Schools of nursing are the institutions charged with preparing students for professional nursing practice. Today, this practice includes caring for persons with AIDS (PWAs). Some authorities suggest that a model nursing curriculum should be developed (McGriff & Hurley, 1989). Yet, others advise an individualized approach based on a thorough assessment of faculty and students' learning needs prior to curriculum planning and educational programs concerning HIV (Mueller, Cerny, Amundson, & Waldron, 1992).
Review of the Literature
Many studies have been reported on the effect of various teaching strategies on knowledge and attitudes about HIV/ADDS.
Researchers stress the importance of group discussion, information giving, and participatory teaching methods when addressing attitudes related to HIV/AIDS (Aggleton & Homans, 1987; Lawrence & Lawrence, 1989). Others have found that the use of lecture followed by a question and answer period improved health care providers' knowledge and attitudes related to HTV/ AIDS ( Wertz, Sorenson, Liebling, Kessler, & Heeren, 1987). Others have found no significant difference in knowledge and attitudes based on teaching method (Doran, Laxson, & Pepper, 1988). According to Ungvarski (1987), the most important ingrethent for a successful educational program is to have PWAs address students.
Nursing faculty have used innovative formats to incorporate the myriad topics related to HIV/AIDS. These efforts range from workshops, elective courses, and audiovisual learning packages to development of interdisciplinary courses with other professional schools. Goldenberg and Laschinger (1991) found that young baccalaureate nursing students (JV =46) had positive attitudes toward caring for AIDS patients following two 2 -hour instructional units by AIDS experts.
In a study of nursing students and faculty (2V= 166), Oermann and Gignac (1991) revealed that knowledge scores increased as students progressed through the program. However, students' attitude scores were low and did not vary significantly from one level to the next. Faculty had the highest knowledge about AIDS; however, their attitude scores were comparable to those of the students.
Williams, Benedict, and Pearson (1992) studied the effect of a National Institutes of Health (NIH)-sponsored 1-day workshop on HIV/AIDS on baccalaureate nursing students' degree of comfort in providing basic nursing care to PWAs. They found no statistically significant decrease after the workshop in the amount of discomfort associated with providing care to PWAs.
Feit, Melzer, Vermud, and Shelov (1990) surveyed health care providers and found that 30% of the participants had an increased concern of occupational HIV infection following an informational symposium. They concluded that education alone may be inadequate to reassure some providers and recommended small group sessions that address their psychosocial needs.
In summary, a variety of teaching methods have been advocated for presenting HIV/AIDS content. Nurse educators agree that nurses need to be knowledgeable about HTY/AEDS and to possess positive attitudes when caring for PWAs. There is less agreement on the teaching strategies that will produce the desired outcomes. The purpose of the study was to determine the effect of an HTV/AIDS elective course, which used a variety of teaching strategies, on nursing students' knowledge about and degree of comfort in providing basic nursing care to people known or not known to have AIDS.
Subjects were students enrolled in an HD//AIDS elective course. The course was open to all nursing majors and to health care providers in the community. The elective, taught over a 10-week term, focused on current issues and challenges of providing care to clients with HIV infection and AIDS. Flaskerud's (1989) AIDSfHTV Infection: A Reference Guide for Nursing Professionals was the required text. Prior to the first class, students were asked to write their objective(s) for taking the course. The major theme that emerged from both basic and RN students was to learn to provide the best care and support of PWAs and their families and friends. In addition, the basic students (N =5) were concerned with occupational exposure and were particularly interested in learning appropriate infection control measures.
The course's format included group discussion and lecture with a question and answer period. Audiovisuels included videotapes, such as Overcoming Irrational Fear of AIDS (Carle Medical Communications, 1987) and Care of HIV Infected Children (American Journal of Nursing, 1990). All students completed computerassisted instruction on universal precautions. Learning activities included written abstracts and a verbal presentation of an HrvVAIDS-related project or field trip. An additional requirement was a reaction paper. This informal two-page paper was written in response to a class topic that was of particular interest or that evoked a strong response in the student. Examples of reaction paper topics included mandatory HIV testing of health care professionals and the panel presentation by the HIV-positive client. In addition to the other assignments, students who were enrolled in the course for graduate credit wrote a scholarly paper and presented this to the class.
