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5002 Part One

Introduction

This piece of writing will explore the effect that training and improved knowledge has on the
opinions of Health Care Professionals (HCPs) within the National Health Service (NHS)
towards patients who have a diagnosis of Human Immunodeficiency Virus (HIV), and the
impact it has on the care that is provided; this will be done by comparing and contrasting a
small number of research papers. Although the research papers come from other countries,
it can be assumed that the data is transferrable to the NHS.

Impact of HIV Attitudes

The reason that this particular topic has been chosen is due to a continued stigma towards
individuals with HIV, and the increased incidence of HIV in the United Kingdom (UK) (Public
Health England, 2014). As the NHS is the primary organisation responsible for the health
care of individuals living in the UK, it is important to consider their values as this impacts on
the quality of care provided. NHS (2013) states in its values that it will provide a service to
every individual and will demonstrate dignity and respect at all times. This is a contradictory
statement as many prejudices exist within the NHS (Scott, 2012) and dignity and respect are
lost due to stigmatised views; Malterud and Ulriksen (2011) suggest that prejudice is a form
of discrimination which lowers the self-worth of an individual. Although there is little evidence
to suggest that HCPs had prejudiced opinions on patients with HIV before training
interventions, in my experience I have observed that this is possibly a hidden issue within
the NHS. Prejudice towards patients/people living with HIV (PLHIV) should not exist, as
HCPs are vitally important in the lives of PLHIV, and Rydstrom et al. (2013) support this by
stating that young individuals growing up with HIV rely heavily on HCPs for support and
guidance. Many sources, like Johnson and Cowin (2013) suggest that Student Nurses are
more perceptive and will have more open-minded, less-stigmatised views towards patients;
therefore I will be focussing the articles chosen on Student Nurses views.
Due to the pandemic of HIV throughout the world, numbers of patients with HIV is
increasing in the UK. Long et al. (2014) suggest that this has a large impact on the NHS

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because cost towards HIV research and treatment will continue to increase as many people
living with HIV remain undiagnosed, which will have a detrimental effect on healthcare costs
in the future. Many of these patients will be cared for by HCPs, and stigmatised views from
the HCPs will reduce the quality of life for that patient, making them less likely to display
health-seeking behaviours (Peate, 2013) which could impact on other aspects of the
individuals health such as mental health, self-esteem, or increased risk of infection
(Perisse et al., 2013).

Method of Choosing Research Papers

From the four research papers chosen, all four (Bekta and Kulaka, 2007; Stavropoulou et
al., 2011; Veeramah et al., 2008; Diesel et al., 2013) relate to Student Nurses views,
attitudes, and knowledge towards PLHIV. The search engine used to locate all these papers
was Liverpool John Moores University Discover. The terms student nurse, attitudes, and
HIV were typed in the search bar; the Print and Online Fulltext and Peer Reviewed
options were selected; and the date published option had 2004 2014 entered. This
search provided the four articles that will be discussed, and many more relevant
publications. The chosen papers were selected as they fully researched the topic chosen for
this piece of writing and provided mainly quantitative research methods, although one paper
discusses qualitative research methods in detail. The selection process was challenging as
there are very few research publications based on HIV issues in the UK, with a large number
from Africa and the United States of America. In saying this, many aspects of the topic
chosen are transferrable from other countries to the UK, as the pandemic of HIV and the
related stigma is existent worldwide (Katz et al., 2013). Other articles were initially selected,
but subsequently excluded, as one discussed medical students views - which would not
have been appropriate for the chosen topic -, and the others did not fully explore the issues
that would be examined in this piece of writing.

Synopsis of Papers

This section will compare, contrast, and analyse the four research papers that have
formerly been mentioned, including research methods, findings, and recommendations.

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Qualitative and Quantitative Data

As previously stated, all four research papers use qualitative research methods to attain
data to use in the discussions. Polit and Beck (2010 p. 222) state that qualitative data
provides the best evidence for nursing practice. Qualitative data is a method of data
collection that uses only figures and direct answers; this adds reliability to the data collected
in the research papers chosen. Additionally, each paper uses questionnaires to collect the
data; this means that the papers are survey research papers. These questionnaires include
questions on HIV knowledge and attitudes. Survey research is very effective, as it provides a
consistency throughout the study, and reduces the risk of bias (Burns and Grove, 2011 p.
353). Stavropoulou et al. (2011) and Veeramah et al. (2008) both used a mixture of openended and closed-ended questions, which allowed for some qualitative data to be extricated
from the data. Qualitative data is a method of data collection that relies on opinions and
discussions, allowing flexibility in the data collection process (Polit and Beck (010 p. 259).
Similarly, Bekta and Kulaka (2007) use closed-ended questions, but the participants were
required to write essays immediately after the questionnaire on specific topics, such as their
feelings when looking after PLHIV. This method enabled the researches to analyse both
qualitative and quantitative data, which is advantageous because Polit and Beck (2010 p.
259) discuss that this method provides a holistic view on the topic being studied. In contrast,
Diesel et al. (2013) only used closed-ended questions; this eradicated the opportunity for
opinions to be given by the participants of the study (Burns and Grove, 2011 p. 353). The
results of the data collected from all four research papers conclude that there was a great
need to educate health care providers on HIV to reduce stigma.

