Exploring the fear of contracting hiv / aids among traum a nurses in the province of Kw azulu-Natal

A qualitative study, using phenomenology as an approach was conducted. The title of the study was “Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal”. Participants were selected on the basis of category (registered nurses), workplace (level one trauma units), and work experience (six months experience in a trauma unit). Twelve nurses participated in the study, six from the state institutions and six from the private institutions. The objectives of the study were to explore the fear of contracting HIV/AIDS, its effect on their personal/ work­ ing lives and how they coped with it. The findings of the study revealed that trauma nurses per­ ceived themselves to be at risk of acquiring HIV/AIDS from their working environment despite the available precaution­ ary measures. Needlestick injuries appeared to be the main source of fear. They used different coping and defence mechanisms effectively to cope with this fear of contracting HIV and none were in any emotional crisis. Education at different levels and development of support networks has been recommended as the key strategies to decrease these fears. Other recommendations include im­ proving the quality and availability of protective materials and equipment, making HIV/AIDS a notifiable disease as well as improving general and specific beliefs that increase coping. Introduction and background to the study free flowing blood, the rush to save lives of trauma victims and the frequent need for invasive procedures in seriously traumatised patients make the trauma workers even more susceptible to HIV infection. AIDS and HIV have been described as one of the greatest challenges of the twentieth century to public health. UN AIDS report indicated that about 40 million people were living with HIV/AIDS worldwide, with about 28.5 million people living SubSaharan Africa (UNAIDS, 2002). In South Africa, in a popula­ tion of about 43 million people, it is estimated that 5 million are infected with HIV, which translates to about 1 in every 9 people (UNAIDS, 2002). Statistics indicate that KwaZulu Natal is the worst affected province with a 37.8% infection rate among ante­ natal clinics attendees (Dorrington, Bradshaw and Budlender,

Introduction and background to the study free flowing blood, the rush to save lives of trauma victims and the frequent need for invasive procedures in seriously traumatised patients make the trauma workers even more susceptible to HIV infection.AIDS and HIV have been described as one of the greatest challenges o f the twentieth century to public health.UN AIDS report indicated that about 40 million people were living with HIV/AIDS worldwide, with about 28.5 million people living Sub-Saharan Africa (UNAIDS, 2002).In South Africa, in a popula tion of about 43 million people, it is estimated that 5 million are infected with HIV, which translates to about 1 in every 9 people (UNAIDS, 2002).Statistics indicate that KwaZulu Natal is the worst affected province with a 37.8% infection rate among ante natal clinics attendees (Dorrington, Bradshaw and Budlender, 2002).
On the other hand unnatural events such as assaults, motor vehicle accidents, drowning and other trauma-related incidents have been reported as the leading cause o f death in South Africa between the years 1997and 2001(Statistics South Af rica, 2002, p.5).In KwaZulu Natal trauma resulting from politi cal, criminal, occupational or domestic violence; road or sports accidents, and suicide has claim ed a considerable num ber of lives, caused extensive disability and loss o f potential manhours.Trauma personnel are especially at risk of HIV infection because o f greater incidence of HIV seroprevalence in trauma patients and other blood-borne infections.The presence of Although there are prescribed precautions to prevent infec tion to caregivers, risk still exists, especially through needle stick injuries, and is estim ated at 0.3% (M cCarthy, S s a li, Bednarsh, Jorge, W angrangsimakul, Page-Shafer, 2002;Van der Ryst, 1999).As of June 2001, occupational exposure to HIV had resulted in 57 docum ented cases o f HIV seroconversion among healthcare personnel in the United States (Centre for Disease Control, 2001).Although this is relatively low, research shows that the fear o f contagion remains a concern among nurses and other health care workers involved in caring for HIV/AIDS patients (Sherman, 2000:2;Uwakwe, 2000:5;MCCann andSharkey 1998:2, Kemppainen, Dubbert andM cW illiams, 1996;Wang and Paterson, 1996).
The statistics o f HIV/AIDS presented in the previous section pose a challenge to health care workers who are expected to care for the HIV/AIDS patients indiscriminately.At present there has been no internationally accepted definitive treatment for HIV/AIDS or vaccine.Health care workers rely on preventa tive measures to protect themselves against the virus.A number o f studies have indicated that hospital nurses were the most e x p o se d g ro u p s , and u n d e rre p o rtin g w as co m m o n (Moloughney, 2001:2 ;: 1, Williams and McCahon, 2001;Knight & Bordsworth, 1998:2).Preventative measures include some of the following (Center for Disease Control, 2001):

