KNOWLEDGE, ATTITUDE AND PRACTICES AMONG NURSES TOWARDS HIV/ AIDS PATIENTS IN TERTIARY CARE HOSPITAL, AMROHA

Background: Human Immunodeficiency Virus (HIV) has become one of the most serious challenges to public health due to its high morbidity, mortality and economic impacts. Good Knowledge, positive attitudes and practices are important aspects of providing nursing care for people living with HIV/AIDS. Aim: This study aimed to assess knowledge, attitudes and practices of nurses working with HIV/AIDS patients. Methods: This study was descriptive, performed on 200 nurses working with HIV/AIDS patients at a tertiary care Hospital, Amroha. Data was collected using pretested, validated, self administered questionnaire consisting of knowledge, attitude and practice based questions related to HIV/Aids and infected patients along with demographic variables of nursing staff under study. Results: The result of this study showed that majority of nurses (81%) working with HIV/AIDS patients possess adequate level of knowledge. Most of the nurses under study showed high level of empathic attitude toward people living with HIV/AIDS (above 80%) but at the same time high level of avoidance was observed among some nurses. Practice of nurses working with HIV/AIDS patients was found good. Conclusions: There was satisfactory knowledge, positive attitudes and good practice level among nurses under study. Recommendations: Training should focus on Preventive methods and modes of HIV transmission, care and support of all patients no matter what the disease, emphasizing confidentiality as a patient right that should not be ignored and should train nurses and monitor nursing skills.


Introduction:
HIV positive patients access to Hospital with an aim to receive proper treatment and care. Nursing staff in a hospital plays an important role in providing treatment and care to these HIV patients. Nurses perform a variety of roles such as caregiver, communicator, teacher, counselor, leader, change agent, manager, and research consumer in Hospitals. They may be carried out simultaneously depending on the need of the subject in a particular situation and case. As a caregiver, nurses are expected to assist the convalescent's physical, psychological, developmental, cultural, and spiritual needs to attain the utmost possible level of health and wellness. The duties of Nurses include collecting body samples such as blood samples, sputum samples, urine samples, stool samples, other body fluids, cleaning and changing beds along with administering intravenous, intramuscular and oral medications. Ineffective sterilization technique, inappropriate disposal of used syringes, needles, poor sanitation and use of inadequate precautions while nursing HIV patients increases the hazards of getting HIV infected. The transmission rate of HIV per exposure is less than 0.5% and contributes to 0.01% of global infections.
It has widely been observed that people infected with HIV frequently encounter discrimination while seeking and receiving health care services. The lack of universal adherence to infection control protocols such as Injection safety possess a great risk for nurses of occupational HIV infection at virtually every level of their daily work. Due to the risk of getting infected while handling and nursing HIV patients, it has been observed sometimes that nurses discriminate and avoid treating HIV patients.

Methodology
A descriptive cross sectional study was conducted over a period of 2 months at tertiary care hospital in Amroha amongst nursing staff of the Hospital. Study was carried out from 5th January 2020 to 5th March 2020. Nurses working in General Medicine, Obstretics and Gynecology, Surgery, Pulmonary Medicine and Casualty were included. The selection of study subjects was done using convenient sampling technique from amongst those nurses present at the time of study. Those nurses who were not willing to participate in the study were excluded from the study. A written informed consent was obtained from the Nurses after properly explaining them about objectives of the study. The data was collected by using a pretested, validated, self administered questionare consisting of 30 questions for assessment of Knowledge, attitude and practices of nurses regarding HIV patients (10 questions for each) other than demographic details of study subjects. The questionare was pilot tested among 4 senior Nursing staff members with respect to its clarity, comprehensibility and cultural appropriateness to this institutional setup. The questionnaire was divided into 4 main sections and the information required was collected under following categories: 1) Demographic variables of Nursing staff in the Hospital 2) Knowledge about HIV with special consideration given to its spread, mode of transmission, safety measures and universal precautions to be used and post exposure prophylaxis 3

) Attitude of Nurses towards HIV positive patients 4) Practices of Nurses while handling & nursing HIV/AIDS patients
Knowledge assessement of the study subjects was done with a pretested questionnaire containing 10 questions as mentioned above in which on the basis of the number of correct answers given, their knowledge was classified into Adequate (6-10 correct answers) and Inadequate (0-5 correct answers).
Attitude assessement of the study subjects was done with a pretested questionnaire containing 10 questions in which answer found satisfactory as per expectations and promoting proper health care of HIV/AIDS patients was given 1 point and further, their attitude was classified into Positive (6-10 expected answers) and Negative(0-5 expected answers) on the basis of number of satisfactory answers given by study subjects.
Similarly, assessement of practices of study subjects was done with a pretested questionnaire containing 10 questions in which answer found satisfactory as per expectations and promoting proper health care of HIV/AIDS patients was given 1 point and further, practices were classified into Good (6-10 expected answers) and Poor (0-5 expected answers) on the basis of number of satisfactory answers given by study subjects.