Intervention Method

From all the research papers, only Diesel et al. (2013) employ the intervention method.
Polit and Beck (2010 p. 222) stipulate that the intervention method is very effective in data
collection, as it allows for a comparison to be made from the results; thus enabling
assumptions towards the intervention. In this study the participants were required to
complete a questionnaire (which includes the Nurse Willingness Questionnaire, the AIDS
Knowledge Scale, the AIDS Attitude Scale, and the Obstetrical Knowledge Scale), then to
attend a 4-day workshop on HIV that would be taught by American nursing students. The

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participants then completed the same questionnaire after finishing the workshop, and again
after 60 days. In this case, the intervention was the 4-day workshop. The results from the
study show that there was a high initial perceived stigma towards PLHIV, although
improvements were noted after the intervention in all of the participants. This licences the
assumption that training and improved knowledge on HIV has a positive effect on Student
Nurses attitudes and the subsequent care that they will provide to PLHIV.

Purposive Sampling

Although purposive sampling was required for all the research papers - as all required the
participants to be nursing students -, Bekta and Kulaka (2007), Stavropoulou et al. (2011),
and Veeramah et al. (2008) all state that they chose only final-year nursing students.
Although there is no reasoning to this requirement, it can be perceived that this is due to
senior Student Nurses having more experience and knowledge on many topics, including
HIV, and, as a result: having more improved attitudes on PLHIV (Semiha et al., 2013). Also,
these final year Student Nurses will be much closer to becoming Registered Nurses;
therefore, they provide a more accurate representation as to what a Registered Nurses
attitudes on PLHIV may be.

Findings

All four of the research papers concluded that training, and further education was
paramount in reducing stigmatised views towards PLHIV. Participants from Bekta and
Kulaka (2007), Stavropoulou et al. (2011), and Veeramah et al. (2008) all expressed an
interest in gaining additional training, whereas Diesel et al. (2013) has evidenced that
training interventions have a positive effect on Student Nurses attitudes towards PLHIV.
Though the questionnaires asked different questions in all of the studies, it can be assumed
that the results would be similar if all the questions were the same for each study.
The studies also prove that the Student Nurses views towards PLHIV were quite shocking
with 9% of UK Student Nurses refusing to care for PLHIV (Veeramah et al., 2008), 40% of

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Greek Student Nurses being very afraid of caring for PLHIV (Stavropoulou et al., 2011),
and 7% of Turkish Student Nurses stated that they would not walk to the cinema with a
person living with HIV (Bekta and Kulaka, 2007). These views are similar, and show that
strong prejudices and misconceptions still exist worldwide even in healthcare.
Interestingly, Diesel et al. (2013) highlights that the participants who had previously cared
for, or knew someone living with HIV, or someone who had died of AIDS, had more positive
views on HIV. This view is shared by the Turkish participants (Bekta and Kulaka, 2007),
where the data indicates that those individuals would be more likely to care for PLHIV than
individuals who had not known someone living with HIV or someone who had died of AIDS.

Recommendations

It is no surprise that all four of the studies recommend an increase in HIV education for
Student Nurses and Registered Nurses. It has already been stated that participants views
varied positively with a previous experience of HIV, therefore it can be ascertained that more
experience with PLHIV and knowledge about HIV will have a positive impact on Student
Nurses views on PLHIV, which would have a desired impact on the quality of care given to
PLHIV. All four of the research papers mention the impact of negative attitudes towards
PLHIV on the quality of care given to those individuals.
Veeramah et al. (2008) writes that 47% of the UK participants had not received any class
instruction on the topic of HIV as final year students. This statistic is concerning, as the
stigma of HIV is so prevalent, and universities should be making more of an effort to
eradicate these perceptions. 64% of the participants in the UK study stated that they had
increased their knowledge about HIV in their own time, which shows that there is a strong
interest in HIV with students.

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Variables

Not all of the data from the four research papers can be assumed similar, as other factors
affect the results. Each study is from a different country, so cultural differences will have an
impact on the Student Nurses views, like the Cameroonian students (Diesel et al., 2013)
who come from an area suffering from a large death toll due to HIV/AIDS. The Turkish
students will also have a differing viewpoint as Turkey is primarily an Islamic practicing
country, and Islamic views on HIV are different to the beliefs of individuals from other
religious denominations.
Finally, other factors, such as age, gender, sexual orientation, race, and HIV status will
have a large impact on the data, as these circumstances may influence the individuals
opinions.

Conclusion

In conclusion, it is evident that strong stigmas and prejudices still exist worldwide, even in
the NHS, where it would be expected to be an open-minded institution. These attitudes have
a negative impact on the quality of care given to PLHIV, causing those individuals to avoid
healthcare settings.
The four research articles prove that negative attitudes are prevalent in modern cultures,
and the evidence from each study recommends that increased education will have a positive
effect on the attitudes of Student Nurses in differing countries. Although external factors can
influence the data (like culture, religion, and sexual orientation), it can be assumed that the
data collected can be transferrable to other countries and to the NHS.