Nurses’ Knowledge and Attitude Towards COVID-19 Patients

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Table of Contents

Topic Importance
Question
Background Information
Topic Significance to Nursing Practice
Purpose of the Project
Literature Summary
Literature Analysis
Research Question, Ethics Approval, and Timeline
Study Design
References

Topic Importance

Knowledge, attitude, and practice play an important role in the prevention and control of virus outbreaks. Nursing is an essential component of medical care, and nurses’ knowledge about the disease directly affects healthcare effectiveness and patient outcomes. During an outbreak, nurses play a positive role in improving the recovery rate, reducing the length of the hospital stay and mortality, and preventing in-hospital infection (Jin et al., 2020). Knowledge of the disease significantly influences nursing practice, with incorrect attitudes and insufficient knowledge directly increasing the risk of infection (Zhang et al., 2020). Understanding the level of nurses’ awareness and preparedness towards COVID-19 allows health authorities to implement relevant measures directed at the prevention and control of infection in healthcare facilities.

Question

In COVID-19 patients, how does the nurses’ good knowledge and positive attitude influence patient outcomes, compared to insufficient knowledge and negative attitude during the pandemic?

Background Information

The COVID-19 pandemic has affected all groups of the population all over the world, with health care providers being at the most risk of contracting and transmitting the infection. At the initial stages of the disease outbreak, health care professionals working at the front line were often infected due to negligence and lack of knowledge (Tamang et al., 2020). The infection rates in most countries were reduced by increasing the level of knowledge and implementing protective and prevention measures, which also resulted in a more positive attitude of nurses and doctors towards COVID-19 patients. In order to control and prevent infection, education and training programs for healthcare workers need to be developed that address the most important issues encountered in their practice during the pandemic.

Topic Significance to Nursing Practice

Working with COVID-19 patients is challenging for nurses due to the novelty of the disease, lack of information, fear of infection, and the psychological trauma resulting from patient deaths. Decreasing the level of stress and anxiety among nurses is important for improving both the quality of care and their own wellbeing. The findings show that good knowledge of the disease and proper implementation of infection control measures are significant predictors of the nurses fulfilling their professional care obligations (Nashwan et al., 2020). If the factors that affect nurses’ knowledge, attitude, and practice towards COVID-19 can be determined promptly and properly, relevant training and policies can be developed that prioritize their protection and reduce the level of stress.

Purpose of the Project

The purpose of the project is to identify the problems in nurses’ knowledge and attitude towards COVID-19 patients based on cross-sectional survey results.

