Knowledge and attitude of ICU nurses plays a vital role in implementing actions for CLABSI. Despite such importance of nurse’s knowledge for CLABSI prevention, less research attention has been paid by the researchers to examine nurse’s knowledge of CLABSI prevention . There is an immense need to develop an instrument for measuring nurse’s knowledge on CLABSI prevention control. Therefore, to determine to which extend ICU nurses understand the correct way of preventing CLABSI, a survey across the province will be conducted, and this instrument was developed for this province-wide study.
In this study, we had outlined key methodologies and considerations for researchers who were interested in developing and verifying a questionnaire about CLABSI. The improved methods used in the development of the questionnaire will enable more confidence in reported measures of CLABSI.
CLABSI is associated with a reported mortality rate of 42% , and it can result in delays in primary disease treatment, increased morbidity and mortality, prolongation of hospital stays, and substantial financial burden. The study had shown that it was essential that nurses receive training and that quality improvement programs were in place to decrease ICU-acquired catheter-related infection .
The study carried out has a sample size of 280 participants. As this is a pilot study, researchers followed the principles of pilot test participants, and the sample size is recommended to be larger than 30 and less than 500 participants [21, 22]. Then we selected 280 ICU nurses using the convenience sampling method for pre-survey in Lanzhou City. While developing the tool, this study also assessed the validity and reliability to ensure the tool is appropriate. Results of this study indicated that the tool has acceptable validity and reliability.
This study was part of the evidence-project, which aimed to create and develop a reliable and customizable questionnaire and provide assessment tools for nurses on CLABSI prevention. Then we used the questionnaire to investigate on KAP of CLABSI of ICU nurses and analyze the influencing factors, to better and more targeted training of ICU nurses and reduce the incidence of CLABSI.
In this study, we first made an initial questionnaire containing 54 items. Then we tested the content validity by panel experts who are ten intensive care experts. After two rounds of panel experts. The Kendall’s were 0.491 and 0.589 respectively. Therefore, the score indicated moderate reliability. At the same time, the coefficient of variation indicated that the expert opinions tend to be consistent. According to the opinions of the interviewed ICU nurses, two items were deleted and adjusted the expressions for seven items.
Items analysis was mainly carried out through critical ratio and homogeneity tests. The results of the critical ratio showed that five items with poor discrimination were deleted. According to the results of the homogeneity test, the correlation between A10 and the total score was low and did not reach the 0.05 level of significance, so it was deleted.
The principal component analysis method and the maximum variation method were used for the orthogonal rotation axis, and the common factor with a characteristic value greater than 1 was extracted. After rotating four times and deleting 10 items, we contained the ultimate component matrix which contains 4 common factors. At the same time, we verified that the four common factors are the most appropriate by the scree plot.
To further verify whether the corresponding relationship between the measurement factors and the items was consistent with expectations, confirmatory factor analysis was carried out. The result showed that the knowledge, attitudes, and practice of CLABSI were both consistent in direction and there were certain differences.
Cronbach’s alpha (α) internal consistency reliability reached the acceptable threshold value. In social science, the acceptable α value is 0.70 , which is also practiced by other researchers. Two weeks later, we conducted a second survey of 41 ICU nurses who participated in the preliminary survey. The results showed that the questionnaire had great stability across time. Finally, we got the ultimate version of the questionnaire, which mainly included three dimensions and 32 items.
The tool may be used as a simple guide to aid researchers in studies related to ICU nurse’s knowledge on CLABSI prevention activities, and a more in-depth instrument can be developed to further improve this instrument.
Several limitations of the present study deserve mention. First, limited by time and resources, the experts are all from Gansu province, which may have a certain impact on the preparation of the initial questionnaire. In addition, we adopted the convenience sampling method and only pre-surveyed ICU nurses in four tertiary general hospitals in Lanzhou City, which may produce a certain selection bias. While the sample size for the study is enough, the additional sample size may add further value to the validation test. Therefore, whether the research results apply to other hospitals and regions will need further verification.