Saudi Student Nurses’ Perception of Their Educational Preparation for HIV/AIDS Patient Care Research Paper

Abstract

This study shall investigate nursing students’ attitude and perception on their educational programs. The perception of students on their training significantly correlated to the nursing care that they will offer to HIV patients during their nursing practice. In Saudi Arabia, little research studies have been demonstrated to establish the attitudes of student nurses on the kind of education and training offered. In collection of data for analysis will be through demographic and student form questionnaires. The study will involve 500 nursing students from the Saudi Nursing colleges from all study levels. The research findings shall offer insight to improve training of nurses in Saudi Arabia by determining the overall perception and attitudes on the course content in respect of HIV/AIDS.

Introduction

Throughout her history, Saudi Arabia has recorded significant advancements in the field of nursing research with an aim of improving the theory and practice of nursing. Through training of nurses has received much attention, studies indicate that perceptions of practicing nursing professionals towards HIV/AIDS patients were still at its low rate (Akala, Jenkins, & World Bank, 2005). Research conducted both in Saudi and outside revealed that nurses were still not well knowledgeable about the pandemic and as such, their provision of nursing care to HIV patients was impaired. Despite that Saudi is the largest Gulf country in the Middle East, its nursing sector remains a young and fragile profession.

Perceptions of nursing students correlated strongly with their willingness to accept caring for HIV patients ( Baumann & Blythe, 2008). Therefore, it is important to structure programs to enable nursing student to develop desired perceptions to facilitate better care for HIV/AIDS patients. According to Barbe (2005), there has been a controversy and discrepancy in the nature and level of correlation between attitude and knowledge about AIDS among nursing students and the relationship between the two over their four-year program.

Literature Review

In this research, the review will explore the current knowledge and literature regarding the level of comfort of nursing student’s on educational program preparation for the care of people living with HIV/AIDS in Saudi Arabia. In this study, students’ overall understanding of the concept of HIV will be factored in. additionally; perceptions on AIDS, factors that influence their attitude about course content, and the effects of the scourge in the society shall be discussed (Abu-Raddad, 2010). To gain understanding of nursing education, the study will consider a number of items. They shall include their comfort with people suffering from HIV, their future preparation for nursing care for HIV patients, and significance of their knowledge in nursing care.

In a study conducted by Aydin et al. (2007), 61.3% of practicing nurses expressed anxiety about HIV patients, and approximately 63 % feared socializing with HIV (+) persons. Extensive studies indicate that nurses working and with experience anxiety while administering care to people living with HIV/AIDS. This revelation may be because of lack of sufficient knowledge by nurses about transmission of HIV/AIDS. In a separate study conducted by Aydin (2007), 73% of the nurses expressed their right to refuse to deal with AIDS patients before they underwent educational training. The findings of this study indicated that uneducated health care nurses had negative attitude towards care for people living with HIV/AIDS (Oxford Business Group, 2009) and (AL‐Jabri & Al‐Abri, 2004).

Interesting to note is that training in some nursing workers had no significant impact on change of attitude even long after the training (AL‐Jabri & Al‐Abri, 2004). In assessing levels of comfort of students about the educational and course trainings are imperative in ensuring that they are competent enough to deal with the patients ailing from HIV/AIDS. Though discomfort may be a difficult item to measure, attitude submission will serve as a tool to establish the level of their comfort. In a report released by WHO, student nurses were very knowledgeable about transmission of HIV/AIDS (International Council of Nurses/World Health Organization, 2005)

A study by Miller-Rosser (2006) established that nursing students had little knowledge on virology as well as immunology. This study results compared nursing student, medical students, and general undergraduate about their confidence regarding knowledge in HIV/AIDS. Their findings suggested that 81% of the students were less or under-confident. The research attributed these eminent results to the fact that the knowledge related to a subject causing anxiety hence making them exercise caution on being over-confident about an issue perceived to be potentially risky (Miller-Rosser (2006)

A similar but separate study conducted by Al shehri (2009) revealed that nursing students generally had low scores on knowledge on HIV/AIDS. Student’s knowledge about HIV was high except in symptoms disease and immunopathology (Al shehri, 2009). Current studies still reveal that there are gaps in nursing student knowledge levels concerning the mode of HIV transmission; for example, student still expressed their thoughts that transmission of HIV was possible through contact with fishing hooks and mosquitoes (UNAIDS/ WHO, 2004).

