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Development of a questionnaire assessing nursing staff’s knowledge, attitude, and practice on the prevention of the nosocomial infection in elderly patients: testing reliability and validity†

Fu-Lin Cai
Fu-Lin Cai
, 
Xiu-Feng Chen
Xiu-Feng Chen
 and 
Yong-Xin Wang
Yong-Xin Wang
   | Aug 18, 2021
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Article Category: Original article
Published Online: Aug 18, 2021
Page range: 141 - 151
Received: Aug 14, 2020
Accepted: Oct 22, 2020
DOI: https://doi.org/10.2478/fon-2021-0016
Keywords
© 2021 Fu-Lin Cai et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Health belief model.
Health belief model.

Figure 2

Path diagram of nursing staff’s knowledge, attitude, and practice on nosocomial infections (N2 = 340).
Path diagram of nursing staff’s knowledge, attitude, and practice on nosocomial infections (N2 = 340).

Component matrix* of the questionnaire.

Items Component
1 2 3 4 5 6 7 8
A1 0.740
A2 0.796
A3 0.779
A4 0.686
A5 0.793
A6 0.801
A7 0.709
A8 0.773
A9 0.747
A10 0.532
K1 0.866
K2 0.823
K3 0.868
K4 0.853
K5 0.729
P5 0.740
P6 0.800
P7 0.670
P8 0.812
P9 0.717
P10 0.673
K6 0.863
K7 0.910
K8 0.903
K9 0.721
P1 0.805
P2 0.839
P3 0.842
P4 0.859
K10 0.950
K11 0.933
K12 0.953
K13 0.714
K14 0.820
K15 0.846
K16 0.901
K17 0.880
K18 0.946
Eigenvalue 5.623 3.648 3.358 3.036 3.018 2.915 2.899 2.622
Total variance explained (%) 14.419 9.354 8.610 7.784 7.738 7.474 7.433 6.724

GFI indicators for confirmatory factors (N = 681).

Indicators χ2/df GFI AGFI CFI RMSEA
Knowledge (CFA) 3.986 0.911 0.903 0.901 0.061
Attitude (CFA) 2.262 0.969 0.946 0.958 0.043
Practice (CFA) 3.322 0.918 0.898 0.902 0.059

Component matrix* of practice.

Items Component
1 2
P5 You will wear masks and other protective gears when performing nursing operations on elderly patients. 0.772
P6 You will encapsulate with single-layered packaging medical wastes of patients suspected of infectious disease or with non-infections disease but under quarantine. 0.815
P7 You will observe cleaning standard when the ward is occupied with multiple elderly patients. 0.640
P8 You will arrange patients with open wounds or immune suppression to be placed in the same ward when the ward is insufficient. 0.808
P9 For elderly patients with respiratory symptoms (cough, runny nose, stuffy nose), visitors and medical staff need to observe respiratory etiquette. 0.703
P10 If your hand skin is damaged, you will wear single-layered gloves amidst treating and caring for elderly patients, during which you are likely to contact their blood and other body fluid. 0.698
P1 You will not wash or sanitize your hands after the treatment and care of elderly patients are completed. 0.813
P2 You will point out their mistakes when your colleagues don’t wash hands before treating patients. 0.865
P3 You will repeatedly teach hand hygiene and other knowledge to elderly patients and their families. 0.869
P4 you will attach greater importance to hand hygiene when caring for elderly patients. 0.859
Eigenvalue 3.332 2.966
Total variance explained (%) 33.318 29.656

Experts’ sociodemographic information.

Basic information Total number (n = 15)
Number Proportion (%)
Age
  <40 2 13.3
  40–50 9 60.0
  >50 4 26.7
Years of service
  10–20 2 13.3
  >20 13 86.7
Educational background
  PhD 3 20.0
  Master 4 26.7
  Scholar 8 53.3
Professional title
  Professional 7 46.7
  Associate 8 53.3
Field of work
  Clinical nursing 5 33.3
  Clinical medical echnology 4 26.6
  Nosocomial infection 6 40.0

Correlation analysis between each dimension and the questionnaire (N = 681).

