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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 3  |  Page : 281-291

Effect of educational sessions about dengue fever on nurse’s knowledge and attitude at Zagazig Fever Hospital


Community Health Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt

Date of Submission27-Aug-2018
Date of Acceptance16-Oct-2018
Date of Web Publication28-Dec-2018

Correspondence Address:
Samia Farouk Mahmoud
Community Health Nursing Department, Faculty of Nursing, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_18_18

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  Abstract 


Background Dengue fever (DF) is emerging as a serious global health problem. Nurses serve as the frontline health care workers who assist in the diagnosis and treatment of dengue and other febrile illnesses.
Aim The aim of this article is to assess the effect of educational sessions about DF on nurse’s knowledge and attitude at Zagazig Fever Hospital.
Patients and methods A quasi-experimental design was used in carrying out the study during the period from November 2017 to January 2018. The study was conducted in Zagazig Fever Hospital, Sharkia Governorate. The sample included 71 nurses (39 diploma nurses and 32 bachelor nurses), working at the outpatient and the emergency clinic according to the inclusion criteria. Two tools were used. Tool 1 was a questionnaire that consisted of two parts: part A was used to collect data relating to demographic characteristics of the nurses, whereas part B involved nurse’s knowledge about DF using a self-administered questionnaire. Tool 2 was a self-administered questionnaire that was designed to assess nurses’ attitude toward DF.
Results The comparison of pretest and post-test scores of nurses’ knowledge and attitudes revealed highly statistically significant improvement (P<0.001), which justified the research hypotheses of educational sessions’ implementation. The total score of their knowledge increased from 9.9% in pre-implementation session to 87.3% 1 month after the implementation, and the total score of their attitudes increased from 60.6% before the sessions, to 91.5% 1 month after the sessions.
Conclusion The post-test score was higher than the pretest score for both knowledge and attitudes of nurses regarding DF.
Recommendations Primary prevention of infectious diseases like DF should be given priority, and education about it should be provided in fever hospitals, through in-service health educational training session to be provided to all nurses in the fever hospitals, especially the newly appointed ones before they start their work.

Keywords: dengue fever, educational sessions, fever hospital, nurses


How to cite this article:
Abd El-Ghany GM, Mahmoud SF. Effect of educational sessions about dengue fever on nurse’s knowledge and attitude at Zagazig Fever Hospital. Egypt Nurs J 2018;15:281-91

How to cite this URL:
Abd El-Ghany GM, Mahmoud SF. Effect of educational sessions about dengue fever on nurse’s knowledge and attitude at Zagazig Fever Hospital. Egypt Nurs J [serial online] 2018 [cited 2019 Aug 17];15:281-91. Available from: http://www.enj.eg.net/text.asp?2018/15/3/281/248961




  Introduction Top


Dengue fever (DF) is a very ancient disease, with the first registered cases of compatible disease occurring in China in 992. During that time, the Chinese referred to the disease as water poisoning and were able to connect its occurrence to flying insects. Outbreaks of a disease thought to be dengue occurred in 1635 in the French West India, in 1699 in Panama, and in 1779–1780 in Indonesia, Egypt, and the USA, in Boston and Philadelphia (McGuire, 2010).

In recent years, mosquito-borne diseases have emerged as a serious public health concern in Egypt. The first dengue cases were reported in October 2015. A total of 253 cases were admitted to the Dayrout Fever Hospital owing to acute febrile illness. Various samples including oropharyngeal swabs and blood and serum samples were collected. A total of 28 of the 118 serum samples were positive for dengue virus type I by ELISA and PCR {World Health Organization (WHO), 2015}. Similarly, before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in Africa. The America, South-east Asia, and the Western Pacific regions are the most seriously affected {World Health Organization (WHO), 2015}. Moreover, an estimated 0.5 million people with severe dengue require hospitalization each year. Approximately 2.5% of those affected die (Heera and Parajuli, 2016).

The mosquitoes rest indoors on various objects such as closed and dark places and outside in cool and shady places. The vector Aedes though can fly only to a distance of 400 m, it can spread mechanically through various types of vehicles used by man over a vast distance. The transmission of dengue depends upon two factors, that is, biotic: vector and the host and abiotic: temperature, humidity, and rainfall. There is increased viral load in human blood 2 days before the onset of fever and lasts for 5–7 days after the onset of the fever. The vector Aedes gets infected during these two periods and thereafter human becomes dead-end for transmission (Cameron and Simmons, 2012).

