DOI: https://doi.org/10.21203/rs.3.rs-26236/v1
Background: The Coronavirus Disease in 2019 (COVID-19) is not only the deadly outbreak disease but also it affects the mental status of the population including the nurses. Nurses play a vital role in dealing with COVID-19 victims. Nurse’s infection control measures is affected by their knowledge, attitude, practice (KAP), and psychological responses towards COVID-19. Therefore, this study was aimed to determine the knowledge, attitude, practice, and psychological response among nurses toward the COVID-19 outbreak in Northern Ethiopia. The hospital-based cross-sectional study design was employed. The data were collected from March to April 2020. Data was collected through a self-administered questionnaire.
The data were entered into Epi-data manager version 4.2 and exported to SPSS 23 for analysis. Descriptive analysis was reported to describe the demographic, mean knowledge, attitude practice, and psychological response score of nurses.
Results: A total of 415 nurses were participated in this study making that 100% response rate. Of the participants 241(58.1%) were female. From the 415 nurses 307(74%), 278(67%), 299(72%%), and 354(85.3%) were had good knowledge, good infection prevention practice, a favorable attitude, and disturbed psychological response towards COVID-19 respectively.
World Health Organization (WHO) declared that, the COVID–19 outbreak is as public health emergency in December 2019 [1]. Coronavirus disease 2019 (abbreviated “COVID–19”) is an infectious respiratory illness caused by a novel coronavirus, first identified in Wuhan, China, in December 2019. Coronaviruses are a large class of viruses that have been relatively widespread all across the world. The Chinese authorities in Wuhan City, the capital of the province of Hubei, China, first announced this at the end of December 2019.[2–4]. This virus has low pathogenicity and high transmissibility capability[5].According to the WHO, the outbreak of coronavirus disease in 2019 (COVID–19) has been a pandemic that infected more than 3 million people at the time of writing this research paper and caused more than 200,000 deaths worldwide[6]. In Africa, morbidity and mortality reached greater than 30,000 and 1200 respectively. Of those 122 morbidities and 3 death were from Ethiopia[6].
It is well established that transmission of the disease among nurses is associated with overcrowding, absence of isolation room facilities, and environmental contamination. However, this is likely compounded by the fact that some nurses have inadequate awareness of infection prevention practices[7]. Knowledge of disease can influence nurses’ attitudes and practices, disturbed psychological responses incorrect attitudes and practices directly increase the risk of infection[8]. Extensive media coverage of the epidemic can now influence the public’s physical and psychological response to the infectious disease threat, which may inevitably amplify apprehension while serving as a pivotal tool to encourage precautionary and preventive measures[9].
Understanding nurses’ knowledge, attitudes, practices (KAP), and psychological response help to predict the outcomes of planned behavior. Thus, this study aimed to investigate KAP and psychological response towards COVID–19 among nurses. If nurses’ KAP concerning the virus and the factors that affect their attitudes and behaviors can be determined promptly in the early stages of the epidemic, then this information can inform relevant training and policies during the outbreak and guide nurses in prioritizing protection and avoiding occupational exposure.
The hospital-based cross-sectional study design was used at governmental public hospitals of Northen Ethiopia. The study was conducted at the Aksum St.Marry general Hospital and Aksum comprehensive Specialized Hospital. The study period was from March to April 2020. The source population was all nurses who were working in the study area and the study population was all selected nurses from the selected health facilities
Single population proportion formula was used and the following assumptions were made: 56.5 % nurses had good knowledge regarding COVID–19 from the previous studies conducted in Iran[10], 5% marginal error (d) with 95% confidence was employed as a parameter. By assuming 10%, nonresponse rate the final sample size was 415 nurses. A simple random sampling technique was used to select the study participants. The sample size was proportionally allocated to each public health facilities.
A self-administered structured questionnaire was used to collect the knowledge, attitude, practice, and psychological response towards the COVID–19 outbreak. The questionnaire was adopted from other published articles [10–16] and further modification was done to fit the local context and research objective. Two BSc holder nurses were recruited for data collection and one MSc holder nurse was recruited as a supervisor. Overall, the data collection process was coordinated and supervised by the principal investigator.
Dependent variable: Knowledge, attitude practice, and psychological response were the dependent variables.
