Assessment of Knowledge, Attitude and Practice of Nurses towards Oxygen Therapy at Wolaita Sodo University Comprehensive Teaching and Referral Hospital, Ethiopia, 2021
- Corresponding Author:
- Hindu Argeta
Department of Emergency and Critical Care Nursing, College of Health Science and Medicine, Wolaita Sodo University,
Received: 22-June-2022, Manuscript No. ijocs-22-67370; Editor assigned: 28-June-2022, PreQC No. ijocs-22-67370 (PQ);Reviewed: 01-July-2022, QC No. ijocs-22-67370 (Q); Revised: 12-July-2022, Manuscript No. ijocs-22-67370 (R); Published: 25-July-2022, DOI:10.37532/1753-0431.2022.16(7).250
Abstract
Background: Oxygen therapy is a medical treatment prescribed to prevent or treat hypoxemia. Based on a WHO report every year at least 1.4 million deaths occur due to the lack of supplemental oxygen therapy and inappropriate administration of oxygen. Oxygen therapy is the administration of oxygen as a medical intervention, which can be used for a variety of medical conditions. Patients can be harmed by receiving too little or too much oxygen. In addition, assessment of the need for oxygen in most cases is a nursing responsibility. Administering oxygen therapy (OT) has an essential role in preventing/ managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94% to 98% in most cases.
Objective: To assess the knowledge, attitude, and practice of nurses on supplemental oxygen therapy in Wolaita Sodo University Teaching and Referral Hospital, 2021.
Methods: An institution_based cross-section study design was conducted to collect data from 268 sampled nurses in the hospital. A structured questionnaire was used to assess KAP related to oxygen therapy of nurses currently working at Wolaita Sodo University Comprehensive Specialized Hospital. The attitude was assessed using a Likert scale from 1 to 5, whereas practice was assessed as a yes/ no categorical variable supported by an observational checklist developed from the literature. Data were collected using structured questionnaires that measure nurses’ knowledge, attitudes, and practice regarding supplemental oxygen therapy. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. The descriptive analysis of frequency distribution was conducted and the data were presented with tables, figures, and diagrams.
Results: Among 268 nurses included in the study with a response rate of 98.17%, 38.2% were males. The mean score on knowledge, attitude, and practice were 3.03 (SD= 1.6665), 13.76(SD= 2.102), and 3.0921(SD= 1.76183) respectively. Levels of knowledge, attitude, and practice on oxygen therapy were poor and good in 119(44.40%) and 149(55.60%) for knowledge; 105(39.20%) and 163(60.80%) for attitude; 70(26.10%) and 198(73.90%) for practice respectively.
Conclusions: This study showed that there is relatively good knowledge, attitude, and practice among nurses than in the previous other studies but it is less than the standard performance. It gives clues for policymakers and stack holders to prepare different training and workshops for nurses regarding oxygen therapy and be updated. National oxygen therapy guidelines or hospital protocols must be developed. Oxygen supply and delivery devices should always be adequate and be used properly.
Keywords
Knowledge; Practice; Nurse; Oxygen
Introduction
Oxygen therapy (OT) is a medical treatment prescribed mainly for hypoxic patients; OT provides oxygen at higher concentrations than that found in the atmosphere (>21%) [1]. It is listed as a core item on the World Health Organization (WHO) model of essential medicines, which is a list of the most effective and safe drugs used in a health care system [2]. In Ethiopia, the optimal amount and method of oxygen delivery vary depending on a patient’s underlying medical condition and whether the condition is acute or chronic. The selection of the best oxygen delivery device and flow rate of oxygen depends on many factors some of which are the patient’s age, therapeutic goals, and patient tolerance.
Even though OT is one of the most widely used resuscitation methods, it may harm or cause a patient’s status to deteriorate if used inappropriately. Pulmonary oxygen toxicity and oxygen_induced hypercapnia are considered two of the major side effects of OT [3, 4]. A favourable effect that improves survival rates has been reported at OT saturations between 94% and 98% for acutely ill patients; however, lower saturation, 88% to 92% should be considered for patients with suspected risk of hypercapnic respiratory failure.
Oxygen Therapy (OT) is a medical treatment used for tissue hypoxia. It has the potential to improve medical outcomes and save lives when used appropriately and cause harm if used inappropriately. Oxygen is listed as a core item in the World Health Organization’s (WHO) model of essential medicines used in a healthcare system [4].
Administering SOT has an essential role in preventing and managing hypoxemia in both acute and chronic conditions. SOT is considered a key instrument in resuscitating patients during general evaluation [5, 6]. SOT has a pivotal role in saving the lives of many patients with heart and lung diseases if used at an appropriate time and in an appropriate amount according to WHO updated guidelines [4,7].