Dengue viruses are transmitted between humans by the bite of an infected mosquito. Mosquitoes pick up the dengue virus when they bite a human who is infected with the virus. The mosquito then carries the virus in its own blood and spreads it when it bites other humans. After a dengue virus enters the human bloodstream, it spreads throughout the body. Symptoms appear in about eight to 10 days after a bite from an infected mosquito (Donough, 2011).

DF is treated by administering intravenous fluids and blood transfusions in severe cases. The treatment of DF is only supportive, and there is no licensed vaccine or medication yet (US Department of Health and Human Services, 2018). According to the WHO, dengue can be classified into DF, dengue hemorrhagic fever (DHF), and dengue shock syndrome. Most DF cases are self-limited, but DHF and dengue shock syndrome cases are life threatening if not treated. The mortality rate from complications of DF is 20% when untreated. However, it is less than 1% if recognized early and treated (Lee et al., 2011).Community health nurse (CHN) in Egypt especially in Sharkia Governorate is the forefront of health promotion and disease prevention, including dengue prevention. In line with the efforts to increase community participation in maintaining health, the CHN implements dengue prevention strategies in collaboration with various community groups, community leaders, schools, maternal child health centers, and outpatient clinics in hospitals providing care to patients with communicable disease. Public health nurses play an important role in health care system in both institutionalized settings and community care centers. In a hospital, nurses come across various types of patients. So, nurses should have wide knowledge about all the diseases, especially infectious diseases like DF [World Health Organization {WHO), 2015}.


  Significance of the study Top


There are numerous gaps in dengue research, including lack of immunization, unavailable treatment, inadequate surveillance, changing global parameters, and entomological evolution. Therefore, there is pressing need to develop tools for translating what is known about risk factors into risk-mitigating practices within communities in particular to nurses. In Egypt, the epidemiological data identify nurses as high risk for dengue morbidity and mortality. The successful use of nursing intervention may be effective in improving both knowledge and attitudes regarding DF for this high-risk population. Nurses are trusted health professionals in a unique job to influence awareness and education about vector ecology, transmission, and clinical characteristics of this disease in ways that are easily understood to help reduce mosquito-borne transmission and control growing epidemics (Gubler, 2011). According to the researchers’ knowledge, there is limited or no research found about nursing intervention perspective on DF.


  Aim of the study Top


The aim of study was to assess the effect of educational sessions about DF on nurse’s knowledge and attitude at Zagazig Fever Hospital.

Hypotheses

  1. Nurses’ knowledge score regarding DF will be improved after conducting nursing educational sessions.
  2. Nurses’ attitude score toward DF will be more positive after conducting nursing educational sessions.



  Patients and methods Top


Study design

A quasi-experimental interventional design, with pretest–post-test, was used to conduct this study.

Study setting

This study was conducted at the Outpatient and Emergency Clinic in Zagazig Fever Hospital. Only one hospital in Sharkia Governorate provides care for patients who have infectious diseases or communicable diseases like DF, malaria, influenza, measles,  Salmonella More Details, typhoid,  Brucellosis More Details, diarrheal disease, AIDS, and other food-borne illnesses.

Patients

A convenience sample of 71 nurses, 39 diploma nurses and 32 bachelor nurses holders, (BSc N.) out of 141 nurses working in the hospital, was recruited for the study, who fulfilled the inclusion criteria; only nurses and staff nurses working at the Outpatient and Emergency Clinic, present at the time of data collection and willing to participate in the study were recruited. The clinic works all days of the week from Saturday to Friday, and the rate of cases per day ranges from 40 and 45 cases, that is, the rate of cases per week ranges from 280 and 315 cases.

Tools of data collection

Two tools were developed by the researchers to collect the necessary data for achieving the study objectives.

Tool 1

This was a questionnaire developed by the researchers through reviewing related literature. It consisted of two parts:
  1. Part A includes nurse’s demographic characteristics, such as age, sex, marital status, residence, years of experience, years of experience in fever hospital, qualification, training, sources of information, attended a patient with DF, and action taken by the nurse (Q1–12).
  2. Part B includes nurse’s knowledge about DF, through a self-administered questionnaire. It was guided by El-Habshiyet al.(2015). It was used to assess nurse’s knowledge about DF. The questionnaire comprised close-ended questions on the following sections: definition (one question), signs/symptoms (10 questions), transmission (nine questions), sources of infection (six questions), diagnosis (seven questions), vector (three questions), prevention (nine questions), emergency manifestation (seven questions), nursing role (five questions), and treatment (four questions).


