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How a Nurse Can Deal With a Hiv Ethical Dilemma Involving a Family Member at Risk for Acquiring Hiv

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Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam

  • Koji Wadathree,
  • Huong Thi Xuan Hoangfour,
  • Anh Thi My Bui5,
  • Hung Dinh Nguyenhalf dozen,
  • Hung Le7 &
  • Derek R. Smithviii

Environmental Wellness and Preventive Medicine volume 22, Article number:ix (2017) Cite this commodity

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Abstract

Objectives

This study examined the factors associated with nurses' willingness to care for patients infected with homo immunodeficiency virus (HIV) or hepatitis B or C virus (HBV/HCV) in Vietnam.

Methods

A cantankerous-department of 400 Vietnamese nurses from two hospitals were selected using stratified random sampling, to whom a self-administered questionnaire was administered which included demographic items, previous feel with patients infected with HIV or HBV/HCV, and their attitudes toward these patients. Information was analyzed using descriptive statistics and multiple logistic regression.

Results

The lifetime prevalence of needlestick or sharps injury whilst caring for a patient infected with HIV or HBV/HCV was 9 and 15.8%, respectively. The bulk of participants expressed a willingness to intendance for patients infected with HIV (55.eight%) or HBV/HCV (73.3%). Willingness to care for HIV-infected patients was positively associated with beingness xl–49 years of age and confidence in protecting themselves confronting infection. Regarding HBV/HCV infection, willingness to care was positively associated with private conviction in protecting themselves confronting infection.

Conclusions

This study revealed that Vietnamese nurses were somewhat willing to care for patients infected with HIV or HBV/HCV, and this was associated with private conviction in protecting themselves against infection and with negative attitudes towards HIV and HBV/HCV. Establishing a positive safety culture and providing appropriate professional education to help reduce the stigma towards infected patients offers an effective way forwards to meliorate quality of care in Vietnam, as elsewhere.

Introduction

In Vietnam, patients infected with blood-borne diseases have been known to suffer from stigma and discrimination past healthcare workers [one], which is alarming given that the national prevalence of infectious disease is estimated to be 12.0% for hepatitis B virus (HBV), 2.0% for hepatitis C virus (HCV), and 0.v% for human being immunodeficiency virus (HIV) [ii, 3]. The primary transmission routes in Vietnam are believed to be prenatal transmission for HBV [4], injectable drug use and hemodialysis for HCV [5], and injectable drug use and unsafe sexual contact for HIV [6]. Since 2006, the government has prohibited refusal of intendance or discriminatory treatment against any patient infected with HIV [7], notwithstanding about hospitals yet lack a formal policy and hospital practices to eliminate stigma and discrimination on this result [8, 9]. Previous studies have suggested that injectable drug apply and commercial sex were nonetheless considered as "social evils" in Vietnamese gild; and these social mores, in turn, take the effect of strongly stigmatizing attitudes of healthcare workers toward patients infected with HIV [10, 11].

Nurses sometimes hold negative attitudes toward patients infected with HIV [12,thirteen,14,15], HBV or HCV [16,17,18]. Providing intendance for such patients may put health professionals at risk for acquiring an infection, with the risk post-obit a contaminated needlestick or sharps injury being estimated at between 6 and thirty% for HBV, 1.8% for HCV, and 0.3% for HIV [19]. Although HBV infection can largely be prevented by vaccination; in that location is currently no effective vaccine for HIV or HCV, and a lack of constructive mail service-exposure prophylaxis for HCV [xx]. As such, risk perception may influence nurses' unwillingness or refusal to care for patients with claret-borne diseases [21].

Positive attitudes toward patients infected with HIV or HBV/HCV represent an essential element in the appropriate care of such individuals. Nevertheless, few studies have investigated the factors affecting attitudes of Vietnamese nurses toward patients infected with HIV or HBV/HCV. This report was designed therefore, to examine the factors associated with nurses' willingness to intendance for patients infected with HIV or HBV/HCV in Vietnam.

Materials and methods

Participants and process

We conducted a questionnaire study of Vietnamese nurses in February 2016. According to a report from the Vietnam Ministry of Health in 2008, 63,040 nurses were registered in Vietnam and were distributed as follows: 13% in cardinal hospitals, 44% in province hospitals, 27% in commune hospitals, and 17% in community hospitals [22]. Nurses in Vietnam are recognized in three categories depending on education levels (secondary educated nurses, college educated nurses and bachelor degree nurses). Secondary medical schools provide ii-years of training for nurses, junior colleges provide 3-year training for nurses, and universities provide a 4-year bachelor of nursing degree. All courses require 12-years of compulsory education for access. Regardless of the different levels of their nursing education, nevertheless, all nurses work at the same level and scope in the clinical environs. The role of each nursing degree are currently under examination in Vietnam.

