ORIGINAL RESEARCH

The self-protection against HIV for nursing professionals: study of social representations

Thelma Spindola^I; Renato Martins de Oliveira Braga ^II; Sergio Corrêa Marques^III; Glaucia Alexandre Formozo^IV; Hellen Pollyanna Mantelo Cecilio^V; Denize Cristina de Oliveira^VI

^I PhD in Nursing. Associate Professor, Rio de Janeiro State University. Brazil. E-mail: tspindola.uerj@gmail.com
^II Master in Nursing, State University of Rio de Janeiro. Brazil. E-mail: renatormob@yahoo.com.br
^III PhD in Nursing. Adjunct Professor, Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil. E-mail: sergiocmarques@uol.com.br
^IV PhD in Nursing. Adjunct Professor, Federal University of Rio de Janeiro. Brazil. E-mail: glauciaformozo@gmail.com
^V PhD student in Nursing, State University of Rio de Janeiro. Brazil. E-mail: pollymantelo@gmail.com
^VI PhD in Nursing. Full Professor, State University of Rio de Janeiro. Brazil. E-mail: dcouerj@gmail.com
^VII From the dissertation Professional and personal self-protection in the network of social representations of HIV/AIDS from the perspective of nursing professionals , of the University of the State of Rio de Janeiro

DOI: http://dx.doi.org/10.12957/reuerj.2018.34277

ABSTRACT

Objective: to examine the professional and personal self-protection in the network of HIV/AIDS's social representations from the perspective of nursing professionals. Method: qualitative study based on the theory of social representations in its processual approach. Participants were 36 nursing professionals working in HIV/AIDS programs in Rio de Janeiro. Results: the contents of the representations were organized into five categories revealing the psychosocial aspects of self-protection: Protective measures in caring for people living with HIV; Knowledge and fear of exposure to HIV determining personal and professional self-protection; Sexual behavior and condom use: aspects of self-protection against HIV; Health education and professional training as strategies for personal and professional self-protection; The care for people living with HIV mediating professional self-protection. Conclusion: for adopting self-protection in the professionals' daily work and personal life, it is necessary to perceive themselves as vulnerable and to integrate the knowledge learned with the constituted representations.

Descriptors: HIV; primary prevention; nursing care; health personnel.

INTRODUCTION

Acquired Immunodeficiency Syndrome (AIDS) is a disease with a strong social and stigmatizing character. Since 1980, it has been adding meanings and constructing social representations wrapped in negative cognitive, affective and social elements. Their representations, however, have gradually transformed, and resemble chronic diseases.¹

Self-protection is an important issue to be addressed by health professionals, such as nursing professionals, who provide direct care to seropositive clients and are exposed to the risk of accidents and contamination with body fluids. Professionals should always pay attention to safety procedures, regardless of the knowledge of the clients' diagnosis.²

The relevance of the study^VII refers to the possibility of reflection on self-protection, in its different aspects and on the social representations constituted on the theme. It may contribute to the discussion in the healthcare field of health professionals, to the practices of care, humanization and integrality of the same, encouraging the adoption of effective measures for self-protection. The purpose of this study was to analyze the professional and personal self-protection contents of the network of social representations of the Human Immunodeficiency Virus (HIV) and AIDS, with the purpose of analyzing the professional and personal self-protection in the network of social representations of HIV/AIDS under nursing professionals perspective.

LITERATURE REVIEW

Nursing professionals are responsible for the direct care of people and perform care activities, among others. While caring for people, workers are aware that they act in a risky environment.

Since the HIV emerged, professional self-protection practices have evolved. In the early days of nursing there was no concern about professional protection mechanisms, even when care was provided to the person with infectious disease. The lack of adequate protection, however, could cause the professional to become sick and, later, to leave his work activities. ^3-4 Nurses who leave the workplace and take on the role of common citizens, a family member, with their interpersonal relationships, do not always adopt a care attitude towards their health. Many of them do not use the theoretical and practical contribution to self-protection at work and personal life.