Scoring system:

For the knowledge items, a correct response was scored 1 and the incorrect 0. For each area of knowledge, the scores of the items were summed up and the total divided by the number of the items, giving a mean score for the part. The total score of knowledge was 61 points. These scores were converted into percent scores. Knowledge was considered satisfactory if the percent score was 60% or more and unsatisfactory if less than 60%.

Tool 2

Part A consists of nurses’ attitudes toward DF through a self-administered questionnaire. It was guided by El-Habshiy et al. (2015) and based on three-level Likert scale. This tool was intended to assess nurses’ attitudes toward DF. Nurses were asked to respond by any of three-level Likert scale, this is, ‘disagree,’ ‘not sure,’ and ‘agree,’ for each statement. Of the 15 attitude statements, except for ‘you are at risk of injury when you are among many patients’, it is a negative attitude if answered by ‘disagree,’ whereas the remaining 14 indicate positive attitudes if answered by ‘agree.’ The scale is composed of four categories: the first describes exposure to the principal vector of DF, which is the mosquito and staying away from sources of insects may decrease DF infection. The second focuses on prevention, as DF can be prevented, and knowing the sources of infection is important. It is necessary to discard breeding places and spraying the swamps and around the house to prevent DF, and these preventive procedures are more important than the clinical treatment. The third category focuses on risks, as DF is a serious disease; one is at risk of injury when he/she is among many patients, and infection gives the person lifelong immunity from the same serotype. The fourth is the nurse’s role, as registration of cases among patients is very important. Blood tests are important to confirm dengue infection, and training sessions about the disease give a sense of safety. Moreover, the nurse by involving the health team in these sessions has an important role in controlling and preventing dengue diseases. Moreover, teaching the teams involved in vector control is an important role of the nurse.

Scoring system

The responses ‘disagree,’ ‘not sure,’ and ‘agree’ were scored 3, 2, and 1, respectively. The scoring was reversed for negative statements. The scores of the items were summed up, and the total divided by the number of the items, giving mean scores, which were converted into percent scores. The attitude was considered positive if the percent score was 80% or more, and negative if less than 80%.

Content validity

The validity of data collection tools and booklets’ content was tested by four experts, two professors from the Community Health Nursing, the Faculty of Nursing, Zagazig University, one professor from the Community Health Nursing, Faculty of Nursing, Ain Shams University, and one professor from the Faculty of Medicine, Zagazig University, to assess clarity, application, and understanding of the tools. All recommended change on the tools were done. The Cronbach’s α test was 0.874 for tool 1 and 0.89 for tool 2.

Field work

Data collection took 3 months from November 2017 to January 2018. The searchers initiate the data collection 2 days per week (Mondays and Wednesdays) from 10.00 a.m. to 12.00 noon during the 3 months. The accomplishment of the study was done through four phases: assessment, planning, implementation, and evaluation.

Assessment phase

This phase included the pre-intervention data collection for baseline assessment. The researchers first introduced themselves and explained the purpose of the research to the Manager of Zagazig Fever Hospital and to the directors of nurses.

All the nurses working in the outpatient and emergency clinic were met. The pretest knowledge and attitude questionnaires were distributed and then the same questionnaires were used after the implementation of sessions (1 month later) as post-test for comparison. The time consumed for answering questionnaires ranged from 15 to 20 min for each. The data were primarily tested to provide the basis for designing the intervention sessions.

Planning phase

Based on the review of literature, sample features, and the results obtained from the assessment phase, the researchers designed the intervention sessions’ content. An illustrated booklet was prepared by the researchers, and after its content validation, it was dole out to nurses to be used as a guide for self-learning.

The general objective of the nurses’ sessions was to improve their knowledge and promote a positive attitude toward DF.

Regarding specific objectives, by the end of the intervention, the nurses should be able to do the following:
  1. Define the meaning of dengue disease.
  2. Enumerate the signs and symptoms of DF and DHF.
  3. Discuss the mode of transmission of DF.
  4. Identify the sources of DF infection.
  5. Recognize the diagnosis of DF.
  6. Discuss the vector of mosquito.
  7. Explain the prevention of DF.
  8. Discuss the emergency manifestations of DF.
  9. Explain the role of the nurse in DF.
  10. Discuss the treatment of DF.


