Factors Correlated with Practices Regarding Care of Dengue Patients Among Nurses from 94 Primary Care Units in a High- Risk Province in Southern Thailand

Figures & data

Table 1 Personal Factor of Nurses in 94 PCUs

Personal Factor	n (%)
1. Sex
Female	91 (96.8)
Male	3 (3.2)
2. Position of registered nurse
Junior clinical nurse	14 (14.9)
Senior clinical nurse	80 (85.1)
3. Age group (years); mean ± SD = 43.2 ± 8.3 years (range, 22–57 years)
≤45	57 (60.6)
>46	37 (39.4)
4. Total work experience (years); mean ± SD = 20.8 ± 8.9 years (range, 1–36 years)
≤10	18 (19.1)
>10	76 (80.9)
5. Current work experience in the PCU (years); mean ± SD = 7.8 ± 6.8 years (range, 1–25 years)
≤10	71 (75.5)
>10	23 (24.5)
6. Experience in dengue-patient care within previous 5 years (cases)
No	27 (28.7)
Yes (mean ± SD = 24.6 ± 44.8 (range, 1–300))	67 (71.3)
6.1 Experience of treating dengue patients in the fever phase
No	24 (25.5)
Yes (mean ± SD = 10.7 ± 21.6 (range, 1–150))	70 (74.5)
6.2 Experience of caring for dengue patients in the shock phase
No	83 (88.3)
Yes (mean ± SD = 14.7±21.1 (range, 1–60))	11 (11.7)
6.3 Experience of caring for dengue patients in the recovery phase
No	51 (54.3)
Yes (mean ± SD = 9.7 ± 16.3 (range, 1–70))	43 (45.7)
6.4 Experience of doing the tourniquet test
No	23 (24.5)
Yes (mean ± SD = 8.7 ± 15.0 (range, 1–100))	71 (75.5)
6.5 Experience giving intravenous fluids to patients suffering from shock
No	80 (85.1)
Yes (mean ± SD= 23.6 ± 24.5 (range, 1–60))	14 (14.9)
	6.6 Experience of referring dengue patients to a tertiary hospital (mean ± SD = 6.80 ± 11.93)
No	83 (88.3)
Yes (mean ± SD = 6.3 ± 11.4 (range, 1–40))	11 (11.7)
	6.7 Experience related to death of dengue patients
No	93 (98.9)
Yes (mean ± SD = 1 ± 0.0 (range, 1–1))	1 (1.1)
	6.8 Experience of preventing dengue in the community
No	25 (26.6)
Yes (mean ± SD = 12.6 ± 26.5 (range, 1–200))	69 (73.4)

Table 2 Number and Percentage of Correct Answers of Knowledge Regarding Dengue-Patient Care

Item	Correct Answer n (%)
1. Signs and symptoms of dengue: dengue hemorrhagic fever includes increased leakage of plasma and reduced platelet count	89 (94.7)
2. Dengue includes four types: dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue grade 4 (negative question)	30 (31.9)
3. An individual may have dengue infection more than once because the dengue virus has four serotypes	91 (96.8)
4. After 2 days, high fever is observed after a bite from a mosquito infected with the dengue virus (negative question)	33 (35.1)
5. A probable dengue-fever case involves an acute fever with at least two signs, such as headache, muscle/joint pains, positive tourniquet test, WBC count <5000 cell/mm^3, platelets <150,000 cell/mm^3 and increased hematocrit (5–10%)	83 (88.3)
6. Almost all symptoms of dengue hemorrhagic fever include high fever for 2–7 days with a red face, headache, poor appetite, abdominal pain, positive tourniquet test, WBC count <5000 cell/mm^3, platelet count <100,000 cell/mm^3 and increased hematocrit (>10%)	76 (80.9)
7. Patients with dengue shock syndrome have important signs, such as cold skin, restlessness, crying (in children) and increased urine output (negative question)	50 (53.2)
8. Patients with dengue can die from a delayed diagnosis	71 (75.5)
9. Patients with dengue in the convalescent phase show reduced fever, itching and a good appetite	69 (73.4)
10. Aedes aegypti is small, and black and white	90 (95.7)
11. Female Aedes aegypti bite humans for breeding	82 (87.2)
12. Eggs of Aedes aegypti remained at a dry temperature for >1 year	60 (63.8)
13. Secondary infection by the dengue virus increases the severity of signs and symptoms	80 (85.1)
14. A human can be infected with the dengue virus several times, leading to severe and non-severe disease	90 (95.7)
Total knowledge regarding dengue-patient care (total of 14 points)^a
Good knowledge (≥11 points)	21 (22.3)
Poor knowledge (<11 points)	73 (77.7)

Note: ^aCutoff for a good level ≥11 points (80%).

