bs_bs_banner
Research into Work Life Experiences
Nurses’ job satisfaction and attitudes towards people living with HIV/AIDS in Russia L. Hamama1 PhD, E. Tartakovsky2 PhD, K. Eroshina3 MD, E. Patrakov4 PhD, A. Golubkova5 MD, J. Bogushevich5 MD & L. Shardina5 MD 1 Senior lecturer, Social worker, 2 Senior lecturer, Psychologist, Tel Aviv University, Tel Aviv, Israel, 3 Manager of the Global Fund Project, Open Health Institute, Moscow, 4 Psychologist, Head of the Social Security Department of Ural Federal University, Ekaterinburg, 5 Physicians, Urals State Medical Academy, Ekaterinburg, Russia
HAMAMA L., TARTAKOVSKY E., EROSHINA K., PATRAKOV E., GOLUBKOVA A., BOGUSHEVICH J. & SHARDINA L. (2014) Nurses’ job satisfaction and attitudes towards people living with HIV/AIDS in Russia. International Nursing Review 61, 131–139 Background: Previous studies internationally have highlighted that working with people living with HIV/AIDS may lead to nurses’ stress and burnout. However, this topic has not been well explored in Russia, a country with an exponential growth in HIV/AIDS. Aim: This study focused on nurses’ job satisfaction and their attitudes towards people living with HIV/AIDS in centres where nurses regularly treat such patients, and in a general hospital where nurses rarely treat such patients. Method: We distributed three self-report questionnaires: demographics, job satisfaction and attitudes towards people living with HIV/AIDS to nurses working in six HIV/AIDS centres and the largest general hospital in Ekaterinburg, Russia. Sixty-nine nurses from the HIV/AIDS centres and 66 from the general hospital (about 90% of those approached) completed these. Results: Nurses who regularly treated people with HIV/AIDS were significantly younger and a greater number held master degrees than those who rarely treated such patients. No significant differences between the two settings emerged for job satisfaction but what did emerge were differences in nurses’ attitudes: nurses in HIV/AIDS centres reported less avoidance than nurses in the general hospital. Regarding empathetic attitudes, no significant differences emerged, but empathetic attitudes contributed to the explained variance of job satisfaction. Conclusion: Although our sample was small, the associations found between avoidant attitudes and job satisfaction highlight the need for stigma-reduction strategies and increased disease knowledge. Healthcare managers should consider attitudes towards people living with HIV/AIDS as an important factor in ensuring adequate care for them and initiate education programmes for nurses, especially programmes dealing with HIV/AIDS in general hospitals.
Correspondence address: Dr Liat Hamama, Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv 69970, Israel; Tel: +972-3-9305551; Fax: +972-3-9305551; E-mail: [email protected].
Funding: This study was funded in part by a Sara Peleg grant from the School of Social Work at Tel Aviv University (grant no.34030000). Conflict of interest: No conflict of interest has been declared by the authors.
© 2013 International Council of Nurses
131
132
L. Hamama et al.
Implications for nursing and health policy: Support and supervision can be used as a strategy, for empowering nurses to meet the challenges of working with HIV/AIDS patients. Keywords: Attitudes, HIV/AIDS, Job Satisfaction, Nursing, Russia
Introduction Nurses have always been at the forefront of the HIV epidemic; they are on the frontline of HIV prevention, care and advocacy (Li et al. 2007; Qu et al. 2010). Working with people living with HIV/AIDS (PLWHA) may lead to nurses’ stress, burnout and even dropout, especially when physical contact with HIV/AIDS patients elicits misunderstandings and avoidance among nurses’ social connections and families (Bride 2007). Although this has been well studied in the West, this phenomenon has not been studied in Russia. In the current study, we aimed to assess the associations between Russian nurses’ job satisfaction and attitudes towards PLWHA, in order to inform healthcare policy and identify training and supervision needs. Specifically, the present study highlighted the similarities and differences regarding job satisfaction and attitudes towards PLWHA among Russian nurses working in two settings that vary in exposure to PLWHA: specialized HIV/AIDS centres where nurses regularly treat PLWHA vs. general hospitals where nurses rarely treat PLWHA. HIV/AIDS continues to be a major public health issue in Russia (UNAIDS/WHO 2010). The Russian Federation is experiencing an exponential growth in HIV incidence, as reflected in an increase in reported cases of new HIV diagnoses, from less than 40 000 in 2006 to over 60 000 in 2011 (UNAIDS 2012). In Russia, each large city (population over 200 000) has its own HIV/AIDS centre. These centres provide HIV diagnostics, treatment of opportunistic infections, psychosocial consulting for patients and their families, and information dissemination on these issues to mass media and educational systems (Ekaterinburg Regional Center for Prophylactics and Treatment of HIV/AIDS 2008). Nurses and other staff working in HIV/AIDS centres are well informed about HIV/AIDS, receive specialized training, have close intensive contacts with PLWHA and their families, and accrue substantial experience in treating these patients (Pankratov & Peresypkina 2012). On the other hand, general hospitals in Russia rarely treat HIV/AIDS patients. Most PLWHA who are treated in general hospitals either do not know their diagnosis or for some other reason do not wish to be treated in HIV/AIDS centres. Once
© 2013 International Council of Nurses
hospitalized, patients are diagnosed and they are usually then referred to a centre for the continuation of treatment. Therefore, medical staff in general hospitals are often unaware that they are treating PLWHA and receive very little training and experience in dealing with PLWHA (Pankratov & Peresypkina 2012). The present study is the first of its kind to examine the connection between job satisfaction and nurses’ attitudes towards PLWHA in these two settings.
Job satisfaction
Job satisfaction is a multidimensional construct consisting of elements essential to the personal fulfilment from one’s job (Shader et al. 2001). It pertains to how employees feel about their work environment and about diverse aspects of their employment (Spector 1997; Thompson & Phua 2012). As such, job satisfaction is conceived as a reaction to role stressors and as a predictor of occupational mental health (Sheward et al. 2005; Tourigny et al. 2010). Low job satisfaction in nurses has been found to result in burnout, high turnover, physical and psychological disturbances, higher stress levels and low levels of patient care (Chang et al. 2010; Mrayyan 2009; Murrells et al. 2008). Job satisfaction has been studied especially among nurses working in HIV/AIDS services (Chirwa et al. 2009; Delobelle et al. 2009). These studies conducted in African countries found that perceived HIV stigma was the strongest predictor of job dissatisfaction (Chirwa et al. 2009) and that the work itself was associated with job satisfaction (Delobelle et al. 2009). The importance of job satisfaction in the nursing profession has been linked to positive patient outcomes as rated by healthcare providers (Aiken et al. 2002) and to a higher quality of care as perceived by patients (Murrells et al. 2005). Nurses’ personal characteristics, attitudes and behaviours are factors that may influence their job satisfaction (Hayes et al. 2010; Utriainen & Kyngas 2009). Moreover, according to a literature search that was conducted by Hayes et al. (2010), factors associated with nurses’ job satisfaction can be grouped into intrapersonal, interpersonal (between the nurse and colleagues
Job satisfaction among nurses in Russia
or patients) and extrapersonal. In the current study, we focused on the intrapersonal factor, using the attitudes variable. Attitudes towards PLWHA
Attitude is an internal state generally believed to reflect three different components: the cognitive component linked to a person’s beliefs or thinking, the affective component linked to a person’s values, and the behavioural component linked to a person’s actions (Smith & Mackie 2007). Thus, attitudes can significantly affect a person’s choices regarding personal behaviour, and in the case of nurses, may have an important impact on the quality of patient care (Smith & Mathews 2007). Previous studies showed that higher empathy and compassion among nurses working with PLWHA in particular were associated with lower feelings of psychological distress (e.g. Delobelle et al. 2009; Smit 2005). On the other hand, several studies (Li et al. 2007; Tyer-Viola 2007) have documented negative attitudes towards HIV/AIDS patients shared by many healthcare professionals for a number of reasons, including but not limited to the fear of contracting the disease, a dislike of working with terminally ill patients, perceptions of personal risk, an unwillingness to work with certain patient populations (e.g. intravenous drug users, homosexuals) and concern over being professionally stigmatized. Furthermore, researchers assume that increased contact with PLWH helps healthcare providers increase their knowledge about HIV transmission and their empathy towards their patients (Pettigrew & Tropp 2006). These findings are consistent with Allport’s social psychological theory of intergroup contact (Allport 1954), which argues that prolonged contact with an out-group weakens prejudices and leads to a more positive attitude towards the group. The intergroup contact is consequently understood as both a cognitive process of obtaining more objective knowledge about the out-group and a behavioural process of changing attitudes towards the out-group (Pettigrew and Tropp 2006). With regard to nurses, Chirwa et al. (2009) found that the perception of stigma related to HIV influences their job satisfaction significantly. Notably, these variables were examined among nurses in South Africa (Chirwa et al. 2009; Delobelle et al. 2009, 2011; Smit 2005), in Belize (Andrewin & Chien 2008) and in Finland (Suominen et al. 2010). However, to the best of the authors’ knowledge, Russian HIV/AIDS nurses have not been well studied regarding their attitudes towards PLWHA in centres and hospital settings. Hypotheses
This study investigated the possible differences between job satisfaction and attitudes towards PLWHA of nurses who regularly
© 2013 International Council of Nurses
133
treated PLWHA (working in HIV/AIDS centres) and nurses who rarely treated PLWHA (working in general hospitals) in Russia. We predicted that Russian nurses working in HIV/AIDS centres would reveal lower job satisfaction than those working in general hospitals due to the uniquely stressful characteristics of caring primarily for PLWHA in the centres: stigma, discrimination and overexposure to suffering (Ijumba 2003). We also predicted that Russian nurses working in HIV/AIDS centres would reveal lower avoidance attitudes and higher empathetic attitudes than those working in general hospitals, in line with Allport’s (1954) social psychological theory positing that intergroup contact reduces intergroup prejudice, which in turn may affect attitudes. Thus, nurses with more frequent exposure to PLWHA should reveal more positive (empathetic) attitudes and fewer negative ones (avoidant), but also lower job satisfaction. In sum, the following hypotheses were tested: 1 Nurses who regularly treat PLWHA (in the centres) will report lower job satisfaction than nurses who rarely treat PLWHA (in the hospital). 2 Nurses who regularly treat PLWHA will report less avoidant attitudes and more empathetic attitudes than nurses who rarely treat PLWHA. 3 Avoidant attitudes will associate with low job satisfaction and empathetic attitudes will associate with high job satisfaction.