In the care of people living with HIV, three phases in the formation of social representations stand out: professional performance in the 1980s, regulation of the universal access to antiretroviral medication and AIDS chronification.⁵ Social representations can appear as a form of support in the understanding of a certain theme for a specific group. They can be defined as a form of knowledge common to many people, coming from the interpretations and translations of the society about a certain subject. Communication and the media play a prominent role in the formation, analysis and diffusion of social representations.⁶

Regarding the analysis of personal and professional self-protection of HIV, it is known that no social representation can be seen in isolation and maintains relation with several other representations, constituting a historical and social context of individuals.⁷ The relationship with social representations is called network of social representations.⁸

METHODOLOGY

This research integrates a national multicenter project, developed from data obtained in interviews, with the authorization of the responsible researcher so that they could be treated, analyzed and discussed in this investigation. It is a qualitative, descriptive study, based on the Theory of Social Representations, in its procedural approach.

Thirty-six nursing professionals who worked in the outpatient care network for people living with HIV, including 19 nurses, 13 nursing technicians and 4 auxiliaries, participated in the study.

As inclusion criteria in the study were defined: professionals working in institutions for the treatment and follow-up of people living with HIV in activity in 2011, in the Service of Specialized Assistance (SAE) and Testing and Counseling Center (CTA) of the city from Rio de Janeiro. 14 health units participating in the National STD/AIDS Program were chosen based on the following inclusion criteria: services responsible for the diagnosis and/or follow-up of HIV/AIDS cases, distributed in the five planning areas of the city of Rio de Janeiro.

Data were collected between the years 2011 and 2012, by the application of a socio-economic-professional questionnaire and a semi-structured interview, with a thematic roadmap previously established. In the data collection process, the researcher explained the objectives of the research, thought on possible doubts and presented the Informed Consent Form (ICF) for signature.

For the analysis of the data obtained in the interviews, the technique of content analysis was used and operationalized by the NVIVO^® software version 8.0. For the interviewees' differentiation and preservation of their identity, the following codes were used: letter E for nurses, letter A for auxiliaries and letter T for technicians, followed by the interview order number.

In carrying out this research, the norms and guidelines of Resolution No. 196/96 of the National Health Council, in force at the time, were respected. The research project was approved by the Research Ethics Committee with the opinion 074/2010.

RESULTS

The analysis of the socioeconomic-professional data allowed to know the profile of the interviewees and the content analysis of the interviews sought to meet the objectives proposed for the study. It was found that 32 (88.89%) of the interviewees were women and 24 (66.67%) were in the age range of 41 to 60 years. All of them had undergraduate education required for the position held, that is, from the upper level to the secondary level, according to the professional category. In the investigated group, 31 (86.11%) have already participated in some training activity directed to HIV/AIDS. Even though working in a health program focused on the care of people living with HIV, 20 (55.56%) professionals reported that they thought they were infected with HIV, and only one said that they had never taken the serological test for HIV.

The thematic analysis of the interviews of the 36 participants generated 440 units of records (UR), being allocated in 22 units of signification (US), later grouped into five categories: Protective measures in the care of the person living with HIV; Knowledge and fear of exposure to HIV determining personal and professional self-protection; Sexual behavior and condom use - facets of personal self-protection against HIV; Health education and professional training as strategies for personal and professional self-protection; The care of the person living with HIV mediating professional self-protection.

The description of the constituents of these categories allows the observation of representational contents revealing the meanings related to personal and professional self-protection, presented below.

Protective measures to care for people living with HIV

The first category has 120 UR, two US; represents 27.4% of the total corpus analyzed and addresses the use of personal protective equipment (PPE) and collective equipment (EPC) equipment in the care of people living with HIV.

In the HIV/AIDS scenario, PPE is an important instrument for protecting the professional when exercising care. However, it has been observed that many professionals associate worker protection only with glove use and do not mention other relevant aspects.

Many professionals are not able to perceive the situations of vulnerability to which they are exposed in daily work.

Another problem is that some people living with HIV do not report their diagnosis. Self-protection, however, should not be restricted to patients known to be seropositive.

