Knowledge, attitude and practice of nurses working in South Gondar zone hospitals toward initial management of acute poisoning, 2021

¹Department of Emergency Medicine and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia, ²Department of Pediatrics and Child Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia, ³Department of Adult Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia, ⁴Department of Social and Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia, ⁵Department of Geography and Environmental Studies, College of Social Science, Debre Tabor University, Debre Tabor, Ethiopia

^&Corresponding author
Sheganew Fetene Tassew, Department of Emergency Medicine and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia

Introduction    

Poison is defined as any chemical that has the ability to alter or degrade human physiology through general or local cell damage or death as a result of its chemical action. It's a global issue that takes up a lot of health-care resources and leads to a lot of fatalities that could have been avoided. The underdeveloped world bears the brunt of serious poisoning. Poisoning-related morbidity and mortality, on the other hand, is a major public health concern in the developed world [1]. Poisoning is a serious health issue that affects people all around the world. Poisoning is becoming more common; from 1999 to 2016, drug-poisoning fatality rates tripled, rising from 6.1 per 100,000 to 19.8 per 100,000. Drug poisoning claimed the lives of 63,632 people in 2016 [2,3]. Poisoning is a common cause of medical visits and hospitalisation around the world. In many regions of the world, it is a leading cause of morbidity and mortality. Poisoning episodes are thought to cause more than one million diseases each year around the world [4,5]. Treatment for poisoning should be started as soon as possible and appropriately. In most developed countries, knowledge of the typical pattern of poisoning in a given region would aid in early diagnosis and care of poisoning, reducing morbidity and mortality. However, in most developing countries, delayed initiation of resuscitative efforts results in preventable death [6,7].

Patients who appear with serious toxic consequences almost always require immediate treatment. As with any emergency patient, the initial step is to stabilise the airway, breathing, and circulation. Identifying the toxin via history, toxidrome, or laboratory tests may point the nurse in the right direction [8]. Nurses are typically the first health care providers to contact patients who have consumed poisons. When it comes to this early and critical judgement, they are frequently at the forefront. The knowledge, skills, and attitude of nurses are critical to their practice and have a significant impact on the overall patient outcome. The agent eaten, the dose consumed, the time since ingestion, clinical aspects, patient variables, and geographic location must all be known to nurses. To ensure that problems are identified and treated appropriately, all nurses must be aware with the clinical priorities in initial poisoning management [9,10]. It is critical to assess nurses' knowledge and skills in order to improve nursing poisoning management and have a beneficial outcome for poisoned patients. As a result, the purpose of this study was to assess the knowledge, attitude, and practice of nurses working in Debre Tabor Comprehensive specialized hospital in regard to the initial management of acute poisoning in 2021 GC.

Methods     

Study area and period: institution based cross sectional study was conducted from August 1-30/2021 in Debre Tabor Comprehensive Specialized Hospital. Debre Tabor comprehensive specialised hospital is located in Debre Tabor town, which is the administrative centre of the South Gondar zone. It's 765 kilometers from Addis Ababa and 102 kilometers from Bahir Dar. The hospital employs 152 nurses who work in a variety of inpatient and outpatient units.

Eligibility criteria: nurses working in Debre Tabor Comprehensive Specialized Hospital available during data collection period were included. Nurses on annual, maternity or sick leave during the data collection period were excluded from the study.

Sample size determination and sampling technique: all nurses who were working in different units of the hospital during the data collection period were included in the study. In addition, six head nurses were involved for the interview. Simple random sampling technique was used to select the study participants.

Data collection instrument and procedure: the data were collected using structured interviewer administered questionnaire adopted from previous study [10]. A pretest was conducted among five percent of the total sample size that was not included in the study. Data were collected to 2 BSC nurses, a two-day training was given before data collection.

Study variables: the variables of this study were knowledge, attitude and practices of nurses toward initial management of poisoning.

Data processing and analysis: the collected data were entered, coded and cleaned into Epi-info manager version 7.2 and then exported to SPSS window version 25 for analysis. Descriptive statistics were used to describe participants knowledge, attitude and practices.

Data quality control: to assure the quality of data, questionnaires were pretested prior to the actual in Tibeb Gion specialized Hospitals. Based on the pretested result, correction of unclear and vague issues was carried out. At the time of data collection, all data collectors were rechecked for completeness of the questionnaire, then the investigators and supervisors made spot-checking and reviewing of completed questionnaires.

Operational definitions

Poison: substance capable of producing damage or dysfunction to the body by its chemical activity. In this study, it is a substance that has been ingested through the oral cavity, injected to bloodstream, absorbed via skin and produces damage or dysfunction to the body by its chemical activity.

Acute poisoning: when the body is exposed to a toxic substance in a high dose, on one occasion and during a short period of time. Symptoms develop in close relation to the exposure.

Initial assessment: management and care given by nurses to poisoned patient on arrival at hospital. The care ends when the patient´s physiological parameters are within normal and patient is out of life-threatening situations.

Knowledge: familiarity with acute poisoning management among emergency nurses. It includes; information, facts and skills acquired through experience and education on poisoning.

Good knowledge: knowledge level from 75-100% scores for the given general knowledge and initial management of acute poisoning items.