Method Design
This study used a cross-sectional, quantitative research design. Sample
The research questionnaires were distributed to the nurses who worked regularly with PLWHA in six HIV/AIDS centres in Ekaterinburg, during the centres’ training seminars at a time when 76 nurses participated in the training seminars (168 nurses employed in all centres, groups of 21–35 nurses in each centre). The nurses were informed of the purpose of the study and were assured that the study was confidential and voluntary. After completing the questionnaires, the nurses sealed them in an envelope and handed them to the researchers personally or through the administrative assistant. The comparison sample of nurses who did not work regularly with PLWHA was recruited from the largest general hospital in Ekaterinburg, which runs the largest nursing school in the region (Sverdlovsk Regional Medical College 2012). In this hospital, 371 nurses are employed. The research questionnaires were distributed to these hospital nurses during three randomly selected sessions of a conference held in the hospital to provide the latest practical nursing information and teach skills for
134
L. Hamama et al.
working with PLWHA. Seventy-five nurses participated in these selected sessions (groups of 21–29 nurses in each). The hospital’s nurses were randomly assigned to the sessions; therefore, the sample obtained was a random representation of the nurses working in the hospital. Ethical considerations
The nurses were informed of the purpose of the study and were assured that the study was confidential and voluntary. They completed the questionnaires anonymously and returned them to the researchers in sealed envelopes with a signed, informed consent form. The study was approved by the Ethical Commission in the general hospital and the HIV centres in Ekaterinburg and supervised by Tel Aviv University Research Ethics Committee. Data collection
Participants completed three self-report questionnaires. All questionnaires used in the present study were translated from English to Russian and back to English by two bilingual translators. Internal consistency of all the scales in the present study was similar to that obtained in previous studies applying English-language scales (for job satisfaction, see: Taber & Taylor 1990; for attitudes towards PLWHA, see: Froman & Owen 1997). Demographic questionnaire
This self-report related to demographic details of age, sex, family status, religiosity, health, education, professional experience and experience in treating PLWHA. Job satisfaction
Hackman & Oldham’s (1975) 15-item Job Diagnostic Survey measured workers’ satisfaction with various aspects of their jobs (e.g. skill variety, task identity, task significance, autonomy). Previous applications of the Russian version of this scale, in Russia and other countries of the former Soviet Union, confirmed its validity and reliability (see Bondarenko 2010). Participants rated their job satisfaction along a 7-point Likert-type scale ranging from not at all satisfied (1) to completely satisfied (7), with higher scores indicating higher job satisfaction. Internal consistency (Cronbach’s alpha) was 0.87. (Internal consistencies for the two settings were as follows: regularly treated HIV/AIDS = 0.88; rarely treated HIV/AIDS = 0.87). Attitudes towards PLWHA
The 21-item AIDS Attitude Scale questionnaire (Froman et al. 1992) was used to assess two aspects of attitudes towards
© 2013 International Council of Nurses
patients with HIV/AIDS: avoidance (14 items, e.g. ‘Patients who are HIV positive should not be put in rooms with other patients’) and empathy (7 items, e.g. ‘Patients with AIDS should be treated with the same respect as any other patient’). Participants rated their attitudes towards PLWHA on a 6-point Likerttype scale ranging from strongly disagree (1) to strongly agree (6), where higher scores indicated more avoidance attitudes towards PLWHA. Internal consistency (Cronbach’s alpha) was 0.88. (Internal consistencies for the two settings were as follows: avoidance: regularly treated HIV/AIDS = 0.87, rarely treated HIV/AIDS = 0.82; empathy: regularly treated HIV/AIDS = 0.76, rarely treated HIV/AIDS = 0.80).
Data analysis
To examine the differences between the two groups (nurses who regularly treated PLWHA and nurses who rarely treated PLWHA) in job satisfaction and in attitudes towards PLWHA (avoidance, empathy), we conducted univariate one-way multivariate analysis of variance (MANOVAs). In our analyses, we controlled for the two demographic variables that differed between the two settings – age and education.
Findings
About 90% of the nurses who were approached in both settings agreed to participate in the study (in the HIV/AIDS centres – 69; in the general hospital – 66). Participants comprised 135 female nurses in Russia, 69 of whom regularly treated PLWHA in HIV/AIDS centres, and 66 of whom worked in a general hospital and rarely treated PLWHA. Mean age overall was 41.3 years (SD = 9.88), but the nurses who regularly treated PLWHA were significantly younger (M = 39.58, SD = 8.61) than the nurses who rarely treated PLWHA (M = 43.15, SD = 10.81), t = 2.13, P < 0.05. Nurses had a mean of 19.65 years of professional experience (SD = 10.00), which did not differ significantly between the two groups. In terms of other demographic variables (see Table 1), only in education did a significant difference emerge between the two groups, χ2 = 4.51, P < 0.05. In both groups, the majority of nurses held a bachelor’s degree (∼80% of the nurses who treated PLWHA and ∼92% of the nurses who rarely treated PLWHA), although approximately 20% of the nurses who treated PLWHA held a master’s degree, whereas only 8% of those in the general hospitals did. No significant differences were found between the groups with regard to marital status, religiosity or health. Validating the hypothesis that nurses working in general hospitals rarely treated PLWHA, only five hospital nurses reported seeing, at the most, two HIV/AIDS patients during the previous
Job satisfaction among nurses in Russia
135
Table 1 Demographic characteristics for nurses in the two settings Variable
Marital status Education Religiosity Health†
Single Married BA MA Religious Not religious Healthy Not healthy
Total
Regularly treated HIV/AIDS – centres (n = 69)
Rarely treated HIV/AIDS – hospitals (n = 66)
n
%
n
%
30 39 55 14 63 6 62 7 69
43.5 56.5 79.7 20.3 92.3 7.7 91.2 8.8 100.0
20 46 61 5 55 11 58 8 66
30.3 69.7 92.4 7.6 90.2 9.8 92.1 7.9 100.0
χ2
0.11 4.51* 0.54 0.85
*P < 0.05. †There are missing values for health.
Table 2 Means, standard deviations and F and eta squared values for job satisfaction and attitudes in the nurses’ two settings Variables
Job satisfaction Attitudes towards PLWHA Empathy Avoidance
Regularly treated HIV/AIDS – centres (n = 69)
Rarely treated HIV/AIDS – hospitals (n = 66)
M
SD
M
SD
3.60
0.68
3.50
0.70
3.72 2.17
0.73 0.94
3.54 3.41
0.76 0.81
F†
0.64 1.90 62.41***
η2
0.00 0.01 0.33
***P < 0.001. †For job satisfaction: F (2, 126); for attitudes: F (3, 124). PLWHA, people living with HIV/AIDS.
week. In contrast, for those working in the HIV/AIDS centres, the mean number of HIV-infected patients seen during the previous week was 33.6. Significant differences emerged between the groups only regarding avoidance attitudes towards PLWHA, F (3, 124) = 62.41, P < 0.001, η2 = 0.33, where the nurses working in HIV/ AIDS centres revealed significantly lower avoidance towards PLWHA than their counterparts in the general hospitals. Empathy did not significantly differ between the groups. Likewise, the MANOVA comparing the two groups’ rates of job satisfaction yielded no significant difference between the two settings, F (2, 126) = 0.40, P > 0.05. That is to say, job satisfaction did not significantly differ between nurses who regularly
© 2013 International Council of Nurses
treated PLWHA and nurses who rarely treated PLWHA. Means, standard deviations and F values for each measure are presented in Table 2. Correlations between the variables
Pearson’s analyses were conducted to examine correlations between the demographic variables (age, sex, family status, religiosity, health, education, professional experience and experience in treating PLWHA) and the study variables. No demographic variables were found to be linked to the study variables. Pearson’s analyses were conducted to examine correlations among the study variables. Job satisfaction showed a positive
136
L. Hamama et al.
Table 3 Hierarchical regression coefficients (β) to explain differences in job satisfaction (N = 135) Predictors Step 1 Group Step 2 Group Empathy Avoidance
B
SE B
β
R2
ΔR2
0.00 0.08
0.12
0.06
−0.23 0.17 −0.23
0.14 0.08 0.08
−0.17 0.18* −0.36**
0.16***
*P < 0.05; **P < 0.01; ***P < 0.001.