Independent Variables: Socio-demographic and personal factors were the independent variables.
The total knowledge score for the nurses varied between 0 (with no correct answer) and 18 (for all correct answers), and a cut off level of ≤9was evaluated as poor knowledge, and >9 indicated good knowledge[13–17].
The question regarding the attitude was eleven (with minimum score 11 and maximum score 55). The score of the attitude based on 5 points Likert scale, in which the score of 1 to 5 was given from strongly disagree to strongly agree. A mean score >33 (answering for strongly agree or agree) was carried out as a favorable e attitude and a score of 11 to 33 indicated an unfavorable attitude (answering strongly disagree or dis-agree or neutral)[11, 13, 15, 16].
The question regarding the practice was fourteen (with minimum score 14 and maximum score 70). The score of the practice based on 5 points, in which the score of 1 to 5 was given from never to always. A mean score >42 (answering for always or most of the time or sometimes) was carried out as having good practice and a score of ≤42 indicated a poor practice (answering never or occasionally)[13, 15, 16].
The question regarding the psychological response was nine (with minimum score 9 and maximum score 36). The score of the psychological response based on 4 points, in which the score of 1 to 4 was given from not disturbed at all to almost daily disturbance. A mean score >18 (answering for almost daily disturbance or disturbed for more than 7 days) was carried out as having psychological disturbance and a score of ≤18 indicated a having not psychological disturbance (answering not disturbed at all or for a few days disturbance)[16].
Data collectors trained about the aim of the study and methods of data collection. The English version of the questionnaire was prepared. The supervisor and principal investigator made continuous follow-up and supervision for completeness and consistency of the data.
The collected data was checked for its completeness manually and then entered into EPI-data manager version 4.2.1 and analyzed using SPSS version 23 statistical software package. Descriptive statistics including proportion, Percentage, ratios, frequency distribution, the mean and standard deviation were used to describe the normally distributed data, whereas, for the skewed data, the median and interquartile range was used.
Four hundred fifteen nurses were fulfilling the inclusion criteria and included in this study. Of them, more than half 241(58.1) of the participants were females and the remaining were male participants. The median age of the participants was 30(±3 IQR). Out of the total nurses, 334(80.5) were Christian orthodox in religion and the remaining were Muslim. Regarding participants, marital status about 335(80.7) was married and the remaining were single. Of the participants, 380(91.6%) and 35(8.4%) were Tigrian and Amhara in their Ethnic. More than half 241(58.1%) of the participants had greater than five years of work experience
Nurses knowledge towards the COVID–19 was measured using eighteen questionnaires and by proving numerical value for each question (1 = Yes (correct), 0 = No (incorrect answer (Table 1)
Table1: Knowledge of nurses toward the COVID-19 during the COVID-19 outbreaks in Northern Ethiopia,2020
|
Questions |
Response |
Frequency (%) |
|
|
COVID-19 is a virus infection |
Yes |
388(93.5) |
|
|
No |
27(6.5) |
||
|
COVID-19 vaccine is available in markets |
Yes |
210(50.6) |
|
|
No |
205(49.4) |
||
|
Antibiotics are the first-line treatment |
Yes |
218(52.5) |
|
|
No |
197(47.5) |
||
|
Washing hands with soap and water, and using face masks can help in the prevention of disease transmission |
Yes |
319(76.9) |
|
|
No |
96(23.1) |
||
|
Healthcare workers are at a higher risk of infection |
Yes |
315(75.9) |
|
|
No |
100(24.1) |
||
|
COVID-19 could be fatal |
Yes |
300(72.3) |
|
|
No |
115(27.7) |
||
|
The main clinical symptoms of COVID-19 are fever, cough, sore throats and shortness breath and myalgia/ fatigue |
Yes |
374(90.1) |
|
|
No |
41(9.9) |
||
|
Unlike the common cold, stuffy nose, runny nose, and sneezing are less common in persons infected with the COVID-19 virus. |
Yes |
308(74.2) |
|
|
No |
107(25.8) |
||
|
