Preparing Student Nurses for HIV Care: What They Say They Need to Become More Willing and Competent
Article information
Shi, C., & Cleofas, J. V. (2024). Improving willingness to care and training needs for PLWHA from the perspective of student nurses in China: A qualitative study. Healthcare, 12(16), 1646. https://doi.org/10.3390/healthcare12161646
What this study is about
People living with HIV and AIDS need fair, respectful, skilled, and non-judgmental healthcare. Nurses are central to this work because they often provide direct care, health education, treatment support, counseling, and long-term follow-up. But HIV-related stigma remains a barrier in healthcare settings. Some healthcare workers, including nurses and students, may feel fear, uncertainty, discomfort, or reluctance when caring for people living with HIV and AIDS.
This study asks two practical nursing education questions:
What can improve student nurses’ willingness to care for people living with HIV and AIDS?
What HIV/AIDS training do student nurses say they need?
The study is important because student nurses are future registered nurses. If they graduate with fear, misconceptions, or inadequate HIV care skills, this can affect the quality of care that PLWHA receive. But if nursing education can provide the right knowledge, clinical preparation, psychological support, and role modeling, students may become more willing and competent HIV care providers.
What the researchers did
This was a descriptive qualitative study. The researchers interviewed 18 undergraduate student nurses who had cared for at least one patient with AIDS during clinical internship. Participants came from nine nursing schools, had internships in 14 tertiary hospitals, and represented seven provinces in China. Most participants were female and aged 21 to 23 years old.
The interviews explored two main topics. First, students were asked about their willingness to care for PLWHA before and after internship. Second, they were asked what HIV/AIDS education or training they had received and what additional training they wanted. The interview guide is shown in Table 1 on page 3.
The researchers used qualitative content analysis to identify themes from the interviews.
What the study found
1) Many students did not expect to care for PLWHA before internship
More than half of the participants said they had not expected to care for people with AIDS during internship. Some were surprised when they encountered HIV/AIDS patients in clinical practice. This suggests that many students entered clinical settings without fully anticipating that HIV care could become part of ordinary nursing work.
This matters because lack of expectation can create anxiety. If students are not mentally and practically prepared, their first encounter with PLWHA may feel frightening or overwhelming.
2) After internship, all participants expressed willingness to care
A major finding is that all 18 participants said they would be willing to care for PLWHA in future clinical work. They framed this as part of professional nursing responsibility: PLWHA are patients, and nurses have a duty to provide care to all patients.
This is a hopeful finding. Clinical exposure did not make students reject HIV care. Instead, many students appeared to move toward stronger willingness once they had real contact with patients and understood that PLWHA are not fundamentally different from other patients.
3) Students wanted more HIV/AIDS education and training
Thirteen participants said that increasing HIV/AIDS education and training could improve willingness to care. They believed that better knowledge and practical preparation could reduce fear, correct misconceptions, prevent occupational exposure, and reduce stigma.
This is an important lesson for nursing schools. Willingness is not only an attitude problem. It is also a training problem. Students may become more willing when they feel knowledgeable, skilled, and protected.
4) Psychological preparation is needed
Ten participants said students need psychological preparation before caring for PLWHA. In plain language, they need help managing fear. Students need to understand that HIV care can be done safely when proper precautions are followed.
This finding is important because fear of infection can remain even when students know basic HIV facts. Nursing education should therefore address both the mind and the emotions: what students know, what they fear, and how they can safely care.
5) Positive role models can improve willingness
Seven participants said positive role models could help improve willingness. These role models may include senior nurses, clinical instructors, healthcare workers, or students with meaningful HIV care experiences. Students suggested that hearing from people who successfully cared for PLWHA could reduce fear and show that HIV care is possible, meaningful, and professionally important.
Role modeling matters because students do not learn only from lectures. They also learn by watching how nurses behave. If clinical nurses treat PLWHA with calmness, dignity, and respect, students may internalize those same professional behaviors.
6) Students need to see PLWHA as real people, not stereotypes
Six participants said that raising awareness of PLWHA could improve student willingness. Some suggested scenarios, video links, autobiographies, experience sharing, or direct contact that would help students understand the real lives of PLWHA.
This addresses a core problem in HIV stigma: people may imagine PLWHA through fear-based stereotypes. But clinical exposure helped some students realize that many PLWHA are ordinary people who can be cheerful, loving, hopeful, and similar to other patients.
7) Nursing professionalism should be strengthened
Four participants emphasized nursing professionalism. They saw HIV care as part of nurses’ mission, responsibility, compassion, and duty.
This does not mean students should be forced into care without support. Rather, professionalism should be taught alongside knowledge, safety, empathy, and anti-stigma education. Students need to understand that professional nursing includes caring for stigmatized groups fairly and respectfully.
Training gaps identified by students
1) Lack of hands-on HIV/AIDS training in schools
Seven participants said their schools provided some HIV/AIDS content, often through infectious disease courses or pamphlets, but did not provide enough practical training. Some students described lectures as not very helpful because they did not include hands-on skills or realistic scenarios.
This suggests that HIV education should move beyond “information delivery.” Students need simulation, skills practice, case discussion, and clinical decision-making exercises.
2) Lack of specialized HIV/AIDS training in hospitals
Fourteen participants said their internship hospitals did not provide specialized HIV/AIDS training. Some received general infection-control or pre-service training, but not focused HIV/AIDS instruction. Three students reported receiving no HIV/AIDS training during clinical internship.
This is a serious gap because clinical internship is precisely when students are likely to encounter patients and need guidance. Hospitals and schools need better coordination so students are not left to learn HIV care only through surprise encounters.