correlation with empathetic attitudes towards PLWHA (r = 0.28, P < 0.001) and a negative correlation with avoidant attitudes towards PLWHA (r = −0.32, P < 0.001). In other words, nurses with higher empathy towards PLWHA and with lower avoidant towards PLWHA, reported higher job satisfaction. We next conducted a hierarchical regression analysis with job satisfaction as the dependent variable. The first step assessed the group (PLWHA-treating nurses vs. general nurses). The second step assessed the contribution of the two attitude subscales (avoidance, empathy). As seen in Table 3, these variables explained 16% of the variance in job satisfaction. The group (PLWHA-treating nurses vs. general nurses), entered in the first step, yielded no significant contribution. However, nurses’ attitudes towards PLWHA, entered in the second step, added 16% to the explanation of the variance. A significant contribution was made by the attitudes of empathy and avoidance to explain job satisfaction: nurses with more empathetic and less avoidant attitudes reported higher job satisfaction. To examine the differences between the two settings (nurses working in HIV/AIDS centres and nurses working in general hospitals) on these correlations, Pearson’s analyses were conducted separately. Significant differences emerged between the two settings: among nurses working in HIV/AIDS centres, job satisfaction correlated significantly and positively with empathetic attitudes (r = 0.36, P < 0.001), and correlated significantly and negatively with avoidant attitudes (r = −0.34, P < 0.001). In contrast, the nurses working in general hospitals revealed no significant correlations between job satisfaction and attitudes (avoidance, empathy).
Discussion The current study is innovative regarding the comparison between two settings: nurses who worked in dedicated HIV/
© 2013 International Council of Nurses
AIDS centres vs. nurses who worked in general hospitals and rarely treated PLWHA in Russia. Our findings did not confirm our first hypothesis, which predicted differences in job satisfaction between nurses who worked in specialized HIV/AIDS centres and nurses who worked in general hospitals and rarely treated PLWHA. To the best of our knowledge, no research has yet been conducted to examine the differences between nurses who work in these two settings in relation to job satisfaction. Perhaps the current lack of differences in job satisfaction between the groups can be related to the methodology of the study, that is, a small sample size and differences in the characteristics associated with the work environment rather than the differences associated with whether or not nurses regularly treated PLWHA (in line with the fact that only 16% of the variance in job satisfaction was explained by attitudes). As mentioned previously, nurses’ job satisfaction is multifaceted, complex and highly subjective (Hayes et al. 2010). Another explanation can be related to Hobfoll’s (1989) conservation of resources model. This model assumes that people consciously and unconsciously utilize the amount and quality of resources at their disposal. In a stressful situation, when a specific resource is threatened, people will ‘compensate’ by utilizing a different resource. According to this model, it seems that nurses from both groups may be efficient at utilizing their motivation and their intrinsic rewards to help their patients (HIV/AIDS and non-HIV/AIDS). Moreover, nurses are expected to give quality care to patients regardless of diagnosis; they are expected to feel ethically bound to act indiscriminately towards all patients (Smit 2005). The second hypothesis, related to nurses’ attitudes towards PLWHA, did confirm our expectations. Nurses working in HIV/ AIDS centres reported less avoidant attitudes towards PLWHA than their peers working in general hospitals who experienced less frequent exposure to PLWHA. Nevertheless, no significant difference emerged regarding empathetic attitudes; thus, the second hypothesis was only partially confirmed. A probable explanation for the less avoidant attitudes among nurses in the specialized HIV/AIDS centres may be that their personal contact with PLWHA and their AIDS-specific training acted to dispel misinformation and decrease stigma (Brems et al. 2010). In contrast, nurses who work in general hospitals rarely have contact with PLWHA and may experience deficiencies in AIDS-specific training, resulting in insufficient and inadequate knowledge regarding HIV/AIDS care, leading to avoidant and negative attitudes towards PLWHA (Smit 2005). Further study, including more detailed qualitative and quantitative reports about nurses’ interactions with PLWHA in both settings, specifically in the Russian context, is needed to validate this speculation, which coincides with Allport’s social
Job satisfaction among nurses in Russia
137
This study had several limitations that should be noted. First, literature is scarce on the cultural aspects that may influence the study variables; therefore, special care should be taken in the future to examine the possible effects of such cultural issues and to untangle the specifics of the healthcare system, specifically the HIV/AIDS system, in the Russian Federation. Second, it was a convenience sample and the sample size restricted usage of structural equation modelling; therefore, we could not conduct an assessment of generalizability. Third, the study was of a cross-sectional nature, which allowed us to establish associations but not causal relationships. Fourth, the present self-report survey responses were subject to common method variance bias. Nurses’ job satisfaction is multifaceted, complex and highly subjective (Hayes et al. 2010). Therefore, researchers would do well to collect complementary objective data on the actual work environment, to confirm current outcomes. In addition, the current quantitative design should be complemented in the future by qualitative methods that give voice to the unique perspectives on job satisfaction among nurses. That is to say, interpersonal (between the nurse and colleagues or patients) and extrapersonal (those external to the nurse; Hayes et al. 2010; Utriainen & Kyngas 2009).
victims is likely to be marginal if the reduction plan focuses solely on educating healthcare professionals about false beliefs. They found it necessary to change general dispositions for prejudice, a much more difficult task. Thus, healthcare managers should augment education programmes for nurses, especially programmes dealing with HIV/AIDS in general hospitals. They must consider attitudes towards PLWHA as an important factor in ensuring adequate care for PLWHA. Moreover, nurses and healthcare professionals who work with HIV/AIDS patients should be encouraged to stay current on changing issues relating to HIV/AIDS, and to understand that the disease process has already helped to start a social reconstruction of HIV as a chronic illness (Qu et al. 2010). From these changes, both an oppressed client population and the nurses who have an obligation to provide the best care possible are likely to benefit. Thus, these changes might contribute to enhancing the job satisfaction of nurses and other healthcare professionals. Given the fact that nursing is a highly stressful profession with severe concern regarding retention issues (Curtis 2007), results of this study may assist in developing practical organizational strategies to increase workers’ job satisfaction. Further research should investigate the similarities and differences between these two settings with respect to physical, social and organizational work–environment characteristics. Furthermore, the results of this study have theoretical implications. The study expanded knowledge about attitudes towards PLWHA among nurses in two different health settings and their associations with job satisfaction. It also extended intergroup contact theory to Russian nurses who work in specialized HIV/ AIDS centres vs. nurses who worked in general hospitals and rarely treated PLWHA. Nurses and heath providers are part of the general society, and their perceptions and attitudes towards HIV/AIDS are expected to be influenced by societal norms and attitudes. If AIDS were viewed as a normal disease in society, the health providers could feel more comfortable when they treat AIDS patients. Thus, HIV education might be a necessary intervention component to maintain a healthy psychological state among nurses and health providers and to increase their productivity.
Implications
Implications for health and nursing policy
The associations found between avoidant attitudes and job satisfaction highlight the need for stigma-reduction strategies and increased disease knowledge. Stigma and discrimination represent not only human rights violations, but also violations of the ethical principles on which the healthcare system is based (Brems et al. 2010). A recent study by Collani et al. (2010) showed that a reduction in the stigmatization faced by AIDS
From a health policy perspective, the Russian political system is shaped by its Soviet institutional legacy. That is to say, the state still plays a large part in Russian health, education and the economy. Private health facilities exist, but the vast majority of Russians continue to receive health care through the state system (Pankratov & Peresypkina 2012; Wallander 2005). Hence, to be able to meet the challenges of their profession and
psychological theory of intergroup contact (Allport 1954). In a meta-analytic test of intergroup contact theory, Pettigrew & Tropp (2006) found that intergroup contact typically reduces intergroup prejudice. Thus, nurses who work in general hospitals and rarely treat PLWHA may be flooded with anxiety over their safety practices and fears of occupational contagion, which may evoke avoidant attitudes towards PLWHA. Regarding the third hypothesis, the correlation between lower job satisfaction and nurses’ greater avoidance towards PLWHA was confirmed only among nurses who worked in HIV/AIDS centres. As mentioned above, direct contact with PLWHA may produce anxiety over safety practices and fears of occupational contagion, which may be very stressful for AIDS caregivers (Gueritault-Chalvin et al. 2000). Further study is needed to validate this speculation and to also consider as a whole the information about job satisfaction for nurses in Russia. Study limitations
© 2013 International Council of Nurses
138
L. Hamama et al.
work with HIV/AIDS patients, nurses need to perceive themselves as being empowered. Support and supervision can be used as a strategy for commitment and involvement when providing care for people with HIV/AIDS (McGlynn et al. 2012). Because of the lack of research focusing on nurses’ experiences of HIV/AIDS-related job satisfaction and attitudes in Russia, similar studies should be conducted at other hospitals and HIV/AIDS centres to ascertain whether the findings can be replicated. The greater understanding gained by such studies could inform social policies and programmes dealing with HIV/ AIDS-related care in Russia.