Literature Summary

Authors, Title, Publication Date	Problem	Purpose	Data Collection Method	Sample	Major Findings / Conclusions for Quantitative Research
Tadesse. D. B., Gebrewahd, G. T., & Demoz, G. T. Knowledge, attitude, practice and psychological response toward COVID-19 among nurses during the COVID-19 outbreak in northern Ethiopia, 2020. 2020.	Nurses’ practice and infection control measures are affected by their knowledge of the disease and psychological response towards it.	To determine the knowledge, attitude, practice, and psychological response among nurses towards the COVID-19 outbreak in northern Ethiopia.	A self-administered questionnaire, adopted from other published articles and modified to fit the local context. The data was collected from March to April 2020.	415 nurses selected by using a sample random technique from a number of public health facilities.	Of the 415 nurses, 74%, 67%, 72%, and 85.3% had good knowledge, good infection prevention practice, a favorable attitude, and a disturbing psychological response towards COVID-19, respectively.
Jin, Z., Luo, L., Lei, X., Zhou, W., Wang, Z., Yi, L., & Liu, N. Knowledge, attitude, and practice of nurses towards the prevention and control of COVID-19. 2020.	Nurses’ knowledge, attitude, and practice (KAP) about the prevention and control of the disease directly affect patients’ outcomes, but there is little knowledge about the nurses’ KAP during the COVID-19 pandemic.	To understand the current status of the KAP of nurses towards the prevention and control of COVID-19 during the outbreak in March 2020.	An anonymous survey using a customized questionnaire designed on the Sojump platform.	1323 nurses in Wuhan working at designated COVID-19 hospitals, non-designated hospitals, and Fangcang shelter hospitals in Wuhan.	Nurses showed comprehensive knowledge of protection and prevention measures, with more than 60% accuracy. However, they reported a general lack of knowledge about the route of transmission of COVID-19, the use of protective equipment, and patient management, with less than 45% accuracy.
Al-Dossary, R., Alamri, M., Albaqawi, H., Al Hosis, K., Aljeldah, M., Aljohan, M., Aljohani, K., Almadani, N., Alrasheadi, B., Falatah, R., & Almazan, J. Awareness, attitudes, prevention, and perceptions of COVID-19 outbreak among nurses in Saudi Arabia. 2020.	Nurses’ knowledge, attitudes, and perceptions of the COVID-19 outbreak influence clinical management strategies and are critical to expediting positive outcomes.	To examine nurses’ demographic information, awareness, attitudes, and perceptions of COVID-19 during the outbreak in Saudi Arabia in May 2020.	A cross-sectional descriptive study using the Kruskal-Wallis test and the Mann-Whitney test.	500 nurses working at government and non-governmental hospitals in five regions of Saudi Arabia, selected using convenience sampling.	The majority of nurses (96.85%) showed excellent knowledge of COVID-19, and 83.2% of nurses reported significant prevention knowledge and treatment skills. More than half of the respondents (60.4%) had high positive attitudes toward caring for COVID-19 patients.
Alrubaiee, G. G., Al-Qalah, T. A. H., & Al-Aawar, M. S. A. Knowledge, attitudes, anxiety, and preventive behaviors towards COVID-19 among health care providers in Yemen: An online cross-sectional survey. 2020.	Improving the knowledge, attitude, and practice towards COVID-19 is crucial for protecting and enhancing the ability of health care providers to perform their role in responding to COVID-19.	To study the knowledge, attitude, anxiety, and preventive behaviors among Yemeni health care providers towards COVID-19.	A descriptive cross-sectional study using an online questionnaire adapted from previously published studies. The data was collected in April 2020.	1231 health care providers, with nurses constituting 16% of the respondents.	The results revealed that the majority of respondents had adequate knowledge, optimistic attitude, moderate level of anxiety, and high performance in preventive behaviors (69.8%, 85.1%, 51%, and 87.7%, respectively) towards COVID-19.
Nashwan, A., Abujaber, A., Mohamed, A., Villar, R., & Al-Jabry, M. Nurses’ willingness to work with COVID-19 patients: The role of knowledge and attitude. 2020.	The knowledge and attitude of nurses and other health care professionals largely influence the degree of adherence to the proper use of personal protective measures and clinical outcomes for patients with COVID-19.	To assess the role of nurses’ knowledge and attitude to their willingness to work with patients diagnosed with COVID-19 in Qatar.	A cross-sectional study using a 35-item self-administered online survey based on a Likert-style questionnaire, which included different levels of questions about the knowledge and attitudes towards COVID-19.	377 nurses who completed the survey distributed to all the nursing services at Hamad Medical Corporation in June 2020.	Nurses’ knowledge level and monetary compensation associated with the risk were found to have a significant positive relationship with their willingness to care for patients with COVID-19.