Nursing students’ attitudes on Caring for People Living with HIV

The nursing Code of Ethics gives a guideline that practicing nurses must provide their nursing care to people living with HIV with great respect (AL‐Jabri & Al‐Abri, 2004). This code acknowledges any patient as a person, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust, and the dignity of all members of society. The International Code of Ethics for Midwives states that a nurse must above all put compassion and respect for the patient’s life, must be constantly ready to provide competent care to patients regardless of their age or sex, nature of the disease or other differences (Ellis &Hartley, 2001). Arrogance, neglect or degrading treatment of a patient is not allowed. A nurse is not entitled to impose their moral patient, religious and political beliefs. Failure to comply with this statement of the Code of Ethics substantially hampers the realization of the inalienable right of every individual on the confidentiality, obtaining quality health care and social support. To maximize patient care the nurse should be somewhat away from the meticulous execution of his/her direct responsibilities under the internal regulations of the hospital or other medical institution, and strive to establish long-term professional relationship with the patient and his or her milieu. Though this clarity has been made to nurses, some of the nurses still believed that they had the right to refuse to care for patients with HIV (UNAIDS/ WHO, 2004). In an older study by UNAIDS, students recognized that though patients with HIV were deserving of care, 49% of the students would rather not provide care to HIV/AIDS patients. Of these students, only approximately 24% would be willing to administer mouth-to-mouth resuscitation if there were no protective devices (UNAIDS/ WHO, 2004).

In a separate research conducted the same year, (Roupa et al, 2004) noted that 54% of the students suggested that nurses should be allowed to reject providing care to AIDS patients while 36% would out rightly be unwilling to provide health care to AIDS patients. In a study conducted in three large teaching Australian hospitals by UNAIDS & WHO (2004), nurses were refusing to provide care due to the underlying perceived risks and lifestyles of HIV/AIDS patients. The results of the surveys show that prejudice against HIV patients among nursing students is sufficiently high, though their awareness about HIV transmission. Infected are often denied treatment based on their HIV status, violate privacy, unreasonably impose quarantine, compulsory internment and / or segregation. Stigma and discrimination are major obstacles to effective treatment and care of HIV / AIDS patients. Stigma is a social stereotype that reflects the bias of medical officers as well as other people to HIV-positive. It leads to feelings of shame, guilt and isolation among people living with HIV infection, and negative attitudes of others (discrimination) are pushing these people to inaction or action that may cause harm to others. But the negative attitude of nurses to such patients can and should be changed by examining the needs and motives of fears. The determination of the causes and motives of fear of contamination among nurses makes possible to eliminate them in individual work with each individual or a group. This kind of work is to be carried out by professional psychologists and co-operation of HIV-infected persons.

The relationship between Prevalence of HIV/ AIDS in the Students’ Study Area and student’s perception and knowledge

The level of AIDS prevalence in the students’ environment is a fundamental aspect that affects their level of knowledge and attitude. This factor has far-reaching influence on the level of confidence that nursing students on the educational program preparing them for HIV care. Research reveals suggests that students whose origin is of an area characterized by low HIV prevalence have higher tendency to develop positive attitudes on patients with HIV/AIDS. On the other hand, students from areas with high-prevalence rates showed higher knowledge about HIV/AIDS pandemic (Aydin et al, 2007)

According to studies by Al-shehri (2009), results about high knowledge of students from high prevalent regions was due to the widespread community awareness about HIV, increases in infection rates, and mandatory educational programs. This study approach was to establish the students’ attitude and knowledge about HIV in high prevalence regions.

