Study Setting and Period
The study was conducted at three comprehensive specialized hospitals, namely Wachemo University Comprehensive Specialized Hospital found in Hadiya zone, Worabe comprehensive specialized hospital found in Silte zone and Wolayita Sodo University Otona comprehensive specialized Hospital found in Wolayita zone from May15 to June 15, 2021. Hadiya, Silte and Wolayita zonal administrations are among the zonal administrations of SNNPR. Hosaena town is a capital town to Hadiya zonal administration and 230km away from Addis Ababa. Worabe town is a capital town to Silte zonal administration and 170km away from Addis Ababa. Wolayita Sodo town is capital town to Wolayita zonal administration it is 151km far from capital of SNNPR and 312km far from Addis Ababa.
Study Design
Institution based cross-sectional study conducted among nurses working in surgical units of comprehensive specialized hospitals of southern Ethiopia.
Source population
All nurses working at surgical units of specialized hospitals in southern Ethiopia.
Study population
Nurses who were assigned in surgical units of Southern Ethiopian specialized hospitals.
Inclusion criteria
All nurses who were assigned at surgical units within a year in selected hospitals.
Exclusion criteria
-
Nurses who had rotated from surgical unit before a year
-
Nurses who were in annual leave, sick leave and maternal leave
-
Nurse who has other specific specialties like, medical nursing and other nursing specialities.
Sample size determination
The sample size for the first specific objective was determined by using a standard formula for single population proportion. The proportion (P) was taken as 63%. Since, in the study conducted in Nigeria revel that the practice of preoperative visit was 63% (20). With a 95% confidence interval (CI), margin error of 5%, and 10% non- response rate. By considering 10% for non-response rate the final sample size for specific objective one was 395
The sample size of the second specific objective was determined by considering factors that are significantly associated with the outcome variable, two-sided confidence level of 95%, power 80% and the ratio of exposed to unexposed 1:1 using Epi Info Version 7.2.4.0 and the calculated sample size for the selected factors as shown in Fig. 1.
Table 1
Sample size determination using objective 2 for practice of preoperative patient care and associated factors among surgical unit nurses of southern Ethiopian specialized hospitals from May 15- June15, 2021.
Factors associated with practice of preoperative visit | Exposed outcome % | None exposed outcome % | Sample size | Total | Reference |
Group 1 | Group 2 |
Past experience of nurses | 84 | 15 | 10 | 10 | 20 | (20) |
Nurses’ knowledge on preoperative visit | 95.2 | 4.1 | 6 | 6 | 12 | (20) |
Finally, the required sample size for this particular study is decided by taking the maximum sample size. Since sample size by first specific objective was greater than sample size by using the second specific objective (i.e., First specific objective = 359), the final sample size became 359 + 35.9 = 395.
Sampling procedure and Sampling Technique
All three specialized hospitals from SNNPR Ethiopian governmental specialized hospitals were selected. Proportional allocation was used to allocate sample to each unit number of nurses in each hospital. The study sample in each unit was selected by simple random sampling using nurse director’s nurse rotation book as framework as shown in Fig. 2
. The same procedure was conducted for observational study.
Data Collection Tools
A data collector assisted, self-administered questionnaire and observational checklists are adopted from different literatures designed for the same study purpose. Then variables are reviewed to suit the local context ((13, 14, 15, 6, 7, 16, 12, 17). The questionnaire had two main categories: Category 1 consists of Self-administer questionnaires with having four parts: A) socio- demographic data, B) knowledge of nurses on preoperative care, C) Practice of nurses on preoperative care which have three sub-topics 1)preoperative care during preadmission to surgical unit practice questionnaire 2)preoperative care during admission to Surgical Center practice questionnaire, 3)preoperative care in the Holding Area for operation practice questionnaire, D) Factors affects practice of Preoperative Care. Category 2 consists of observational checklist questionnaires with 29 items which were provided for about 1/3rd (132) of total participants.
Operational Definitions
Perioperative period
Period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care (18)
Preoperative period
Period of time from the decision for operative procedure is made to the patient transferred to the operating room table. (18)
Level of practice- Leveling participant practice of patient care as good and poor.
Good practice- When respondents who scored above mean from the preoperative patient care practice questions. The mean score was calculated out of 29 by adding each participant’s score on the preoperative patient care practice questionnaires and dividing it to the total number of participants (19).
Poor practice- When respondents who scored below the mean value from preoperative patient care practice questions. The mean score was calculated out of 29 by adding each participant’s score on the preoperative patient care practice questionnaires and dividing it to the total number of participants (19).
Data Quality Control
Training was given for data collectors and supervisors. The questionnaire was first pretested in 5% of the samples at Hawassa Specialized Hospital to verify the appropriateness of the tools. Finally, the data were entered into Epidata software as part of data management. During data cleaning, a logical checking technique was employed to identify errors. Data cleaning was done by sorting and running frequency distribution with Epidata to check for missing or incomplete data. Furthermore, the data collectors, supervisors, and the principal investigator check the collected data each day; double data entry was done by two data clerks, and consistency of the entered data was cross-checked.
Data Processing and Analysis
Collected data was checked by the principal investigator and the supervisors, then data was cleaned, coded, and double entered using Epi-data version 3.01software and it was finally exported into SPSS version 21 for analysis. Frequencies and percentages were calculated to all variables which were related to the objectives of the study. Bivariate analysis, crude odds ratio with 95% confidence interval were used to see the association between each independent variable and the outcome variable. Variables with p-value of ≤ 0.25 were entered in to multi-variable logistic regression model. Model fitness was checked by Hosmer-Lemeshow goodness of fit test. Finally, variables that show level of P-value less than 0.05 in multi-variable analysis were declared as statistically significant. Multi-collinearity was checked to see the linear correlation among the independent variables by using variance inflation factor.
Ethical Considerations
First, the study was approved by Haramaya University, College of Health and Medical Sciences, Institutional Health Research Ethics Review Committee IHRERC and then ethical clearance was obtained from Institutional Health Research Ethics Review Committee (IHRERC) Haramaya University College of Health and Medical Science. An official letter of cooperation was written to each hospital. The head of health facilities was informed about the objective of the study including the risks, benefits, and confidentiality issues. Permission letter was obtained from each hospital concerning bodies. The participant also was informed clearly about the objective, benefit, and rights to participate or refuse or withdraw the interview. Their privacy was respected and confidentiality maintained throughout the research process by giving code for participants, omitting the names of the respondents. After all, informed, written and signed consent was obtained from study participants. The contacts address of principal investigator and IHRERC was provided for participants in case of any questions.