There currently is no effective cure for COVID-2019, but early symptomatic and supportive treatment can help most patients recover from the infection. |
Yes |
208(50.1) |
|
|
No |
207(49.9) |
||
|
Elderly pt and Patients with underlying chronic diseases are at a higher risk of severe infection and death |
Yes |
308(74.2) |
|
|
No |
107(25.8) |
||
|
Eating or contacting wild animals would result in the infection by the COVID-19 virus. |
Yes |
225(54.2) |
|
|
No |
190(45.8) |
||
|
Persons with COVID-2019 cannot infect the virus to others when a fever is not present. |
Yes |
201(48.4) |
|
|
No |
214(51.6) |
||
|
COVID-19 is transmitted by close contact and via respiratory droplets with the infected person |
Yes |
316(76.2) |
|
|
No |
99(23.8) |
||
|
Ordinary residents can wear general medical masks to prevent the infection by the COVID-19 virus. |
Yes |
204(49.2) |
|
|
No |
211(50.8) |
||
|
Children and young adults don't need to take measures to prevent the infection by the COVID-19 virus. |
Yes |
215(51.8) |
|
|
No |
200(48.2) |
||
|
To prevent the infection by COVID-19, individuals should avoid going to crowded places such as train stations and avoid taking public transportations. |
Yes |
205 (49.) |
|
|
No |
210 (50.6) |
||
|
Isolation and treatment of people who are infected with the COVID-19 virus are effective ways to reduce the spread of the virus. |
Yes |
198(47.7) |
|
|
No |
217(52.3) |
||
|
People who have contact with someone infected with the COVID-19 virus should be immediately isolated in a proper place. In general, the observation period is 14 days. |
Yes |
210(50.6) |
|
|
No |
205(49.4) |
||
|
Knowledge |
Good |
307(74) |
|
|
Poor |
108 (26.) |
||
|
Mean knowledge (9.9±4.6 SD) with a range of 1 to 16 |
|
|
|
The infection prevention practices towards the COVID–19 was measured by fourteen questions using five criteria and by proving numerical value (1 = never, 2 = occasionally, 3 = sometimes, 4 = most of the time and 5 = always) (Table 2)
Table 2: Infection prevention practice of nurses toward the COVID-19 during the COVID-19 outbreaks in Northern Ethiopia,2020
|
Questions |
Never (Frequency (%)) |
Occasionally Frequency (%)) |
Sometimes Frequency (%)) |
Most of the time Frequency (%)) |
Always Frequency (%)) |
||
|
Have you gone to any crowded place? |
40(9.6) |
55(13.3) |
240(57.8) |
20(4.8) |
60(14.5) |
||
|
Have you worn a mask when leaving home? |
325(78.3) |
14(3.4) |
25(6) |
26(6.3) |
25(6) |
||
|
Always remove protective equipment carefully? |
11(2.6) |
87(20.9) |
46(11.1) |
86(20.7) |
185(44.6) |
||
|
Do you cover mouth when coughing and sneezing in the past 14 days? |
15(3.6) |
77(21) |
51(12.3) |
87(21). |
185(44.6) |
||
|
Do you avoid public transportation in the past 14 days? |
77(21) |
182(43.9) |
86(20.7) |
55(13.3). |
15(3.6) |
||
|
Do you wash hands with soap and water in the past 14 days? |
21(5.1) |
71(17.1) |
42(10.1) |
83(20). |
198(7.7) |
||
|
Do you wash hands immediately after coughing, rubbing the nose, or sneezing in the past 14 days? |
177(42.6) |
87(20.9) |
82(19.7) |
55(13.3). |
14(3.4) |
||
|
Do you wear a mask regardless of the presence or absence of symptoms in the past 14 days? |
41(9.9) |
97(23.4) |
52(12.5) |
182(43.9). |
43(10.4) |
||
|
Do you wash hands after touching contaminated objects in the past 14 days? |
11(2.6) |
42(10.1) |
86(20.7) |
84(20.2). |
192(46.3) |
||
|
Do you avoid using the elevator in the past 14 days? |
0 |
0 |
0 |
0 |
415(100) |
||
|
Do you sit in one row while having a meal in the past 14 days? |
40(9.6) |
50(12) |
245(59) |
18(4.3) |
62(14.9) |
||
|
Do you avoid meeting with more than 10 people in the past 14 days? |
21(5.1) |
87(21) |
42(10.1) |
83(20). |
182(43.9) |
||
|
Do you feel that too worry or anxiety has been made about COVID-19? |
11(2.6) |
87(20.9) |
46(11.1) |
86(20.7) |
185(44.6) |
||
|
Do you stay at home to avoid COVID-19 than a normal situation(Family Quarantine)? |
21(5.1) |
87(21) |
42(10.1) |
83(20). |
182(43.9) |
||
|
Practice |
Good |
278(67) |
|
|
|
|
|
|
|
Poor |
137(33) |
|
|
|
|
|
|
Mean of practice (42.9±12.5 SD) with a range of 17 to 68 |
|
|
|
|
|||
The nurses’ attitude towards the COVID–19 has measured eleven questions using five criteria and by proving numerical value (1 = Strong dis-agree, 2 = Dis-agree, 3 = Neutral, 4 = Agree, and 5 = Strong agree) (Table 3).