Even though OT is one of the most widely used resuscitation methods, it may harm or cause a patient’s status to deteriorate if used inappropriately. Pulmonary oxygen toxicity and oxygen_induced hypercapnia are considered two of the major side effects of OT [8, 9]. A favourable effect that improves survival rates has been reported at OT saturations between 94% and 98% for acutely ill patients; however, lower saturation, 88% to 92% should be considered for patients with suspected risk of hypercapnic respiratory failure [9]. A study done in Bethesda on trauma patients admitted to the ED room reported that the mortality rate in patients who received pre-hospital OT was higher than in those who did not receive OT [10].
Long-term OT is the provision of oxygen supplements over a minimum of 15 hours per day, including an overnight period. The benefit of long-term OT has been controversial and much disputed within the field of chronic obstructive pulmonary disease [9,11]. There is evidence on OT in patients with mild or moderate hypoxemia may improve their neurocognitive function and quality of life, but it might not reduce the mortality rate.
According to the study conducted in Ethiopia; Addis Ababa governmental hospital, the mean score of knowledge, attitude, and practice (KAP) concerning O2 use was 3.03 (SD=1.6665), 13.76 (SD=2.102), and 3.0921 (SD=1.76183) respectively; 38.2% of participants were males and their median age was 26-30 years. The level of KAP of oxygen therapy was poor and good in 97 (63.8%) and 55 (36.2%) of nurses concerning knowledge 71 (46.7%) and 81 (53.3%) regarding attitude and 86 (56.6%) and 66 (43.4%) with regards to practice [12].
Based on research studies conducted in different countries there is a knowledge and practice gap in oxygen therapy among practising nurses in hospitals [6, 12]. For instance; the study conducted in Addis Ababa showed that there are knowledge, attitude, and practice gaps among nurses who were working in an ED of a public hospital in Addis Ababa. To the authors’ knowledge, it is hard to find studies that have been conducted in the study setting to identify the knowledge and practice of nurses in public hospitals. Therefore, this study aims to assess and identify the knowledge, attitude, and practice of nurses with OT.
Methods
• Study area and period
The study was conducted by Wolaita Sodo University Comprehensive specialized hospital. The Hospital is located in Wolaita Sodo which is 394 km far from Addis Ababa, the capital city of Ethiopia in the Southern direction and is also 134 km far from Hawassa city, the capital of the SNNPR regional state. The hospital provides preventive, curative, and rehabilitative services for the catchment and surrounding population. As well it is a teaching and training centre for the University health science students and continuous professional development programs. The study was conducted from September to October 2014 at Wolaita Sodo University Teaching and Referral Hospital.
• Study design
An institution_based simple cross-sectional design was used.
Source Population
The source population was nurses in the study hospital were used as a source population.
Study Population
Among a total of 1247 nurses, all nurses and midwives who were working in emergency departments were the study population.
Inclusion Criteria
All Bsc nurses and diploma nurses (diploma, BSc. or above) who were working in the study hospital were included in the study.
Exclusion Criteria
Nurses who were having an incomplete response to the questionnaire and nurses with annual leave, maternity and sick leave during the study period were excluded.
Sample Size and Sampling Technique
The Sample size was calculated using the single population proportion formula
Description:
n = required sample size ;
Z = confidence level at 95% (standard value of 1.96)
p = estimated prevalence of the variable (56.4%) (Knowledge level of O2 therapy by nurses)
d = margin of error at 5% (standard value of 0.05)
Calculated sample size was 378. However, the population is 723 (less than 10,000); the required sample size is calculated using the finite Population Correction for Proportions formula.
This gives a sample size of 248 and by considering the 10% non-response rate; finally calculated sample size became 273.
• Data collection tools and techniques
A questionnaire in English was adopted from previous studies and literature done among nurses. Reliability and content validity was done before final data collection through pretesting done in Dubbo saint marry primary hospital. T he questionnaire included demographic information such as gender, age, category of the profession and total duration of work. There was an additional four sections: OT knowledge, OT attitude, and OT practice. The questions were asked using a Likert scale in which “strongly agree” scored five and “strongly disagree” scored one. T he questionnaires were self-administered to the participants by data collectors and were collected one hour after distribution on the same day.