Maswanya et al. (2008) conducted a study on knowledge and attitudes about HIV/AIDS among nursing students in Nagasaki, Japan. The study involved a survey on 383 female nursing students. In their study, they found that students accessed knowledge about HIV/AIDS mainly through the media, and not from their teachers. Although students exhibited a high level of understanding about HIV/AIDS, a significant number of them had reserved attitudes about patients living with AIDS. The study concluded that an appropriate nursing training was required to reduce that gap between students’ knowledge and perception with respect to HIV/AIDS (Maswanya et al., 2008).

Qualitative study revealed absence of an effective training for nursing students in Japan especially on AIDS pandemic. In Japan, limited literature is available about education, attitude and perception of nursing interns on HIV/ AIDS. The study hence informs other researchers that absence of proper knowledge programs results in misconceptions about issues in dealing with HIV/AIDS. It is therefore imperative to note that cases where such reports are unavailable, students tend to develop negative perceptions during their preparation for HIV/AIDS nursing care.

Kermode, Holmes, & Langkham (2005) took a study on the influence of knowledge on musing professionals’ attitude towards patients living with HIV in rural India. The study administered questionnaires to 266 female nurses from rural areas. The study indicates that most of the nurses had developed a positive attitude towards caring for patients living with AIDS. However, the analysis showed a misconception of the knowledge about infection and risks. Furthermore, the results from findings indicated that willingness to offer nursing care for HIV/AIDS patients significantly correlated with their experience in dealing with such patients. In the same study, qualitative analysis gave an inference that no correlation between knowledge of transmission and attitudes towards risk. This study reveals that nursing professionals and students needed first-hand experience with HIIV/AIDS patients during their training to reinforce their positive perceptions (Kermode, Holmes, & Langkham, 2005).

A separate study conducted by Miller-Rosser (2006) established that students who accessed frequent nursing experience in caring for people living with HIV demonstrated high positive attitude towards the nursing curriculum that prepared them for HIV/AIDS care. A similar study by Miller-Rosser to determine the level of perception of nursing students on HIV/AIDS care in Riyadh Military hospital involved 100 nursing intern students from Jeddah, Saudi Arabia. The study’s main objective was to find out how nursing students’ knowledge influenced their ability and perception to care for HIV/AIDS patients. The study used a qualitative methodology to explain how knowledge and attitude, and how they influenced nursing students’ ability to care for HIV/AIDS patients. Student nurses who were comfortable with handling HIV patients had wide knowledge coverage on the concept of HIV/AIDS in relation to transmission and perceived risk.

According to Al-Mazrou, Y et al. (2005), the government of the Kingdom has established many strategies to battle with the increasing prevalence of HIV/AIDS through the National Aids Control Program. However, challenges that face the implementation of the strategic plan include the inability to access perceived high-risk areas and limited reporting. Although the Saudi Ministry of Health has gathered data on HIV/AIDS pandemic, continuous surveillances do not offer specific absolute information. Al-Mazrou et al. (2005) noted that little studies have explored the subject of HIV/AIDS and as such, little literature is available to equip nursing students about the pandemic.

To understand the influence of perception on nursing education on the kind of nursing care offered by practicing professional, we examine a study conducted by Kermode, Holmes & Langkham (2005) in India. The study is a descriptive analysis of the impact of knowledge and attitude of nursing students on their training in preparation for nursing care for HIV/AIDS patients. The study employed a self-administered questionnaire whose objective was to explain the impact of nursing education on perception of nursing students while in their actual care for patients living with HIV/AIDS. In their findings, they concluded that the ability of students to incorporate and internalize their nursing education and training had a positive correlation with the ability to offer high quality nursing care for people living with HIV/AIDS.

Significance of Study

The concept of nurse’s perception on the educational knowledge in preparation for HIV patient is imperative since it is critical in determining the perception of the “would be” nurses on HIV patients during their nursing practice. Studies on perception of nursing students discussed in the literature review indicate that the topic of study is significant in establishing of a more inclusive, sufficient and relevant knowledge that can influence the underlying attitudes of nursing students and even practicing ones (Polit, & Tatano, 2004). Although numerous studies have explored the topic, the Saudi Arabian student nurses have gained little attention in improving their training programs. Nursing colleges need information that would help in creating a curriculum capable of improving the level of student knowledge and attitude towards the content and the AIDS pandemic. This study is hence imperative in contributing its findings to the research literature already available and more so, the findings will be beneficial to the education sector, nursing health care of the Saudi Ministry of Health.