The psychological response towards the COVID–19 was measured nine questions using four criteria and by proving numerical value (1 = : Not disturbed at all, 2 = for a few days disturbance, 3 = Disturbed for more than 7 days, 4 = Almost daily disturbance) (Table 3).
Table 3: Attitude and Psychological response of nurses toward the COVID-19 during the COVID-19 outbreaks in Northern Ethiopia,2020
|
Questions regarding the attitude |
Strong disagree |
Disagree |
Neutral |
Agree |
Strong agree |
|
|||||
|
Do you agree that COVID-19 will finally be successfully controlled? |
15(3.6) |
68(16.4) |
62(14.9) |
169(40.7) |
101(24.3) |
|
|||||
|
Do you have confidence that Ethiopia can win the battle against the COVID-19 virus? |
20(4.8) |
67(16.1) |
60(14.5) |
168(40.5) |
100(24.1) |
|
|||||
|
You think you will probably get the illness |
25(4.8) |
66(16.1) |
59(14.5) |
167(40.5) |
98(24.1) |
|
|||||
|
You are worried one of your family members may get an infection |
21(5) |
60(14.5 |
63(15.2) |
169(40.7) |
102(24.5) |
|
|||||
|
If getting COVID-19, you will accept isolation in health facilities |
9(2.2) |
60(14.5) |
60(14.5) |
178(42.9) |
108(26) |
|
|||||
|
Transmission of COVID-19 can be prevented by washing hands with soap frequently |
15(3.6) |
68(16.4) |
62(14.9) |
169(40.7) |
101(24.3) |
|
|||||
|
Prevalence of COVID-19 can be reduced by the active participant of HCWs in hospital infection control programs |
9(2.2) |
60(14.5) |
60(14.5) |
178(42.9) |
108(26) |
|
|||||
|
If a COVID-19 vaccine was available, I would have it |
20(4.8) |
67(16.1) |
60(14.5) |
168(40.5) |
100(24.1) |
|
|||||
|
Covid-19 patients should be kept in isolation |
25(4.8) |
66(16.1) |
59(14.5) |
167(40.5) |
98(24.1) |
|
|||||
|
Patients should disclose their exposure |
8(4.8) |
60(14.5) |
68(16.4) |
173(41.7) |
105(25.1) |
|
|||||
|
Medical staffs are ready to participate in anti-epidemic in the community |
21(5) |
60(14.5 |
63(15.2) |
169(40.7) |
102(24.5) |
|
|||||
|
Attitude |
Favorable attitude |
299(72%) |
|
|
|
|
|
|
|||
|
Unfavorable attitude |
116(28%) |
|
|||||||||
|
Mean of attitude e (33.8±11.6 SD) with a range of 12to 55 |
|
|
|
|
|
||||||
|
Questions regarding psychological response |
Not disturbed |
For a few days disturbance |
Disturbed for more than 7 days |
Almost daily disturbance |
|||||||
|
Seemed have no interest or pleasure in doing work or leisure activities |
30(7.2) |
181(43.6) |
182(43.8) |
22(5.3) |
|||||||
|
I felt depressed and hopeless/ Level of fear of COVID-19 |
25(6) |
184(44.3) |
183(44.1) |
23(5.5) |
|||||||
|
I found it difficult to fall asleep or keep sleeping or slept too much suddenly |
35(8.4) |
185(44.6) |
173(41.7) |
22(5.3) |
|||||||
|
I felt tired or had little energy/ Feelings of fatigue after the outbreak |
40(9.6) |
171(41.2) |
178(42.9) |
26(6.3) |
|||||||
|
I tended to have no appetite or overeat |
54(13) |
168(40.5) |
175(42.2) |
18(4.3) |
|||||||
|
I felt that I have no confidence. / I felt like I am a failure and let myself or my family down/ Confidence in defeating the virus |
67(16.14) |
164(39.5) |
172(41.4) |
12(2.9) |
|||||||
|
It was difficult to concentrate on such things as reading newspapers or watching television |
73(17.6) |
151(36.4) |
182(43.8) |
11(2.6) |
|||||||
|
When someone was watching me, I felt like moving or talking slowly. On the contrary, It was more active than usual, too restless or impetuous |
44(10.6) |
174(41.9) |
179(43.1) |
18(4.3) |
|||||||
|
I thought that it is better to die or that I would harm myself anyway |
61(14.7) |
161(38.8) |
172(41.4) |
