|Year : 2015 | Volume
| Issue : 1 | Page : 15-19
A Study of Knowledge and Practice among Nurses Regarding Care of human immunodeficiency virus Positive Patients in Medical College and Hospitals of Kolkata, India
Panchali Som1, Sharmistha Bhattacherjee2, Rituparna Guha3, Madhumita Basu4, Sumit Datta5
1 Department of Anatomy, Institute of Post Graduate Medical Education and Research, Kolkata, India
2 Department of Community Medicine, North Bengal Medical College, Darjeeling, West Bengal, India
3 Department of Health, Kolkata Corporation, NRS Medical College, Kolkata, India
4 Department of Community Medicine, NRS Medical College, Kolkata, India
5 Department of Radiology, MGM Medical College, Kishanganj, Bihar, India
|Date of Web Publication||21-Aug-2015|
C/O, Dr. Sumit Datta, Flat 1A, Trinayani Apartments, 131, Kalitala Main Road, North Pubachal, Kolkata - 700 078, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background and Objectives: Nurses are the frontline health workers whose work compels them to come in contact with different blood-borne pathogens, including human immunodeficiency virus (HIV). Therefore, their awareness regarding HIV is critical to successful implementation of the programmes.
Objectives: To find out the knowledge and practice regarding HIV among nurses in medical colleges of Kolkata.
Materials and Methods: A cross-sectional observational study was carried out among 250 nurses employed in five medical colleges of Kolkata over a period of 2 months (January-February 2015). Their knowledge in the areas of virology, modes of transmission, prevention, and nursing practices regarding HIV/Acquired Immune Deficiency Syndrome (AIDS) patients' care was assessed using a pretested questionnaire. The collected data were analyzed using SPSS software.
Results: While the basic information about the disease such as causative agent, modes of transmission, etc., were known to most of the participants, deficiencies in their knowledge and awareness in many critical areas of the disease such as voluntary counseling and infant feeding practices were noticed. The practice was also found to be unsatisfactory. Training in HIV was found to be an important factor influencing the knowledge of participants.
Conclusion: The knowledge and practice regarding HIV was found to be less than satisfactory which necessitates the need to impart focused training on prevention counseling regarding HIV, keeping in mind the rising incidence of HIV infection in India.
Keywords: Human immunodeficiency virus/acquired immune deficiency syndrome, knowledge, practice, risk perception
|How to cite this article:|
Som P, Bhattacherjee S, Guha R, Basu M, Datta S. A Study of Knowledge and Practice among Nurses Regarding Care of human immunodeficiency virus Positive Patients in Medical College and Hospitals of Kolkata, India. Ann Nigerian Med 2015;9:15-9
|How to cite this URL:|
Som P, Bhattacherjee S, Guha R, Basu M, Datta S. A Study of Knowledge and Practice among Nurses Regarding Care of human immunodeficiency virus Positive Patients in Medical College and Hospitals of Kolkata, India. Ann Nigerian Med [serial online] 2015 [cited 2021 Apr 18];9:15-9. Available from: https://www.anmjournal.com/text.asp?2015/9/1/15/163330
| Introduction|| |
Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are the major challenges to healthcare oriented research today. In the 30 years since HIV/AIDS was first discovered, the disease has become a devastating pandemic; more than 60 million people have been infected with the virus and nearly 30 million people have died of HIV-related causes.  The risk of contracting HIV/AIDS is quite high among healthcare workers. Every day thousands of healthcare workers around the world undergo accidental exposures to blood-borne pathogens.  It is probably the grimmest and causes the highest level of concern amongst healthcare workers in many countries. 
Internationally, studies evaluating knowledge, attitudes and practices of health care providers toward HIV/AIDS patients have suggested that current negative attitudes of health care workers toward people with HIV - compounded by fear of infection in the workplace, perceptions of risk, lack of understanding of HIV and inconsistent universal precautions adherence - perpetuate the prevalence and manifestation of stigma toward this population. ,
Nurses are the primary level caregivers playing very important roles in patient care. Therefore their knowledge, attitude, and practice as it relates to patient care are of immense importance to cut down transmission rates, prevent infection, aids early detection, and reduce social stigmatization of HIV/AIDS patients.