Acknowledgements We wish to thank all nurses who participated and collaborated in this study whose contribution enabled the production of this paper.
Author contributions Liat Hamama: study conception, data analysis, drafting of manuscript, critical revisions for important intellectual content; Eugene Tartakovsky: study design, data analysis, drafting of manuscript, critical revisions for important intellectual content; Ksenia Eroshina: study design, drafting of manuscript, administrative support; Eduard Patrakov: study design, data collection, drafting of manuscript, critical revisions for important intellectual content; Alla Golubkova: study conception, data collection, critical revisions for important intellectual content, material support; Julia Bogushevich: study conception, data collection, drafting of manuscript, administrative support. Loubov Shardina, data collection; drafting of manuscript; material support.
References Aiken, L.H., et al. (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987–1993. Allport, G.W. (1954) The Nature of Prejudice. Addison Wesley, Reading, MA. Andrewin, A. & Chien, L. (2008) Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care and STDS, 22 (11), 897–906. doi: 10.1089/apc.2007.0219. Bondarenko, I.N. (2010) Adaptation of the job satisfaction scale of Hackman and Oldham to the Russian population. Psikhologicheskii Zhurnal, 31 (3), 109–124. Brems, C., Johnson, M.E., Warner, T.D. & Roberts, L.W. (2010) Health care providers’ reports of perceived stigma associated with HIV and AIDS in rural and urban communities. Journal of HIV/AIDS & Social Services, 9 (4), 356–370. Bride, B.E. (2007) Prevalence of secondary traumatic stress among social workers. Social Work, 52 (1), 63–70.
© 2013 International Council of Nurses
Chang, Y.H., Li, H., Wu, C.M. & Wang, P.C. (2010) The influence of personality traits on nurses’ job satisfaction in Taiwan. International Nursing Review, 57, 478–484. Chirwa, M.L., et al. (2009) HIV stigma and nurse job satisfaction in five African countries. Journal of the Association of Nurses in AIDS Care, 20, 14–21. doi: 10.1016/j.jana.2008.10.001. Collani, G.V., Grumm, M. & Streicher, K. (2010) An investigation of the determinants of stigmatization and prejudice toward people living with HIV/AIDS. Journal of Applied Social Psychology, 40 (7), 1747–1766. Curtis, E.A. (2007) Job satisfaction: a survey of nurses in the Republic of Ireland. International Nursing Review, 54 (1), 92–99. Delobelle, P., et al. (2009) HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Journal of Advanced Nursing, 65 (5), 1061–1073. doi: 10.1111/j.1365-2648.2009.04973.x. Delobelle, P., et al. (2011) Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey. Journal of Advanced Nursing, 67 (2), 371–383. doi: 10.1111/j.1365-2648.2010 .05496.x. Ekaterinburg Regional Center for Prophylactics and Treatment of HIV/ AIDS (2008) Service Center. Available at: http://www.livehiv.ru/ index.php?page=about&pid=4 (accessed 1 May 2013). Froman, R.D. & Owen, S.V. (1997) Further validation of the AIDS Attitude Scale. Research in Nursing & Health, 20 (2), 161–167. doi: 10.1002/ (SICI)1098-240X(199704)20:23.0.CO;2-I. Froman, R.D., Owen, S.T. & Daisy, C. (1992) Development of a measure of attitudes toward persons with AIDS. Image, 24, 149–152. Gueritault-Chalvin, V., Kalichman, S.C., Demi, A. & Peterson, J.L. (2000) Work-related stress and occupational burnout in AIDS caregivers: test of a coping model with nurses providing AIDS care. AIDS Care, 12 (2), 149–161. doi: 10.1080/09540120050001823. Hackman, J. & Oldham, R. (1975) Development of the job diagnostic survey. Journal of Applied Psychology, 60 (2), 159–170. Hayes, B., Bonner, A. & Pryor, J. (2010) Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature. Journal of Nursing Management, 18, 804–814. Hobfoll, S.E. (1989) Conservation of resources: a new attempt at conceptualizing stress. American Psychologist, 44, 513–525. Ijumba, P. (2003) ‘Voices’ of primary health care facility workers. In South African Health Review 2002 (Ijumba, P., ed.). Health Systems Trust, Durban, South Africa, pp. 186–200. Li, L., et al. (2007) Stigmatization and shame: consequences of caring for HIV/AIDS patients in China. AIDS Care, 19 (2), 258–263. doi: 10.1080/ 09540120600828473. McGlynn, K., Griffin, M.Q., Donahue, M. & Fitzpatrick, J.J. (2012) Registered nurse job satisfaction and satisfaction with the professional practice model. Journal of Nursing Management, 20, 260–265. Mrayyan, M. (2009) Job stressors and social support behaviors: comparing intensive care units to wards in Jordan. Contemporary Nurse, 31 (2), 163– 175. Murrells, T., Clinton, M. & Robinson, S. (2005) Job satisfaction in nursing: validation of a new instrument for the UK. Journal of Nursing Management, 13 (4), 296–311.
Job satisfaction among nurses in Russia
Murrells, T., Robinson, S. & Griffiths, P. (2008) Job satisfaction trends during nurses’ early career. BMC Nursing, 7 (7), 1–13. Pankratov, L.E. & Peresypkina, N.A. (2012) Prophylactics of HIV infection among medical workers in a health organization. Social Work and Social Education: Challenges of Interaction. Conference Proceedings, 97–101. (Russian). Available at: http://www.rsvpu.ru/filedirectory/6415/ Socialqnaya-rabota-i-socialqnoe-obrazovanie.pdf#page=98 (accessed 29 September 2013). Pettigrew, T.F. & Tropp, L.R. (2006) A meta-analytic test of intergroup contact theory. Journal of Personality and Social Psychology, 90 (5), 751– 783. doi: 10.1037/0022-3514.90.5.751. Qu, B., Zhang, Y., Guo, H. & Sun, G. (2010) Relationship between HIV/ AIDS knowledge and attitude among student nurses: a structural equation model. AIDS Patient Care and STDS, 24 (1), 59–63. doi: 10.1089/ apc.2009.0190. Shader, K., et al. (2001) Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration, 31 (4), 210–216. Sheward, L., et al. (2005) The relationship between UK hospital nurse staff and emotional exhaustion and job dissatisfaction. Journal of Nursing Management, 13 (1), 51–60. Smit, R. (2005) HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa. Journal of Advanced Nursing, 51 (1), 22–29. Smith, D.M. & Mathews, W.C. (2007) Physicians’ attitudes toward homosexuality and HIV: survey of a California medical society – revisited (PATHH-II). Journal of Homosexuality, 52 (3–4), 1–9. Smith, E.R. & Mackie, D.M. (2007) Social Psychology. Psychology Press, London. Spector, P.E. (1997) Job Satisfaction: Application, Assessment, Cause and Consequences. Sage, Thousand Oaks, CA. Suominen, T., et al. (2010) Nurses’ knowledge and attitudes to HIV/AIDS: an international comparison between Finland, Estonia and Lithuania.
© 2013 International Council of Nurses
139
International Journal of Nursing Practice, 16, 138–147. doi: 10.1111/ j.1440-172X.2010.01822.x. Sverdlovsk Regional Medical College (2012) About the College. Available at: http://www.somkural.ru/about/ (in Russian) (accessed 17 November 2013). Taber, T.D. & Taylor, E. (1990) A review and evaluation of the psychometric properties of the job diagnostic survey. Personnel Psychology, 43, 467– 500. doi: 10.1111/j.1744-6570.1990.tb02393.x. Thompson, E.R. & Phua, F.T.T. (2012) A brief index of affective job satisfaction. Group & Organization Management, 37 (3), 275–307. doi: 10.1177/1059601111434201. Tourigny, L., Baba, V.V. & Wang, X. (2010) Burnout and depression among nurses in Japan and China: the moderating effects of job satisfaction and absence. International Journal of Human Resource Management, 21 (15), 2741–2761. Tyer-Viola, L. (2007) Obstetric nurses’ attitudes and nursing care intentions regarding care of HIV-positive pregnant women. Journal of Obstetric, Gynecologic & Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families & Newborns, 36 (5), 398–409. UNAIDS (2012) World AIDS Day Report. Available at: http:// www.unaids.org/en/media/unaids/contentassets/documents/ epidemiology/2012/gr2012/JC2434_WorldAIDSday_results_en.pdf (accessed 7 October 2013). UNAIDS/WHO (2010) AIDS epidemic update. Global report. Geneva. Utriainen, K. & Kyngas, H. (2009) Hospital nurses’ job satisfaction: a literature review. Journal of Nursing Management, 17 (8), 1002–1010. Wallander, C.A. (2005) The politics of Russian AIDS policy. PONARS Policy Memo No. 389. Center for Strategic and International Studies, 141–147.