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Universal Precautions which include the following: • Wearing protective clothing during handling of body fluids and infected material e.g.Gloves.

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Covering of cuts and avoiding HIV infected patients by healthcare workers with weeping dermatitis • Limiting high-risk procedures e.g.mouth to mouth resuscitation.
• Avoiding needle stick injury through appropriate precautions and education.
• Post-exposure prophylaxis.Some literature has been published on the subject o f health care workers fear o f AIDS, and there has been a strong indica tion that it exists even though they know about universal pre cautions (Uwakwe, 2000:2; Sherman, 2000:2; M cCann and Sharkey 1998:2; Wang & Paterson, 1996).Other studies have shown that some nurses wanted to have a choice whether to care or not to care for HIV positive patients, while other nurses exhibited negative attitudes towards caring for HIV positive patients (M banya, Zebase, K engne, M inkoulou, Awah and Beures, 2001:5;Sherman, 2000:2;Wang & Paterson, 1996).N urses' fear o f contracting HIV has been shown to decrease their willingness to care for HIV positive patients and this can in turn com prom ise the quality o f care (Lohramn, Valimaki, Suominen, Dassen, and Peate, 2000:1).In some countries, con tinuous education and action research projects have been re ported as beneficial in developing confidence to care for pa tients with AIDS (Pratt, Pellowe, Juvekar, Potdar, Weston, Joykutty, Robinson and Loveday, 2001:6 ;Mbanya, et.al 2001:7), but other studies have reported educational programmes as not effective in changing nurses' attitudes and fears.
M ost of the research in this area has been conducted in the United States, some in Europe and other developed countries.Very little research has com e from developing countries, espe cially Africa.Valimaki, Suominem and Peate (1998:3) also argue that the main focus o f empirical research conducted in this area has been am ongst the general public and students with little attention to practising nurses.
The fear o f contracting HIV could also be present in other South African nurses even if it is not expressed, especially in high-risk areas such as traum a and theatres.No study o f a similar nature was identified in the province of KwaZulu-Natal.This is what prom pted the researcher to undertake this study.

Methodology
Qualitative study using the phenomenological approach.The rationale for choosing this qualitative approach was based on the fact that m ost research o f this nature has been conducted using quantitative methods, which might fail to give the inter pretation o f the lived experiences and the fear o f contracting HIV.Valimaki et. al (1998:3) also argue that the main focus of empirical research conducted in this area has been conducted using questionnaires which have been developed by the re search team , and had m ainly involved large sam ples.A phenomenological approach focuses on describing the experi ences as they are lived within a particular situation (Bums and Grove, 2001;Polit and Hungler, 2001).The researcher was in terested in studying the phenomenon o f fear o f contracting HIV, w h ic h is a liv e d e x p e rie n c e and th e re fo re the phenomenological approach seemed more appropriate.

Population and selection of participants
Purposive selection of participants from two urban area level-1 traum a units was done.They were selected on the basis of category (registered nurses), workplace (level-1 trauma units) and experience (should have w orked there for at least six months).This study concentrated on urban areas since they were the ones that had level-1 traum a units.