Implementation phase

The intervention was implemented in the outpatient clinic, waiting room, and training unit of the hospital. The educational training methods were lectures and group discussions. The sessions were aided by using pictures and posters through laptop; data were shown to facilitate and illustrate teaching. The intervention was implemented in three sessions, and the time of each session was 20–25 min. The number of nurses in each session was three to seven nurses. The objectives of the sessions were as follows.

In the first session, the researchers introduced the basic knowledge regarding DF, such as the meaning of dengue disease, followed by the signs and symptoms of DF. Hemorrhagic fever was explained by the researchers, as it is characterized by hemorrhagic symptoms including bleeding, thrombocytopenia, and reduction of intravascular blood volume.

The objective of the second session was the explanation the mode of the transmission of DF, diagnosis of DF, and vector. Moreover, the second session focused on preventive measures of DF. Additionally, the researchers emphasized the importance of stagnant water surface removal to prevent potential mosquito’s breeding ground, inspection of drains for potential blockage, and covering all toilet bowls. On the same context, the researchers focused on emergency action to be used for DF when patients have the aforelisted manifestations as well as any of the following signs and symptoms: severe abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, or increase in hematocrit along with decrease in platelets.

In the third session, the researchers illustrated the role of the nurse, which composed of two categories:
  1. Preventive and control measures:
    1. Anti-mosquito control measures: hospital management should make sure a regular session in the elimination of mosquito in hospital is strictly followed, and continued education of staff and the use of a checklist are encouraged.
    2. Early case detection and notification: early detection of cases is most important in the control of any community outbreak.
    3. Patient management: a high index of suspicion should be given to patients with recent exposure to DF endemic countries or local regions with reported cases.
      1. Suspected cases:
      1. If the patient presents 6 or more days after symptom onset, the serological test for IgM antibody should be done without delay.
      2. The patient should be kept in air-conditioned ward or area with mosquito control pending confirmation/exclusion of the diagnosis.
    4. Infection control measures: this includes isolation of patients of DF/DHF is not indicated, as DF is not directly transmitted from person to person.


    Evaluation phase

    Evaluation of the nursing intervention was done 1 month later after application of the sessions, through the same tools.

    Pilot study

    A pilot study was carried out on seven nurses, representing 10% of the study sample, in Zagazig Fever Hospital, to assess clarity, feasibility, and the applicability of the tools. Moreover, the time needed to fill in the data collection tools was estimated. Nurses who participated in the pilot study were excluded from the main study sample, and then the necessary modifications were done.

    Administrative and ethical considerations

    Approval of the local Ethical Committee was taken before starting the study. Before data collection, a formal written permission was obtained from the concerned authority of the selected hospital, upon submission of official letters from the Faculty of Nursing, Zagazig University, to the responsible authorities of the study settings to obtain their permission for data collection. Moreover, an informed consent was taken from each of the nurses who agreed to participate in the study. They were also assured about confidentiality of the information given to carry out the study and that the data will be used only for the purpose of the study.

    Statistical analysis

    Data entry and statistical analysis were done using the statistical package for the social sciences, version 20.0 (Chicago, Illinois, USA). Cronbach’s α coefficient was calculated to assess the reliability of the attitude scale through its internal consistency. Qualitative categorical variables were compared using χ2 test. Spearman’s rank correlation was used for assessment of the inter-relationships among quantitative variables and ranked ones. To identify the independent predictors of the knowledge and attitude scores, multiple linear regression analysis was used and analysis of variance for the full regression models done. Statistical significance was considered at P value less than 0.05.


      Results Top


    The age of the nurses in the study sample ranged between 22.0 and 59.0 years, with a median of 35.0 years, as [Table 1] indicates. Additionally, 95.8% of nurses were females, 88.7% were married, and 50.7% resided in urban areas. Moreover, the mean years of experience for the study sample was 14.4±9.0 years, compared with 13.5±8.7 years in Fever Hospital. Furthermore, 54.9% in the study sample had nursing diploma qualification.
    Table 1 Demographic characteristics of nurses in the study sample (n=71)

