Knowledge, Attitude, and Practices of Mothers Working as Nurses Toward Multidrug-Resistant: Impact of an Educational Program in Neonatal Intensive Care Unit

Figures & data

Table 1 Comparison of the Nurses’ Socio-Demographic and Professional Characteristics Between the Two Groups of Nurses. N=168

Variable	Category	Educational group n (%)	Control group n (%)	X^2	df	P-value
Hospital Name	Rahma Hospital	0(0.00)	39(100.00)	168.00	4	0.00
	Albasheer Hospital	84(100.00)	0(0.00)
	Raya Hospital	0(0.00)	15(100.00)
	Moath Bin Jabal Hospital	0(0.00)	7(100.00)
	Al-Abdali Hospital	0(0.00)	23(100.00)
Gender	Females	84(50.00)	84(50.00)
Age	20–30y	46(66.67)	23(33.33)	13.329	2	0.001
	31–40y	31(41.33)	44(58.67)
	More than 40 y	7(29.17)	17(70.8)
Educational	Diploma	0(0.00)	6(100.00)	8.829a	2	0.012
	Bachelors	78(54.17)	66(45.83)
	Postgraduate	6(33.33)	12(66.67)
Experience Year	Less than 5 years	23(57.50)	17(42.50)	12.347a	3	0.006
	5–10 years	39(60.94)	25(39.06)
	11–15 years	12(46.15)	14(53.85)
	More than 15 years	10(26.32)	28(73.68)
Experience ICU	Less than 5 years	41(62.12)	25(37.88)	9.610a	3	0.022
	5–10 years	29(48.33)	31(51.67)
	11–15 years	5(23.81)	16(76.19)
	More than 15 years	9(42.86)	12(57.14)
Primary Role	Registered Nurse	84(51.23)	79(48.77)	2.716a	1	0.099
	Practical Nurse	0(0.00)	6(100.00)
Educational Course	No	78(51.66)	73(48.34)	1.570a	1	0.21
	Yes	6(35.29)	11(64.71)

Table 2 Comparison of Nurses’ Knowledge Toward Antibiotic Use and Prevention of Antibiotic Resistance in the Pre-Post Educational Time

Items	Answer	Pre-Education n=84	Post-Education n=84	X^2	df	P-value
1. An antibiotic is a medication that kills or slows down the growth of bacteria.	Incorrect	31(96.88)	1(3.13)	34.74	1	≤.001
	Correct	53(38.97)	83(61.03)
2. Antibiotics can have side effects, like allergic reactions and diarrhea.	Incorrect	35(100.00)	0(0.00)	44.21	1	≤.001
	Correct	49(36.84)	84(63.16)
3. The common side effects of antibiotics are rash, nausea, vomiting, and diarrhea.	Incorrect	52(98.11)	1(1.89)	71.69	1	≤.001
	Correct	32(27.83)	83(72.17)
4. The microorganism that can be killed by antibiotics is normal and infectious flora.	Incorrect	65(98.48)	1(1.52)	102.2	1	≤.001
	Correct	19(18.63)	83(81.37)
5. The effectiveness of antibiotics will be reduced if the full course is not completed.	Incorrect	17(100.00)	0(0.00)	18.91	1	≤.001
	Correct	67(44.37)	84(55.63)
6. Nosocomial infection is the type of infection acquired in the healthcare setting.	Incorrect	2(100.00)	0(0.00)	2.02	1	0.155
	Correct	82(49.40)	84(50.60)
7. Antibiotic resistance is defined as bacteria changes in a way that reduces or eliminates the effectiveness of antibiotics.	Incorrect	54(100.00)	0(0.00)	79.57	1	≤.001
	Correct	30(26.32)	84(73.68)
8. Developing new generations of antibiotics is not considered a cause of antibiotic resistance.	Incorrect	22(88.00)	3(0.00)	16.96	1	≤.001
	Correct	62(43.36)	81(56.64)
9. Antibiotic resistance can affect any age group.	Incorrect	47(100.00)	0(0.00)	65.25	1	≤.001
	Correct	37(30.58)	84(69.42)
10. Overuse of antibiotics is the most important factor leading to antibiotic resistance around the world.	Incorrect	4(100.00)	0(0.00)	4.09	1	0.04
	Correct	80(48.78)	84(51.22)			3
11. Infections caused by antibiotic resistance are difficult and sometimes impossible to treat	Incorrect	42(100.00)	0(0.00)	56	1	≤.001
	Correct	42(33.33)	84(66.67)
12. Antibiotic resistance spread through animal and human	Incorrect	60(100.00)	0(0.00)		1	≤.001
	Correct	24(22.22)	84(77.78)
13. Treating a viral infection with an antibiotic is an example of the improper use of antibiotic therapy.	Incorrect	30(100.00)	0(0.00)	36.52	1	≤.001
	Correct	54(39.13)	84(60.87)
14. Effective handwashing is the most important procedure for the prevention of infection from microorganisms.	Incorrect	3(100.00)	0(0.00)	3.06	1	0.08
	Correct	81(49.09)	84(50.91)
15. Immunization and infection prevention is considered the most important factor in preventing antibiotic resistance.	Incorrect	63(100.00)	0(0.00)	100.8	1	≤.001
	Correct	21(20.00)	84(80.00)
16. The antibiotic stewardship program aims to improve the use of antibiotics and prevent antibiotic resistance.	Incorrect	35(100.00)	0(0.00)	44.21	1	≤.001
	Correct	49(36.84)	84(63.16)
17. Antibiotic therapy should be started ideally when there is a positive microbiological result.	Incorrect	4(100.00)	0(0.00)	4.09	1	0.043
	Correct	80(48.78)	84(51.22)
18. A patient expressing that antibiotics can be taken when symptoms are gone indicates a lack of knowledge	Incorrect	9(100.00)	0(0.00)	9.50	1	0.002
	Correct	75(47.17)	84(52.83)
19. Implementing infection prevention and control practices is the key action that a nurse should take to prevent resistant infections and their spread.	Incorrect	13(100.00)	0(0.00)	14.09	1	≤.001
	Correct	71(45.81)	84(54.19)
20.Prospective audits, formulary restrictions, and preauthorization and guidelines, and clinical pathways are considered antibiotic stewardship strategies to combat antibiotic resistance.	Incorrect	5(100.00)	0(0.00)	5.15	1	0.023
	Correct	79(48.47)	84(51.53)
Overall, Knowledge, Mean (SD)		12.8929	16.9405	40.11	83	≤.001