D ata collection and analysis
An interview guide was developed, but the researcher was directed by the participants responses on the progress of the interview, and could probe or follow up information that came to the fore.Two interviews per participant were conducted.During the first interview the researcher endeavoured to es tablish a trusting relationship with the participants, explained the purpose of the study and explored the phenomenon under study.The emergency nurses' conceptualisation of the fear of contracting HIV/AIDS was explored, its effects on their every day working and personal lives, as well as their coping strate gies.The second interview reflected on the data obtained from the first interview, clarified misunderstandings or m isconcep tions, asked participants for suggestions and solutions from their own views and exited based on the principle o f data satu ration.

M easures used to ensure validity of the study
Bracketing-The researcher undertook the process o f acknowl edging and revealing her thoughts about the topic by docu menting them.The researcher is a trauma nurse by training, and has worked in traum a settings before, although no longer working in these settings.It is her opinion that traum a nurses have the fear o f contracting HIV/AIDS as they work.This is also based on her previous interactions with the traum a nurses and this is what prom pted this study.This information was  and Carpenter, 1999).
Trustworthiness and authenticity o f data-This was achieved mainly through member checks.Data was analysed and a short summary made from each participant's responses and referred back to the participants to validate it and add any new informa tion to it and that formed the starting point o f the second inter views Expert Validation-The study was conducted under the guid ance and supervision o f an experienced researcher.She lis tened to the tapes and also looked at the transcribed data as well as the analysis.

Pilot Study
Two participants were selected for the targeted population on a similar basis as for the main study.The pilot study was nec essary to establish any am biguity in the questions, and to check w hether data produced was relevant to the research questions.The results o f the pilot form ed part o f the actual study itself.The reason for including them in the study was that in qualitative research all the data is valuable, and it should be used towards the study, not separated from it (Polit and Hungler, 2001).

Ethical issues and gaining access
Participants' permission was obtained and the recordings de stroyed after transcribing to ensure confidentiality.Pseudo nyms were used to ensure anonymity.Permission was obtained from the KwaZulu Natal Head o f Health Services for State hos pital interviews.Permission to interview staff in private hospi tals was obtained from the managem ent o f identified hospitals.Participants had a right to withdraw from the study at any point and time if they wished to do so.

Presentation of results
The theory o f coping was chosen to guide this study as it deals with fear, which is also described as a prim ary coping response to threats (Lazarus, 1966).Since this study is investi gating the fear o f contracting H1V/ AIDS and how nurses are handling it (coping), it seem ed appropriate that results are pre sented according to this framework.
Categories were formulated based on the theoretical frame-13 Curationis August 2003 work for presentation o f results.These were operationalised as follows: Primary appraisal: Refers to the significance of HIV /AIDS as perceived by the traum a nurses, the history of its significance, how it has evolved over the years and its significance in their working and personal lives.
Secondary appraisal: Refers to the assessment and use of cop ing strategies and resources and includes the defence mecha nisms employed and the behavioural changes that have taken place to adapt to the threat of HIV/AIDS in their workplace.Reappraisal: Refers to the trauma nurses' reaction to the threat of HIV/AIDS in the workplace and their families' fear, as well as their reaction to, and knowledge about, issues pertaining to seroconversion.
Outcomes: Refers to the outcom es of the overt behaviours, cognitive behaviours, and defence mechanisms activated and instituted and will include mastery, resiliency and crisis.
needlestick injury which you cannot always avoid and that worries me ".
They also expressed concern about the reliability of the pro tective equipment, especially the gloves and felt that the qual ity be improved to offer maximum protection against the virus.The following are some of the comments made: "....You know with the gloves we use, they are not 100% safe, so you fin d that sometimes when you remove them they are perforated and th a t' s when the fe a r c o m e s..... "