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    Regarding training and exposure to DF cases among nurses in the study sample, [Table 2] shows that only 12.7% had training in DF. Additionally, 14.1% were exposed to a patient with DF. Considering the nursing action taken, for 80.0% of the studied nurses, it was infection control. Moreover, the study sample revealed that the highest source of information on DF mentioned by the nurses was the hospital (70.4%), followed by internet (21.1%), and then by posters (11.3%).
    Table 2 Training and exposure to dengue fever cases among nurses in the study sample (N=71)

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    [Table 3] portrays that only 1.4% of the study sample identified the diagnosis of DF at pre-educational program compared with 78.9% at post-test. A considerable improvement was noticed between the studied sample in preprogram and postprogram implementation related to prevention among the studied nurses (χ2=38.84 at P=0.001). Additionally, 90.1% of them were identified as having knowledge about treatment related to DF diseases in postintervention session. Furthermore, the total satisfactory score of their knowledge increased from 9.9% in presessions to 87.3% postsessions. All the differences in knowledge items related to DF were observed as statistically significant (P=0.001).
    Table 3 Nurses knowledge related to dengue fever pre–post educational sessions

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    [Table 4] clarifies that there were highly statistically significant differences between nurses’ attitudes towards DF disease throughout intervention phases, pre and post (P<0.001). The total score of their positive attitudes increased from 60.6% in presessions to 91.5% 1 month after sessions. Additionally, the highest positive attitude focuses on nurse role in preprogram, representing 69.0% compared with 97.2% in post-test.
    Table 4 Nurses’ attitudes toward dengue fever pre–post educational sessions

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    Concerning the relations between nurses’ attitudes towards DF and their knowledge of related areas, [Table 5] demonstrates statistically significant relations of nurses’ attitudes and their knowledge of related areas. It is noticed that the percentage of those with satisfactory knowledge was higher among the nurses with positive attitudes (χ2=32.64, P=0.001).
    Table 5 Relations between nurses’ attitudes towards dengue fever and their knowledge of related areas

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    As [Table 6] reveals, there were statistically significant relations between nurses’ knowledge of DF and their attitudes toward related areas. It is evident that the percentage of positive attitudes was higher among those having higher satisfactory knowledge (χ2=32.64, P=0.001).
    Table 6 Relations between nurses’ knowledge of dengue fever and their attitudes towards related areas

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    As displayed in [Table 7], nurses’ knowledge score pre-intervention had a statistically significant strong positive correlation with their attitude score (r=0.679). Moreover, nurses’ knowledge score postintervention had a statistically significant strong positive correlation with their attitude score (r=0.393). Meanwhile, at postintervention, their score of attitudes toward influencing factors had a statistically significant weak negative correlation with their qualification (r=−0.241).
    Table 7 Correlation between nurses’ knowledge and attitudes and their characteristics

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    In a multivariate analysis, [Table 8] shows that the statistically significant independent positive predictors of the nurses’ knowledge scores related to DF were their intervention, experience in fever hospital, and exposed to a case. Conversely, their experience (total) was a negative predictor. The model explains 68% of the variation in this score, whereas none of the other nurses’ characteristics had a significant influence on it.
    Table 8 Best fitting multiple linear regression model for the knowledge score

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    Concerning the nurses’ perception of the factors influencing their attitude score to DF, [Table 9] reveals that the knowledge score was a statistically significant independent positive predictor of this score. However, the intervention was a statistically significant independent negative predictor of this score. The model explains 66% of the variation in this score, whereas none of the other nurses’ characteristics had a significant influence on it.
    Table 9 Best fitting multiple linear regression model for the attitudes score

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      Discussion Top


    DF is a rapidly increasing infection throughout the tropics and subtropics with expanded public health burden. Adequate training of health care providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. Additionally, dengue prevention in Egypt has been undertaken since 2015 involving physicians and CHNs. However, prevention remains a huge challenge for nurses and other health professionals {World Health Organization (WHO), 2015}.

    The targeted populations in the current study were nurses. This target is selected because the nurses are the first-line health care providers of DF infection diagnosis and in providing nursing care. Nurses can help the society by giving awareness related to the DF, and its prevention and control measures mainly focused towards protection from mosquito bites and its breeding. Many similar studies involved nurses as the same target, such as the study of Ho et al. (2013), in southern Taiwan; Streich (2014) in Bozeman, Montana; Rajakumari {2015} in India, El-Habshiy et al. {2015}, in AL-Yemen; and Mane (2016) in India.