Data Analysis
After data collection, the questionnaires were entered into SPSS and checked for correctness. Data were managed and analyzed using SPSS. T he Statistical Package for the Social Sciences V.23 (SPSS) was used for data management and analysis. Descriptive statistics were used to assess the baseline demographics; they were carried out by calculating the frequencies and percentages comparing those who had a fall and those who had not. Prevalence was calculated with 95% CI. The mean scores were calculated for the KAP and categorized further into categorical variables: knowledge was reported as having good knowledge or poor knowledge; attitude was presented as good and poor attitude, and practices were categorized as good and poor practices. All categories were done based on a Likert scale of 1 to 5.
Quality Control Measures
A brief orientation and training were given to data collectors and supervisors and during data collection, the supervisor monitored closely on each day of data collection. A Pre-test of the questionnaires was conducted.
Ethics Approval and Consent to Participate
The research proposal was approved by the Wolaita Sodo University College of Health Sciences and Medicine ethical committee. Before data collection, each study participants were well informed about the study, and informed verbal consent was secured from the study participants; study participants’ confidentiality was maintained; no personal identifiers were used in the data collection questionnaire, and codes were used in place of them.
Operational Definitions
• Good knowledge
Nurses who scored the correct response or answers to knowledge questions above the mean result.
• Good attitude
Nurses who scored the correct response or answers to attitude questions above the mean result.
• Good practice
Nurses who scored the correct response or answers to practice questions above the mean result.
• Poor knowledge
Nurses who answer knowledge questions below the mean result.
• Poor attitude
Nurses who scored the correct answer to attitude questions below the mean result.
• Poor practice
Nurses who gave the correct answer to practice questions below the mean result.
Results
• Socio-demographic Characteristics of Nurses
A total of 268 nurses with a response rate of 98.13% participated in the study. Among the study participants, 68.90% were females. Age categories ranged from 20 years - 30 years, 174(64.90%), 30 years - 40 years 86(32.10%), and >40 years 8(30%) respectively. Among 268 nurses the type of nursing profession were diploma nurses 27(17.8%), BSc nurses 104(68.4%) (Table 1).
Table 1: Socio-demographic characteristics of nurses working in WSUCST hospital, Ethiopia, 2021. (N=268).
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Sex | Male Female |
81 187 |
30.20 69.80 |
| Total | 268 | 100 | |
| Age | 20–30 years 30–40 years >40 years |
174 86 8 |
64.90 32.10 3.00 |
| Total | 268 | 100 | |
| Religion | Protestant Orthodox Muslim | 156 85 18 |
58.20 31.70 6.70 |
| Total | 268 | 100 | |
| Educational background | Diploma Nurse Degree (BSC Nurse) | 81 187 |
30.20 69.80 |
| Total | 268 | 100 | |
| Marital Status | Single Married Divorced | 99 169 |
36.90 63.10 |
| Total | 268 | 100 | |
| Work experiences | ≤5 years 5–10 years 11-30years ≥30 years |
41 39 163 25 |
15.2 14.5 61.0 9.3 |
| Total | 268 | 100 | |
| Type of Ward | Emergency Pediatrics Surgical Medical Oby-gyn Other |
90 61 27 28 44 18 |
33.6 22.8 10.1 10.4 16.4 6.0 |
| Duration of work in Oxygen Therapy | <=1year 1-5years 6-10years >10years |
36 71 90 71 |
13.4 26.5 33.6 26.5 |
| Total | 268 | 100 |
Knowledge of Nurses about Oxygen Therapy
Among a total of 14 knowledge questions provided, the mean knowledge score of the participants was 11.20 ± 1.75. The majority, 250 (93.30%) were aware that SOT should be administered to treat and prevent hypoxia, while 153 (57.10%) nurses were aware that SOT is contraindicated for untreated pneumothorax. Regarding normal oxygen saturation, 258(96.30%) of them answered correctly. Almost all respondents (248, 92.50%) were aware that a non-rebreathing oxygen face mask with a reservoir bag is used to deliver a higher oxygen concentration than a nasal prong (Table 2).
Table 2: Nurses' knowledge of Supplemental Oxygen Therapy in WSUCST hospital, Ethiopia, 2021. (n=268).
