Journal of Nursing
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Nurse Attitudes And Care For Patients With Sexually Transmitted Diseases

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Sexually Transmitted Disease
A Sexually Transmitted Disease (STD), also known as Venereal disease (VD), is a disease that is transmitted primarily by sexual contact including vaginal intercourse, oral sex and anal sex. STDs are also transmitted via the needles, birth canal and breast feeding. The infection may be bacterial, fungal, viral or protozoan. Bacterial infection includes Chancroid  caused by Haemophilus ducreyi , Donovanosis caused by Granuloma inguinale or Calymmatobacterium granulomatis ,Gonorrhea caused by Neisseria gonorrhoeae and  Syphilis caused by Treponema pallidum.. Fungal infection includes Jock Itch and Yeast Infection .Viral infection includes AIDS caused by HIV, Cytomegalovirus infection, Genital Herpes and Genital warts caused by Human Papillomavirus strains. Protozoal infection includes Trichomoniasis  caused by Trichomonas vaginalis. The prevalence of sexually transmitted diseases is a serious social problem across the globe. Sociological changes brought about by rapid modernization in the twenty-first century has led to chronic problems like pre marital sex, homosexualism and multiple partnerships in sexual life and these have greatly contributed to moral degradation and subsequent rise in STDs.

Nurse Attitudes
Nurse care for such patients is complex in the sense that such sexually transmitted infections can occur even in patients who are not actually guilty of an act that can cause a STD. For example, Gonorrhea or Syphilis is transmitted to a child via the birth canal and HIV is transmitted by blood transfusion process. STD nurse care and risk assessment involves sexuality and intimacy issues that can be challenging for nurses.  Although treatment of STDs has been the primary focus, little has been done to know about the attitudes, beliefs and problems of nurse practitioners who care for such patients. A survey including a 21-item AIDS Attitude Scale measuring the constructs of avoidance and empathy to describe the nurse attitudes and care practices related to such patients has shown that nurses have relatively low avoidance and high empathy and hence, are comfortable treating such patients (Martin and Bedimo, 2000). But, nurse’s awareness, fear and emotions do play a role in determining the comfort level. A  study to determine nurses’ knowledge, attitudes and overall level of comfort in giving nursing care to acquired immune deficiency syndrome patients and identify the sociodemographic variables that influence nurses’ attitudes has shown that nurses with low levels of knowledge show negative attitudes towards people with acquired immune deficiency syndrome and other STDs. Nurse's specialty, rank, prior education and experience with patients have been shown to influence their attitudes (Oyeyemi, 2006).The positive beliefs and values about sexuality of nurses do play a role in shaping nurse attitudes in STD care (Nustas et.al , 2002). The conflict between nurses’ belief and values about sexuality and patient’s sexual behaviour has been well documented (Yun-Fang Tsai, 2002).
A strong fear of acquiring HIV infection at work substantiated by the fact that needlestick and sharps injuries are the most common method of transmitting blood-borne pathogens between patients and the nurses has been shown in a sample of 601 surgical and emergency nurses and this fear factor has been shown to instigate inappropriate HIV testing of all surgical patients and inpatients (Gańczak and Barss, 2007). A cross-sectional survey from seven health settings undertaken with a self-administered written questionnaire to study HIV-related knowledge, attitudes and risk perception and to identify predictors of willingness to provide care for such patients has shown that perceived risk of fatal occupational infection and previous experience in STD care greatly influence the attitudes of nurses although these nurses have a positive attitude towards caring for people with HIV and STDs
(Kermode et .al, 2005). A recent study to assess nurses' level of comfort in providing care to patients living with AIDS and to determine the sociodemographic variables that influence nurses' comfort using a questionnaire to elicit information on their comfort taking vital signs, handling, administering enema and mouth-to-mouth resuscitation and in recommending exercise or physical therapy to patients living with AIDS has shown that nurses are uncomfortable with resuscitation and prefer wearing gloves while handling these patients (Oyeyemi et.al,2008). A study using a five-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’ with seven statements regarding the nurse attitudes towards caring for patients with HIV and two statements regarding perceived risk of occupational HIV infection has shown that nurse’s unwillingness to care for such patients was associated with a lack of prior experience in STD  patient care and the majority (63%) perceive their risk of occupational infection with HIV as ‘high’ especially following a needlestick injury with a needle contaminated with HIV-positive blood (Kermode et .al,2005). Studies have also shown that nurses want to prevent themselves or colleagues from becoming infected after experiencing a needle stick accident (Tsai and Hsiung, 2003). Studies have also shown that nurses who have training in communication aspects of STD care are better equipped to care STD patients.