    The current study results revealed that the most common sources of knowledge on DF mentioned by the nurses was the hospital, followed by internet, and then by posters. This might be owing to that the nurses stay most of the time in hospital. This study result was in disagreement with that of Itrat et al. (2008), in Pakistan, who found that television was considered as the most (62%) important and useful source of information on DF. Friends were the second most common source (31%), followed by newspapers. In line with this finding was the study done by Swati et al., (2014), in India. Additionally, Rajakumari {2015}, in India, mentioned that television emerges as the most important source of information (37.8%). This finding was in agreement with that of a study carried out by Kwon and Crizaldo (2014), in the Philippines, who mentioned that 93.8% recalled that television was their main source of information on DF. This finding is agreement with a study conducted by Mahyiddin et al. (2016) in Malaysia, who found that almost all of the patients (95.6%) reported television as the main source of information. This emphasizes upon the fact that mass media like television is a very important source of information, and this can be further used to disseminate more awareness regarding DF.

    The distribution in the present study sample by age highlighted that it ranged between 22 and 59 years, whereas the distribution by sex showed that majority of them were females and less than three-quarters of the nurses had 10 or more years of experience. This result was supported by that of Ho et al. (2013), who reported that 51% of health care professionals had more than 10 years of experience. Moreover, Mahyiddin et al. (2016), in Malaysia, found similar results. These results were in accordance with that of Ekra et al. (2017), in Abidjan, who mentioned that the age of the nurses ranged from 23 to 65 years, whereas among nurses, females represented an overwhelming majority (97%), and 31% of nurses had more than 10 years of experience.

    Concerning attending a patient with DF and action taken by nurses, the present study results revealed that less than one-fifth had reported being exposed to DF cases, and the primary action taken among them were patient isolation, and taking preventive measures. This result was supported by that of Ho et al. (2013), in Southern Taiwan, who found that 13.1% of nurses had attended DF cases. These results concur with the finding of Audain and Mahr (2017), who stated that nurses are excellent health and community educators and are known for their personal approach using a one-on-one communication style, sharing complex scientific, medical, and policy health information, and assessing individuals sympathetically. The art of effectively teaching patients and communities can lead to changing behavior for better understanding of mosquito­borne illnesses. Increasing understanding about why preventive measures are important may help persons at risk to take protective steps consistently.

    Regarding the main objectives of the present study was the assessment of nurses’ knowledge about DF. The overall knowledge score in preprogram among nurses related to DF was very poor. This study result highlighted the pressing need for implementing DF intervention, where knowledge often comes from educational session. Moreover, only less than one-fifth of the nurses under study had received in-service training regarding DF, and most of the study sample had diploma qualification. This may be a reason for nurses to possess poor knowledge on DF. This finding was in agreement with that of a study carried out by Huang et al. (2011), in Taiwan, who found that the nurses and other health professionals usually possessed less knowledge. In line with the previous findings, Sharma et al. (2012) conducted a study in Nepal and demonstrated that the majority of participants had poor level of knowledge. This finding is supported by Valarmathi and Parajulee (2013), who in their study done in Nepal, to assess the knowledge of nurses regarding DF detected poor knowledge regarding DF among the nurses, owing to that the majority of those who participated in their study were diploma holders. Furthermore, a study carried out in India by Mane (2016), to evaluate the knowledge, attitude, and practice of general public and nursing staff of hospitals regarding the DF, showed that most of the nurses do not have enough knowledge regarding the disease and its preventive practices. In the same context, Streich (2014) conducted a study on nursing faculty’s knowledge on health effects owing to climate change in Bozeman, Montana, and found that majority had poor level of knowledge.

    This study finding contradicted that of a thesis study done by El-Habshiy et al. {2015} in AL-Yemen, Kwon and Crizaldo (2014), in the Philippines. This result is similarly to that of a very recent a study conducted in India by Pavani and Kumar (2017); they detected high level of knowledge and awareness among nurses regarding dengue epidemiology, clinical presentation, and preventive measures. These results contraindicated those of the current study owing to that mosquito-borne diseases may have emerged as a serious public health concern in these countries and media like television may have been a very important source of information in these countries.