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Supplemental Oxygen therapy is used to prevent and treat hypoxia | Aware Not aware |
250 18 |
93.30 6.70 |
| The normal oxygen saturation for an adult is 95–100% | Aware Not aware |
258 10 |
96.60 3.40 |
| Supplemental oxygen therapy is indicated during surgery | Aware Not aware |
258 10 |
96.60 3.40 |
| Supplemental oxygen therapy is indicated during shock | Aware Not aware |
161 107 |
60.10 39.90 |
| Pulse oximetry monitoring is affected by nails varnish/ paint, hypothermia, and or patient position | Aware Not aware |
242 26 |
90.20 9.70 |
| The humidifier reduces the risk of dry oxygen and its side- effects | Aware Not aware |
204 64 |
76.10 23.90 |
| Non-rebreathing oxygen face mask with a reservoir bag is used to deliver higher oxygen concentration than a nasal prong | Aware Not aware |
248 20 |
92.50 7.50 |
| During oxygen therapy, apply water_based gauze if lips or nose become dry | Aware Not aware |
232 36 |
66.60 13.40 |
| Supplemental oxygen is contraindicated for untreated pneumothorax | Aware Not aware |
153 115 |
57.10 42.9 |
| For severe lung diseases, patients can take oxygen therapy | Aware Not aware |
206 62 |
76.90 23.10 |
| The oximeter can be affected by nail, position, or hypothermia | Aware Not aware |
242 26 |
90.30 9.70 |
| Supplemental oxygen is used in surgery | Aware Not aware |
258 10 |
96.30 3.70 |
| know oxygen therapy indication | Aware Not aware |
259 9 |
96.60 3.40 |
| Know oxygen therapy contraindication | Aware Not aware |
258 10 |
96.30 3.70 |
In this study, about 55.60% of the nurses had good knowledge whereas 44.40% of nurses had poor knowledge of oxygen therapy (Table 3).
Table 3: Nurses' knowledge levels of Supplemental Oxygen Therapy in WSUCST hospital, Ethiopia, 2021. (n=268).
| Variable | Values | Frequency | Percent |
|---|---|---|---|
| Knowledge | Poor knowledge Good knowledge |
119 149 |
44.40 55.60 |
• An attitude of Nurses toward Oxygen Administration
Among a total of 7 attitude questions provided, the mean attitude score of the participants was 6.30 ± 1.54 (Table 4).
Table 4: Nurses' mean and SD of attitude to supplemental oxygen therapy in WSUCST hospital, Ethiopia, 2021. (n=268).
| Outcome | Mean | Std. Deviation |
|---|---|---|
| Attitude | 5.32 | 1.750 |
In this study, about 60.80% of the nurses had a good attitude, whereas 39.20% of nurses had a poor attitude toward oxygen therapy (Table 5).
Table 5: Nurses' attitude levels on supplemental oxygen therapy in WSUCST hospital, Ethiopia, 2021. (n=268).
| Outcome | Values | Frequency | Percent |
|---|---|---|---|
| Attitude | Poor attitude Good attitude |
105 163 |
39.20 60.80 |
• The practice of Nurses in Oxygen administration
Observational practice cheek lists were used to assess nurses’ practice on supplemental oxygen administration. Only 21.9% and 27.9% of the nurses assessed oxygen saturation and vital signs during supplemental oxygen administration, respectively (Table 6).
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Assess oxygen saturation before administration | Yes No |
251 17 |
93.70 6.30 |
| Assess oxygen saturation during administration | Yes No |
232 36 |
86.60 13.40 |
| Check the device before administration | Yes No |
242 26 |
90.30 9.70 |
| Collect all necessary equipment before administration | Yes No |
234 34 |
87.30 12.70 |
| Adjust the flow rate appropriately during the administration | Yes No |
251 17 |
93.70 6.30 |
| Use appropriate device size and way | Yes No |
251 17 |
93.70 6.30 |
| Follow the patient's vital signs during the administration | Yes No |
241 27 |
89.90 10.10 |
The mean practice score was 2.37 ± 1.76 (Table 7).
Table 7. The summarized mean and SD Practice on oxygen therapy, WSUCST hospital from Oct 10-25, 2021. (n=268).
| Practice | Mean | Std. Deviation |
|---|---|---|
| 6.30 | 1.540 |
Based on the observed practice of supplemental oxygen administration, about 73.90% of the nurses had a good practice and the rest (26.10%) of nurses had a poor practice of supplemental oxygen administration. (Table 8).
| Variable | Values | Frequency | Percent |
|---|---|---|---|
| Practice | Poor practice Good practice |
70 198 |
26.10 73.90 |
Discussion
Oxygen therapy is the administration of oxygen as a medical intervention, which can be used for a variety of medical and surgical conditions. Patients can be affected by getting no oxygen or too little or too much oxygen. It is appropriate to provide the optimal concentration of supplemental oxygen to the acutely ill hypoxemic patient; inadequate oxygen administration may result in cardiac arrhythmias, tissue injury, renal injury, and ultimately cerebral damage.
