Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study

doi:10.5847/wjem.j.1920-8642.2019.02.004

Abstract

Abstract:

BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia.
METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable.
RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group.
CONCLUSION: This study demonstrates that there is a gap in EHCWs’ KAP, particularly regarding when to provide OT to a patient. This gap can affect patients’ safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.

Key words: Emergency medicine, Oxygen therapy, Knowledge, Attitude, Practice

Amairah Fahad Aloushan, Faisal Abdullah Almoaiqel, Raid Naysh Alghamdi, Fatmah Ismail Alnahari, Abdulaziz Fahad Aldosari, Nazish Masud, Nawfal Abdullah Aljerian. Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study[J]. World Journal of Emergency Medicine, 2019, 10(2): 88-93.

Figures/Tables 4

Table 1

Table 2

Participants’ knowledge, attitude and practice toward oxygen therapy represented by number and percentage (n=444)

Knowledge	Good knowledge, n (%)	No knowledge, n (%)
Oxygen indication	55 (12.4)	389 (87.6)
Oxygen contraindication	310 (69.8)	134 (30.2)
Normal SpO₂ at rest for adults <70-year old	323 (72.7)	121 (27.3)
Oxygen therapy is not indicated	316 (71.2)	128 (28.8)
The term used to describe movement of air into and out of the lungs	358 (80.6)	86 (19.8)
The term used to describe passive process in respiratory physiology	181 (40.8)	263 (59.2)
Normal breathing rates in a child >2-year old	361 (81.3)	83 (18.7)
Can oxygen therapy be harmful?	374 (84.2)	70 (15.8)
Giving O₂ to patents with STEMI and SpO₂ ≥90% on room air	52 (11.7)	392 (88.3)
Giving O₂to patients with head injury and normal SpO₂	117 (26.4)	327 (73.6)
Practice, n (%)	Good practice, n (%)	Bad practice, n (%)
Conditions that do not affect pulse oximetry readings	99 (22.3)	345 (77.7)
The best practice on pulse oximetry	295 (66.4)	149 (33.6)
Benefit of attaching humidification devices	301 (67.8)	143 (32.2)
Effect of water collection in the tubing during O₂ administration	183 (41.2)	261 (58.8)
Strategies to optimize O₂ travel through wet secretions	298 (67.1)	146 (32.9)
Nasal cannula	286 (64.4)	158 (35.6)
Tolerating oxygen mask device	166 (37.4)	278 (62.6)
Using non-rebreathing O₂ mask in trauma patient	312 (70.3)	132 (29.7)
Applying petroleum jelly to minimize inflammation of lips and nose	80 (18.0)	364 (82.0)
Attitude, n (%)	Positive attitude, n (%)	Negative attitude, n (%)
O₂ is given only when ordered by a medical professional, or a registered nurse initiated order in an emergency situation	324 (72.9)	75 (16.9)
Oral and nasal hygiene and normal saline drops as necessary should be done when giving OT in children	310 (69.8)	41 (9.3)
Continuous O₂ administration is more beneficial than intermittent OT	120 (27.0)	170 (38.3)
Humidification is the best practice to prevent dryness of mucus membrane of upper respiratory tract	399 (71.8)	13 (3.0)
Persons with severe lung disease need to be maintained at the prescribed SpO₂ range	396 (89.2)	12 (2.8)
Administration of O₂ to patients is not safe and it is very dangerous	146 (32.8)	206 (46.4)
A patient on OT indicates that the patient is at the end stage of life	320 (72.1)	58 (13.1)

Table 2

Table 3

Table 4

References 20

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Variables	Frequency	Percentage
Age
20-25 years	72	16.2
26-30 years	154	34.7
31-35 years	116	26.1
36-40 years	41	9.2
41-45 years	35	7.9
46-50 years	15	3.4
≥51years	11	2.5
Gender
Male	225	50.7
Female	219	49.3
Hospital name
KAMC	124	27.9
KSMC	110	24.8
KKUH	103	23.2
SRC	107	24.1
Category of profession
Nurse	266	59.9
Paramedics	91	20.5
EMT	40	9.0
EMS physician	47	10.6
Duration of work
≤1 year	55	12.4
2-5 years	165	37.2
6-9 years	121	27.3
10-13 years	60	13.5
≥14 years	43	9.7

		Type of hospital					Type of health care provider
Variables	Knowledge	KAMC (n, %)	KSMC (n, %)	KKUH (n, %)	SRC (n, %)	P value	Nurses (n, %)	Paramedics (n, %)	EMTs (n, %)	EMS physicians (n, %)	P value
Can oxygen therapy be harmful?	Good	104 (27.8)	101 (27)	81 (21.7)	88 (23.5)	0.057	230 (61.5)	71 (19.0)	28 (7.5)	45 (12)	0.002
Can oxygen therapy be harmful?	Poor	20 (28.6)	9 (12.9)	22 (31.4)	19 (27.1)	0.057	36 (51.4)	20 (28.6)	12 (17.1)	2 (2.9)	0.002
Do patents with STEMI and SpO₂ ≥90% on room air require oxygen therapy?	Good	11 (21.2)	11 (21.2)	7 (13.5)	23 (44.2)	0.004	19 (36.5)	16 (30.8)	8 (15.4)	9 (17.3)	0.001
	Poor	113 (28.8)	99 (25.3)	96 (24.5)	84 (21.4)	0.004	247 (63.0)	75 (19.1)	32 (8.2)	38 (9.7)
Do patients with head injury and normal SpO₂ require oxygen therapy?	Good	29 (24.8)	40 (34.2)	21 (17.9)	27 (23.1)	0.042	83 (70.9)	11 (9.4)	7 (6.0)	16 (13.7)	0.001
	Poor	95 (29.1)	70 (21.4)	82 (25.1)	80 (24.5)	0.042	183 (56.0)	80 (24.5)	33 (10.1)	31 (9.5)	0.001

Associated factors	Response	Frequency	Percentage
Training on OT	Yes	359	80.9
Training on OT	No	85	19.1
Availability of OT guideline	Yes	267	60.1
	No	92	20.7
	I don’t know	85	19.1
Adequate supply of O₂ and delivery system	Yes	385	86.7
	No	28	6.3
	I don’t know	31	7.0
Workload effects on OT	Yes	169	38.1
	No	213	48.0
	Unknown	62	14.0

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