The student's projects and field trips took many directions. Several students visited area funeral homes to ask about the care of the body after the death of a PWA. They learned that many funeral homes were not willing to conduct these services. Some learning activities developed into innovative projects. An RN-toMSN student invited classmates to an in-class baby shower for an Alabama center for infants and children with AIDS. Students brought baby food and inexpensive toys. During the "shower," the student presented a paper on perinatal AIDS. Another student, who is also a minister, organized a workshop for African American ministers interested in providing pastoral care to those affected by HIWAIDS. Seven ministers participated in the workshop and have formed a network to help meet the needs of PWAs and their families.
The sample consisted of 21 students currently enrolled in a state university nursing program and represented sophomores, juniors, seniors, and graduate students. The sample consisted of 20 females with a mean age of 37.1 years. The students were residents of a midsized city or its surrounding area in northern Alabama and southern Tennessee. Sixteen students (76.2%) were RNs who were enrolled in the course and pursuing a bachelor's or master's degree in nursing. There was no control for the amount of experience the students had in the care of PWAs or for other factors, such as other experience with HIV/AIDS or perceived personal risk. The major limitation of the study was the use of a small, nonprobability sample; therefore, the results are not generalizable to the population.
The instruments addressed two areas: knowledge of HTV/AIDS and comfort in caring for persons with AIDS. Knowledge was measured using the National League for Nursing (NLN, 1988) HIV/AIDS assessment test: Caring for Persons with AIDS. This 60-item, multiple-choice question, "timed" test was designed to assess the basic knowledge needed to provide safe nursing care to PWAs (NLN). The Kuder-Richardson Formula 20 (KR20) for the entire exam is 0.84. The 21 knowledge questions have a KR20 of 0.68 and the 39 application questions have a KR20 of 0.76.
The questionnaire entitled "Nursing Care Comfort Scale" (NCCS) (Form A and B) has been used previously to measure the effect of an HIV/AIDS workshop on baccalaureate nursing students (Williams et al., 1992). The NCCS lists 18 basic nursing procedures such as giving a bath to a patient. Two forms of the questionnaire were developed: Form A contained statements ending with "to a patient with AIDS"; Form B contained identical statements but without the ending "with AIDS." Form B was used to control for change in nursing students' comfort with nursing procedures in general. The students were instructed to indicate how they would feel doing these nursing procedures with responses ranging from "I would be very comfortable doing this" (5) to "I would be so uncomfortable that I would not be able to do this" (1). Scoring of the questionnaires was done by quantifying the responses (maximum score, 90; minimum score, 18).
Students completed the NLN test and both forms of the NCCS at the beginning of the first class and 10 weeks later at the conclusion of the course. A subjectgenerated ID provided for matching the pretest and the posttest of the individual subjects while preserving their anonymity.
Twenty-one students participated in the course, and scores (before and after as matched pairs on all tests) were available for 19 students on Forms A (AIDS) and B (nonspecific) and for 18 students on the NLN questionnaire. Because the assumption of normal distribution of scores could not be met, a Wilcoxon Signed Ranks test was used to determine the difference between pretest scores and posttest scores of the 18 pairs of students completing the NLN test and Forms A and B of the NCCS.
There was a statistically significant difference in the NLN knowledge scores between the pretest (mean = 40.95) and posttest (mean = 46.89, Wilcoxon matchedpairs signed-ranks test, f = 3.57, p<.001, iV=18). There was a statistically significant (p = .05) increase in the amount of comfort of Form A (AIDS) pretest (mean = 69.10) and posttest (mean = 76.63). There was no significant difference in the pretest (mean = 80.52) and posttest (mean = 82.42) of Form B (nonspecific), indicating students felt comfortable in giving basic care to persons not known to have HIV/AIDS. The Spearman's rho test supported a positive correlation (rho = .43) between knowledge scores and degree of comfort at the .05 level.
The results of the study have implications for nursing education. This study concluded that the elective course on HIV/ AIDS did affect knowledge levels and the overall degree of comfort nursing students anticipated they would experience while providing basic care to people with AIDS.
There are several possible explanations for the course's positive effect on students' knowledge and comfort. Students selected the HIV/AIDS course over other électives, suggesting interest and readiness to learn about the subject. Students' NLN knowledge scores improved significantly between the pretest and posttest. Yet, the posttest knowledge mean was only 78%. The NLN test was used as a standard to measure what experts believed was the basic knowledge needed to provide safe nursing care to PWAs. The NLN test, however, did not guide the nurse educator's decision on course content. Much of the course content related to issues and aspects of care that are not included on the NLN.