Research into Work Life Experiences
Nurses’ job satisfaction and attitudes towards people living with HIV/AIDS in Russia L. Hamama1 PhD, E. Tartakovsky2 PhD, K. Eroshina3 MD, E. Patrakov4 PhD, A. Golubkova5 MD, J. Bogushevich5 MD & L. Shardina5 MD 1 Senior lecturer, Social worker, 2 Senior lecturer, Psychologist, Tel Aviv University, Tel Aviv, Israel, 3 Manager of the Global Fund Project, Open Health Institute, Moscow, 4 Psychologist, Head of the Social Security Department of Ural Federal University, Ekaterinburg, 5 Physicians, Urals State Medical Academy, Ekaterinburg, Russia
HAMAMA L., TARTAKOVSKY E., EROSHINA K., PATRAKOV E., GOLUBKOVA A., BOGUSHEVICH J. & SHARDINA L. (2014) Nurses’ job satisfaction and attitudes towards people living with HIV/AIDS in Russia. International Nursing Review 61, 131–139 Background: Previous studies internationally have highlighted that working with people living with HIV/AIDS may lead to nurses’ stress and burnout. However, this topic has not been well explored in Russia, a country with an exponential growth in HIV/AIDS. Aim: This study focused on nurses’ job satisfaction and their attitudes towards people living with HIV/AIDS in centres where nurses regularly treat such patients, and in a general hospital where nurses rarely treat such patients. Method: We distributed three self-report questionnaires: demographics, job satisfaction and attitudes towards people living with HIV/AIDS to nurses working in six HIV/AIDS centres and the largest general hospital in Ekaterinburg, Russia. Sixty-nine nurses from the HIV/AIDS centres and 66 from the general hospital (about 90% of those approached) completed these. Results: Nurses who regularly treated people with HIV/AIDS were significantly younger and a greater number held master degrees than those who rarely treated such patients. No significant differences between the two settings emerged for job satisfaction but what did emerge were differences in nurses’ attitudes: nurses in HIV/AIDS centres reported less avoidance than nurses in the general hospital. Regarding empathetic attitudes, no significant differences emerged, but empathetic attitudes contributed to the explained variance of job satisfaction. Conclusion: Although our sample was small, the associations found between avoidant attitudes and job satisfaction highlight the need for stigma-reduction strategies and increased disease knowledge. Healthcare managers should consider attitudes towards people living with HIV/AIDS as an important factor in ensuring adequate care for them and initiate education programmes for nurses, especially programmes dealing with HIV/AIDS in general hospitals.
Correspondence address: Dr Liat Hamama, Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv 69970, Israel; Tel: +972-3-9305551; Fax: +972-3-9305551; E-mail: [email protected].
Funding: This study was funded in part by a Sara Peleg grant from the School of Social Work at Tel Aviv University (grant no.34030000). Conflict of interest: No conflict of interest has been declared by the authors.
© 2013 International Council of Nurses
131
132
L. Hamama et al.
Implications for nursing and health policy: Support and supervision can be used as a strategy, for empowering nurses to meet the challenges of working with HIV/AIDS patients. Keywords: Attitudes, HIV/AIDS, Job Satisfaction, Nursing, Russia
Introduction Nurses have always been at the forefront of the HIV epidemic; they are on the frontline of HIV prevention, care and advocacy (Li et al. 2007; Qu et al. 2010). Working with people living with HIV/AIDS (PLWHA) may lead to nurses’ stress, burnout and even dropout, especially when physical contact with HIV/AIDS patients elicits misunderstandings and avoidance among nurses’ social connections and families (Bride 2007). Although this has been well studied in the West, this phenomenon has not been studied in Russia. In the current study, we aimed to assess the associations between Russian nurses’ job satisfaction and attitudes towards PLWHA, in order to inform healthcare policy and identify training and supervision needs. Specifically, the present study highlighted the similarities and differences regarding job satisfaction and attitudes towards PLWHA among Russian nurses working in two settings that vary in exposure to PLWHA: specialized HIV/AIDS centres where nurses regularly treat PLWHA vs. general hospitals where nurses rarely treat PLWHA. HIV/AIDS continues to be a major public health issue in Russia (UNAIDS/WHO 2010). The Russian Federation is experiencing an exponential growth in HIV incidence, as reflected in an increase in reported cases of new HIV diagnoses, from less than 40 000 in 2006 to over 60 000 in 2011 (UNAIDS 2012). In Russia, each large city (population over 200 000) has its own HIV/AIDS centre. These centres provide HIV diagnostics, treatment of opportunistic infections, psychosocial consulting for patients and their families, and information dissemination on these issues to mass media and educational systems (Ekaterinburg Regional Center for Prophylactics and Treatment of HIV/AIDS 2008). Nurses and other staff working in HIV/AIDS centres are well informed about HIV/AIDS, receive specialized training, have close intensive contacts with PLWHA and their families, and accrue substantial experience in treating these patients (Pankratov & Peresypkina 2012). On the other hand, general hospitals in Russia rarely treat HIV/AIDS patients. Most PLWHA who are treated in general hospitals either do not know their diagnosis or for some other reason do not wish to be treated in HIV/AIDS centres. Once
© 2013 International Council of Nurses
hospitalized, patients are diagnosed and they are usually then referred to a centre for the continuation of treatment. Therefore, medical staff in general hospitals are often unaware that they are treating PLWHA and receive very little training and experience in dealing with PLWHA (Pankratov & Peresypkina 2012). The present study is the first of its kind to examine the connection between job satisfaction and nurses’ attitudes towards PLWHA in these two settings.
Job satisfaction
Job satisfaction is a multidimensional construct consisting of elements essential to the personal fulfilment from one’s job (Shader et al. 2001). It pertains to how employees feel about their work environment and about diverse aspects of their employment (Spector 1997; Thompson & Phua 2012). As such, job satisfaction is conceived as a reaction to role stressors and as a predictor of occupational mental health (Sheward et al. 2005; Tourigny et al. 2010). Low job satisfaction in nurses has been found to result in burnout, high turnover, physical and psychological disturbances, higher stress levels and low levels of patient care (Chang et al. 2010; Mrayyan 2009; Murrells et al. 2008). Job satisfaction has been studied especially among nurses working in HIV/AIDS services (Chirwa et al. 2009; Delobelle et al. 2009). These studies conducted in African countries found that perceived HIV stigma was the strongest predictor of job dissatisfaction (Chirwa et al. 2009) and that the work itself was associated with job satisfaction (Delobelle et al. 2009). The importance of job satisfaction in the nursing profession has been linked to positive patient outcomes as rated by healthcare providers (Aiken et al. 2002) and to a higher quality of care as perceived by patients (Murrells et al. 2005). Nurses’ personal characteristics, attitudes and behaviours are factors that may influence their job satisfaction (Hayes et al. 2010; Utriainen & Kyngas 2009). Moreover, according to a literature search that was conducted by Hayes et al. (2010), factors associated with nurses’ job satisfaction can be grouped into intrapersonal, interpersonal (between the nurse and colleagues
Job satisfaction among nurses in Russia
or patients) and extrapersonal. In the current study, we focused on the intrapersonal factor, using the attitudes variable. Attitudes towards PLWHA
Attitude is an internal state generally believed to reflect three different components: the cognitive component linked to a person’s beliefs or thinking, the affective component linked to a person’s values, and the behavioural component linked to a person’s actions (Smith & Mackie 2007). Thus, attitudes can significantly affect a person’s choices regarding personal behaviour, and in the case of nurses, may have an important impact on the quality of patient care (Smith & Mathews 2007). Previous studies showed that higher empathy and compassion among nurses working with PLWHA in particular were associated with lower feelings of psychological distress (e.g. Delobelle et al. 2009; Smit 2005). On the other hand, several studies (Li et al. 2007; Tyer-Viola 2007) have documented negative attitudes towards HIV/AIDS patients shared by many healthcare professionals for a number of reasons, including but not limited to the fear of contracting the disease, a dislike of working with terminally ill patients, perceptions of personal risk, an unwillingness to work with certain patient populations (e.g. intravenous drug users, homosexuals) and concern over being professionally stigmatized. Furthermore, researchers assume that increased contact with PLWH helps healthcare providers increase their knowledge about HIV transmission and their empathy towards their patients (Pettigrew & Tropp 2006). These findings are consistent with Allport’s social psychological theory of intergroup contact (Allport 1954), which argues that prolonged contact with an out-group weakens prejudices and leads to a more positive attitude towards the group. The intergroup contact is consequently understood as both a cognitive process of obtaining more objective knowledge about the out-group and a behavioural process of changing attitudes towards the out-group (Pettigrew and Tropp 2006). With regard to nurses, Chirwa et al. (2009) found that the perception of stigma related to HIV influences their job satisfaction significantly. Notably, these variables were examined among nurses in South Africa (Chirwa et al. 2009; Delobelle et al. 2009, 2011; Smit 2005), in Belize (Andrewin & Chien 2008) and in Finland (Suominen et al. 2010). However, to the best of the authors’ knowledge, Russian HIV/AIDS nurses have not been well studied regarding their attitudes towards PLWHA in centres and hospital settings. Hypotheses
This study investigated the possible differences between job satisfaction and attitudes towards PLWHA of nurses who regularly
© 2013 International Council of Nurses
133
treated PLWHA (working in HIV/AIDS centres) and nurses who rarely treated PLWHA (working in general hospitals) in Russia. We predicted that Russian nurses working in HIV/AIDS centres would reveal lower job satisfaction than those working in general hospitals due to the uniquely stressful characteristics of caring primarily for PLWHA in the centres: stigma, discrimination and overexposure to suffering (Ijumba 2003). We also predicted that Russian nurses working in HIV/AIDS centres would reveal lower avoidance attitudes and higher empathetic attitudes than those working in general hospitals, in line with Allport’s (1954) social psychological theory positing that intergroup contact reduces intergroup prejudice, which in turn may affect attitudes. Thus, nurses with more frequent exposure to PLWHA should reveal more positive (empathetic) attitudes and fewer negative ones (avoidant), but also lower job satisfaction. In sum, the following hypotheses were tested: 1 Nurses who regularly treat PLWHA (in the centres) will report lower job satisfaction than nurses who rarely treat PLWHA (in the hospital). 2 Nurses who regularly treat PLWHA will report less avoidant attitudes and more empathetic attitudes than nurses who rarely treat PLWHA. 3 Avoidant attitudes will associate with low job satisfaction and empathetic attitudes will associate with high job satisfaction.