Items Items Knowledge Attitude Practice Score
Knowledge Pearson 1 0.177** 0.475** 0.683**
sig 0.001 0.000 0.000
Attitude Pearson 1 0.249** 0.686**
sig 0.006 0.000
Practice Pearson 1 0.673**
sig 0.000
Score Pearson 1

Correlation analysis between each variable and the questionnaire (N = 681).

Item F1 F2 F3 F4 F5 F6 F7 Attitude Score
Basic knowledge F1 1 0.093 0.094 0.144** 0.143** 0.188** 0.054 0.106 0.451**
Clinical knowledge F2 1 0.097 0.212** 0.111 0.099 0.095 0.103 0.422**
Infection prevetion F3 1 0.115* 0.104** 0.092** 0.337** 0.159** 0.482**
Infection control F4 1 0.144* 0.119* 0.154** 0.101 0.487**
Compliance awareness F5 1 0.055 0.039 0.135* 0.424**
standard precaution F6 1 0.182** 0.116* 0.489**
Hand hygiene F7 1 0.131* 0.544**
Attitude 1 0.686**
Score 1

Expert authority coefficient.

Indicators Expert inquiry
Ca Cs Cr
Result 0.9215 0.8895 0.9055

Component matrix* of attitude.

Items Component
A1. Is it important to prevent nosocomial infections in elderly patients? 0.745
A2. Is it important to implement a management system to prevent nosocomial infections? 0.805
A3. Is it important to timely report elderly nosocomial infection cases? 0.779
A4. Is the right use of antibacterial drugs important to prevent nosocomial infections in elderly patients? 0.710
A5. Is the right implementation of hand hygiene important to prevent nosocomial infections in elderly patients? 0.809
A6. Is it important to keep elderly patients’ skin, mouth, eyes, perineum, and anus clean? 0.799
A7. Is multidisciplinary cooperation important to prevent nosocomial infections in elderly patients? 0.720
A8. Is knowing hospital infection and preventive measures important to prevent nosocomial infection in elderly patients? 0.777
A9. Is it important to strengthen the knowledge and education of nosocomial infection among elderly patients and their families? 0.740
A10. Is avoiding falling over in elderly patients important for preventing nosocomial infections? 0.519
Eigenvalue 5.545
Total variance explained (%) 55.455

Reliability-testing statistics (N = 681).

Items Item number Cronbach’s α coefficient ICC
Questionnaire 38 0.851 0.877
Knowledge 18 0.803 0.851
Attitude 10 0.886 0.899
Practice 10 0.774 0.801

Component matrix* of knowledge.

Items Component
1 2 3 4 5
K1. What’s the definition of nosocomial infection? 0.872
K2. What’s the definition of the outbreak of nosocomial infection? 0.834
K3. How do multiple drug-resistant organisms transmit? 0.873
K4. What’s the definition of occupational exposure? 0.859
K5. What’s the bed space of elderly patients infected with the same pathogen? 0.735
K6. Elderly patients will not develop nosocomial infection when going out for physical checks. 0.864
K7. Elders who cannot take care of themselves are prone to nosocomial infections. 0.914
K8. Elders with diabetes are prone to nosocomial infections. 0.727
K9. Bedridden elders are not prone to hypostatic pneumonia. 0.909
K10. What are the external factors causing nosocomial infections in elders? 0.975
K11. What are measures to prevent elders from nosocomial infections? 0.962
K12. What are elders’ own factors contributing to nosocomial infections. 0.976
K13. What are quarantines measures for seriously-ill elderly patients? 0.938
K14. Elderly patients’ wards should open windows regularly for ventilation. 0.829
K15. Ensuring their skin, mouth, eyes, perineum, and anus are clean can prevent the occurrence of nosocomial infections in elderly patients. 0.848
K16. Elderly patients attach great importance to hygiene and they are not prone to nosocomial infections. 0.915
K17. Elderly patients have deep dependence on disposables. 0.890
K18. Elderly patients understand quick and well, and educating them about nosocomial infection knowledge is effective. 0.954
Eigenvalue 3.551 3.002 2.893 2.844 2.623
Total variance explained (%) 18.691 15.798 15.228 14.966 13.803
eISSN:
2544-8994
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Assistive Professions, Nursing
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