Though the topic has been dealt with by various authors, published literature in this part of the country are scarce. In this context, this study was undertaken to assess the knowledge in the field of virology, modes of transmission, prevention, and- practice of nurses regarding HIV/AIDS patients care.
| Materials and Methods|| |
A cross-sectional institution based study was conducted over a period of 2 months (January-February 2015) among all the nurses working in Medicine, Surgery, Paediatrics and Gynaecology and Obstetrics Departments of Medical College Hospitals of Kolkata with at least 3 years working experience.
There are in all five medical colleges in Kolkata which cater to the majority of the population of the city as well as the suburban areas. Nurses form the bulk of the workforce in these institutions.
After explaining the subjects of the purpose of the study, their signed consent was obtained. Data were collected with the help of pretested, semi-structured schedule designed specifically to identify predictive factors associated with patient care.
Knowledge of HIV/AIDS was assessed using questions assessing provider knowledge on:
- HIV virology,
- Presenting symptoms,
- Modes of HIV transmission,
- Prevention strategies, and
- Risk assessment.
Each correct response under knowledge was given one point, whereas any wrong or 'don't know the answer' was given no mark.
The knowledge was then classified as "good" (>80%), "fair" (70-79%), or "poor" (<69%).
Provider perceived risk of infection was assessed for two kinds of patient contact scenarios: Casual contact and contact through clinical examination. The former examined perceived risks when:
- Working everyday with an HIV-infected colleague,
- Shaking hands with an AIDS patient with a generalized rash,
- Being sneezed on by an AIDS patient,
- Touching a patient when assessing him or her, or
- Sharing a glass with someone with HIV/AIDS.
Casual contact with a HIV positive patient exerts no risk. Those who perceived risk in relation to the above scenario had overestimated perceived risk.
Perceived risk of infection through clinical contact examined providers' risk rating for procedures such as
- Cleaning and dressing a wound,
- Inserting or removing an intravenous cannula,
- Administering an injection,
- Delivering babies, or performing surgery
- Scenarios where providers accidentally pricked themselves with a needle that had been used on a patient with AIDS or who recap needles after drawing blood.
For analysis, providers were categorized as those who did or did not assign risk to any of the above scenarios. A correct risk perceiver is awarded one mark against each correct risk perceptions and those who had overestimated/underestimated risk perception got 0 against each incorrect response. Practices of caring for HIV-positive patients were assessed by questions regarding the use of selective universal protective measures.
After collecting all data, data entry was done in Microsoft Excel. Data were organized and presented by applying principles of descriptive statistics. Categorical data were analyzed using Chi-square test and Fisher's exact test wherever applicable. SPSS software version 20 (IBM corporation) was used for analysis.
Before conducting the study, ethical permission was obtained from the Institutional Ethics Committee, All India Institute of Hygiene and Tropical Health. Prior permission from the Heads of the Institutions of all the medical colleges was obtained.
| Results|| |
Of the 290 nurses contacted for the study, 250 returned completely filled-up questionnaires (response rate 86.2%). The majority of them were in the age group of 25-35 years (63.2%), were married (61.2%) and had work experience of >10 years (36.4%). 155 (62%) of them had received training on HIV/AIDS, whereas the rest had not.
Regarding causation of HIV, 79.6% of the respondents were aware that AIDS is caused by HIV virus, 65% of respondents answered that later stage of HIV is known as AIDS and 99.2% of the nurses knew that sexually transmitted disease (STD) increases the risk of HIV infection. Regarding the modes of transmission of HIV, it was observed that most of the respondents knew about spread of HIV via different modes of sexual contact such as vaginal sex (94%), oral sex (80.4%), and anal sex (86%). The fact that AIDS can be transmitted through blood in various ways was also known to most of the nurses, e.g., receiving blood from HIV-positive patients (86%) and exposure to blood when taking care of patients (86.8%). Mother to child transmission of HIV/AIDS was also well known to respondents, as 76.8% of them know it can be spread via breastfeeding while 96% of them knew that it can be transmitted during delivery of the baby [Table 1].
|Table 1: Knowledge of study population regarding various aspects of HIV/AIDS (n = 250)|
Click here to view
The respondents were asked about the conditions where integrated counseling and testing (ICT) for HIV is recommended. The fact that ICT should be recommended to some patients was well known to the nurses, e.g., Patients with STD (93.2% nurse correctly knew that ICT should be done in these patients), persons donating blood (90.8%), patients with tuberculosis (78%) and pneumonia in patient with acute weight loss (60%) and 85.6% nurses correctly knew that a pregnant woman must undergo ICT [Table 1].