Fam ily concern
It appeared that the significance of HIV/AIDS went beyond the working environment to include their concern about family.Nurses did not only see themselves as at risk, but were also worried about the possibility of contracting HIV/AIDS at work and then transmitting it to their partners or offsprings.One nurse commented as follows: " .....you know especially if you have family and stuff like that you worry for them and about them " .
P rim a ry a p p ra is a l (s ig n ific a n c e ) Previous perceptions about HIV/AIDS M ost nurses interviewed admitted that fear was their initial response when the threat of HIV/AIDS was first publicised.At that stage they were scared of even coming near patients who had tested HIV positive or diagnosed with AIDS, as well as coming into contact with bloods and body fluids.They attrib uted this to lack o f knowledge and understanding of the dis ease process itself, as well as the mode of spread o f HIV and the myths about the spread o f HIV/AIDS at that stage.The biggest fear also came from the fact that there was no treatment for HIV/AIDS and they thought of it as a death sentence.They described their initial feelings as being in a state of shock, confusion and apprehension.They were also concerned about whether they had already contracted HIV/AIDS because of previous unprotected exposures before HIV/AIDS was publi cised.One nurse com m ented as follows: I was placed in casualty and trauma departm ents in the early eighties when HIV/AID S was not a common thing to know, and being at the governm ent hospital, we dealt with gun shots, stabbings, taxi violence victims, you know what I mean and we ju s t worked with bare hands only with no system o f gowns, masks and gloves.When I look back now at the way we worked then, I thank G od I am negative, very often we had cuts on our hands and because I did diving, I got a lot o f them fro m div ing, because you are under the sea and you get cuts fro m the coral, and we did not even bother covering them, we ju s t worked with our bare hands and no gloves and we did not even know who was positive and who was not.I have been exposed badly.

Perception about possibility of contracting H IV in the w orkplace
It appeared that the fear o f contracting HIV in the workplace still exists despite the available precautionary measures.They responded that it was due to the fact that they handled blood and body fluids m ost o f the time and worked in a haste.The needlestick injury was their main concern as most felt they could not always avoid it.One nurse com mented as follows: "Although we treat everybody as H IV positive, there is this Secondary appraisal (coping resources)

Cognitive and defence mechanisms
It appeared that the nurses had developed different coping and defence mechanisms to deal with their fear of contracting HIV in the workplace.The follow ing m echanisms were identified from the nurses responses: (a) H um our -Some nurses used hum our to express their fear when talking about HIV/AIDS, but without causing each other discomforts.This is reflected in the following statements: "I said to her you and I will be dead after 10 years because they say the incubation period is about 5 to 10 years and we both laughed"."Sometimes we talk and jo ke about it... "

(b)
Suppression -Some nurses avoided thinking about the possibility of contracting HIV as they worked but often thought about it later.This is reflected in the following statements: "I t ' s not a good thing to think about all the time." "No, its not good to think about it when you are working, because you might end up panicking and pricking yourself, so you ju st take it out o f your m ind and apply your universal precautions." ( c ) Altruism-Some nurses said that they were more sym pa thetic and understanding towards HIV/AIDS patients and had becom e more caring towards them.This is reflected in the fol lowing statement: "we ju st think about this poor patient" (d) M inimizing-Some nurses used m inimizing as a defence m echanism and equated HIV/AIDS to any other infectious conditions that they can contract at work, although the threat o f HIV/AIDS is higher than those other conditions which can be treated.One nurse comm ented as follows: W orking in trauma, we are aware of it*it's not just HIV that we can contract, it's TB, it's whatever you can get, you can get chicken pox, measles, mumps, or anything from a patient, and that's just in the line o f duty (e) Anger A nger was mainly directed towards the m anagem ent who viewed needlestick injuries as caused by negligence and were therefore unsupportive.Anger was also directed at patients whose behaviour put them at high risk for HIV/AIDS such as womanisers and sex workers.This is evident the following state ment from a nurse who sustained a needlestick injury while attending a patient known for promiscuity and practising un safe sex: "I was so upset about the whole thing because o f his behav iour as well, the fa c t that there was so much talk about H IV/ AID S and there were still people who were foo ling around like th a t, so I was really very upset and angry with him ."(0 Displacement It appeared that the employer was mainly blamed for the number o f accidental exposures to HIV, for not providing adequate protective equipment, andfor viewing accidental occupational exposure to HIV as negligence.W hile most of the allegations could be accepted as appropriate, they could also be viewed as displacement, with the em ployer becoming the scapegoat for the incidents that could have been prevented by applying the necessary universal precautions properly.One nurse com mented as follows: Exactly, when you get a person that is employed as a painter and he falls from the scaffolding, the em ployer must take re sponsibility because it is his work and there is a likelihood that he may fall as a result o f his job, so with the nature o f our jobs there is a likelihood that we will get pricked.