Knowledge and fear of exposure to HIV determining personal and professional self-protection

The category is composed of 111 UR, corresponds to 25.3% of the material, with seven US and discusses how knowledge and fear can interfere in the self-protection practices of the person living with HIV.

Nursing professionals are responsible for caring for people who need health care, but care must also be taken for their health. This care, however, is not always considered.

Over the years, the social representation of AIDS has been changing and information is spreading faster. Thus, the transmission of the virus was evidenced, and procedures were established for the professionals to ensure the necessary security in the care provided, without risk of contamination.

Sexual behavior and condom use: facets of self-protection against HIV

This category has 110 UR, eight US, comprises 20.8% of the total corpus, and addresses the personal life stories of nursing professionals. Sex-related issues are usually surrounded by myths and taboos; however, there is an increasing need to address them so that people are educated about the risks of unprotected sex and its consequences.

AIDS today is not exclusive to a group and is spreading mainly among young people and the elderly. The change in the epidemiological profile of the disease has caused strangeness among professionals, which reinforces the need for self-protection for care.

Health education and professional training as strategies for personal and professional self-protection

The fourth category has 65 UR, six US, represents 14.9% of the total corpus. It deals with health education as a form of empowerment that allows professionals to be aware of mechanisms and the need to care about their self-protection.

The orientation related to HIV prevention becomes a constant in the life of the professional who, even leaving the work environment, continues to guide friends and family.

Training is an important way to encourage professional learning. The knowledge and the experience of the day to day can be apprehended, systematized and practiced in the professional and personal life.

Care for people living with HIV through professional self-protection

The fifth category has 51 UR, 11.6% of the total corpus, and contains three US. The category addresses how care provided to people living with HIV can mediate professional self-protection.

Nursing is characterized by its general education. You must exercise care to every client, in a holistic and individualized way, without neglecting their self-protection. In order to do so, it should associate its theoretical knowledge with practice, adopting strategies to perform a safe assistance, with the use of protective equipment.

In the provision of care, nursing professionals practice practices inherent to their doing, regardless of the diagnosis of the clients.

DISCUSSION

Nursing is a profession with great concentration of female people. In Brazil, 84.6% of nursing professionals are women.⁹ The professionals investigated have satisfactory schooling for the positions held, and most participated in training for the care of people living with HIV.

In the descriptions, it is noticed that the EPI and EPC are forms of self-protection recognized in the labor practice. The PPE should be associated to the expertise in the execution of the procedure, being necessary to maintain the attention in the action that is being carried out, and to prioritize its use independent of the diagnosis of the client to be assisted.

The protective equipment must be offered by the services and used consciously by the professionals, without bringing embarrassment to them or to the subject being cared for. Protection should be understood as a safety measure for professionals, who should not leave work due to an occupational disease.¹⁰

The health professional counts on a regulatory norm that deals with criteria for the use of protective equipment, establishing guidelines for the use of each one of them, besides, it makes the nurses responsible, as managers in the supervision and guidelines of the use of these resources. ¹¹ The services are obliged to offer the inputs for the protection of workers.¹²

The findings indicate that knowledge and fear are associated with the use of self-protection by nursing professionals in professional and personal life. Health care for people living with HIV, as well as the social construction of the syndrome, have undergone changes over time with discussions about the risks inherent in the profession and the forms of self-protection of the professional after the onset of AIDS in the 1980s. Some people experienced an exacerbated fear of encountering HIV-positive patients, especially if they were showing signs of AIDS.¹³

Knowledge about an individual's vulnerability should stimulate the practice of self-protection. Fear of exposure to the virus, however, should not alienate the professional from the clients, hampering the care. Knowledge and fear have modulated care, but not self-protection.

Continuing education makes professionals aware of the importance and consequences of using these resources, alerting them to the types of PPE protection.¹⁴ Prejudice and fear, however, induce discrimination, which only health education can dissipate.^15,16 Education contributes to demystify AIDS as a lethal disease, alerting to chronicity, clarifying that protection practices are like other diseases.