Table 3 Number and Percentage of Positive-Attitude Responses to Items Regarding Dengue-Patient Care

Item	Positive Response n (%)
1. Dengue has been a public-health problem in tropical countries and Thailand	91 (96.8)
2. In the fever stage, the dengue virus could be transmitted to other people so there is a need to prevent mosquito bites	89 (94.7)
3. Severity of dengue disease causes death from shock and bleeding	93 (98.9)
4. Drinking fluids and giving intravenous fluids are important in dengue hemorrhagic fever	94 (100)
5. Wording “prevention is the best treatment of dengue”	82 (87.2)
6. Community participation is the strategy for sustainable prevention of dengue	94 (100)
7. High levels of larval indices predict the risk of a dengue outbreak	93 (98.9)
8. All stakeholders are important for dengue prevention/control	24 (25.5)
9. Rapid notification (within 72 h) to a health official after a dengue case is found is important	30 (31.9)
10. A probable dengue case needs investigation if he/she has a high fever and a red face for >2 days	65 (69.1)
Total attitude regarding dengue-patient case (total = 10 points)
Positive attitude (≥8 points)	21 (22.3)
Negative attitude (<8 points)	73 (77.7)

Note: Cutoff point for a positive attitude ≥80%.

Table 4 Number and Percentage for Nurses Preparing Equipment and Using Medical Supplies in PCUs

Item	Number (%)
1. Mercury sphygmomanometer and cuff of sizes small, medium and large	32 (34.0)
2. Blood glucometer	91 (96.8)
3. Hematocrit centrifuge	78 (83.0)
4. 5% dextrose in normal saline solution, 5% dextrose in lactated Ringer’s solution or 5% dextrose acetar Ringer’s solution capacity 500 mL.	64 (68.1)
5. Oral resuscitation solution and nasogastric tube of sizes 8, 14, 16 and 18	70 (74.5)
6. Set intravascular fluid, medicut size number 18, 20, 21, 22 and 23	70 (74.5)
7. Manual on management of dengue patients	74 (78.7)
8. Training of healthcare providers for dengue and guidelines for clinical practice	60 (63.8)
Preparation of equipment and use of medical supplies in PCUs
No	37 (39.4)
Yes	58 (60.6)

Note: Cutoff point was ≥6 points (80%).

Table 5 Number and Percentage for Nurse Practices Regarding Dengue-Patient Care

Aspect	n (%)
1. Practice of initial assessment of patient visiting the PCU/hospital for screening of dengue infection (five items = 25 points)
Good practice (≥22 points)	83 (88.3)
Poor practice (<22 points)	11 (11.7)
2. Basic practice after meeting dengue patients within the first 2 days of the fever phase (seven items = 35 points)
Good practice (≥31 points)	82 (87.2)
Poor practice (<31 points)	12 (12.8)
3. Practice guideline for dengue diagnosis in the shock phase with drowsy signs after 3 days (12 items = 60 points)
Good practice (≥54 points)	80 (85.1)
Poor practice (<54 points)	14 (14.9)
4. Practice guideline for administering intravenous fluids for initial resuscitation (four items = 20 points)
Good practice (≥18 points)	47 (50.0)
Poor practice (<18 points)	47 (50.0)
5. Practice guideline for referral to a tertiary hospital (13 items = 65 points)
Good practice (≥58 points)	46 (48.9)
Poor practice (<58 points)	48 (51.1)
6. Practice guideline for dengue prevention (six items = 30 points)
Good practice (≥27 points)	73 (77.7)
Poor practice (<27 points)	21 (22.3)

Note: Cutoff for good practice ≥90% for each aspect.

Figure 1 Correlation among personal factors (numbers 1–5), experience (numbers 6–14), knowledge (number 15), attitude (number 16), equipment (number 17) and practice regarding dengue patient care (numbers 18–24) Spearman’s test statistics: - Not statistically significant; *p < 0.05; **p < 0.01. Remarks, 1 Sex. 2 Age group (Cutoff point 45 years). 3 Position level (Practical/expert level). 4 Working experience up to the present (Cutoff point 10 years). 5 Working experience in the current duty at PCU (Cutoff point 10 years). 6 Have experience in treating dengue patients in previous 5 years (Yes/no). 7 Have experience in treating dengue patients in fever phase (Yes/no). 8 Have experience in caring for dengue patients in the shock phase (Yes/no). 9 Have experience in caring for dengue patients in the recovery phase (Yes/no). 10 Have experience in doing tourniquet test (Yes/no). 11 Experience giving intravascular fluid to patients in the critical phase (Yes/no). 12 Experience in referring dengue patients to hospital. 13 Experience related to dengue patient death (Yes/no). 14 Experience in prevention of dengue diseases in community (Yes/no). 15 Knowledge regarding DPC (Cutoff point for good knowledge level at ≥80%). 16 Attitude regarding DPC (Cutoff point for positive attitude level at ≥80%). 17 Preparation of equipment (Cutoff point for preparation level at ≥80%). 18 Practice regarding DPCA1: Practice to initial assessment of patient visiting the PCU/hospital for screening dengue infection (Cutoff point for good practice level at ≥90%). 19 Practice regarding DPCA2: Basic practice after meeting dengue patients within the first 2 days of the fever phase (Cutoff point for good practice level at ≥90%). 20 Practice regarding DPCA3: Practice guideline for dengue diagnosis with dengue shock phase with drowsy sign after 3 days (Cutoff point for good practice level at ≥90%). 21 Practice regarding DPCA4: Practice guideline for taking intravascular fluid for initial resuscitated shock (Cutoff point for good practice level at ≥90%). 22 Practice regarding DPCA5: Practice guideline for referral to province hospital (Cutoff point for good practice level at ≥90%). 23 Practice regarding DPCA6: Practice guideline for dengue prevention (Cutoff point for good practice level at ≥90%).