Method Design
This study used a cross-sectional, quantitative research design. Sample
The research questionnaires were distributed to the nurses who worked regularly with PLWHA in six HIV/AIDS centres in Ekaterinburg, during the centres’ training seminars at a time when 76 nurses participated in the training seminars (168 nurses employed in all centres, groups of 21–35 nurses in each centre). The nurses were informed of the purpose of the study and were assured that the study was confidential and voluntary. After completing the questionnaires, the nurses sealed them in an envelope and handed them to the researchers personally or through the administrative assistant. The comparison sample of nurses who did not work regularly with PLWHA was recruited from the largest general hospital in Ekaterinburg, which runs the largest nursing school in the region (Sverdlovsk Regional Medical College 2012). In this hospital, 371 nurses are employed. The research questionnaires were distributed to these hospital nurses during three randomly selected sessions of a conference held in the hospital to provide the latest practical nursing information and teach skills for
134
L. Hamama et al.
working with PLWHA. Seventy-five nurses participated in these selected sessions (groups of 21–29 nurses in each). The hospital’s nurses were randomly assigned to the sessions; therefore, the sample obtained was a random representation of the nurses working in the hospital. Ethical considerations
The nurses were informed of the purpose of the study and were assured that the study was confidential and voluntary. They completed the questionnaires anonymously and returned them to the researchers in sealed envelopes with a signed, informed consent form. The study was approved by the Ethical Commission in the general hospital and the HIV centres in Ekaterinburg and supervised by Tel Aviv University Research Ethics Committee. Data collection
Participants completed three self-report questionnaires. All questionnaires used in the present study were translated from English to Russian and back to English by two bilingual translators. Internal consistency of all the scales in the present study was similar to that obtained in previous studies applying English-language scales (for job satisfaction, see: Taber & Taylor 1990; for attitudes towards PLWHA, see: Froman & Owen 1997). Demographic questionnaire
This self-report related to demographic details of age, sex, family status, religiosity, health, education, professional experience and experience in treating PLWHA. Job satisfaction
Hackman & Oldham’s (1975) 15-item Job Diagnostic Survey measured workers’ satisfaction with various aspects of their jobs (e.g. skill variety, task identity, task significance, autonomy). Previous applications of the Russian version of this scale, in Russia and other countries of the former Soviet Union, confirmed its validity and reliability (see Bondarenko 2010). Participants rated their job satisfaction along a 7-point Likert-type scale ranging from not at all satisfied (1) to completely satisfied (7), with higher scores indicating higher job satisfaction. Internal consistency (Cronbach’s alpha) was 0.87. (Internal consistencies for the two settings were as follows: regularly treated HIV/AIDS = 0.88; rarely treated HIV/AIDS = 0.87). Attitudes towards PLWHA
The 21-item AIDS Attitude Scale questionnaire (Froman et al. 1992) was used to assess two aspects of attitudes towards
© 2013 International Council of Nurses
patients with HIV/AIDS: avoidance (14 items, e.g. ‘Patients who are HIV positive should not be put in rooms with other patients’) and empathy (7 items, e.g. ‘Patients with AIDS should be treated with the same respect as any other patient’). Participants rated their attitudes towards PLWHA on a 6-point Likerttype scale ranging from strongly disagree (1) to strongly agree (6), where higher scores indicated more avoidance attitudes towards PLWHA. Internal consistency (Cronbach’s alpha) was 0.88. (Internal consistencies for the two settings were as follows: avoidance: regularly treated HIV/AIDS = 0.87, rarely treated HIV/AIDS = 0.82; empathy: regularly treated HIV/AIDS = 0.76, rarely treated HIV/AIDS = 0.80).
Data analysis
To examine the differences between the two groups (nurses who regularly treated PLWHA and nurses who rarely treated PLWHA) in job satisfaction and in attitudes towards PLWHA (avoidance, empathy), we conducted univariate one-way multivariate analysis of variance (MANOVAs). In our analyses, we controlled for the two demographic variables that differed between the two settings – age and education.
Findings
About 90% of the nurses who were approached in both settings agreed to participate in the study (in the HIV/AIDS centres – 69; in the general hospital – 66). Participants comprised 135 female nurses in Russia, 69 of whom regularly treated PLWHA in HIV/AIDS centres, and 66 of whom worked in a general hospital and rarely treated PLWHA. Mean age overall was 41.3 years (SD = 9.88), but the nurses who regularly treated PLWHA were significantly younger (M = 39.58, SD = 8.61) than the nurses who rarely treated PLWHA (M = 43.15, SD = 10.81), t = 2.13, P < 0.05. Nurses had a mean of 19.65 years of professional experience (SD = 10.00), which did not differ significantly between the two groups. In terms of other demographic variables (see Table 1), only in education did a significant difference emerge between the two groups, χ2 = 4.51, P < 0.05. In both groups, the majority of nurses held a bachelor’s degree (∼80% of the nurses who treated PLWHA and ∼92% of the nurses who rarely treated PLWHA), although approximately 20% of the nurses who treated PLWHA held a master’s degree, whereas only 8% of those in the general hospitals did. No significant differences were found between the groups with regard to marital status, religiosity or health. Validating the hypothesis that nurses working in general hospitals rarely treated PLWHA, only five hospital nurses reported seeing, at the most, two HIV/AIDS patients during the previous
Job satisfaction among nurses in Russia
135
Table 1 Demographic characteristics for nurses in the two settings Variable
Marital status Education Religiosity Health†
Single Married BA MA Religious Not religious Healthy Not healthy
Total
Regularly treated HIV/AIDS – centres (n = 69)
Rarely treated HIV/AIDS – hospitals (n = 66)
n
%
n
%
30 39 55 14 63 6 62 7 69
43.5 56.5 79.7 20.3 92.3 7.7 91.2 8.8 100.0
20 46 61 5 55 11 58 8 66
30.3 69.7 92.4 7.6 90.2 9.8 92.1 7.9 100.0
χ2
0.11 4.51* 0.54 0.85
*P < 0.05. †There are missing values for health.
Table 2 Means, standard deviations and F and eta squared values for job satisfaction and attitudes in the nurses’ two settings Variables
Job satisfaction Attitudes towards PLWHA Empathy Avoidance
Regularly treated HIV/AIDS – centres (n = 69)
Rarely treated HIV/AIDS – hospitals (n = 66)
M
SD
M
SD
3.60
0.68
3.50
0.70
3.72 2.17
0.73 0.94
3.54 3.41
0.76 0.81
F†
0.64 1.90 62.41***
η2
0.00 0.01 0.33
***P < 0.001. †For job satisfaction: F (2, 126); for attitudes: F (3, 124). PLWHA, people living with HIV/AIDS.
week. In contrast, for those working in the HIV/AIDS centres, the mean number of HIV-infected patients seen during the previous week was 33.6. Significant differences emerged between the groups only regarding avoidance attitudes towards PLWHA, F (3, 124) = 62.41, P < 0.001, η2 = 0.33, where the nurses working in HIV/ AIDS centres revealed significantly lower avoidance towards PLWHA than their counterparts in the general hospitals. Empathy did not significantly differ between the groups. Likewise, the MANOVA comparing the two groups’ rates of job satisfaction yielded no significant difference between the two settings, F (2, 126) = 0.40, P > 0.05. That is to say, job satisfaction did not significantly differ between nurses who regularly
© 2013 International Council of Nurses
treated PLWHA and nurses who rarely treated PLWHA. Means, standard deviations and F values for each measure are presented in Table 2. Correlations between the variables
Pearson’s analyses were conducted to examine correlations between the demographic variables (age, sex, family status, religiosity, health, education, professional experience and experience in treating PLWHA) and the study variables. No demographic variables were found to be linked to the study variables. Pearson’s analyses were conducted to examine correlations among the study variables. Job satisfaction showed a positive
136
L. Hamama et al.
Table 3 Hierarchical regression coefficients (β) to explain differences in job satisfaction (N = 135) Predictors Step 1 Group Step 2 Group Empathy Avoidance
B
SE B
β
R2
ΔR2
0.00 0.08
0.12
0.06
−0.23 0.17 −0.23
0.14 0.08 0.08
−0.17 0.18* −0.36**
0.16***
*P < 0.05; **P < 0.01; ***P < 0.001.