21(5.1) |
|||||||
|
Psychological response |
Disturbed |
354(85.3) |
|
|
|
|
|||||
|
Undisturbed |
61(14.7) |
||||||||||
|
Mean of Psychological response (18.3±5.1 SD) with a range of 9 to36 |
|
|
|
|
|||||||
This study was tried to assess the knowledge, attitude, practice, and psychological response toward the COVID–19 outbreaks among nurses. In this study, the socio-demographic, knowledge level, attitude, infection prevention practical level, and psychological response of 415 nurses were analyzed.
From the 415 nurses 307(74%), 278(67%), 299(72%%), and 354(85.3%) were had good knowledge, good infection prevention practice, a favorable attitude, and disturbing psychological response towards COVID–19 respectively.
In this study, 74% ( with CI; 70 to 78.1) of the participants had good knowledge regarding the COVID–19 outbreaks. This is higher than with the study conducted in Iran[14, 17] and Saudi Arabia[18]. This might be due to the time of the study and study population difference.
Our study findings regarding the knowledge lvel of nurses towards the COVID–19 was is consistent with the study conducted in Pakstan[19].
Among the nursrs 67% (CI; 62 to 71.8) had good infection prevention practice towards the COVID–19.
Our finding showed 72% (CI,67.8 to 76.4) of the study participants had favorable attitude towards the COVID–19. This findings is in line with the study conducted in China and Iran[12, 14] and SaudiArabia[18].
In our finding, 85.3% (CI, 82.2 to 88.7)of the nurses had disturbed psychological responses towards the COVID–19. This result is similar to the study conducted in Singapore[20] and China[21] And, this study lower than with a study conducted in Hong Kong [22]. This might be due to the same characteristics of the infection since this is respiratory distress disease.
Nurses had nearly three-fourth good knowledge and favorable attitude regarding COVID–19. More than two-thirds of the nurses had good infection prevention practices towards COVID–19. Nurses had an almost disturbed psychological response to COVID–19.WHO and the Ministry of Health still must provide more information for better control of the infectious disease.
The data presented in this study are self-reported and partly dependent on the participants’ honesty and recall ability; thus, they may be subject to recall bias.
COVID–19: Corona Virus Disease in 2019, WHO: World Health Organization, KAP: Knowledge Attitude and Practice
Ethical clearance was obtained from the College of Health Sciences, Aksum University. Written consent was obtained from the respondents. Confidentiality was assured for all the information provided, no personal identifiers were used on the questionnaire.
The authors declare that they have no competing interests.
Not applicable
Not applicable
The datasets used and/or analyses during the current study are presented within the manuscript and available from the corresponding author on reasonable request
DBT conceived and designed the initial study. All authors contributed to the conceptualization and design of the study. DBT, GTG and GTD drafted the initial manuscript. All authors contributed to the development of the selection criteria, the risk of a bias assessment strategy, and data extraction criteria. DBT is the guarantor of the review. All authors read, provided feedback, and approved the final manuscript before submission.
Authors thanks to all staffs of Aksum University, College of Health Science and Comprehensive Specialized Hospital, data collectors and supervisors who had a dedicated output