Nurse Care
Nurse care and risk assessment of patients with sexually transmitted diseases involves conduct of physical examinations, determination of medical and personal histories of patients and providing treatment. This involves active interviews, review of medications used and collection of specimens. The STD nurse care requires a thorough knowledge of the principles, practices and techniques of nursing and their application to patient care diseases, the anatomy and physiology of the reproductive system and current trends in STD practices (Tsai and Hsiung, 2003). The STD nurse care also requires a capability to perform pelvic examinations and general physical examinations, evaluate results of examinations and instruct and counsel patients in the area of sexually transmitted diseases. The nurse practitioner must obtain detailed, comprehensive information on sexual history while investigating any sexually transmitted disease in a factual manner. This includes details of vaginal, oral or anal sites of sexual contact, homosexual, bisexual or heterosexual sexual orientation, use of condoms to prevent STDs, use of other birth control methods, number of sexual partners in recent past, history of sex with injection drug users, period since last sexual intercourse with most recent partner and previous history of STDs (Kimberly et.al, 2006). Initial medical examination includes the investigation of  symptoms of STDs in client and in his or her partner/partners, enlargement of lymph nodes and fever. Detailed examination in men includes the investigation of urethral discharge, dysuria, itch or irritation in distal urethra or meatus, pain or swelling in the scrotum or inguinal region, genital rash or lesions, rectal discharge, itch or pain, joint pain, arthritis, conjunctivitis and rash at other body sites. Detailed examination in women includes the investigation of vaginal discharge , painful intercourse on penetration or deep dyspareunia, burning sensation with urination, genital rashes or lesions ,pain in lower abdominal region, postcoital, midcycle or excessive menstrual bleeding ,dysuria, nocturia, hematuria , joint pain, arthritis, conjunctivitis ,rash at other body sites, enlargement of lymph nodes, fever, last menstrual period and pregnancy. The clinical findings are substantiated by diagnostic tests (Kimberly et.al, 2006).

Conclusion
STD nurse care and risk assessment involves sexuality and intimacy issues that can be challenging for nurses. Nurse’s awareness, fear and emotions do play a role in determining the comfort level of care for STD patients. A strong fear of acquiring sexually transmitted infections at work, especially following a needlestick injury and prior STD care experience greatly influence the attitudes of nurses towards STD patient care. Such Knowledge gaps on perceived risk of exposure, and attitudes toward STD patients must be well addressed in the nursing curriculum. 

Reference

  • Jane E. Martin and Ariane Lisann Bedimo (2000). Nurse Practitioner, Nurse Midwife and Physician Assistant Attitudes and Care Practices Related to Persons with HIV/AIDS. Journal of the American Academy of Nurse Practitioners. 12 (2); 35-42.
  • Cornelius, Judith Bacchus (2006). African-American Nursing Students from a High Prevalence AIDS Area. Journal of Multicultural Nursing & Health, winter.
  • Adetoyeje Oyeyemi (2006). Caring for patients living with AIDS: knowledge, attitude and global level of comfort. Journal of Advanced Nursing .53(2): 196-204.
  • S. Deb, A. Mukherjee, S. Acharya (2004). Attitude of Nursing Students of Kolkata towards Caring for HIV/AIDS Patients. Indian Journal of Community Medicine. 29(3).
  • Maria Gańczak and Peter Barss (2007). Fear of HIV Infection and Impact of Training on the Attitudes of Surgical and Emergency Nurses toward Inpatient HIV Testing. Infect Control Hosp Epidemiol 28:230–233.
  • Kimberly A. Workowski and Stuart M. Berman (2006). Sexually Transmitted Diseases Treatment Guidelines. http://www.cdc.gov/std/treatment/2006/rr5511.pdf.
  • Michelle Kermode, Wendy Holmes, Biangtung Langkham, Mathew Santhosh Thomas & Sandy Gifford (2005). HIV-related knowledge, attitudes & risk perception amongst nurses, doctors & other healthcare workers in rural India. Indian J Med Res 122; 258-264.
  • Adetoyeje Y Oyeyemi, Bashir O Oyeyemi and Ibrahim S (2008). AIDS care in Nigeria: Are nurses comfortable performing procedures? International Journal of Nursing Practice. 14(1):11-18.
  • Yun-Fang Tsai and Ping-Chuan Hsiung (2003). Aboriginal Nurses' Perception of Facilitators and Barriers for Taking a Sexual History in Taiwan. Public Health Nursing 20(4); 281-286.
  • Yun-Fang Tsai (2002). Aboriginal Nurses’ Beliefs, Attitudes, and Values about Sexuality in Taiwan. Western Journal of Nursing Research 24(7): 803-814.
  • Wasileh Petro-Nustas, Anahid Kulwicki and Arwa F. Zumout (2002). Students’ Knowledge, Attitudes, and Beliefs about AIDS: A Cross-Cultural Study. Journal of Transcultural Nursing, 13(2); 118-125


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Editor-in Chief:
Alison Palmer

Editorial Staff:
Alison Palmer
Laura Fitzgerald
Kimberly McNabb
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