Zhang, M., Zhou, M., Tang, F., Wang, Y., Nie, H., Zhang, L., & You, G. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. 2020.	Knowledge of the disease influences health care workers’ attitudes and practices, and incorrect attitudes and practices directly increase the risk of infection.	To investigate KAPs regarding COVID-19 among health care workers in Henan, China, in February 2020.	A self-administered online questionnaire designed to assess KAP concerning COVID-19.	1357 health care professionals working in medical and surgical wards and intensive care units in ten public hospitals in Henan, China, with nurses constituting 46.5% of the respondents.	89% of health care workers showed significant knowledge of COVID-19; more than 85% feared self-infection, and 89.7% followed correct practices regarding the infection.
Tamang, N., Rai, P., Dhungana, S., Sherchan, B., Shah, B., Pyakurel, P., & Rai, S. COVID-19: A national survey on perceived knowledge, attitude and practice among healthcare workers in Nepal. 2020.	Frontline health care workers are prone to infection, with the lack of knowledge being the primary causative factor.	To determine the KAP regarding COVID-19 among frontline health care workers in hospitals in Nepal in June 2020.	A cross-sectional survey using a self-administered online questionnaire based on previously published papers.	603 doctors, nurses, and paramedics working at different hospitals in Nepal, with nurses constituting 56.7% of the respondents.	Among the participants, 76% reported adequate knowledge, 54.7% reported a positive attitude, and 78.9% reported appropriate practice.
Elhadi, M., Msherghi, A., Alkeelani, M., Zorgani, A., Zaid, A., Alsuyihili, A., Buzreg, A., Ahmed, H., Elhadi, A., Khaled, A., Boughididah, T., Khel., S., Abdelkabir, M., Gaffaz, R., Bahroun, S., Alhashimi, A., Biala, M., Abulmida, S., Elharb, A.,… Amshai, A. Assessment of healthсare workers’ level of preparedness and awareness regarding COVID-19 infection in low-resource setting. 2020.	COVID-19 poses a higher risk for physicians and nurses working on the frontline, which raises concerns regarding their preparedness, readiness, and knowledge.	To determine the level of preparedness and knowledge of Libyan healthcare workers regarding COVID-19 and to develop a measurement tool for estimating healthcare preparedness on a global scale.	A self-administered anonymous questionnaire developed by the authors of the study based on a framework similar to the of previous studies of infectious disease outbreaks. The data was collected between February 26, 2020, and March 10, 2020.	1,572 healthcare workers employed in the emergency departments, intensive care units, and respiratory and infectious disease departments in 21 hospitals in Libya, with nurses constituting 34.9% of the respondents.	A significant number of respondents expressed low levels of awareness and preparedness regarding COVID-19, with 77.4% of health care workers feeling personally unprepared to address the pandemic.
Huyhn, G., Nguyen, T. N. H., Tran, V. K., Vo, K. N., Vo, V. T., & Pham, L. A. Knowledge and attitude towards COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. 2020.	Health care workers are at a high risk of getting the infection and transmitting it to patients.	To assess the knowledge and attitude towards COVID-19 among health care workers at District 2 Hospital in Ho Chi Minh City, Vietnam, between January 2020 and February 2020.	A self-administered questionnaire designed according to Ahmed M. Asaad’s study on the Middle East Respiratory Syndrome Coronavirus and the Question and Answer about COVID-19 in the webpage of the World Health Organization.	327 health care workers employed at District 2 Hospital in Ho Chi Minh City, with nurses constituting 70.9% of the respondents.	The majority of health care workers had good knowledge and a positive attitude toward COVID-19. However, the level of some knowledge and attitude was lower than expected for their position.
Hoque, A. M., Buckus, S., Hoque, M., & Hogues, M. E. Knowledge, attitude & practices of primary healthcare workers on COVID-19 from a rural setting of Kwa-Zulu-Natal, South Africa. 2020.	Knowledge, attitude, and practices of the COVID-19 pandemic play a significant role in reducing the transmission of the virus, particularly among health care workers.	To investigate the KAP of health care workers from a primary health care setting in South Africa in September 2020.	A cross-sectional study using a self-administered anonymous questionnaire developed using previously published articles.	159 health care professionals employed at KwaDabeka Community Healthcare Center and seven public clinics, with nurses comprising 69.2% of the respondents.	Only 24% of the respondents had good knowledge of COVID-19; 81% had a positive attitude, and 63% reported good practice.

