الفهرس 
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Abstract
Immunodeficiency Virus (HIV) was one of the most serious infectious disease challenges to public health. Health care workers (HCWs) especially nurses are at high risk of HIV/AIDS when they do not follow the standard precautions when providing care for those patients, that‘s why bringing up-to-date nurses‘ knowledge regarding the nature of HIV/AIDS, prevention, and treatment is essential to provide better care. Besides nurses’ knowledge and positive attitude toward HIV/AIDS patients is essential to provide optimal care to such patients. Community health nurses as healthcare providers are performing multiple functions in HIV programs, including referring community members for HIV testing, linking them to care, accompanying them to clinic appointments, providing complete physical and psychosocial support, and making referrals to other services and counseling. Self-directed learning has become a popular concept in nursing education. The benefits of self-directed learning include independence, professional autonomy, and increased choice and motivation. Information education and communication (IEC) programs are the most effective available approaches for combating the HIV pandemic, especially among nurses. Aim of the study The study aimed to determine the effect of nurses’ self-learning on knowledge and attitude on caring for patients with human immunodeficiency virus. Study design The quasi-experimental study design was used in the study. Study setting the study was conducted at the AIDS department in Tanta and Alexandria fever hospitals. Study subjects: A convenient sample of 79 nurses who provide direct care to HIV/AIDS patients in the previous setting was involved in the study, 37 nurses from Tanta fever hospital and 42 nurses from Alexandria fever hospital. Study tools: three tools were used for data collection. Tool (I): Structured Interview schedule which developed by the researcher to assess the biosocial data and knowledge of nurses regarded HIV/AIDS; it included two-part as follows: Part I: it included items related to socio-demographic data such as age, sex, marital status, education level, and years of experience working with HIV/AIDS patients and previous training courses related to caring for HIV patients. Part (2); Nurses’ knowledge regarding HIV/AIDS Knowledge which measured by using the nursing Human Immunodeficiency Virus Knowledge Questionnaire (HIVKQ 20) which was developed by Carey and Schroder (2002) (91) and adopted by the researcher, it consists of 20 items to measure nurse’s knowledge of HIV (Causes, Risk factors, Transmission, Prevention, Treatment and How to cope with HIV). The scoring system of nurses regarding HIV knowledge Each question was scored (1) point for the correct answer. And (0) for incorrect/false answers. The total score is equal to 20 and the nurse‘s level of total knowledge score was classified as follows: - (1) Point for correct /true answer and (0) for incorrect /false answers Low knowledge <60% of the total knowledge score. (<12degree) Moderate knowledge60-80% of the total knowledge score. (12-16 degrees) High knowledge >80% of the total knowledge score. (>16 degrees) Tool (П): Nurses’ attitudes toward HIV/AIDS patients which are measured by using AIDS Attitude Scale (AAS) AIDS Attitude Scale was developed by Forman et al, (1992) (92) and adopted by the researcher. It is used for measuring the attitude of nurses toward HIV/AIDS patients. Estimation of total attitude score: The total score of nurse‘s attitudes about HIV statement was calculated according to the nurse’s answers as follows: - The scoring of the statements was done through a three-point Likert scale agree (3), uncertain (2), and disagree (1), for empathetic positive statements. (1- 5,15 and 21) and (1 agree,2 uncertain, 3 for disagree for negative non empathic statements). The total attitude Score was classified into two categories as follows: Positive attitude: ≥75% of total attitude score) ≥ 47degree) Negative attitude: < 75% of total attitude score (<47 degrees) Tool III Nurses’ Practice in dealing with HIV/AIDS patients by using observation of checklist: it was developed by the researcher to measure nurses’ performance in caring for HIV/AIDS patients based on the literature review. It consists of items covering direct care The checklist included (48) items covered direct care proved to HIV/AIDS patients and clinical management which included: Infection control measures which included (12) items; Protective measures which included (8) items; Injection and sharps disposal which included (5) items; Counselling which included (10) items; Communication with HIV patients which included (3) items; Managing antiviral therapy (ART) which included (7) items; and health Education about HIV/ADIS which included (3) items. The scoring system of nurse’s performance regarding caring for HIV/AIDS patients: The items which were done by nurses correctly took one point and that incorrectly took zero. The total level of practice was classified as followed: - Satisfactory practice: ≥80% of the total score on the NPC. (38 ≥degree) - Unsatisfactory practice: <80% of the total score on the NPC. (38 < degree) The main results of the present study found that: - The mean age of nurses was (39.61 ± 10.39) years and one-third (30.4%) of them belonged to the age group of 40 – <50. - More than half (57. %) of them were females. The majority (57.0%) of them were married and nearly three fifth (59.5%) of them were from a rural area. - More than half (51.9%) of the studied nurses were bachelor’s degree graduates, while one-third (32.9%) of them were graduates of nursing secondary school, and one-fifth (15.2%) of them were graduates of a nursing technical institute. - The mean years of experience were (16.25 ± 9.35) years. - More than three-fifths of them (60.8%) were more than equal 15 years of experience. – The majority of studied nurses (64.6%) attended training courses related to human immunodeficiency virus. - There was a statistically significant improvement occurred in post-selflearning program implementation than pre-self-learning program implementation regarding the knowledge of the studied nurses regarding signs and symptoms, causes, risk factors, ways of transmission, the importance of nutrition and good lifestyle, prevention, treatment, and how to cope with HIV disease post-intervention. - In pre-implementation of self-learning, nurses had poor Knowledge scores while this percentage increased from (5.1%) to (89.9%) in postself- learning implementation, on the other hand in post –self-learning program implementation the percentage of the nurses who had a fair level of Knowledge. increased from 45.6 to 89.9 post-self-learning. - Regarding to total knowledge score. There was a statistically significant improvement that occurred post-self-learning program implementation than in pre-implementation (p<00.01) - After implementation of the self-learning program 93.7%of the studied nurses had negative attitude scores the percentage decreased to 72.2% in post –self-learning program implementation. On the other hand, the percentage of nurses who had positive attitudes increased from 6.3% to 27.8 % in post-self-learning. - There was a statistically significant difference found between the mean and standard deviation of the studied nurse attitude about human immunodeficiency virus pre- and post-self-learning implementation t=10.150* and p ≤ 0.001. - There was an improvement in most infection control measures postself- learning than pre-self-learning. For example, wearing personal protective requirements increased from 68.4 %to 100%. - There was an improvement in practice related to counseling for example explaining the risks for transmission and how HIV can be prevented increased from 68.4% to 100%. - In relation to Practice related to Communicating with HIV patients’ making time for the patient increased from70.9% to 87.3% and also showing acceptance to the patient increased from 72.2% to 91.1%. - Practice related to initiating and management of antiretroviral therapy (ART) show also, improvement in post-self-learning than pre-selflearning as teaching patients how to correctly take their medications increased from 72.2% to 98.7% and also assessment of side effects during ART increased from 81.0% to98.7% and observe clinical signs as rash or jaundice increased from69.5% to 93.7%. - Practice related to Health Education about HIV had progressed post-selflearning more than pre-self-learning as teaching patients’ modes of transmission and causes of HIV/AIDS increased from 77.2%to 96.2% and teaching Preventive measures of HIV/AIDS changed from 73.4% to 97.5%. - The study clarified that there was a statistically significant between the mean and standard deviation of studied nurses’ overall practice score pre- and post-self-learning implementation (32.77 ± 3.90 and 42.61 ± 2.87) respectively. - There was a statistically significant improvement in the total score of all practices regarding HIV/AIDS patient care. including infection control measures, injection procedures, sharps disposal pretest, counseling, communication with HIV patients, management of antiretroviral therapy (ART), and health education about HIV. - The majority (92.4%) of the studied nurse had unsatisfactory practice in pre-self-learning and this decreased to only (17.7%) post-self-learning and satisfactory level of practice increased to (82.3%) post-selflearning (7.6%) pre-self-learning p<0.001). - There was a significant mean difference between the total mean practice score-self-learning (32.77 ± 3.90) and the post-self-learning total mean score (42.61 ± 2.87) (P<0.001). - There was a statistically significant correlation between nurses‘ total knowledge score and their attitude score post-self-learning implementation (r=0.332, p=0.003). However, there was not a significant correlation found between nurses‘ practice scores and their knowledge and attitude scores (P=0.106 and 0.341) respectively. Conclusion Based on the findings of the present study, it can be concluded that nurses showed a significant improvement in their knowledge, practice, and extent attitudes toward patients with HIV/AIDS after the implementation of the self-learning program. The overall knowledge of the nurses was satisfactory. A planned HIV/AIDS self-learning program significantly improved HIV/AIDS knowledge and to a lesser extent the attitudes toward patients with HIV/AIDS. Some misconceptions about HIV/AIDS were improved. There was a statistically significant positive correlation existed between nurses‘ total knowledge and attitude scores post-self-learning implementation.