Behavioural (a) Influence o f fear on work performance
There were mixed feelings on this aspect.Some felt the fear of contracting HIV had no influence on the manner in which they performed their duties.All of them maintained that they wanted to continue nursing and were not going to change their profes sion because of the fear o f contracting HIV in the workplace.This could be attributed to the fact that job opportunities are scarce, and people need an income to survive and also to the fact that some chose nursing because they liked it.

Positive influences
It appeared that the fear o f contracting HIV has increased the application and efficiency o f universal precautions.It also appeared that a caring attitude had increased as most nurses reported that they felt sorry for the HIV positive pa tients and were quite sympathetic towards them, because there was no cure for HIV/AIDS at this stage.This also increased confidentiality and professional secrecy, as most nurses felt these patients need not be exposed.This is evidenced by the following statement: "w e h a ve b e c o m e m o re c a u tio u s e s p e c ia lly w ith the needlestick injury prevention ".

Negative influences
It appeared that treatment is sometimes delayed as a result of the fear of contracting HIV.Restless patients are expected to settle first before any major intervention like suturing is done.The process o f gloving up, putting on visors and aprons does also cause a few seconds' delay, although it is necessary.Some nurses made the following comments: "there are these rules now, that if a patient is either drunk or restless let him settle before you can suture him, since we do a lot o f suturing here, and in the meantime you apply a pressure bandage and arrest haemorrhage, because that is when most accidental needlestick injuries happen, that is when dealing with restless and drunk patients"."Like I have talked about gloves......... although I am aware that in the process it m ight delay the p a tie n t' s treatment ".

Perceptions tow ards m aking H IV a notifiable disease
There were mixed feelings on this aspect.These can further be subcategorised as follows: Supportive Some participants supported the idea o f making AIDS a notifi able disease, and felt that this would increase awareness and influence behavioural changes and possibly remove the stigma attached to HIV and AIDS.They also felt that it would de crease the fear o f contracting HIV in the workplace by increas ing awareness, and thus the efficiency, o f universal precau tions, and strengthen preventative measures against HIV and AIDS even in the nurses' personal lives.One nurse is quoted as saying "Awareness is not so effective i f there is secrecy" A gainst Some nurses felt it violated a patient's right to privacy.They also believed that it was unnecessary, as there was no avail able treatment at present for these patients.They also felt it would not have any influence on the fear o f contracting H1V/ AIDS in the workplace as the nurses should treat all patients as HIV positive, irrespective of their HIV status.One nurse is quoted as saying, " It infringes on the p a tien t' s right to p ri vacy and confidentiality"

The role o f education and HIV/AID S counselling courses
The widespread education about H1V/A1DS, as well as the inservice education occasionally presented to staff, has increased the nurses' understanding about HIV/AIDS and thereby alle viated some o f their fears.AIDS counselling courses have also played an im portant role in decreasing the fear o f contracting HIV in the workplace.Education alleviated, but did not com pletely elim inate the fear o f contracting H IV /A ID S in the workplace.One nurse is quoted as saying: "Before, it used to worry us, but now that we are well edu cated about H IV and AIDS, doing the courses and the AID S counselling courses, our fea rs have been alleviated fro m that knowledge gained, and fro m the fa c t that we treat all our out patients as p o sitive".