Literature Analysis

Problems and Purposes

The reviewed literature focuses on the importance of increasing nurses’ knowledge and attitude towards COVID-19. During the pandemic, health care professionals experience a high risk of infection and transmitting the infection to patients (Hyuhn et al., 2020), with the lack of knowledge being the primary causative factor (Tamang et al., 2020). Increasing nurses’ awareness helps to improve clinical management strategies (Al-Dossary et al., 2020), enhance the ability of health care providers to perform their role (Alrubaiee et al., 2020), and improve patient outcomes (Nashwan et al., 2020). All reviewed articles aim to assess the knowledge, attitude, and practice of nurses and other healthcare workers towards COVID-19 and determine the main issues of concern that need to be addressed.

Research Methods

All ten reviewed articles use self-administered online questionnaires as the data collection method. There is no unified framework for survey design, and each research uses slightly different questionnaires developed by the authors based on previously published studies and modified in accordance with local specifics and research objectives. Most surveys include a section on demographic characteristics of the participants and three to four sections on knowledge, practice, and attitude towards COVID-19.

In most studies, surveys were distributed over the internet to nurses and health care practitioners working in hospitals in a particular region. The number of respondents varies between 159 and 1,572, with nurses constituting no less than a half of the respondents. In each case, the data was examined using different software, with descriptive statistics being the most popular method of analysis. The reviewed studies were performed from January to September 2020 in nine countries: Yemen, Qatar, China, Nepal, Vietnam, Libya, Saudi Arabia, Ethiopia, and South Africa.

Findings and Conclusions

Different studies show varying levels of knowledge, attitude, and practice towards COVID-19 among health care professionals in different countries. It can be concluded that the general level of nurses’ awareness and preparedness depends on each country’s level of development, quality of healthcare, and pandemic response. For example, China, where the pandemic started, displays significant knowledge of COVID-19 among nurses (Zhang et al., 2020), while in less developed countries, such as Libya, health professionals show low levels of awareness and preparedness (Elhadi et al., 2020). Based on research results, specific problems can be identified that each particular region needs to address at the given period.

Strengths and Weaknesses

A questionnaire is a data collection method that allows researchers to gather lots of information from many people. They can be conducted online, which reduces the risk of disease transmission during the pandemic. They are also cost-effective, allowing researchers to collect data from large samples for a relatively low cost, which is especially relevant for less developed countries that cannot afford large-scale research (DeCarlo, 2018).

The weaknesses of the method include its inflexibility and depth. Most surveys generally consist of true/false or Lykert-scale questions that are easy to analyze but provide no detail to comprehensively examine the topic (DeCarlo, 2018). Particular problems and reasons behind them are hard to determine using standardized questionnaires. Overall, the questionnaire is a reliable method for quantitative evaluation of the knowledge and attitudes towards the disease at a given period in a particular region that can serve as a basis for future research.

Similarities and Differences

All ten studies have the same purpose and use the same data collection method. For each study, the questionnaires were developed by the authors based on the local specifics and research objectives, which explains differences in the structure and topics covered in each survey. For example, the study of nurses’ knowledge and attitudes in Ethiopia focuses on their psychological response towards the infection (Tadesse et al., 2020). The study conducted in Ho Chi Minh City concluded that the level of some knowledge and attitude among nurses was lower than expected for their position (Hyuhn et al., 2020). Overall, while addressing the same problem, each study approaches it from a slightly different perspective, which helps to develop a comprehensive picture of issues encountered by nurses during the pandemic.

Practical and Clinical Significance

The analysis of the level of knowledge, attitude, and practice among nurses in different countries at different stages of the pandemic provides important information on each country’s level of preparedness at a given period. The results have significant implications for future actions, such as increasing COVID-19 prevention awareness and control guidelines, providing training and support for nurses, improving healthcare strategies, and addressing specific problems identified in studies. The countries that display a low level of nurses’ knowledge and awareness could invest in training and implement measures to boost their willingness and preparedness to work with COVID-19 patients.

Research Question, Ethics Approval, and Timeline

The research aims to determine how does the nurses’ good knowledge and positive attitude towards COVID-19 patients influence patient outcomes, compared to insufficient knowledge and negative attitude during the pandemic. In order to answer the question, a comprehensive analysis of research articles needs to be conducted that assess the level of knowledge and attitude of nurses towards COVID-19 in different countries. The research needs to be reviewed by the relevant Institutional Review Board. It can be performed on site and requires no additional costs. The estimated project completion time is three months.

For participation in the research, an informed written consent needs to be obtained from the respondents. Participants must be provided with all relevant information about the research that permits them to make an informed and voluntary decision about whether or not to participate. The consent should be obtained prior to the research using an online consent form sent together with a link to the survey. The consent form can be obtained from the relevant IRB’s website (for example, Templates and forms, n.d.) and adapted to fit the research objectives.

Study Design

Subjects and Setting

For the purpose of the project, the questionnaire will be distributed among the nursing staff working in isolation, intensive care units, and ER. The setting is designated COVID-19 hospitals and non-designated public hospitals in the Madinah region of Saudi Arabia.

Sample Size

The target sample size is 300 nurses working in isolation, intensive care units, and ER. The target sample size is determined based on the previous studies, which included between 150 and 1,500 health care professionals, with around 300 nurses being an average sample size.