The results of this study support the use of a variety of teaching methods. Group discussion encouraged group members to actively participate in discussing and exploring sensitive topics related to HTV/ AIDS, and the lecture teaching method was useful in presenting content such as the epidemiology of HTV infection (Aggieton & Homans, 1987; Lawrence & Lawrence, 1989; Wertz et al., 1987). The interactive panel presentation, a participatory experience for the students, made a significant contribution to the class (Ungvarski, 1987). In fact, according to students, having a PWA address them was the highlight of the course. Almost half (47.6%) of the students' reaction papers were written about the panel discussion with a PWA, an HIV/AIDS nurse, and a social worker. The panel presented the biopsychosocial aspects of caring for HIVinfected patients and their families, the role of the nurse and social worker, and the actual AIDS experience.
The reaction paper was an important strategy as it allowed students to express their fears and concerns about HIV/AIDS, and, in particular, their feelings about PWAs. In a short time, "Joe," the panel member with AIDS, affected the lives of these students as demonstrated by their responses. A sophomore wrote, "I was very surprised to see that this individual appeared to be very healthy. It's ironic that he was the one giving me support and courage to live."
The ultimate aim of the school of nursing's approach to HIV/AIDS curriculum can be summarized by one particularly touching response from an infection control nurse who wrote:
I've been through a lot of educational seminars that focused on medical issues and not much about the other areas that AIDS has impacted. "Joe" and the class have meshed other societal concerns together at one time to even further illuminate the complexity of AIDS on today's world. Every day, as "Joe" relayed, a different front of society is "tested" in new ways, i.e., legal, sexual, medical, political, religious, or financial, it continues to get more complicated. I just hope I can keep up the fight against the disease, and not the people who have it.
- Aggleton, P., & Homans, H. (1987). Training the AIDS educator. Nursing Times, 83(40), 4044.
- American Journal of Nursing Educational Services Division (Producer). (1990). Care of HP/ infected children [Video]. New York: Author.
- Carle Medical Communications (Producer). ( 1987 X Overcoming irrational fear of AIDS [Video]. Urbana, IL: Baxley & Associates.
- Doran, M., Laxson, L., & Pepper, G. (1988). Comparing two approaches to AIDS education. American Journal of Infection Control, 16(2), 73. (Abstract)
- Feit, L.R., Melzer, SM., Vermud, S.H., & Shelov, S.P. (1990). The impact of an AIDS symposium on attitudes of providers of pediatric health care. Academic Medicine, 5, 461463.
- Flaskerud, J.H. (1989). AIDS IHP/ infection: A reference guide for nursing professionals. Philadelphia: W.B. Saunders.
- Goldenberg, D., & Laschinger, H. (1991). Attitudes and normative bebéis of nursing students as predictors of intended care behaviors with AIDS patients: A test of the AjzenFi8hbein Theory of Reasoned Action. Journal of Nursing Education, 30, 119-121.
- Lawrence, S.A., & Lawrence, R.M. (1989). Knowledge and attitudes about acquired immunodeficiency syndrome in nursing and nonnursing groups. Journal of Professional Nursing, 5, 92-101.
- McGriff, E.P., & Hurley, PA. (1989, October). HIV epidemic: Nursing education. In T.P. Phillips & D. Block (Eds.), Proceedings of an invitational workshop. Nursing and the HIV epidemic: A national action agenda (pp. 4767). Washington, DC: USDHHS, Public Health Service.
- Mueller, CW, Cerny, J.E., Amundson, M.J., & Waldron, JA. (1992). Nursing faculty and students' attitudes regarding HTV. Journal of Nursing Education, 31, 273-279.
- National League for Nursing. (1988) Caring for persons with AIDS. New York: Author.
- Oermann, M.H., & Gignac, D. (1991). Knowledge and attitudes about AIDS among Canadian nursing students: Educational implications. Journal of Nursing Education, 30, 217-221.
- Ungvarská, P. (1987). Demystifying AIDS: Educating nurses for care. Nursing and Health Care, 8, 571-573.
- Wertz, D. C, Sorenson, J.R., Liebling, L., Kessler, L., & Heeren, T.C. (1987). Knowledge and attitudes of AIDS health care providers before and after educational programs. Public Health Reports, 102(3), 248254.
- Williams, R.D., Benedict, S., & Pearson, B.C. (1992). Degree of comfort in providing care to PWAs: Effect of a workshop for baccalaureate nursing students. Journal of Nursing Education, 31, 397-402.