The target population for this study was nurses from two general hospitals located in Hanoi, Vietnam where patients infected with HIV, HBV or HCV were routinely cared for. Hospital A was 570 beds along with 500 nurses and Hospital B was 240 beds along with 300 nurses, respectively. Stratified random sampling was employed, with recruitment ceasing when 400 participants had joined the study (comprising 250 from Hospital A and 150 participants from Hospital B). The study questionnaire was completed anonymously and participants gave their written and oral informed consent. Each participant was paid thirty,000 VND (approximately 1.v USD) every bit a financial advantage. The written report was canonical by the Hanoi School of Public Health Institutional Review Board (No. 016-004/DD-YTCC).

Questionnaire

The questionnaire used for this report was adjusted from previous inquiry that had been undertaken in Japan [xvi]. It was translated into Vietnamese using standard translation procedures for cross-cultural studies [23, 24], with some items existence modified for the local context following consultation with a panel of experts [25]. We nerveless information on demographics (gender, historic period, marital status, nurse category, and career duration) likewise as previous experience caring for HIV or HBV/HCV infected patients, measured with binary aye/no responses to ii questions: (1): professional contact with an infected patient inside the previous year, and (2): previous needlestick or sharps injury (always) whilst caring for a patient infected with HIV or HBV/HCV. Attitudes toward patients infected with HIV or HBV/HCV were examined using the following questions: "confidence to protect confronting infection during caring for an infected patient" (confidence); "avoid going almost an infected patient" (discrimination); and "stigma that an infected patient is linked to homosexuality, injectable drug utilize, or having multiple sexual activity partners" (stigma). Attitudes and willingness were assessed with two separate sets of questions, one related to HIV and the other to HBV/HCV. The dependent variable in this study was willingness to intendance for patients infected with HIV or HBV/HCV, and was measured as the participants' level of agreement with the post-obit statement: "I would desire to care for a patient who is infected with HIV (or HBV/HCV)". Each statement regarding attitudes or willingness to care was answered on a four-point Likert response scale (concord; somewhat agree; somewhat disagree; disagree).

Data assay

All variables were analyzed using descriptive statistics, with multiple logistic regression analysis being used to examine factors associated with nurses' willingness to care for patients infected with HIV or HBV/HCV. Attitudes toward and willingness to treat, patients with HIV or HBV/HCV were treated every bit separate outcomes. The multivariable model included gender, historic period, marital status, nurse category, working feel, professional contact with an infected patient, and previous adventitious injection or exposure to a patient with HIV or HBV/HCV. For the statistical analysis, attitudes toward patients infected with HIV or HBV/HCV were reclassified into 3 levels (ane = agree, 2 = somewhat hold, and three = disagree/somewhat disagree), and the outcomes were reclassified into 2 levels (1 = hold/somewhat concord, and 2 = disagree/somewhat disagree). Nosotros applied Zhang's formula for adjusting the results of common outcomes [26]. All data were analyzed using SPSS for Windows 17.0 (SPSS Inc., Chicago, IL, USA), with p values <0.05 interpreted as being statistically pregnant.

Results

A total of 400 nurses participated in the study, amid whom, the bulk were female, aged 20–39 years, married, and Secondary educated nurses (Table 1). Around one-half of participants (46.8%) had cared for patients infected with HIV in the by year, while 71.0% had cared for patients infected with HBV/HCV during this time menstruum. In their professional feel every bit a nurse, ix and xv.eight% reported experiencing a previous needlestick or sharps injury while caring for a patient infected with HIV or HBV/HCV, respectively. Table 2 shows the frequency and distribution of attitudes toward patients infected with HIV or HBV/HCV. The majority answered "agree" or "somewhat hold" in response to the question of willingness to care for patients infected with HIV (55.8%) and HBV/HCV (73.3%). Approximately seventy% of participants agreed or somewhat agreed that they felt confident to protect themselves from infection while caring for patients infected with HIV and HBV/HCV. While the majority of participants reported non-discriminatory and non-stigmatizing attitudes, some agreed or somewhat agreed that they still avoided going virtually patients infected with HIV (23.3%) and HBV/HCV (9.4%). In addition, some participants agreed with the statement that linked infected persons to homosexuality, injectable drug use, or having multiple sex activity partners (32.0% for HIV, xviii.6% for HBV/HCV, respectively).