Poor knowledge: knowledge level below 75%.

Nursing practice: actual provision of nursing care using the nursing process to poisoned casualties.

Positive attitude: attitude level from 75-100% scores for the given acutely poisoned casualty management items.

Negative attitude: attitude score of level below 75%.

Good practice: practice level from 75-100% score for the given acutely poisoned casualty management items of practice.

Poor practice: practice score of level below 75%.

Results     

Socio-demographic characteristics of nurses: a total of 149 nurses were involved in this study with a response rate of 98%. About, 87 (58.4%) of the nurses were males and 66 (44.3%) of them were in the age range of 25-34 years. Majority, 98 (65.8%) of the nurses were BSc nurses and 68 (45.6%) of them had 4-10 years of working experience.

Knowledge of Nurses towards initial management of acute poising: the knowledge of nurses on initial managements of poisoning was assessed using the 17 items. Majority, 132 of nurses defined poison as a substance that produce damage or dysfunction in the body. One hundred and two (102 (68.5%) of nurses believed that considering the dose and time of ingestion of poison is important in managing poisoned patients. The item for which nurses displayed the lowest knowledge level was administration of atropine during organophosphate poisoning, 55 (36.9%) of the Nurse stated that Atropine should be administered in any circumstance during organophosphate poisoning. Generally, based on the given 17 items to assess the general knowledge of nurses on poisoning, the score ranges from 4 to 16 with the range of 10 with the mean score of 10.23 (SD-0. 0.78) for the entire respondents (Table 1).

Attitude of nurses towards initial management of acute poising: from the nurses involved in this study, 38.9% of the nurses strongly agreed that patients presenting with poisoning occupy more staff time, so staff are unavailable to patients who are in greater need of help, while 20.8% of participants disagreed with this. Of these nurses, 30.2% strongly agreed that sometime they feel nervous and uncomfortable when they have to care for a poisoned patient, especially those with deliberate poisoning. More than half, 51% of participants are happy to care for poisoned patients, and they feel sympathy as they care for other patients (Table 2).

Practice of nurses towards initial management of acute poising: less than half 57 (38.3%) of nurses always maintaining adequate airway, respiration and circulation as a priority measure in case of acute poisoning management. Majority, 142 (95.3) of nurses administered Atropine always in any circumstance of organophosphate poisoning. 112 (75.2%) of nurses always decide to perform Gastrointestinal (GI) decontamination based upon the specific poison(s) ingested, time from ingestion to presentation, and the predicted severity of the poison. Generally, 78 (52.3%) of nurses had good practice toward initial managements of acute poisoning (Table 3).

Discussion     

The purpose of this study was to assess nurses´ knowledge, attitude and practice on initial management acute poisoning. According to this study, 88.5% of the nurses had good knowledge of initial management of acute poisoning. This is similar with the findings reported in Kenya [10]. While this result is higher than the study finding in Dessie referral hospital, which stated that 75% of nurses had good knowledge [11]. This variation in level of knowledge of nurses might be related to lack of training, absence of continuous supervision and evaluation. Regarding attitudes of Nurses 30.2% of nurse strongly agreed that sometime they feel nervous and uncomfortable when they have to care for a poisoned patient especially those with deliberate poisoning, this result is comparable with a study from Kenya which reported that 38.3% are frustrated when they provide a care for poisoned patient [10].

Concerning nursing practice of nurses towards initial management of acute poisoning, nearly 53.8% of them assured that there was no standard guideline in their facility for the management of acute poisoning. This result is better when compared with the result of the study conducted in Dessie which found that 68.9% of participants underlined there was no standard guideline in their facility for the management of acute poisoning [11]. This difference may be due to nurses who worked in Dessie had gotten more less training on management of poisoned cases. But this result is higher when compared with a study conducted in Hawassa which showed the availability of guideline was only 16% [9]. This difference may be due to nurses who worked in Hawassa had gotten less training on management of poisoned cases. Concerning necessary availability of standard guideline, this study showed that 83.2% of the nurses agreed on its necessity. This result is higher than the result of the study conducted in Dessie which showed that 62% of the study participants agreed on its necessity. But this result is higher than the result of the study conducted in Hawassa which revealed that its necessity was reported from 43% of the study participants [7].

Limitation: this study was a cross-sectional study which conducted at a single point of time, it was better if it was cohort study.

Conclusion     

In conclusion, even though majority of Nurses had good knowledge toward initial managements of poisoning, their practice is insufficient.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All authors have developed the proposal, were involved in the analysis and the write up of the research. They equally read and approved the manuscript.

Acknowledgments     

We would like to acknowledge the study participants, data collectors, supervisors and hospital staffs for their valuable information and data collection. We would also like to thank Debre Tabor Universities for its support.

Tables     

Table 1: knowledge towards initial management of acute poising among nurses in Debre Tabor Hospital, South Gondar, Ethiopia, 2021 GC

Table 2: attitude towards initial management of acute poising among nurses in Debre Tabor Hospital, South Gondar zone, Ethiopia, 2021 GC

Table 3: practice of Nurse towards initial management of acute poising among in General Debre Tabor comprehensives hospital, 2021 GC

References