Note: Bold number means significant value.

Table 3 Comparison of Nurses’ Attitudes Toward Antibiotic Resistance in the Post-Pre-Educational Time

Items	Category	Pre-Education n=84	Post-Education n=84	X^2	df	P-value
1. The antibiotic can be taken for the flu to get better quickly	Strongly Agree	6(100.00)	0(0.00)	98.264a	4	≤.001
	Agree	25(100.00)	0(0.00)
	Neutral	5(100.00)	0(0.00)
	Disagree	26(100.00)	0(0.00)
	Strongly Disagree	22(20.75)	84(79.25)
2. Antibiotics can be taken without a prescription	Strongly Agree	0(0.00)	0(0.00)	100.800a	3	≤.001
	Agree	11(100.00)	0(0.00)
	Neutral	6(100.00)	0(0.00)
	Disagree	46(100.00)	0(0.00)
	Strongly Disagree	21(20.00)	84(80.00)
3. Instructions are read and understood before taking antibiotics	Strongly Agree	23(21.90)	82(78.10)	88.419a	3	≤.001
	Agree	58(96.67)	2(3.33)
	Neutral	2(100.00)	0(0.00)
	Disagree	1(100.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
4. Antibiotics can be kept in stock to be used whenever feeling sick.	Strongly Agree	2(40.00)	3(60.00)	87.883a	4	≤.001
	Agree	20(100.00)	0(0.00)
	Neutral	8(100.00)	0(0.00)
	Disagree	35(89.74)	4(10.26)
	Strongly Disagree	19(19.79)	77(80.21)			≤.001
5. Participation in infection control activities helps in minimizing the spread of antimicrobial resistance.	Strongly Agree	20(19.23)	84()	103.385a	2	≤.001
	Agree	61(100.00)	0(0.00)
	Neutral	3(100.00)	0(0.00)
	Disagree	0(0.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
6. Reporting and escalating issues related to the misuse of antibiotics is the responsibility of a nurse.	Strongly Agree	3(7.89)	35(92.11)	57.957a	4	≤.001
	Agree	50(50.51)	49(49.49)
	Neutral	16(100.00)	0(0.00)
	Disagree	12(100.00)	0(0.00)
	Strongly Disagree	3(100.00)	0(0.00)
7. Advising patients to complete the prescribed antibiotic course even if they feel better quickly is necessary.	Strongly Agree	25(23.58)	81(76.42)	80.166a	1	≤.001
	Agree	59(95.16)	3(4.84)
	Neutral	0(0.00)	0(0.00)
	Disagree	0(0.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
8. Participation in special training on antibiotic resistance is recommended for all healthcare professionals.	Strongly Agree	22(21.36)	81(78.64)	87.359a	2	≤.001
	Agree	61(95.31)	3(4.69)
	Neutral	1(100.00)	0(0.00)
	Disagree	0(0.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
9. Advising other healthcare professionals in the appropriate use of antibiotics is important.	Strongly agree	20(19.42)	3(80.58)	99.596a	2	≤.001
	Agree	63(98.44)	1(1.56)
	Neutral	1(100.00)	0(0.00)
	Disagree	0(0.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
10. Playing an active role in educating patients and families on the risk of antibiotic resistance is the responsibility of a nurse.	Strongly agree	6(9.38)	58(90.63)	78.791a	3	≤.001
	Agree	48(64.86)	26(35.14)
	Neutral	20(100.00)	0(0.00)
	Disagree Strongly Disagree	10(100.00) 0(0.00)	0(0.00) 0(0.00)
11. Active contribution to institutional policies and guidelines which aim to control antibiotic resistance is the responsibility of a nurse.	Strongly Agree	3(5.00)	57(95.00)	82.906a	3	≤.001
	Agree	58(68.24)	27(31.76)
	Neutral	13(100.00)	0(0.00)
	Disagree	10(100.00)	0(0.00)
	Strongly Disagree	0(0.00)	0(0.00)
12. Advocating the use of new generations of antibiotics that can fight diseases more effectively with caution.	Strongly Agree	8(8.99)	81(91.01)	127.430a	4	≤.001
	Agree	62(95.38)	3(4.62)
	Neutral	9(100.00)	0(0.00)
	Disagree	4(100.00)	0(0.00)
	Strongly Disagree	1(100.00)	0(0.00)
Overall Attitude, Mean (SD)		46.64	8.45	t= 104.23	83	≤.001