Table 1 Participant Demographics (n = 400)

Full size table

Table ii Attitudes Toward Patients Infected with HIV or HBV/HCV (due north = 400)

Total size table

Multivariate analyses revealed factors associated with willingness to care for patients infected with HIV or HBV/HCV (Tabular array 3). Regarding HIV infection, willingness to care for patients was positively associated with existence 40–49 years old (Odds Ratio (OR) i.70, 95% Confidence Interval (95%CI): one.02–2.07), and confidence in protecting myself against infection (concord: OR 1.97, 95%CI: ane.76–2.ten; somewhat concord: OR ane.75, 95%CI: i.48–1.94), and negatively associated with avoiding infected patients (agree: OR: 0.27, 95%CI: 0.ten–0.66; somewhat hold: OR 0.61, 95%CI: 0.35–0.97) and being a bachelor degree trained nurse (OR: 0.62, 95%CI: 0.37–0.95). Regarding HBV/HCV infection, willingness to intendance for patients was simply positively associated with confidence to protect confronting infection (hold: OR 2.27, 95%CI: i.66–two.fourscore; somewhat concur: OR 1.74, 95%CI: 1.21–2.xxx); willingness was negatively associated with the argument that linked infected persons to homosexuality, injectable drug use, or having multiple sex partners (concur: OR: 0.29, 95%CI: 0.12–0.66; somewhat concur: OR 0.33, 95%CI: 0.17–0.61) and with avoiding going well-nigh infected patients (somewhat agree: OR 0.34, 95%CI: 0.fourteen–0.77).

Tabular array 3 Factors associated with willingness to intendance for patients infected with HIV or HBV/HCV

Total size tabular array

Discussion

This report investigated factors associated with nurses' willingness to intendance for patients infected with HIV or HBV/HCV in Vietnam. Our study revealed that nurses who felt confident in protecting themselves against infection were more willing to intendance for patients infected with HIV or HBV/HCV, while nurses with discriminatory attitudes towards HIV and HBV/HCV, and stigma regarding HBV/HCV were less willing to care for such patients. The findings offer important insights for providing appropriate intendance for people infected with HIV, HBV or HCV in Vietnam, as elsewhere.

Healthcare workers may experience an ethical dilemma in deciding whether to provide handling and care for patients infected with HIV, HBV or HCV. For example, unwillingness to treat patients with HIV has been reported in 23 to 50% of physicians in the United States, 21% in Spain and 14% in Canada [27]. The current study revealed that the percentages of Vietnamese nurses unwilling to provide care was similar to that reported among Japanese nurses (44% for HIV and 27% for HBV/HCV in Vietnam; 46% for HIV and 20% for HBV/HCV in Japan) [28]. Some studies have suggested that nurses may be more than probable to give differential care to infected patients when compared to their medical counterparts [12, 29, 30], which may reflect relative differences in their knowledge of infection [31]. Nurses' cognition of infection is probably variable in Vietnam, due to the multiple education pathways to enter nursing, the lack of a national licensing examination, and the multifariousness of practical preparation offered for newly graduated nurses. Our findings propose that hospital managers should take activity in this ethical dilemma amid nurses so that infected patients can receive appropriate care.

Having a positive rubber culture in the health care environment may ameliorate nurses' willingness to care for patients infected with blood-borne infections such as HIV, HBV or HCV. 1 study from Vietnam, for example, reported that nurses' compliance with standard precautions was suboptimal, with 39% not washing their easily following patient contact [32]. Healthcare workers in such situations may fear cantankerous-contamination, which may reduce their willingness to care for patients with blood-borne infections [33, 34]. The current written report suggests that confidence in protecting oneself confronting infection was a positive cistron associated with willingness to intendance for patients infected with HIV or HBV/HCV. In this regard, positive rubber culture, such as strict infection command, may serve not only to protect healthcare workers only also to improve the quality of patient care [35].

Avoidant attitudes were negatively associated with willingness to care for patients infected with HIV and HBV/HCV in the current study. Such attitudes towards HIV, HBV and HCV are not uncommon in healthcare [36, 37]. In Vietnam, caring for HIV positive patients is often stigmatized due to the cultural contexts and historical events related to the disease; meaning that nurses often avoid going near infected patients for fear of suffering prejudice from colleagues and family members [9, ten, 38]. Equally such, information technology can be seen that greater efforts are clearly needed to amend the public image of patients with HIV, HBV and HCV infection. Customs prejudice confronting individuals infected with blood-borne diseases is not limited to Vietnam nonetheless, and has also been reported in other Asian countries [39].