Research Aim

The research aims at determining the level of Saudi Student nurses’ Perception on their educational preparation for HIV/AIDS patient care.

Research Questions

The research questions designed are to prompt the research response from students studying nursing in Saudi Arabia about their level of comfort with the educational and training program that prepares them for the duty of caring for HIV/AIDS patients.

1. Does the knowledge level about the HIV disease increase with year of study?
2. Does change in attitude about HIV/AIDS correlate with the level of study?

What is the relationship between nursing knowledge offered and the perception of students on HIVAIDS?

Research Design

The research shall employ a quantitative approach in which self-administered questionnaires will gather data on nursing students in Saudi Arabia. It will involve collection, organizing and analyzing of numerical data to derive theory to answering the research questions. It will adopt a cross-sectional descriptive design aimed at investigating the level of attitude of nursing students in Saudi on their educational program in preparation for duty to care for HIV/AIDS patients (Zafar et al., 2005).

To facilitate the process of data collection, a questionnaire will be designed for utilization by the nursing students in Saudi Arabia.

Research Setting

This research will narrow its setting to Saudi hospitals in Riyadh region. The study will utilize three hospitals within the city and they will include Riyadh Medical Complex (RMC), a four-hundred-bed capacity Sultan Bin Abdul-Aziz Humanitarian City (SBAHC), and Riyadh Military Hospital (RMH) that has a bed capacity of 1,192. The research’s selection of these hospitals is because of high number of nursing student interns who take their internship programs within the city and more especially in these hospitals.

Study Sample

The sample chosen will utilize 500 nursing students from different levels of study. The study anticipates that this will be the most convenient sample capable of producing reliable and efficacious results that will serve to achieve the study objective. At the same time, the sample is most appropriate and convenient since students are most readily available and as such, it will be an inexpensive process (Watson, 2008).

The following will be the criteria for selection of the research samples and respondents who will volunteer to participate in the study.

• The sample will include Saudi nursing students who are in all levels of study
• Both male and female students who shall be Saudi citizens

Participants who do not meet the requirements of the study criteria shall be excluded from being respondents; for example, non-Saudi nursing studying in Saudi.

Data Collection

• Instrumentation

A demographic questionnaire consisting of seven items shall designed to gather information about respondent’s actual age, nationality, course study level, gender, marital status, how many cases HIV they knew, and number of patients they have previously taken care of. This information will be imperative in describing the research sample. Respondents will fill in or correctly mark in the boxes in response to the study prompts.

Knowledge- Impact questionnaire to assess HIV/AIDS knowledge will benefit the research in gaining validity and reliability. A practicing nurse with extensive experience in HIV/AIDS will review the questionnaire. To achieve content validity, two independent nursing professionals will rate the questionnaire on the scale of 1 to 5on the basis of appropriateness for a sample of nursing students (Taylor & Kermode, 2006).

HIV-impact questionnaire will benefit from student form designed to measure the nursing students’ attitudes and use of precautions while dealing with patients with HIV (Al‐Mazrou et al., 2005). The questionnaire will entail four responses from which respondents will choose. They include; agree, strongly agree, disagree and strongly disagree. Agree and agree will be combined into a cumulative percentage of agree.

• Procedure

The study will seek approval from the three host hospitals together with the primary nursing colleges from which the students learn. Participants who meet the research criteria will be included in the study where the researcher will conduct a meeting geared towards informing them of the study objective and their participation (Munhall, 2010). Participants shall access questionnaires from their respective nursing departments in colleges and hospitals. Respective authorities shall collect dully-filled questionnaires from respondents and deliver them via secured post delivery system.

Research Timeline

Data Analysis

Data collected will be analyzed using the Statistical Package for Social Sciences (SPSS) software. The demographic data will be analyzed using descriptive statistics. Analysis of the data could be carried out by using one-way Analysis of Variance (ANOVA). Year of study would be selected as an independent variable; knowledge and attitude shall be two dependent variables set at 95% level of significance (Houser, 2007).

