Socio-demographic characteristics of the participant
A total of 143 participants were included from delivery and neonatal intensive care units of 10 hospitals with a response rate of 100%. Majorities of the participants 96(67.1%) were from primary hospitals and the rest 47(32.9%) were from a referral hospital. In terms of working unit 102(71.3%) were from a delivery unit and the rest 41(28.7%) were from neonatal intensive care units. Regarding the educational level majority of the participants, 110(76.9%) were degree holders. The maximum and minimum age of the participant was 43 and 20 years respectively. While the mean age of the participants was 29.02(SD = 5.44). Majorities of the participants 71(49.7%) were between the ages of 25 and 29 years (Table 1).
Knowledge level of the participant towards neonatal resuscitation
In this study two-thirds of the participants, 96(67.1%) had poor knowledge scores toward neonatal resuscitations. The minimum and maximum knowledge scores of the participants toward neonatal resuscitation were 8(29.63%) and 25(92.59%) respectively with an inter-quartile range of 7(25.93%). Out of 92 midwives, more than two-thirds of 69.6% had poor knowledge score similarly out of 30 BSC nurses two-third (66.7%) had poor knowledge score toward neonatal resuscitation. From a total of 13 neonatal nurses, more than half 53.8% had poor knowledge scores similarly from a total of 8 pediatric nurses more than half (62.5%) had poor knowledge scores toward neonatal resuscitation. In terms of educational status from a total of 110-degree holders, more than two-thirds (68.2%) had poor knowledge scores towards neonatal resuscitation (Table 1). This study revealed the majority of the participants in all governmental hospitals had poor knowledge scores towards neonatal resuscitation. The lowest knowledge score was observed in two governmental hospitals; Woreilu and Wogidy hospitals where 75% of the participants in these hospitals had poor knowledge scores towards neonatal resuscitation (Figure 1).
Knowledge of the participant in different steps of resuscitation
Among the different steps of neonatal resuscitation, the correct responses given by the participants were more than 80% for only 6 of 27 knowledge questions. In this study 80(55.9%), 70(49%) and 38(26.6%) of the participants had better knowledge in the area of initial steps of resuscitation, BMV and chest compression respectively but none of them had good knowledge in medication administration. The most frequently answered knowledge questions were slightly extended neck for resuscitation 132 (92.3%), 0.9% NaCl is volume expander 128(89.5%), inadequate seal is the reason for the failure of BMV 126(88.1%), epinephrine is the preferred medication for resuscitation 119(83.2%) and 3:1 is the ratio of compression to ventilation 118(82.5%) (Table 2).
Mean knowledge score of the participant
In this study, the overall mean knowledge score of the participant toward neonatal resuscitation was 68.56% (SD = 16.37%). The overall mean knowledge scores for comprehensive nurses, pediatric nurses, neonatal nurses and midwives were 64.69% (SD = 17.22%), 70.83% (SD = 16.61%), 75.21% (SD = 14.05%) and 68.68% (SD = 16.72%) respectively. The mean knowledge scores of the participants in the initial steps of resuscitation, bag, and mask ventilation, chest compression, and medication administration were 69.37% (SD = 26.2%), 75.5% (SD = 20.9%), 61.42% (SD = 20.2%) and 35% (SD = 20.2%) respectively.
Factors affecting knowledge of the participants
This study showed that there was no significant association in the knowledge score of the participants in terms of sex, age, educational level, year of services, working units, level of working hospitals and attitude of the participants. But there was a significant association in the knowledge score of the participants in terms of neonatal resuscitation training (p = 0.002), availability of resuscitation guideline (p = 0.001) and supportive supervision (p = 0.027). Untrained nurses and midwives had 3 times less knowledge than trained nurses and midwives.
Nurses and midwives who had no neonatal resuscitation guidelines in the workplace had almost 4 times less knowledge than those who had a guideline. Participants with no supportive supervision had 2 times less knowledge than those who got supportive supervision (Table 3).
The practice of the participant toward neonatal resuscitation
This study revealed that the majority of the participants (75.5%) had poor practice towards neonatal resuscitation. The minimum and maximum practice scores of the participants about neonatal resuscitation were 8(26.67%) and 27(90%) respectively with an inter-quartile range of 7(23.33%). In this study from a total of 92 midwives, the majority (81.5%) had poor practice similarly from a total of 30 BSC nurses, the majority (70%) had poor practice towards neonatal resuscitation. From a total of 13 neonatal nurses nearly half (53.8%) had poor practice similarly from a total of 8 pediatric nurses, two-thirds (62.5%) had poor practice toward neonatal resuscitation. Among 110-degree holders, 75.5% had poor practice toward neonatal resuscitation. Out of 43 participants who had a poor attitude towards neonatal resuscitation majority (88.4%) had poor practice towards neonatal resuscitation. In terms of neonatal resuscitation training out of a total of 78 participants with no neonatal resuscitation training majority (83.3%) had poor practice toward neonatal resuscitation (Table 5). In this study, the majority of the participant in all governmental hospitals had poor practice towards neonatal resuscitation. About 80% or more of the participants from Woreilu, Jamma and Mekaneselam hospitals had poor practice while none of the participants from Wogidy hospital had good practice toward neonatal resuscitation (Figure 2)
The practice of the participant in different steps of resuscitation
Among the different steps of neonatal resuscitation, the correct response given by the participants was more than 80% for only 10 of 30 practice questions. While the percentages of correct response for 20 practice questions were less than 80%. In this study 55(38.5%), 63(44.1%), 74(51.7%), 67(46.9%), 33(23.1%) and 35(24.5%) of the participants had better practice in the area of preparation step, assessment of the newborn, initial steps of resuscitation, BMV, chest compression and medication administration. The most frequently answered practice questions were clear the new born’s airway 142 (99.3%), ventilate the newborn 40–60bpm 135 (94.4%) and assess the newborn for color 131 (91.6%) (Table 4).
Mean practice score of the participant
In this study, the overall mean practice score of the participant towards neonatal resuscitation was 62.96% (SD = 15.89%). The overall mean practice scores for comprehensive nurses, pediatric nurses, neonatal nurses and midwives were 60.11% (SD = 16.62%), 67.5% (SD = 13.77%), 70% (SD = 13.81%) and 62.5% (SD = 15.96%) respectively. The mean practice scores of the participants in the preparation step, assessment of the newborn, initial steps of resuscitation, bag and mask ventilation, chest compression and medication administration were 64.2% (SD = 21.86%), 69.5% (SD = 23.37%), 74.27% (SD = 20.64%), 68.25% (SD = 21.54%), 52.17% (SD = 24.78%) and 49.65% (SD = 28.27) respectively. This study showed that BSC nurses and midwives had poor mean knowledge scores in all steps of resuscitation. While pediatric nurses and neonatal nurses had good knowledge in initial steps of resuscitation and BMV respectively but they had poor performance in other areas of neonatal resuscitations.
Factors affecting the practice level of the participant.
This study revealed that there was no significant association in the practice score of the participants in terms of sex, age, educational level, year of services, working units, level of working hospitals, workload, attitude and training of the participants. But there was a significant association in the practice score of the participants in terms of availability of resuscitation guidelines (p = 0.028) and supportive supervision (p = 0.002). Lack of neonatal resuscitation guidelines and supportive supervision were associated with a low level of resuscitation performance. Nurses and midwives who had no resuscitation guidelines in the workplace had 3 times less performance than nurses and midwives who had a guideline. Respondents with no supportive supervision had 5 times less performance than those who got supportive supervision (Table 5).