'Othering' tactics and treatments of patients with HIV/AIDS: a study of the construct of professional ethics by Thai nurses and nursing trainees

摘要

Despite efforts to tighten the code of professional ethics amongst health workers by the Thai authorities, recent studies have shown that discrimination towards HIV-positive patients persists amongst nurses, thus compromising the quality of patient care. Using a framework of 'Othering', this paper examines the constructions of professional ethics and duties by a group of Thai nurses, with the aim of identifying problems with the existing approach to discrimination reduction. Twenty semi-structured interviews were conducted with qualified and trainee nurses from a Bangkok nursing college. Following a standard attitudinal measure of HIV-related stigma, participants were asked to explain the reasons behind their responses, and reflect on how these might have shaped their personal and professional encounters with HIV-positive patients. The findings showed that despite heightened awareness about the code of non-discrimination, biases towards HIV-positive patients were evident. Various strategies were employed to maintain a perception of the Self as being in line with the prescribed professional ethical guidelines while leaving personal biases towards HIV-positive patients unchanged. These included the dismissal of discrimination as conducts of 'Other' people (i.e. the lay public or unethical colleagues), redefining the nature of nursing duties to avoid providing certain services to HIV-positive patients (e.g. taking blood), and stigmatising patients on the basis of presumed/actual high-risk behaviours (e.g. injecting drug use) instead of HIV status. Broadening nurses' understanding of the distal factors relating to HIV transmission was discussed as an alternative approach for reducing nurses' biases towards patients with HIV/AIDS.