In this study, 44% of nurses had poor knowledge of oxygen therapy. This finding is comparable with research done in Beirut hospitals (55.1%) and Eritrean hospitals (56.7%), a nurses who had a low level of knowledge regarding oxygen therapy but lower than in Addis Ababa, Ethiopia, which shows that 63.8% of nurses had poor knowledge regarding oxygen therapy. T his discrepancy might be due to the sample size, study setting, and study period difference. Research in Nottingham University Hospitals stated that nurses should know oxygen therapy indications, and normal oxygen saturation at different ages, including normal respiration rates. This study approved that nurses who were working in the hospital during the study period and in the study areas have a knowledge gap on oxygen therapy.
The practice level of nurses on oxygen administration in this research showed that only 74% of the nurses had good practice. This f inding is lower than studies conducted in Addis Ababa hospitals 31(43.4%), Eritrean hospitals 32(45%), and Egypt hospitals 33(74.5%). T his might be due to the difference in nurses’ training regarding OT, unavailability of oxygen administration guidelines, and increased workload of nurses (because nurses’ activities are more than their job description). Based on this study barrier, the factors which could affect the good practice of oxygen administration are the unavailability of a standardized protocol for oxygen therapy, lack of training about OT, and an inadequate supply of O2 and delivery system. T his finding is supported by research conducted in Egypt, Addis Ababa, Ethiopia and Eritrea respectively.
Good knowledge among nurses who were working in the hospital was found to be 149(50.60%) whereas nurses with poor knowledge were 119(44.40%) which is lower than the mean score of 11.2(SD=1.75). Assessment of nurses’ knowledge of oxygen therapy was mainly focused on the indications of oxygen therapy, normal oxygen saturation, and rate of respiration in children. The guidelines from Western Australian Hospitals, British Thoracic Society, Nottingham University Hospitals, Ipswich Hospital, and Royal United Hospitals stated that nurses should know oxygen therapy indications and normal oxygen saturation at different ages including normal respiration rates. This study approved that nurses who were working in the EDs during the study period and in the study areas have a knowledge gap on oxygen therapy.
A good attitude or positive attitude was found to be 163(60.80%) with a mean score of 5.32(SD=1.720) and poor practice was 105(39.20%) which is lower than the mean score. The guideline for Oxygen therapy and delivery devices for paediatrics describes nurses should have an encouraging attitude toward the need for oral and nasal hygiene in children and use humidification devices when administering oxygen therapy. Even if more than half of nurses have a positive attitude toward oxygen therapy much more awareness should have to be done.
Assessment of good practice on oxygen therapy was found to be 198(73.90%) with a mean score of 5.32(SD=1.720) and poor practice was 105(39.20%) which is lower than the mean score. Practical questioners were focused on best practices in pulse oximetry, humidification device attachment, and usage of nasal cannula and facemasks. The guidelines from Nottingham University Hospitals, City Hospital/Queens Medical Centre Nursing practice guidelines for the administration of oxygen and Royal United Hospitals and standard guidelines for oxygen administration and monitoring explained that nurses should have to be skilled in the best practices on pulse oximetry, humidification attachment, use of different oxygen devices to save the life of many emergency patients.
Strengths and Limitations
The strength of this study was to study trying to assess nurses’ KAP and practices on oxygen therapy and this gives clues and alarms other research to identify the gaps. The study has some limitations like the nature of study design and bias effect since the study used self-reported data or data collected through self-administered questionnaires
Conclusion
In conclusion, this study demonstrates that there is relatively good knowledge, attitude, and practice among nurses related to SOT use but has not been achieved to the expected level. The possible reason for this gap includes a shortage of training on SOT, unavailability of national as well as hospital SOT guidelines, and excessive nurse workload. Education programs on the occupational use of SOT through in-service training and workshops are important to raise the awareness and practice of nurses about SOT. Hospital nurses also need to be made aware and skilful regarding the updated guidelines for SOT. T he unavailability of well-functioning equipment and poor maintenance of nonfunctional oxygen machines are the most serious and additional burdens of nurses with SOT.
Recommendations
Therefore, the hospital should have well-trained and always stand by the biomedical technologists to solve such problems. Nurses should be given training on oxygen therapy and be updated and National oxygen therapy guidelines must be there in place.
Author’s contribution
Hindus made substantial contributions; Hindus plays a great role design of the study, managing the collected data, analyzing, and preparing the manuscript. Elsabeth participated in supervision and coordination during and final reading and editing of the manuscript. Biskut participates in the reporting and summarization of the research paper and manuscript. All authors read and approved the final manuscript.
Acknolowegment
First, and for most, we would like to express our heartfelt thanks to Wolaiat Soddo University librarian workers for their cooperation during the literature review by providing the necessary material and resources. Finally, we would like to acknowledge all our respondents for accepting to take their time to give much valuable information that made this study successful. We also extend our thanks to our data collectors and supervisors.
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