What students said they need to learn
1) Progress in HIV/AIDS treatment
Eight participants wanted updated information on HIV/AIDS treatment, especially antiretroviral therapy, newer drugs, cost, tolerability, and treatment outcomes.
This matters because outdated beliefs can fuel stigma. When students understand that HIV can be medically managed, they may become less fearful and more prepared to support patients.
2) HIV prevention strategies
Seven participants wanted more training on HIV prevention, including condom use, handwashing, personal protective equipment, and self-protection.
Students need to understand both patient-centered prevention and occupational safety. This helps them protect themselves without treating PLWHA as dangerous or untouchable.
3) Psychological support for PLWHA
Seven participants wanted to learn how to provide psychological support. They wanted to know how to earn patients’ trust, help patients face the disease, and support patients emotionally.
This is important because HIV care is not only biomedical. PLWHA may face anxiety, depression, stigma, fear of disclosure, relationship problems, and social rejection. Nurses need basic psychosocial care skills, not only infection-control knowledge.
4) Post-exposure reporting protocols and prophylaxis
Six participants wanted clearer training on what to do after possible occupational exposure, such as needlestick injury. Some did not know the reporting chain or post-exposure prophylaxis procedures.
This is one of the most practical findings of the study. Fear often grows when students do not know what to do in an emergency. Clear protocols can reduce panic and improve safety.
5) HIV-infection risk behaviors
Three participants wanted more information about behaviors or populations at higher risk of HIV infection.
This training must be handled carefully. Teaching risk behaviors should not reinforce stigma. It should help students understand transmission scientifically, communicate prevention respectfully, and avoid moral judgment.
Bottom line
This study shows that student nurses can become willing to care for PLWHA, especially after clinical exposure. But willingness does not happen automatically. It needs education, emotional preparation, positive role modeling, practical training, and stigma reduction.
The key message is simple: nursing students should not meet HIV care for the first time through fear or surprise. They should meet it through preparation, skill, compassion, and professional support.
Policy/practice recommendations
- Integrate practical HIV/AIDS training into nursing curricula
HIV/AIDS education should include simulations, case-based learning, skills demonstrations, role play, and guided clinical scenarios—not only lectures. - Provide specialized HIV/AIDS orientation during internship
Hospitals should orient student nurses on HIV care, confidentiality, universal precautions, post-exposure protocols, and patient communication before they encounter PLWHA. - Teach post-exposure protocols clearly
Students need to know what to do after needlestick injury or blood/body fluid exposure: whom to report to, what forms to complete, what tests are needed, and how post-exposure prophylaxis works. - Use contact-based and narrative learning to reduce stigma
Patient stories, testimonials, autobiographies, videos, and carefully structured contact with PLWHA can help students see patients as whole persons rather than stereotypes. - Train students in psychological support for PLWHA
Nursing education should include basic counseling, trust-building, stigma-sensitive communication, and referral skills for patients experiencing distress. - Strengthen role modeling in clinical areas
Nurse educators and clinical nurses should model calm, respectful, evidence-based care for PLWHA. Students learn professional behavior by watching how seniors act. - Frame HIV care as part of nursing professionalism
Professional values such as compassion, fairness, dignity, confidentiality, and non-discrimination should be explicitly linked to HIV care. - Update HIV teaching regularly
Content should reflect current developments in HIV treatment, prevention, antiretroviral therapy, pre-exposure and post-exposure prophylaxis, and public health guidance.
Glossary of key terms
- PLWHA — People living with HIV and AIDS; the population at the center of this study.
- HIV — Human immunodeficiency virus, a virus that affects the immune system.
- AIDS — Acquired immunodeficiency syndrome, the advanced stage of HIV infection when the immune system is severely weakened.
- Willingness to care — A student nurse’s readiness or openness to provide nursing care to PLWHA.
- Clinical internship — The period when nursing students practice in real hospital or healthcare settings under supervision.
- HIV stigma — Negative beliefs, fear, judgment, discrimination, or avoidance directed toward people living with HIV.
- HIV/AIDS education and training — Formal or informal learning activities that prepare students to understand, prevent, manage, and provide care related to HIV/AIDS.
- Hands-on training — Practical training where students apply skills through simulation, demonstration, supervised practice, or realistic clinical scenarios.
- Psychological preparation — Helping students manage fear, anxiety, and emotional reactions before caring for PLWHA.
- Positive role modeling — Learning professional behavior by observing teachers, nurses, or seniors who demonstrate respectful, competent, and compassionate care.
- Nursing professionalism — The values, behaviors, and responsibilities expected of nurses, including compassion, accountability, fairness, patient safety, and respect.
- Antiretroviral therapy / ART — Medicines used to control HIV, improve health, and reduce viral transmission risk.
- HIV prevention strategies — Actions that reduce the risk of HIV transmission, such as condom use, testing, safe injection practices, PPE, and health education.
- Post-exposure prophylaxis / PEP — Medication taken after possible exposure to HIV to reduce the chance of infection.
- Occupational exposure — Possible workplace exposure to infection, such as needlestick injury or contact with blood and body fluids.
- Universal precautions — Infection-control practices used with all patients, including hand hygiene, gloves, PPE, and safe sharps handling.
- Risk behaviors — Behaviors that increase the chance of HIV transmission, such as unprotected sex or sharing needles.
- Qualitative descriptive study — A research design that describes participants’ experiences, views, and needs in clear, practical terms.
- Content analysis — A qualitative analysis method used to identify categories, patterns, and themes in interview data.
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