correlation with empathetic attitudes towards PLWHA (r = 0.28, P < 0.001) and a negative correlation with avoidant attitudes towards PLWHA (r = −0.32, P < 0.001). In other words, nurses with higher empathy towards PLWHA and with lower avoidant towards PLWHA, reported higher job satisfaction. We next conducted a hierarchical regression analysis with job satisfaction as the dependent variable. The first step assessed the group (PLWHA-treating nurses vs. general nurses). The second step assessed the contribution of the two attitude subscales (avoidance, empathy). As seen in Table 3, these variables explained 16% of the variance in job satisfaction. The group (PLWHA-treating nurses vs. general nurses), entered in the first step, yielded no significant contribution. However, nurses’ attitudes towards PLWHA, entered in the second step, added 16% to the explanation of the variance. A significant contribution was made by the attitudes of empathy and avoidance to explain job satisfaction: nurses with more empathetic and less avoidant attitudes reported higher job satisfaction. To examine the differences between the two settings (nurses working in HIV/AIDS centres and nurses working in general hospitals) on these correlations, Pearson’s analyses were conducted separately. Significant differences emerged between the two settings: among nurses working in HIV/AIDS centres, job satisfaction correlated significantly and positively with empathetic attitudes (r = 0.36, P < 0.001), and correlated significantly and negatively with avoidant attitudes (r = −0.34, P < 0.001). In contrast, the nurses working in general hospitals revealed no significant correlations between job satisfaction and attitudes (avoidance, empathy).
Discussion The current study is innovative regarding the comparison between two settings: nurses who worked in dedicated HIV/
© 2013 International Council of Nurses
AIDS centres vs. nurses who worked in general hospitals and rarely treated PLWHA in Russia. Our findings did not confirm our first hypothesis, which predicted differences in job satisfaction between nurses who worked in specialized HIV/AIDS centres and nurses who worked in general hospitals and rarely treated PLWHA. To the best of our knowledge, no research has yet been conducted to examine the differences between nurses who work in these two settings in relation to job satisfaction. Perhaps the current lack of differences in job satisfaction between the groups can be related to the methodology of the study, that is, a small sample size and differences in the characteristics associated with the work environment rather than the differences associated with whether or not nurses regularly treated PLWHA (in line with the fact that only 16% of the variance in job satisfaction was explained by attitudes). As mentioned previously, nurses’ job satisfaction is multifaceted, complex and highly subjective (Hayes et al. 2010). Another explanation can be related to Hobfoll’s (1989) conservation of resources model. This model assumes that people consciously and unconsciously utilize the amount and quality of resources at their disposal. In a stressful situation, when a specific resource is threatened, people will ‘compensate’ by utilizing a different resource. According to this model, it seems that nurses from both groups may be efficient at utilizing their motivation and their intrinsic rewards to help their patients (HIV/AIDS and non-HIV/AIDS). Moreover, nurses are expected to give quality care to patients regardless of diagnosis; they are expected to feel ethically bound to act indiscriminately towards all patients (Smit 2005). The second hypothesis, related to nurses’ attitudes towards PLWHA, did confirm our expectations. Nurses working in HIV/ AIDS centres reported less avoidant attitudes towards PLWHA than their peers working in general hospitals who experienced less frequent exposure to PLWHA. Nevertheless, no significant difference emerged regarding empathetic attitudes; thus, the second hypothesis was only partially confirmed. A probable explanation for the less avoidant attitudes among nurses in the specialized HIV/AIDS centres may be that their personal contact with PLWHA and their AIDS-specific training acted to dispel misinformation and decrease stigma (Brems et al. 2010). In contrast, nurses who work in general hospitals rarely have contact with PLWHA and may experience deficiencies in AIDS-specific training, resulting in insufficient and inadequate knowledge regarding HIV/AIDS care, leading to avoidant and negative attitudes towards PLWHA (Smit 2005). Further study, including more detailed qualitative and quantitative reports about nurses’ interactions with PLWHA in both settings, specifically in the Russian context, is needed to validate this speculation, which coincides with Allport’s social
Job satisfaction among nurses in Russia
137
This study had several limitations that should be noted. First, literature is scarce on the cultural aspects that may influence the study variables; therefore, special care should be taken in the future to examine the possible effects of such cultural issues and to untangle the specifics of the healthcare system, specifically the HIV/AIDS system, in the Russian Federation. Second, it was a convenience sample and the sample size restricted usage of structural equation modelling; therefore, we could not conduct an assessment of generalizability. Third, the study was of a cross-sectional nature, which allowed us to establish associations but not causal relationships. Fourth, the present self-report survey responses were subject to common method variance bias. Nurses’ job satisfaction is multifaceted, complex and highly subjective (Hayes et al. 2010). Therefore, researchers would do well to collect complementary objective data on the actual work environment, to confirm current outcomes. In addition, the current quantitative design should be complemented in the future by qualitative methods that give voice to the unique perspectives on job satisfaction among nurses. That is to say, interpersonal (between the nurse and colleagues or patients) and extrapersonal (those external to the nurse; Hayes et al. 2010; Utriainen & Kyngas 2009).
victims is likely to be marginal if the reduction plan focuses solely on educating healthcare professionals about false beliefs. They found it necessary to change general dispositions for prejudice, a much more difficult task. Thus, healthcare managers should augment education programmes for nurses, especially programmes dealing with HIV/AIDS in general hospitals. They must consider attitudes towards PLWHA as an important factor in ensuring adequate care for PLWHA. Moreover, nurses and healthcare professionals who work with HIV/AIDS patients should be encouraged to stay current on changing issues relating to HIV/AIDS, and to understand that the disease process has already helped to start a social reconstruction of HIV as a chronic illness (Qu et al. 2010). From these changes, both an oppressed client population and the nurses who have an obligation to provide the best care possible are likely to benefit. Thus, these changes might contribute to enhancing the job satisfaction of nurses and other healthcare professionals. Given the fact that nursing is a highly stressful profession with severe concern regarding retention issues (Curtis 2007), results of this study may assist in developing practical organizational strategies to increase workers’ job satisfaction. Further research should investigate the similarities and differences between these two settings with respect to physical, social and organizational work–environment characteristics. Furthermore, the results of this study have theoretical implications. The study expanded knowledge about attitudes towards PLWHA among nurses in two different health settings and their associations with job satisfaction. It also extended intergroup contact theory to Russian nurses who work in specialized HIV/ AIDS centres vs. nurses who worked in general hospitals and rarely treated PLWHA. Nurses and heath providers are part of the general society, and their perceptions and attitudes towards HIV/AIDS are expected to be influenced by societal norms and attitudes. If AIDS were viewed as a normal disease in society, the health providers could feel more comfortable when they treat AIDS patients. Thus, HIV education might be a necessary intervention component to maintain a healthy psychological state among nurses and health providers and to increase their productivity.
Implications
Implications for health and nursing policy
The associations found between avoidant attitudes and job satisfaction highlight the need for stigma-reduction strategies and increased disease knowledge. Stigma and discrimination represent not only human rights violations, but also violations of the ethical principles on which the healthcare system is based (Brems et al. 2010). A recent study by Collani et al. (2010) showed that a reduction in the stigmatization faced by AIDS
From a health policy perspective, the Russian political system is shaped by its Soviet institutional legacy. That is to say, the state still plays a large part in Russian health, education and the economy. Private health facilities exist, but the vast majority of Russians continue to receive health care through the state system (Pankratov & Peresypkina 2012; Wallander 2005). Hence, to be able to meet the challenges of their profession and
psychological theory of intergroup contact (Allport 1954). In a meta-analytic test of intergroup contact theory, Pettigrew & Tropp (2006) found that intergroup contact typically reduces intergroup prejudice. Thus, nurses who work in general hospitals and rarely treat PLWHA may be flooded with anxiety over their safety practices and fears of occupational contagion, which may evoke avoidant attitudes towards PLWHA. Regarding the third hypothesis, the correlation between lower job satisfaction and nurses’ greater avoidance towards PLWHA was confirmed only among nurses who worked in HIV/AIDS centres. As mentioned above, direct contact with PLWHA may produce anxiety over safety practices and fears of occupational contagion, which may be very stressful for AIDS caregivers (Gueritault-Chalvin et al. 2000). Further study is needed to validate this speculation and to also consider as a whole the information about job satisfaction for nurses in Russia. Study limitations
© 2013 International Council of Nurses
138
L. Hamama et al.
work with HIV/AIDS patients, nurses need to perceive themselves as being empowered. Support and supervision can be used as a strategy for commitment and involvement when providing care for people with HIV/AIDS (McGlynn et al. 2012). Because of the lack of research focusing on nurses’ experiences of HIV/AIDS-related job satisfaction and attitudes in Russia, similar studies should be conducted at other hospitals and HIV/AIDS centres to ascertain whether the findings can be replicated. The greater understanding gained by such studies could inform social policies and programmes dealing with HIV/ AIDS-related care in Russia.