Only 50.4% of total respondents correctly knew that exclusive breastfeeding can be done by HIV positive mother to her baby. Regarding incorrect infant feeding practices viz. formula feeding, exclusive breast feeding for 1 st 6 months then abrupt weaning and mixed feeding, 56.8%, 57.6%, and 59.6% of nurses had the incorrect knowledge, respectively [Table 1].
Regarding risk perception during casual contact, 45.2% of the study population had the wrong perception that working every day with a fellow worker who is HIV positive constitutes a high risk. Also 64% of them incorrectly perceived shaking hands with AIDS patients with generalized body rash to be risky while 25.5% think that touching HIV positive patients when assessing them is of some risk [Table 2].
When asked about risk perception during clinical contact, only 1.2% nurses believed that cleaning and dressing a wound without protection in a HIV positive person has a low risk of transmitting HIV and just 1 out of the 250 respondents thought that delivering babies of HIV positive mother without protection and accidentally pricking oneself with a needle that had been used on a patient with AIDS is of low risk. Thus, almost all the nurses could perceive the amount of risk involved in these processes correctly. However regarding practices like recapping needle after withdrawing blood from HIV-positive patient, inserting or removing an intravenous cannula and administering an injection 9.6%, 10.4%, and 11.6% of the respondents respectively perceived these acts to be of no risk at all [Table 2].
Regarding practices pertaining to universal precautions, only 4% of nurses said that they never wear gloves during taking care of HIV-positive patients, while 1.2% nurses admitted that they never wash their hands between procedures and patients. In the same vein, 8.8% of the respondents never wear aprons, 15.6% never use any eye protective device during practice and 12% never wear a mask. 89.6% of nurses thought that HIV testing is mandatory before any surgery, but 2.8% defer from that [Table 3].
|Table 3: Practices of study population with respect to universal precautions (n = 250)|
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Association between grades of knowledge and other variables are shown in [Table 4]. Nurses in age group of ≤25 years, with work experience of 6-10 years and who had received training in HIV were found to have significantly better knowledge (P < 0.05) about different aspects of HIV as compared to their counterparts [Table 4].
| Discussion|| |
Nurses are the largest group of healthcare workers who are responsible for the constant care of in-patients and thus, they come in close contact with blood and other body fluids of patients. Thus, the awareness of nurses about HIV/AIDS and their attitudes toward people living with HIV are of prime importance, especially in developing countries.
In this study, while the basic information about the disease like causative agent, modes of transmission, etc., were known to most of the participants, deficiencies in their knowledge and awareness in many critical areas of the disease like voluntary counseling and infant feeding practices were noticed. A low level of knowledge was seen among nurses employed in Jordan,  Singapore  and China,  whereas Finnish nurses were shown to have high knowledge levels and had positive attitudes toward patients with HIV/AIDS.  These results indicate a need for an increase in training on HIV for nurses.
Risk perception for casual contact was deemed mostly of high risk by a majority of the respondents, which can form the basis of discriminatory measures of safety precautions based on the serostatus of the individual. The findings were consistent with the results of a study done on Thai nurses. 
Universal precautions are infection control guidelines designed to protect people from diseases spread by blood and certain body fluids such as hepatitis B virus (HBV), HCV, and HIV.  Practice of universal precautions was not 100% among the respondents which do not conform to the guidelines of universal precautions. The findings were consistent with a study done among nursing students of Chandigarh. 
Knowledge of HIV was found to be significantly higher in younger nurses. This was in agreement with a study done among Iranian nurses, whereas other studies have failed to show association between age and knowledge of nurses; , however, another study done in Iran by Montazeri showed that older nurses had higher level of knowledge regarding HIV infection.  Intensive interactive HIV professional training workshops can increase knowledge, attitudes, and willingness of health care professionals to provide care to persons infected with HIV. Similarly in the present study, training in HIV proved to be a facilitator for an increase in knowledge among the study subjects. In an interventional study done in a hospital in Delhi, the knowledge of nurses increased significantly after a 2 days training program. 
| Conclusion|| |
The findings of this study reveal average knowledge and an average standard of nursing practices among the nurses working in teaching hospitals of Kolkata. Trained nurses were found to have higher knowledge, necessitating the need to impart focussed training on HIV prevention and counselling, keeping in mind the rising incidence of HIV infection in India.
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[Table 1], [Table 2], [Table 3], [Table 4]
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