Availability and accessibilixy of counselling
M ost nurses expressed concern that the availability and ac cessibility o f post accidental exposure counselling was only immediate, and no follow up m echanism was in place espe cially because o f the window period.They felt that counsel ling sessions should be scheduled to go on until enough proof has been obtained that the individual did not seroconvert."Counselling, it's a one time thing, you are told you are HIV positive and counselled for the first time, that's it you go home and that is all, nobody looks after you then, you are on your own."Anticipation Some nurses had made realistic plans for the future with regard to HIV/AIDS.Some had taken policies that would cover them in the event o f seroconversion from HIV negative to a positive s ta tu s..One nurse is quoted as saying "Some o f us have taken our own individual policies against A ID S/H IV "

Activating spiritual powers
Some nurses expressed feelings o f helplessness, saying that they would leave everything to God, even with regard to the possibility o f accidental exposure to HIV.One nurse is quoted as saying, "ju s t give this thing to God, don't you worry about it."

Reappraisal (own reaction)
Conceptualization or description of the fear of contracting HIV/AIDS The fear was mainly described as a feeling o f anxiety and a worry when they faced with an HIV positive patient, or any situation that rem inds them o f the possibility of getting HIV at work.Some nurses described it as a feeling o f tenseness, others said they were bothered by the knowledge that they were in danger o f contracting HIV in the course o f their work.
Others, who reported that they did not have any fear o f con tracting HIV at work.They also felt that nurses should focus on preventing sexual exposure to HIV, rather than worry about occupational exposure in which the risk was so minimal.Some nurses commented as follows: "The fe a r is not there all the time, it comes and goes, like when you see a bleeding patient and you think that he m ight be H IV positive " "Its an anxious feelin g that you get when you think that as I am working here there is a possibility o f accidental occupational exposure".

Fam ily' s fear
All nurses interviewed adm itted that their families were con cerned about the nature o f their work in the presence o f high HIV prevalence.Husbands, boyfriends and partners were the people who were mostly concerned, some reported poor sup port from them in cases o f needlestick injuries, and some were even ostracised by them.The partners were concerned about the possibility o f their loved ones contracting HIV at work and transm itting it to them.It also appeared that husbands were more sym pathetic and supportive as com pared to boyfriends.The reason given for the family concerns was mainly igno rance.These are some o f the comm ents made: " You know there is this girl I worked with, when she had a needlestick injury, her boyfriend w anted nothing to do with her until she could prove that she was negative and he wanted to see all the results until about six months later."My husband supported me throughout that p e rio d ..." Knowledge of com pany policy and financial issues involved in case of occupational exposure to H IV Nurses in both the State and private hospitals were all aware of the im m ediate managem ent o f the needlestick injury but did not know the long-term im plications and management.They were familiar with the policy and procedure to follow immedi ately after needlestick injury, or any accidental exposure to HIV-infected blood and body fluids.About the long term man agem ent and implications one nurse commented as follows: "No one we know has ever seroconverted, so we just do not know what happens" Nurses in private hospitals have to pay for HIV investigation and treatment post accidental occupational exposure whereas in state hospitals this was provided as a free service.They also did not know if accidental occupational exposure to HIV was covered by the above mentioned Act or not.They were not aware o f whether they could claim back the money they paid for blood tests and treatment.State nurses seemed to regard the accidental occupational exposure to HIV as covered by the W.C.A., although they were unsure about the procedure for com pensation in case o f seroconversion.

Outcom es of the behaviour M astery
All nurses had developed their own standards o f mastering the situation, which were the result o f different coping and defence mechanisms, including the practical efforts to lessen their susceptibility to accidental exposure.

Resiliency
Resiliency was evident in those nurses who had been acciden tally exposed to HIV infected blood and body fluids, especially through the needlestick injuries.They had used coping mecha nisms appropriately and repeatedly in their situations and had recovered their equilibrium.This was evident in the following comment: It's been two years since the needlestick injury and I had a baby a year ago and everything was fine, we were all tested and we were negative and I really feel much better about the whole incident now.