Acknowledgements We wish to thank all nurses who participated and collaborated in this study whose contribution enabled the production of this paper.
Author contributions Liat Hamama: study conception, data analysis, drafting of manuscript, critical revisions for important intellectual content; Eugene Tartakovsky: study design, data analysis, drafting of manuscript, critical revisions for important intellectual content; Ksenia Eroshina: study design, drafting of manuscript, administrative support; Eduard Patrakov: study design, data collection, drafting of manuscript, critical revisions for important intellectual content; Alla Golubkova: study conception, data collection, critical revisions for important intellectual content, material support; Julia Bogushevich: study conception, data collection, drafting of manuscript, administrative support. Loubov Shardina, data collection; drafting of manuscript; material support.
References Aiken, L.H., et al. (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987–1993. Allport, G.W. (1954) The Nature of Prejudice. Addison Wesley, Reading, MA. Andrewin, A. & Chien, L. (2008) Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care and STDS, 22 (11), 897–906. doi: 10.1089/apc.2007.0219. Bondarenko, I.N. (2010) Adaptation of the job satisfaction scale of Hackman and Oldham to the Russian population. Psikhologicheskii Zhurnal, 31 (3), 109–124. Brems, C., Johnson, M.E., Warner, T.D. & Roberts, L.W. (2010) Health care providers’ reports of perceived stigma associated with HIV and AIDS in rural and urban communities. Journal of HIV/AIDS & Social Services, 9 (4), 356–370. Bride, B.E. (2007) Prevalence of secondary traumatic stress among social workers. Social Work, 52 (1), 63–70.
© 2013 International Council of Nurses
Chang, Y.H., Li, H., Wu, C.M. & Wang, P.C. (2010) The influence of personality traits on nurses’ job satisfaction in Taiwan. International Nursing Review, 57, 478–484. Chirwa, M.L., et al. (2009) HIV stigma and nurse job satisfaction in five African countries. Journal of the Association of Nurses in AIDS Care, 20, 14–21. doi: 10.1016/j.jana.2008.10.001. Collani, G.V., Grumm, M. & Streicher, K. (2010) An investigation of the determinants of stigmatization and prejudice toward people living with HIV/AIDS. Journal of Applied Social Psychology, 40 (7), 1747–1766. Curtis, E.A. (2007) Job satisfaction: a survey of nurses in the Republic of Ireland. International Nursing Review, 54 (1), 92–99. Delobelle, P., et al. (2009) HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Journal of Advanced Nursing, 65 (5), 1061–1073. doi: 10.1111/j.1365-2648.2009.04973.x. Delobelle, P., et al. (2011) Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey. Journal of Advanced Nursing, 67 (2), 371–383. doi: 10.1111/j.1365-2648.2010 .05496.x. Ekaterinburg Regional Center for Prophylactics and Treatment of HIV/ AIDS (2008) Service Center. Available at: http://www.livehiv.ru/ index.php?page=about&pid=4 (accessed 1 May 2013). Froman, R.D. & Owen, S.V. (1997) Further validation of the AIDS Attitude Scale. Research in Nursing & Health, 20 (2), 161–167. doi: 10.1002/ (SICI)1098-240X(199704)20:23.0.CO;2-I. Froman, R.D., Owen, S.T. & Daisy, C. (1992) Development of a measure of attitudes toward persons with AIDS. Image, 24, 149–152. Gueritault-Chalvin, V., Kalichman, S.C., Demi, A. & Peterson, J.L. (2000) Work-related stress and occupational burnout in AIDS caregivers: test of a coping model with nurses providing AIDS care. AIDS Care, 12 (2), 149–161. doi: 10.1080/09540120050001823. Hackman, J. & Oldham, R. (1975) Development of the job diagnostic survey. Journal of Applied Psychology, 60 (2), 159–170. Hayes, B., Bonner, A. & Pryor, J. (2010) Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature. Journal of Nursing Management, 18, 804–814. Hobfoll, S.E. (1989) Conservation of resources: a new attempt at conceptualizing stress. American Psychologist, 44, 513–525. Ijumba, P. (2003) ‘Voices’ of primary health care facility workers. In South African Health Review 2002 (Ijumba, P., ed.). Health Systems Trust, Durban, South Africa, pp. 186–200. Li, L., et al. (2007) Stigmatization and shame: consequences of caring for HIV/AIDS patients in China. AIDS Care, 19 (2), 258–263. doi: 10.1080/ 09540120600828473. McGlynn, K., Griffin, M.Q., Donahue, M. & Fitzpatrick, J.J. (2012) Registered nurse job satisfaction and satisfaction with the professional practice model. Journal of Nursing Management, 20, 260–265. Mrayyan, M. (2009) Job stressors and social support behaviors: comparing intensive care units to wards in Jordan. Contemporary Nurse, 31 (2), 163– 175. Murrells, T., Clinton, M. & Robinson, S. (2005) Job satisfaction in nursing: validation of a new instrument for the UK. Journal of Nursing Management, 13 (4), 296–311.
Job satisfaction among nurses in Russia
Murrells, T., Robinson, S. & Griffiths, P. (2008) Job satisfaction trends during nurses’ early career. BMC Nursing, 7 (7), 1–13. Pankratov, L.E. & Peresypkina, N.A. (2012) Prophylactics of HIV infection among medical workers in a health organization. Social Work and Social Education: Challenges of Interaction. Conference Proceedings, 97–101. (Russian). Available at: http://www.rsvpu.ru/filedirectory/6415/ Socialqnaya-rabota-i-socialqnoe-obrazovanie.pdf#page=98 (accessed 29 September 2013). Pettigrew, T.F. & Tropp, L.R. (2006) A meta-analytic test of intergroup contact theory. Journal of Personality and Social Psychology, 90 (5), 751– 783. doi: 10.1037/0022-3514.90.5.751. Qu, B., Zhang, Y., Guo, H. & Sun, G. (2010) Relationship between HIV/ AIDS knowledge and attitude among student nurses: a structural equation model. AIDS Patient Care and STDS, 24 (1), 59–63. doi: 10.1089/ apc.2009.0190. Shader, K., et al. (2001) Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration, 31 (4), 210–216. Sheward, L., et al. (2005) The relationship between UK hospital nurse staff and emotional exhaustion and job dissatisfaction. Journal of Nursing Management, 13 (1), 51–60. Smit, R. (2005) HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa. Journal of Advanced Nursing, 51 (1), 22–29. Smith, D.M. & Mathews, W.C. (2007) Physicians’ attitudes toward homosexuality and HIV: survey of a California medical society – revisited (PATHH-II). Journal of Homosexuality, 52 (3–4), 1–9. Smith, E.R. & Mackie, D.M. (2007) Social Psychology. Psychology Press, London. Spector, P.E. (1997) Job Satisfaction: Application, Assessment, Cause and Consequences. Sage, Thousand Oaks, CA. Suominen, T., et al. (2010) Nurses’ knowledge and attitudes to HIV/AIDS: an international comparison between Finland, Estonia and Lithuania.
© 2013 International Council of Nurses
139
International Journal of Nursing Practice, 16, 138–147. doi: 10.1111/ j.1440-172X.2010.01822.x. Sverdlovsk Regional Medical College (2012) About the College. Available at: http://www.somkural.ru/about/ (in Russian) (accessed 17 November 2013). Taber, T.D. & Taylor, E. (1990) A review and evaluation of the psychometric properties of the job diagnostic survey. Personnel Psychology, 43, 467– 500. doi: 10.1111/j.1744-6570.1990.tb02393.x. Thompson, E.R. & Phua, F.T.T. (2012) A brief index of affective job satisfaction. Group & Organization Management, 37 (3), 275–307. doi: 10.1177/1059601111434201. Tourigny, L., Baba, V.V. & Wang, X. (2010) Burnout and depression among nurses in Japan and China: the moderating effects of job satisfaction and absence. International Journal of Human Resource Management, 21 (15), 2741–2761. Tyer-Viola, L. (2007) Obstetric nurses’ attitudes and nursing care intentions regarding care of HIV-positive pregnant women. Journal of Obstetric, Gynecologic & Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families & Newborns, 36 (5), 398–409. UNAIDS (2012) World AIDS Day Report. Available at: http:// www.unaids.org/en/media/unaids/contentassets/documents/ epidemiology/2012/gr2012/JC2434_WorldAIDSday_results_en.pdf (accessed 7 October 2013). UNAIDS/WHO (2010) AIDS epidemic update. Global report. Geneva. Utriainen, K. & Kyngas, H. (2009) Hospital nurses’ job satisfaction: a literature review. Journal of Nursing Management, 17 (8), 1002–1010. Wallander, C.A. (2005) The politics of Russian AIDS policy. PONARS Policy Memo No. 389. Center for Strategic and International Studies, 141–147.