AIDS has raised issues that are not addressed in the field of health and which represent a taboo for part of society, such as the exercise of homosexual and heterosexual sexuality, differences in the expression of sexuality, injecting drug use, losses resulting from terminal illnesses and death from life styles. It was observed the unpreparedness of the professionals and consequent increase in the stigma around the syndrome, which currently extends when living with HIV.¹⁷

Regarding the personal aspect, the use of condoms is the main form of prevention and protection against HIV. In love relationships, regardless of the sexual practice adopted, the individual needs to use a condom, whether male or female. The knowledge acquired in professional practice should be employed in personal life.

Condoms can be understood as dispensable in stable relationships, and may suggest mistrust in the couple, considering that in a monogamous relationship it is expected not to need this preventive method. ¹⁸ The belief in the personal capacity to judge when a given behavior is or is not a risk to the person is still observed. Protection methods are then employed only when it is believed that there is a greater risk,¹⁷ whether in professional care or in personal relationships, if exposed to situations of vulnerability.

Vulnerability to HIV is related to lack of information, sensitization, difficulty access to protection technology, i.e. personal and collective protective equipment in the workplace and condoms in the personal environment.¹⁹ The individual needs to perceive himself vulnerable to the risks of contagion by the virus, both in the professional context and in his personal life. This is the first step towards adherence to self-protection.²⁰ Thus, you can empower yourself and pass on your recommendations to people close to you.¹⁷

Health education enables the professional to acquire knowledge and pass it on to others, strengthening the propagation of information and applying safer practices among peers.

The professional must understand the vulnerability situation of his profession and use protective equipment correctly and whenever necessary. Self-protection cannot be mediated by the executed care, must be constant, regardless of the type of procedure and diagnosis of the client.²⁰

CONCLUSION

This study investigated the expression of the professional and personal self-protection that is part of the network of meanings revealed in the social representations that involve HIV/AIDS, from the perspective of nursing professionals. The results evidenced facets of self-protection mechanisms used in the professional and personal contexts. These symbolic elements partially participate and overlap the social representations of HIV/AIDS, influencing the practices developed by professionals.

Nursing professionals experience daily the risks inherent in caring for people. The results show that for self-protection to be adequately employed, it is necessary for workers to perceive themselves to be vulnerable.

Fear is an important aspect of the representation of self-protection, being one of the mediators for the use of resources, related to the disease, the client and the family. The fear of contagion of the family is sometimes seen as a defining element of the professional activity. At the onset of the syndrome, the fear was even greater, more justifiable, and AIDS a new disease that had high social stigma.

The study had as limitations the restricted sample and the data collection performed in only one municipality, preventing the generalization of the results to other groups. Research, however, allows greater visibility to representations of HIV/AIDS and ways of symbolizing self-protection, highlighting their relationships with practices developed in professional and personal daily life.

REFERENCES

1.Formoso GA, Oliveira DC. Representações sociais do cuidado prestado aos pacientes soropositivos ao HIV. Rev. Bras. enferm. (online) 2010; 63(2):230-7.

2.Vieira M, Padilha MICS. O HIV e o trabalhador de enfermagem frente ao acidente com material perfurocortante. Esc. Enferm. USP. 2008; 42(4):804-10.

3.Souza MCMR, Freitas MIF. Representations of primary care professionals about the occupational risk of HIV infection. Rev. latinoam. enferm. (Online) 2010; 18(4):748-54.

4.Vilarinho MV, Padilha MI. Percepção da aids pelos profissionais de saúde que vivenciaram a epidemia durante o cuidado prestado às pessoas com a doença. Ciênc. saúde coletiva. (Online) 2014; 19(60):1951-60.

5.Oliveira DC, Oliveira EG, Gomes AMT, Teotônio MC, Wolter RMCP. O significado do HIV/aids no processo de envelhecimento. Rev. enferm. UERJ. 2011; 19(3):353-8.

6.Jodelet D. Representações sociais: um domínio em expansão. In: Jodelet D, organizadora. As representações sociais. Rio de Janeiro: Ed.Uerj; 2001. p.17-44.