Inclusion Criteria

Inclusion criteria are employment in isolation, intensive care units, and ER in the hospitals in the target region, and participation in working with COVID-19 patients. No special requirements are placed on work experience, age, or education. Prior to the survey, the respondents need to confirm their willingness to participate by completing an online informed consent form.

Recruitment Plan

The link to the online questionnaire, together with a consent form. will be distributed through the nursing services of the region, and social platforms used by nurses employed in target hospitals. Participation is voluntary, and the survey will be conducted among nurses who fit all requirements, agree to take part in the research, and sign the consent form.

Data Collection

An online self-administered questionnaire will be used to collect the knowledge, attitude, and practice towards COVID-19. This method was selected as the most reliable, fast, and cost-effective way of evaluating knowledge and attitude based on the previous research on the subject.

Dependent Variables

Dependent variables are the nurses’ knowledge, attitude, and practice towards COVID-19 patients.

Independent Variables

Independent variables are sociodemographic and personal characteristics of nurses working with COVID-19 patients.

References

Al-Dossary, R., Alamri, M., Albaqawi, H., Al Hosis, K., Aljeldah, M., Aljohan, M., Aljohani, K., Almadani, N., Alrasheadi, B., Falatah, R., & Almazan, J. (2020). Awareness, attitudes, prevention, and perceptions of COVID-19 outbreak among nurses in Saudi Arabia. International Journal of Environmental Research and Public Health, 17, 8269. Web.

Alrubaiee, G. G., Al-Qalah, T. A. H., & Al-Aawar, M. S. A. (2020). Knowledge, attitudes, anxiety, and preventive behaviors towards COVID-19 among health care providers in Yemen: An online cross-sectional survey. BMC Public Health, 20, 1541. Web.

DeCarlo, M. (2018). Scientific inquiry in social work. Radford University.

Elhadi, M., Msherghi, A., Alkeelani, M., Zorgani, A., Zaid, A., Alsuyihili, A., Buzreg, A., Ahmed, H., Elhadi, A., Khaled, A., Boughididah, T., Khel., S., Abdelkabir, M., Gaffaz, R., Bahroun, S., Alhashimi, A., Biala, M., Abulmida, S., Elharb, A.,… Amshai, A. (2020). Assessment of healthсare workers’ level of preparedness and awareness regarding COVID-19 infection in low-resource setting. The American Journal of Tropical Medicine and Hygiene, 103(2), 828–833. Web.

Hoque, A. M., Buckus, S., Hoque, M., & Hogues, M. E. (2020). Knowledge, attitude & practices of primary healthcare workers on COVID-19 from a rural setting of Kwa-Zulu-Natal, South Africa. Clinical and Experimental Investigations. Web.

Huyhn, G., Nguyen, T. N. H., Tran, V. K., Vo, K. N., Vo, V. T., & Pham, L. A. (2020). Knowledge and attitude towards COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific Journal of Tropical Medicine, 13(6), 260–265. Web.

Jin, Z., Luo, L., Lei, X., Zhou, W., Wang, Z., Yi, L., & Liu, N. (2020). Knowledge, attitude, and practice of nurses towards the prevention and control of COVID-19. Research Square. Web.

Nashwan, A., Abujaber, A., Mohamed, A., Villar, R., & Al-Jabry, M. (2020). Nurses’ willingness to work with COVID-19 patients: The role of knowledge and attitude. Nursing Open, 0, 1–7. Web.

Tadesse. D. B., Gebrewahd, G. T., & Demoz, G. T. (2020). Knowledge, attitude, practice and psychological response toward COVID-19 among nurses during the COVID-19 outbreak in northern Ethiopia, 2020. New Microbes and New Infections, 38. Web.

Tamang, N., Rai, P., Dhungana, S., Sherchan, B., Shah, B., Pyakurel, P., & Rai, S. (2020). COVID-19: A national survey on perceived knowledge, attitude and practice among healthcare workers in Nepal. Research Square. Web.

Templates and forms. (n.d.). Northwestern. Web.

Zhang, M., Zhou, M., Tang, F., Wang, Y., Nie, H., Zhang, L., & You, G. (2020). Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. Journal of Hospital Infection, 105 (2), 183–187. Web.

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