Our study suggests that stigma of nurses toward patients infected with HBV/HCV was negatively associated with willingness to care for them, while HIV stigma had no such link to willingness. In general, it can exist suggested that individuals may harbor negative views toward HBV and HCV infection, although these are less stigmatized diseases when compared with HIV infection [34]. For example, some healthcare workers link patients infected with HCV to injectable drug use and uncooperative and problematic behavior in the wards [40,41,42,43]. Thus, HCV-related stigma might touch on their unwillingness to provide care for such patients. Regarding HIV stigma, some previous studies have reported an association between homophobia and unwillingness to intendance for HIV patients [44], which is inconsistent with results from the current study. Further research is needed to clarify this inconsistency.

Middle-aged nurses may accept more than positive views nearly providing care for patients infected with HIV in Vietnam, with nurses anile 40–49 years existence more than probable to express willingness to care for such patients in the current study. On the other hand, a previous study from Japan reported that nurses aged 50 years or older were more stigmatized confronting HIV intendance, probably considering they worked during the beginning of the AIDS epidemic [28]. Vietnam has a higher customs HIV prevalence rate when compared to Nippon (0.5% vs <0.one%) [45], and boosted experiences with HIV care probably bring concomitant increases in cognition and skills among middle-aged nurses; which may promote their willingness to care for infected patients [xv, 46]. Although educational strategies clearly represent an appropriate strategy for reducing HIV stigma and discrimination in healthcare practice [47], our study suggests that the healthcare worker's age must also be carefully considered.

Bachelor caste trained nurses were less willing to intendance for patients infected with HIV than secondary educated nurses in the current study. This upshot was inconsistent with previous enquiry which focused on the length of education and professional license category (nurse or nursing aide) [30, 48]. Because the majority of nursing education in universities and colleges has been performed by physicians in Vietnam, the educators of physician tend to focus on medical management of diseases rather than nursing intendance, which might negatively touch nursing treat Vietnamese patients infected with HIV. Every bit such, future research should examine nurse category-based differences in attitudes toward infected patients.

The current study incurred a few limitations which are worth considering. Get-go, the written report design was cross-exclusive; and therefore, crusade and outcome relationships could not exist adamant. Additionally, we conducted the study in just 2 big public hospitals in Hanoi, and the sample was relatively small (n = 400). As these samples may not represent all nurses in Vietnam or elsewhere; our findings should be interpreted with circumspection.

In conclusion, this study revealed that nurses were somewhat willing to intendance for patients infected with HIV or HBV/HCV, and this willingness was associated with their confidence to protect themselves confronting infection, and with their discriminatory or stigmatizing attitudes toward groups of infected individuals. Establishing a positive condom civilisation and providing appropriate professional education to help reduce the stigma towards patients infected with HIV, HBV or HCV offers an effective fashion forwards to improve quality of intendance in Vietnam, as elsewhere.

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Acknowledgements

This study was funded by a grant from the National Centre for Global Health and Medicine, Japan (26-2). The funders had no office in report pattern, data collection and analysis, the decision to publish or preparation of the manuscript. The authors gratefully admit the study participants and staff from the hospitals for their support and cooperation throughout this project.

Authors' contributions

TI, KW, HTXH and ATMB conceived and conducted the study. TI and KW contributed data analysis and results interpretations every bit well as drafting the initial manuscript with DS. HDN and HL revised the manuscript. All the authors read and approved the terminal manuscript.

Competing interests

The authors declare that they have no competing interests.

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Author data

Affiliations

  1. Section of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand

    Tomohiro Ishimaru

  2. Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Nihon

    Tomohiro Ishimaru

  3. Bureau of International Health Cooperation, National Middle for Global Health and Medicine, Tokyo, Japan

    Koji Wada

  4. Department of Infection Control, Faculty of Nursing, Thanh Tay Academy, Hanoi, Vietnam

    Huong Thi Xuan Hoang

  5. Department of Hospital Management, Wellness Direction Preparation Found, Hanoi University of Public Health, Hanoi, Vietnam

    Anh Thi My Bui

  6. Neurosurgical Department, Saint Paul Hospital, Hanoi, Vietnam

    Hung Dinh Nguyen

  7. Dong Da Hospital, Hanoi, Vietnam

    Hung Le

  8. College of Public Health, Medical and Veterinarian Sciences, James Cook University, Townsville, Australia

    Derek R. Smith

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Correspondence to Koji Wada.

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Ishimaru, T., Wada, K., Hoang, H.T.X. et al. Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam. Environ Health Prev Med 22, nine (2017). https://doi.org/10.1186/s12199-017-0614-y

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  • DOI : https://doi.org/ten.1186/s12199-017-0614-y

Keywords

  • Hepatitis B
  • Hepatitis C
  • Human immunodeficiency virus
  • Nurse
  • Stigma

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Source: https://environhealthprevmed.biomedcentral.com/articles/10.1186/s12199-017-0614-y

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