7.Abric JC. Abordagem estrutural das representações sociais: desenvolvimentos recentes. In: Campos PHF, Loureiro MCS. Representações sociais e práticas educativas. Goiânia (GO): AB Editora; 2003. p.53-4.

8.Silva POM, Trindade ZA, Silva Junior AS. As representações sociais da conjugalidade entre casais recasados. Estud psicol.(Online) ( Natal)2012; 17(3):435-43.

9.Fundação Oswaldo Cruz. Pesquisa inédita traça perfil da enfermagem no Brasil. Rio de Janeiro:FIOCRUZ; RJ. 2015; [citado em 20 maio 2018]. Disponivel em: http://portal.fiocruz.br/pt-br/content/pesquisa-inedita-traca-perfil-da-enfermagem-no-brasil

10.Barboza MCN, Almeida MS, Rodeghiero JBH, Louro VA, Bernardes LS, Rocha IC. Riscos biológicos e adesão a equipamentos de proteção individual: percepção da equipe de enfermagem hospitalar. Rev. Pesq. Saúde. 2016; 17(2):87-91.

11.Santos EI, Gomes AMT, Oliveira DC, Marques SC, Bernardes MMR. Desafios e enfrentamentos no cuidar por enfermeiros: estudo de representações sociais. Online braz j nurs. [Internet]. 2014 [citado em 18 jan 2018]; 13(2): 207-18. Disponível em: http://www.objnursing.uff.br/index.php/nursing/article/view/4365

12.Martins CL, Jacondino MB, Antoniolli L, Braz DL, Bazzan JS, Guanilo MEE. Equipamentos de proteção individual: a perspectiva de trabalhadores que sofreram queimaduras no trabalho. Rev enferm UFSM. 2013; 3(Esp.):668-78.

13.Oliveira DC. Construção e transformação das representações sociais da aids e implicações para os cuidados de saúde. Rev. Latinoam. enferm. (Online) 2013; 21(Spec):276-86.

14. Dias EG, Castro AC. Conhecimento dos profissionais enfermeiros das equipes de saúde da família do município de Porteirinha-MG sobre acidentes de trabalho. Rev. Ouricuri. 2014; 4(3):32-47.

15. Marinelli NP, Costa AIP, Basílio LV, Posso MBS, Silva DNO. Em tempos de AIDS: Representações sociais e memória dos profissionais de saúde do centro de testagem e aconselhamento. Rev. Univap. 2014; 20(35):24-34.

16.Machado YY, Oliveira DC, Nogueira VPF, Gomes AMT. representações de profissionais de saúde sobre HIV/AIDS: uma análise estrutural. Rev. Enferm..UERJ. [Internet] 2016 [citado em 29 mar 2018]; 24(1): e14463. Disponivel em: http://www.facenf.uerj.br/v24n1/v24n1a12.pdf

17.Sousa CSO, Silva AL. HIV/aids care according to the perspective of healthcare providers. Esc. Enferm. USP. [Internet]. 2013 [cited 2018 Jan 18]; 47(4):907-14. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342013000400907&lng=en

18.Gomes AMT, Oliveira DC, Santos EI, Santo CCE, Valois BRG, Pontes APM. As facetas do convívio com o HIV: formas de relações sociais e representações sociais da AIDS para pessoas soropositivas hospitalizadas. Esc. Anna Nery Rev. Enferm. [Internet]. 2012 [citado em 18 jan 2018]; 16(1):111-20. Disponivel em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452012000100015&lng=en

19.Fontanella BJB, Gomes R. AIDS prevention in the period of sexual initiation: aspects of the symbolic dimension of the conduct of young men. Cienc. saúde coletiva. [Internet]. 2012 [cited 2018 Jan 17]; 17(12):3311-22. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232012001200016&lng=en

20.Nogueira VPF, Gomes AMT, Machado YY, Oliveira DC. Cuidado em saúde à pessoa vivendo com o HIV/AIDS: representações sociais de enfermeiros e médicos. Rev. enferm. UERJ. 2015; 23(3): 331-7.