Project Ethical Considerations

Professional ethics is a fundamental factor in any given scientific or social research and as such, the project has given this item due consideration to ensure accurate and fair representation. Initially, the project will seek legal authority from parties deemed relevant in giving project mandate. They will include the Saudi Ministry of Health (SMOH), RHC, RNH and SBAHC ethics committees. The research will ensure its response to the laid down research guidelines by the ministry and the research Ethics Committee (REC). In this study, the research ethical considerations that will be addressed shall include; confidentiality, informed consent, concept of no harm, and participant withdrawal. The following ethical considerations shall be important in the process of study.

Confidentiality and privacy policy

The research project will endeavor to assure research participants of their confidentiality and that of the information. Since the research shall depend on individual responses from persons volunteering information regarding the host topic, participant’s privacy shall be fundamental to ensure accurate and honest responses. According to Taylor and Kermode (2006), maintaining of confidentiality includes protecting data from persons unauthorized to access it or by coding data to create anonymity of the source or contributor. To ensure this, the research will design a confidentiality mechanism informed by research design to achieve objectivity of its findings.

No identification of personal details will come from participants to avoid either direct or perceived embarrassment that is likely to impair on the final research results. The research data obtained from field surveys, interviews and questionnaires will be confidential with no access to unauthorized persons. However, the initial design will ensure data coding to avoid mistaken reporting of some perceived personal details (Taylor & Kermode, 2006). In seeking objectivity and validity of participant response, the researcher will request participants to go through the privacy policy and inspect the information so gathered to maintain participant’s confidence (Polit & Beck, 2004). The data collected shall remain under lock and key in data stores and web portals accessible by researchers via security passwords (Taylor & Kermode, 2006).

Participant withdrawal

In this research, participation of respondents shall be free and voluntary. The participants in the research will have the right for informed participation, and of withdrawal without undue penalty. The research will endeavor to facilitate the participation of the respondents through practice of ethics and conduct necessary for respondent confidence in the researcher as well as the research subject.

The researcher shall communicate the study aims and objectives of the research in advance before commencement of data gathering from participants to prevent premature withdrawal of participants from the research study (Latimer, 2005).

No harm

There is a correlation between participant withdrawal and subsequent harm or punishment. As noted, no participant withdrawing from their involvement will suffer any disadvantage due to their action or omission in the research (Watson, 2008). This means that participation may be partial or complete in the sense that participants refusing to volunteer particular information express their partial withdrawal from the research exercise while those who resign from any form of engagement shall have completely withdrawn from their participation. As such, any of the actions taken by the respondents based on their perceived reasons shall not pose a liability on their side (Holloway & Freshwater, 2007).

Informed Consent

Before commencement of study, potential participant nurses will attend study briefings aimed at providing adequate information regarding the host topic. As prospective respondents, the researcher will request the student-nurses to ensure that all study requirements are clear to ensure that they do not compromise their consent. During the conference, nurses will receive study materials such as leaflets and brochures to ascertain their conceptualization about the study topic and participant requirements. To assure the researcher of their participation and consent, nurses will sign and return questionnaire to demonstrate their consent.

Dissemination of Findings

The research project aims at using the findings as a tool for mutual sharing to create value to stakeholders both directly and indirectly involved in the project. Dissemination of research findings will take place through guided sharing after the study as follows:

• Findings will be used by the Saudi Nursing for purposes of symposium aimed at improving its operations
• The research findings will be used by the Saudi Ministry of Health (MOH) as an instrument for future improvements in the nursing section
• The research report will be made available to research participants
• Research findings will be used in publishing of nursing journals
• Presentations of these findings will be useful to both local and international conferences.

Project Funding

The project shall rely on the funding and facilitation from the Saudi Ministry of Health (SMOH). MOH is the main financier to this project since it is the primary party involved in researches conducted in nursing to improve the theory and practice of its nursing care. An overview of the funding needs of the project is as follows:

Table: Project Cost Estimates

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