Crisis
Nobody was in a crisis.

Discussion and recommendations
It appeared that the fear of contracting HIV/AIDS among trauma nurses still exists, despite available precautionary measures.Nurses felt these were not sufficient, or their quality was not up to acceptable standards to prevent contam ination, e.g.gloves that tear easily.Weiss (1997) argued that the success of universal precautions has been limited, especially with regard to percutaneous injuries because gloves fail to prevent pen etrating injuries and tear easily .This fear also appeared to go beyond their working environ ment to their families.They were concerned that they might contract HIV and transmit it to their partners and offspring, and so were the partners.No literature could be identified in relation to this issue.
The fear o f contracting HIV seemed to have increased the ap plication o f universal precautions in preventing needlestick injuries.There was dissatisfaction with the employer and man agement support.Education about H IV /A ID S, as well as AIDS counselling courses, appeared to play a major role in decreasing the fear of contracting HIV and AIDS in the workplace, but did not com pletely eliminate it.This confirm s the findings o f a study con ducted in KwaZulu-Natal among midwives by M abaso (1992) that knowledge increases the application o f universal precau tions.They used different coping and defence mechanisms effectively to cope with the fear o f contracting HIV and none were in a crisis as the result o f this fear.Resiliency was evident among those nurses who had suffered needlestick injuries and said they had bounced back into equilibrium.The following are the recom m endations that came out of this study:

Education In-service education
This should increase and focus not only on the immediate management post accidental occupational exposure to HIV, but should include long-term implications o f seroconversion from HIV negative to positive.There should be some means o f test ing the nurses' knowledge and understanding o f the subject.This could be done by the infection control department and can absolve the employer of some responsibility.Education should also include families and nurses' partners, and could be done by providing them with pamphlets.N urses' organisa tions should also take responsibility in educating their con stituency, especially about their legal rights and the provisions o f the different acts and laws that are applicable.As new infor mation comes to the fore, ways of making sure that the new developments and trends filter down to nurses should be de veloped.

A ID S counselling courses
It would be ideal if all nurses working with HIV positive pa tients are sent for AIDS counselling courses to prepare them to deal with the epidemic of AIDS, this could also decrease their fears and improve their willingness to work with HIV posi tive patients.There should also be follow-up courses to en sure continuity and dissemination of new information.

Increased availability and improvement in protective measures
Protective material should be made available to those who deal with blood and body fluids, quality should be checked to en sure that it is up to standard.More technologically advanced universal precautionary instruments should be made available and accessible to those who handle body fluids and blood e.g.availability of magnets to pick up dropped sharps and punc ture-resistant sharps containers.

Improving sta ff morale
Management can improve staff morale through making univer sal precautions material and prophylaxis available and accessi ble to staff members and increasing access to counseling.

Developm ent of support networks
Development of forums or networks where nurses can share information on issues pertaining to the care o f HIV positive patients within their hospitals and outside, and allow debrief ing would be useful.

Reinforcing positive general and specific beliefs
Garland & Bush (1982) also advocate the re-inforcement of general and specific beliefs that m ake people think that they can m aster most situations e.g.spiritual trusting

Conclusion
The working patterns in trauma units should change to reflect changes in time, experience, attitudes and current issues, such as HIV/AIDS.For nurses to be able to function properly in combating the threat o f HIV/AIDS, their concerns and fears must be heard, and interventions planned to address them.
have been the experiences o f traum a and emergency Curationis room nurses, and what are their fears about contracting HIV/ AIDS in KwaZulu-Natal ?-How do trauma and emergency room nurses cope with the fear of contracting HIV/AIDS ?
Theoretical fram ew ork guiding the study: The coping theory (Garland & Bush, 19 8 2 ) reminding the researcher to listen to what is real to participants than what is real to the researcher (Streubert