Results
200 study subjects who gave consent for the study were selected and they answered to the questionnaire. Most of the study subjects were of the age group of 21-40 yrs (61%). The mean age of the study participants was 26 yrs (N= 200). A majority of study subjects were females (86%). Amongst the study subjects, 71% were married. The qualification of the study subjects in the study were B.Sc Nursing(42%), Diploma Nursing(22%) and GNM (General Nursing and Midwifery-36%). Most of the study subjects were Senior Nurses which included 74% nurses working for ≤5 yrs, 14% nurses working for 6-10 yrs, 12% nurses working since 11 or more years.    The overall knowledge of nurses in this study was found satisfactory, as similar to the findings of similar study conducted by Dorothy et al in Ghana (1) , Ambica Reddy et al in Guntur (2) and Harshvardhan et al in Faridkot (5) . 89% of the study subjects knew that HIV/AIDS can be prevented by use of safe injection practices. 78% of the study subjects knew that HIV is not transmitted through coughing or sneezing. 83% study subjects knew that HIV is not transmitted through flies. 66% of the study subjects knew that HIV and AIDS are different. 78% study subjects knew that complete cure of HIV is not possible. 93% study subjects knew that HIV/ AIDS can spread due to unprotected sex. All of them thought that universal precautions use is mandatory while handling HIV positive patients. 97% study subjects were aware of the fact that HIV/AIDS is not transmitted by eating together. 77% study subjects knew that vaccine is not available for prevention of HIV/AIDS.
However it is a matter of concern that some of the study subjects had no idea about mode of transmission of HIV/Aids. Almost 27% of study subjects didn't knew the difference between HIV and AIDS. 12% incorrectly believed that HIV/Aids can be completely cured. 2% still incorrectly knew that vaccine is available for prevention of HIV/AIDS. 14% didn't used separate containers to dispose used syringes. 8% did not used gloves while handling HIV patients. 2% study subjects didn't had the habit of breaking needles after use. Such practices if not improved can affect the treatment of HIV patients. It was observed that with an increase in experience of the nursing staff there was a increase in knowledge towards nursing HIV patients in the hospital. Most of the well experienced nurses were found to have a comparatively better knowledge than the newly joined nurses. It was seen that with an increase in experience of nurses, there was a decrease in hesitation to handle HIV positive patients. These nurses play a very important role in care and recovery of HIV/ AIDS patients and these if found having inaccurate knowledge, attitude and practices towards HIV patients, it may adversely affect the treatment provided to patients and also the reputation of the Hospital. Such inaccurate knowledge may also lead to increased prevalence of HIV infection among nursing staff. Surprisingly, 3% of the respondents believed that HIV could be spread through flies. Studies carried out illustrate similar findings (2,5) as present study and concluded that majority of nursing staff had adequate (81%) level of knowledge about HIV and AIDS.

Conclusions
The result indicates that majority of nursing staff (81%) at tertiary care hospital have adequate knowledge about HIV/AIDS. Nurses in general expressed high levels of empathic attitudes towards people living with HIV/AIDS (Above 80%), but at the same time refraining attitudes were also observed among some nurses. A relatively high level of positive attitude towards HIV/ AIDS patients was observed. Practices in tertiary care hospital, Amroha were found good in majority of study subjects. Generally, Nurses, especially females and senior nurses were well versed with desired levels of knowledge, attitude & practices towards HIV/AIDS infected patients.

Limitations of study
The current study should be interpreted in light of some limitations. This survey used nursing staff of a private hospital in Amroha. The response rate could have been influenced by the knowledge, attitudes and behaviors of nursing staff of that hospital. Therefore the results of the present study could not be generalized to other groups of nurses. Future studies could include a larger, randomized sample from a more geographically diverse nursing group which may lead to better idea of Knowledge, attitude and practices of Nurses regarding HIV/ AIDS.

Recommendations
Education can improve the knowledge and alter the attitudes towards people living with HIV/AIDS. Counseling of family members, relatives and friends of diseased persons should be given the topmost priority to prevent stigma and discrimination so that HIV/AIDS patients can live with their rights. The people living with HIV/AIDS should be counseled so that they can live free from stress and anxiety. They should also be strongly motivated to have safer sex practice to avoid spread of infection. Sex partners of the patients also should be educated about prevention of HIV/AIDS. Mass media should be utilized in a big way to alleviate the misconceptions associated with HIV/AIDS. It is therefore important that the topic HIV/AIDS is included in the nursing education and curriculum. Training programs for Nurses working in the hospital should be organized intermittently to ensure health practices of nurses working in the hospital. We want to highlight the potential need to improve the level of knowledge and attitudes among nursing staff towards HIV/AIDS as they have a key role in prevention, care and treatment in their future career as nurses. Through evaluating the knowledge, attitudes and practices towards people living with HIV/AIDS among nursing staff, gaps can be identified as well as areas of importance for training and health care education amongst nursing staff can be promoted as well.