Helping clinical nursing students cope with their fears about caring for those with HIV infection is a tremendous educational challenge. Students come to a new clinical learning experience with a certain degree of anxiety regarding their own skills and abilities. They also have the same fears and anxieties regarding the diagnosis of HIV infection that are sources of stress for many health care givers (Bolle, 1988). These fears and anxieties focus primarily around the issues of fear of contagion; lifestyle issues, particularly attitudes toward homosexuality and substance abuse; and issues of loss and fear of death.
During the initial clinical rotation on this unit, faculty observed several student behaviors that indicated fear and anxiety. These feelings were blocking the students* ability to engage in new learning and to meet effectively the objectives of this clinical nursing course. Students were afraid to touch these patients and had many questions about the handling of body fluids. They also expressed fears about transmitting the virus to family members and had many questions regarding the ethical issues surrounding confidentiality. They also had questions about how the staff on the unit coped with caring for numerous terminally ill patients. It became evident that the nursing students needed the opportunity to deal with some of these issues and feelings in order to provide care for persons with HIV infection and to meet the objectives of the course.
Groups of 9 to 11 associate degree nursing students are assigned to this medicalsurgical unit. The unit has a high percentage of patients with HTV infection as well as oncology and gynecology health problems. Collaboration between clinical faculty and practicing nurses is an essential piece of planning for this type of learning experience. Several specific teaching strategies were developed by faculty and staff and implemented with each clinical group having learning experiences on the unit.
The primary goal of faculty and staff was to provide a supportive atmosphere for students to explore their own attitudes and feelings about these highly charged, emotional issues. The other goal was to provide students with the clinical support to learn to provide nursing care for persons with HIV infection. Several strategies were developed to meet these goals.
Role modeling of positive attitudes and competent clinical care was an essential strategy. Students needed to observe and work with nurses at the bedside who were dealing effectively with these issues. The clinical faculty member made a conscious effort to support students at the bedside when care was being provided and to model positive communication with these patients. Faculty also made a deliberate effort to include touching the patient during the care or interaction to help students overcome fears of contagion. The primary nurses caring for these patients assisted students with procedures and, above all, were there to answer questions and to listen to students.
Students were systematically assigned to care for patients with HIV infection throughout the rotation. Faculty took into consideration the number of students assigned to these patients so that the group was not overwhelmed with patients of the same common health problem. Students were assigned to patients who could communicate verbally and who required the level of skill appropriate for these students' learning.
Students were provided with several readings prior to their clinical assignment to increase their knowledge base. These readings were available on the unit and also at the college library. The staff also shared freely their collection of literature regarding HIV infection as well as standardized patient care plans and discharge teaching plans. The theory presentation regarding HIV infection occurs approximately halfway through the rotation. Students who cared for these patients prior to the classroom presentation were able to add considerable clinical data to the classroom discussion.
Two clinical conferences were planned by faculty and staff to provide the students with additional coping mechanisms and additional application of clinical learning. The first clinical conference focused on the psychosocial issues surrounding the care of patients with HIV infection. Leadership for this conference was provided by a nurse with considerable experience in dealing with patient and family issues regarding this group of patients. The discussion centered on fears of contagion, lifestyle issues, and the concept of loss. Specific communication techniques were shared with students.
The second clinical conference focused on physiological needs and specific nursing interventions. Skin care, nutrition, and fluid needs, and promotion of mobility and elimination were discussed by another experienced nurse.
Positive reinforcement and encouragement were utilized by faculty and staff during the entire rotation. Students were praised for their efforts. An open acceptance of students' feelings and concerns was a primary consideration for both faculty and staff.
Use of these strategies resulted in some very positive outcomes for this learning experience. After caring for a person with HIV infection, the students verbalized a reduction in their fears. They became more self-confident and were able to provide competent care and effective interaction. Students began to request reassignment to these patients. They were able to transfer much of their learning about the care of these patients with HIV infection to their care of patients with oncology health problems, a second prominent population group on this unit with similar needs and issues.
The students evaluated the clinical conferences very positively. Questions were answered and the students had the opportunity to think about the priority issues and nursing care needed by these patients in a supportive atmosphere. Both the clinical faculty member and the staff valued the opportunity to enhance the students' learning environment and to help new members of the profession cope with their fears about caring for persons with HIV infection.
Nursing educators must accept the challenge to develop a basic, positively promoted educational process. Nurses make the difference in this disease process and we must prepare the students early in their learning experience to deal with the extremely difficult, controversial, and lifealtering issues of those challenged with HIV infection.
- Bolle, J.L. (1988). Supporting the deliverers of care: Strategies to support nurses and prevent burnout. Nursing Clinics of North America, 23,843-850.