subjects were selected by virtue of their presence in college on the days arranged to distribute questionnaires. The study group consisted of 116 certificate students and 236 diploma students, who comprised of 96.6% and 91.4% of all certificate and diploma students, respectively. The age and sex distribution of the sample are summarized in Table 1.
Date collection
Data were collected using a standard self-administered questionnaire in class rooms after lecture hours. One of us (VM) was responsible for distribution, supervision and collection of completed questionnaires. Questions aimed to obtain information on background variables such as age, gender, educational track and previous experience about HIV and AIDS.
Other questions were asked to obtain information on the basic knowledge, transmission and prevention of HIV infection and students attitudes towards nursing of HIV infected and AIDS patients.
Data Management And Statistical Analysis
Data was keyed, cleared, validated and analyzed using SPSS. The responses of the students were give a score of 0 or 1 for incorrect and correct response, respectively. The mean score for each part were compared for the different years of study, gender, education track, and programs (diploma versus certificate) using the Chi-square test.
RESULTS
An overwhelming majority of students were females 301/352 (85.5%). Most (91.1%) of the certificate students were primary school levers; where as most (99.6%) of the diploma students had secondary school education (Table 1). Most (96.5%) of the certificate students have had a prior one year nursing course compared with only 1.3% of the certificate students have had a prior one year nursing course compared with only 1.3%, of the diploma students. More than 90% of both student groups obtain information on the latest developments in HIV and AIDS, mostly via radio (45.5%), (32.4%), and news papers, 24.5%) 30.1%) of certificate and diploma and there was no difference between certificate and diploma students.
In general both student groups had a good knowledge regarding the transmission of HIV (table 2). A few remarkable responses were noted such as; HIV could be transmitted by shaking hands, sneezing and coughing, kissing saliva, sweat, tears and vomitus. Others thought that HIV could not be transmitted via the well – documented modes of transmission such as sexual intercourse, blood transfusion, mother to child and breast-feeding. About a third mentioned that HIV cannot be transmitted via sharing toothbrushes, razors, or needles. Some few differences in knowledge were found between certificate and diploma students.
Regarding the most infectious stage of HIV infection, most students mentioned fully blown AIDS followed by early disease and early seroconversion stages. The intermediate stage was thought to be the least infective stage.
Table 4 shows the responses of the student regarding the types of measures to be taken for different procedures in order to prevent transmission of HIV infection. Such measures would reduce the small occupational risk of acquiring HIV infection even further.
DISCUSSION
Our findings show generally good knowledge of the HIV; its transmissibility and preventing measures, and a willingness of majority of students to attend HIV infected and AIDS patients.
However, it is apparent that additional information is required regarding the transmissibility of HIV infection; to correct the noted misconceptions such as HIV could be transmitted by shaking hands, sneezing and coughing. There problem therefore, appears to be inadequate knowledge of HIV and AIDS infection control rather than lack of enthusiasm. It also important to educate on the co-infectious agents among HIV infected individual which are likely to cause cross – contamination. The disease has so many core – infections (6). It is therefore important to note that HIV is only one of many infectious pathogens that can be occupationally transmitted from health care workers to patients and vice versa (7).
Further more’ students were unable to correctly identify the basic transmission modalities of HIV infection like sexual intercourse and blood transmission or the requirements for necessary precaution during different procedures to prevent transmission of HIV infection. Other students thought that HIV could not be transmitted via mother to child, breast-feeding, sharing toothbrushes, razors and needle stick injuries. Needle punctures present the greatest risk of transmission of HIV and other blood borne infection (6). This is because blood is a dingle most important source of infection of HIV in health care facilities. It is vital to note that if splashing is anticipated, gowns/aprons and eye protection should be worn to prevent exposure. Intact skin remains the most effective barrier in decreasing the risk of transmission of HIV and other blood borne diseases, superficial cuts or chapped skin may become portals of entry for organisms, (2)
It is important to reinforce the necessary precautions to be undertaken during performance of various procedures (7). This has to be preceded by ranking each procedure according to the health hazard involved. There is thus, a need to establish. Guidelines for different procedures, trying to follow the recommended international infection control procedures.
Health hazards in a particular procedure involves that body fluids to be encountered and their potential for transmitting the HIV (6) . The possibility of noninfectious agents in the body fluid should also be considered.
The guidelines should be simple, practical, achievable and effective to make them relevant. Need to set-up a committee to formulate guidelines for infection control for different procedures without elevating treatment cost too much.
The committee needs to include members from peripheral hospitals, health centers, dispensaries and maternal and health clinics where there is usually a heavy patient load and resources are scarce. During then third year of studies, student to their community health practice in these peripheral areas.
Continuing education in the form of seminars, practical sessions and changes in curricula are needed to able to achieve the required standards of low asepsis in the work of the growing problems of HIV in this society.
The present study involved student nurses alone. However it seem necessary to evaluate knowledge, attitude and practice (KAP) of different cadres of graduate nurses and identify areas needing retraining and conducting continuing education courses on infection, control procedures – seminars, practical sessions and preparation of handouts.
These measures should go hand in hand with provision of the necessary facilities/resources.
The study results demonstrate that education and reinforcement of some infection control procedures such as gown/waterproof apron, and eyeglasses are necessary.
During the course of the study, some students may have recognized they are examined. This may have prompted some of these students to respond when they otherwise would not have. If this was the case, these data may represent fair limit of infection for students studies.
In conclusion, we do recommend a measure to be taken to improve the knowledge on infection control and up hold and even improve the already existing positive attitude of nurses attending HIV – infected and AIDS Patients.
REFERENCES
1. Kaczmarek, R.G., Moore. R.M. McCrohen.J., Casquelin, C., Reynolds, C and Israel, E., Glove use by health Care Workers: Resultys of a triacetate investigation. American Journal of Infection Control. 1991; 19:228-232
2. Steele, A. and Melby, V. Nures’s knowledge and beliefs about AIDSS:
Comparing nurses in hospital, community and hospice settings. Journal of Advanced Nursing. 1995; 22: 879-887
3. De Groot – Kosolcharoen, J. Pandemonium over gloves: use and abuse. American
Journal of Infection Control. 1991; 19: 225-227.
4. Cutcliffe, J.R. How do Nurses inspire and instill hope in terminally ill HIV patients?
Journal of Advanced Nursing. 1995; 888-895.
5. Potter, P.A. and Perry, A.G Basic Nursing Theory - 1987; 104 – 110.
6. Gershon, R.R., Curbow, B., Keten, G., Celantano, D., Lears, K. and Vlahow, D. Correlates of attitudes concerning human immunodeficiency syndrome among hospital workers. American Journal of Infection Control. 1994; 22: 293-299.
7. Knight, V.M and Bodsworth, N.J. Perceptions and Practice of Univesal Blood and body fluid precautions by registered nurses at a major Sydney Teaching hospital. Journal of Advanced Nursing. 1998; 27:746-751.
8. Juntunen, A. and Nikkonen, M. Professional Nursing Care in Ilembula Lutheran Hospital in Tanzania. Journal of Advanced Nursing. 1996: 24: 236 – 544.
9. Bryat, A. Creativity in AIDS Education. AIDS Asia. 1996; 92:6-7
10. Tierney, A.J. HIV/AIDS – knowledge, attitude and education of nurse: a review of the research. Journal of Clinical Nursing. 1995; 4: 13-21.
Table 1 Demographic characteristics of respondents
Table 2 Correct responses on knowledge about transmission of HIV infections
Table 3 Infections likely to be encountered while caring HIV infected individuals
Table 4 Attitudes of students towards nursing care of HIV – infected and AIDS patients