Note: Bold number means significant value.

Table 4 Comparison of Nurse’s Practice Questions in the Post-Pre-Education Time

Items	Answer	Pre-Education n=84	Post-Education n=84	X^2	df	P-value
1. When giving a patient an antibiotic, do you know WHY he or she is receiving the antibiotic?	No	3(100.00)	0(0.00)	3.0	1	0.081
	Yes	81(49.09)	84(50.91)	5
2. If you have a question about the antibiotic being given, whom do you ask?	Charge Nurse	13(100.00)	0(0.00)	16.47	2	≤.001
	Another Staff Nurses	0(0.00)	0(0.00)
	Physician	69(45.10)	84(54.90)
	Primary Health Team	2(100.00)	0(0.00)
	No One	0(0.00)	0(0.00)
3. Have you questioned a physician about the CHOICE of antibiotics for a patient?	No	4(100.00)	0(0.00)	4.0	1	0.043
	Yes	80(48.78)	84(51.22)	9
4. Have you questioned a physician about the DOSE of antibiotics for a patient?	No	1(100.00)	0(0.00)	1.0	1	0.316
	Yes	83(49.70)	84(50.30)	0
5. Have you questioned a physician about the ROUTE of antibiotics for a patient?	No	3(100.00)	0(0.00)	3.0	1	0.081
	Yes	81(49.09)	84(50.91)	5
6. Have you questioned a physician about the DURATION of antibiotics for a patient?	No	13(100.00)	0(0.00)	14.	1	≤.001
	Yes	71(45.81)	84(54.19)	09
7. Have you ever given an antibiotic you thought was inappropriate?	No	46(35.38)	84(64.62)	49.10	1	≤.001
	Yes	38(100.00)	0(0.00)
8. Would you feel comfortable raising concerns to the treatment team about the antibiotic(s) a patient is getting?	No	3(100.00)	0(0.00)	3.0	1	0.081
	Yes	81(49.09)	84(50.91)	5
9.Do you think nurses should be involved in interventions aimed to improve antibiotic use?	No	0(0.00)	0(0.00)	-	-	-
	Yes	84(50.00)	84(50.00)
What advice do you impart to patients on antimicrobial usage? (Discharge advice) (yes/no)
10. The patient must complete the full course of antimicrobials for the recommended duration.	No	0(0.00)	0(0.00)	-	-	-
	Yes	84(50.00)	84(50.00)
11. The patient must take the antimicrobials at the correct time intervals.	No	0(0.00)	0(0.00)	-	-	-
	Yes	84(50.00)	84(50.00)
12.The patient should never share antimicrobial treatment with anyone	No	1(100.00)	0(0.00)	1.0	1	0.316
	Yes	83(49.70)	84(50.30)	0
13. The patient must not stop treatment even if they are feeling better after a few doses.	No	2(100.00)	0(0.00)	2.0	1	0.155
	Yes	82(49.40)	84(50.60)	2
14. The patient should dispose of antimicrobials appropriately	No	2(100.00)	0(0.00)	2.0	1	0.155
	Yes	82(49.40)	84(50.60)	2
Overall practice means (SD)		11.00	12.70	149.311	83	0.38

Note: bold number means significant value.

Table 5 Bivariate Pearson’s Correlations Between Attitude, Knowledge, and Nurses’ Practice Toward Antibiotic Use and Prevention of Antibiotics in the Intervention Group

Group	Test	Pre-Knowledge	Post-Knowledge	Pre-Attitude	Post-Attitude	Pre- Practice	Post- Practice
Pre-knowledge	Pearson Correlation	1
	Sig. (2-tailed)
Post-knowledge	Pearson Correlation	−0.053	1
	Sig. (2-tailed)	0.632
Pre-attitude	Pearson Correlation	0.369**	0.221*	1
	Sig. (2-tailed)	0.001	0.044
Post-attitude	Pearson Correlation	0.088	0.251*	0.099	1
	Sig. (2-tailed)	0.426	0.021	0.373
Pre- practice	Pearson Correlation	−0.031	−0.036	−0.173	−0.209	1
	Sig. (2-tailed)	0.778	0.746	0.115
Post- practice	Pearson Correlation	b	b	b	b	b	b
	Sig. (2-tailed)

Notes: **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed). Bolded number means significant value. b Cannot be computed because at least one of the variables is constant.