    After implementation of the nursing educational sessions about DF, the first objectives and first hypothesis were highly achieved as the findings pointed to generally high level scores of knowledge of DF. These improvements might be owing to the effect of the educational sessions, which was provided to nurses. In addition, they were enthusiastic to participate in the sessions and willing to attend future educational session as reported by them. This finding was in agreement with that of Pacheco and Coutinho (2011), who conducted a study to assess the knowledge of undergraduate nursing students, entering and graduating nursing school, concerning health promotion, prevention, and treatment of DF in which the nursing students’ knowledge about the disease was good. In this context, a Jamaican study done by Shuaib et al. (2012) revealed that most participants have good knowledge on the mosquito vector and signs and symptoms of DF. Similarly, Begonia et al. (2013) in Philippines, in their study on dengue hemorrhage among rural residents in Samar Province, found that 61.45% of the respondents had good knowledge on causes, signs and symptoms, mode of transmission, and preventive measures about DF. The study results also showed that 52.63% of the respondents used DF measures such as fans, mosquito coil, and bed nets to reduce mosquitoes.

    Additionally, this result was in agreement with the study by Rajakumari {2015} in India, which mentioned that 93.33% of nurses had satisfactory knowledge. Similarly, Swapna {2015}, who carried out a study in Delhi, India, mentioned that the mean pretest score was 11.44 and increased to 18.82 during post-test with 93%. Similar result was found in a study done by Johnson (2016) in Punjab. This finding is consistent with that conducted in Machala by Handel et al. (2016) about dengue infection among public sector health care providers they found that 89% of nurses reported good knowledge. Similarly, Su et al. (2016), in Malaysia, reported that generally patients had better understanding of DF and dengue preventive measures after health education. This finding was also in agreement with Ekra et al. (2017), who in their very recent study, to assess practices for dengue diagnosis among health care professionals working in public hospitals in Abidjan, mentioned that nurses had a good practice of DF. The same results were achieved in the study of Syed et al. (2011) and Sandeep et al. (2014) both done in India.

    Regarding the attitude, the current study results showed that there were statistically significant positive attitudes toward whole areas such as exposure, risks, prevention, and nursing role of DF throughout intervention phases, where improvements between pretest and post-test intervention were detected. This might be owing to that results provided evidence that the health educational session played a significant role in improving attitude scores among nurses. The study findings demonstrated a significant positive correlation between nurses’ scores of knowledge and attitudes. A similar positive correlation was reported by Rajakumari {2015} in India. Similar results were shown by a supportive study by Swapna {2015}, who conducted a study in south Delhi, India, and reported that 84% of the sample had positive attitude at pretest, whereas the post-test attitude score was increased to 93%. This study result is consistent with that of a study done by El-Habshiy et al. {2015} in Al-Yemen, who revealed that 98.1% of the patients had positive attitude about DF.

    The factors that significantly related to nurses affecting their knowledge, in the present study, were the intervention, experience, and being exposed to a case. Moreover, nurses’ knowledge scores were positively correlated with age, attitude score, experience, and qualification. This is quite plausible to the success of nursing educational intervention, and knowledge about dengue is extremely necessary for effective prevention measures to be established and increase positive attitude. This finding is in accordance with that of a study conducted by Sharma et al. (2012), in Nepal, who found that the level of knowledge regarding DF has a statistically significant relation with age (P=0.005) and participation in dengue awareness program (P=0.007). This finding of the respondents was supported by a research conducted by Merga and Alemayehu {2015} in Ethiopia which reported similar results.


      Conclusion Top


    In light of the results of the current study, it can be concluded that nursing sessions were effective in increasing the level of nurses’ knowledge as well as their positive attitude toward DF. Additionally, the result showed that the post-test knowledge score was higher than the pretest score in both knowledge and attitude of nurses.

    Recommendations:

    Based on the current study findings, the following recommendations were suggested: primary prevention of infectious diseases like DF should be given priority, and education about it should be applied in fever hospitals, through in-service health educational training session to be provided to all nurses in the fever hospitals especially the newly appointed ones before starting their work. Furthermore, they need to be given illustrated booklets for maintaining knowledge of the most important types of DF and to be used as a reference. Further research should be geared toward implementing interventions to improve nurses’ knowledge and attitudes about DF.

    Acknowledgements

    The authors express thanks and gratitude to ALLAH, the most kind and most merciful. The authors would like to show their greatest appreciation toward Prof. Dr. Salwa Abass Ali Hassan, Professor of Community Health Nursing, Faculty of Nursing, Zagazig University, for the continuous support. We would like to thank all the participants in the study, the nurses, who provided us with their most valuable asset, time. Many thanks for all of them, as without them we would not have been able to conduct this study.[33]

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

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      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



     

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