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| ORIGINAL RESEARCH REPORT |
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| Year : 2022 | Volume
: 19
| Issue : 1 | Page : 2-9 |
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Knowledge, attitude, and anxiety of Nigerian nurses toward coronavirus: An online cross-sectional survey
Ogechi Helen Abazie1, Oluwafunmilola Mary Mobolaji-Olajide1, Linda Chihurunanya Odikpo2, Emon Umeh Duke3, Dooshima Dorothy Gbahabo1, U Ayishetu Musa-Malikki4
1 Department of Nursing Science, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
2 Department of Nursing Science, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
3 Department of Nursing Science, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Nigeria
4 Department of Nursing Science, ABU, Zaria, Nigeria
| Date of Submission | 15-Mar-2021 |
| Date of Acceptance | 25-Jan-2022 |
| Date of Web Publication | 07-Mar-2022 |
Correspondence Address:
Dr. Ogechi Helen Abazie
Department of Nursing Science, Faculty of Clinical Sciences, College of Medicine, University of Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcls.jcls_10_21
Background: Health care workers have been affected the most by coronavirus all over the world. Their knowledge and attitude toward caring for people with coronavirus have neither reduced their anxiety nor number of casualties from the pandemic. The aim of this study is on knowledge, attitude, and anxiety of Nigerian nurses toward coronavirus. Methods: A cross sectional, online quantitative survey of the six geopolitical zones in Nigeria was done using multistage sampling technique. Data were collected using Google Forms from 209 nurses, and the Statistical Package for the Social Science (SPSS) version 20 software was used for data analysis. Level of anxiety was determined using Generalized Anxiety Disorder Assessment. Descriptive data of participants were presented in tables, charts, percentages, means, and standard deviation, while the inferential data were tested with Chi square at a significance level of P = 0.05. Results: Mean age of the respondents was 41.01 ± 8.21 years, with 13.1 ± 8.44 years as mean for years of experience. Only 57% had good knowledge with mean of 10.67 ± 1.197, while 70.8% had positive attitude toward nursing care during coronavirus pandemic. Anxiety level increased from 1.88 ± 0.82 before to 2.33 ± 0.96 during the pandemic. Association of knowledge and anxiety before and during was P = 0.79 and P = 0.27, respectively. Gender and age were significant with anxiety during the pandemic with P = 0.01 and P = 0.02, respectively. Conclusion: Adequate knowledge with positive attitude may not be enough to reduce the anxiety level of nurses, hence the need for adequate psychosocial support and provision of personal protective equipment for the nurses in other to keep them safe for optimum health workforce.
Keywords: Anxiety, attitude, coronavirus, knowledge, nurses
How to cite this article:
Abazie OH, Mobolaji-Olajide OM, Odikpo LC, Duke EU, Gbahabo DD, Musa-Malikki U A. Knowledge, attitude, and anxiety of Nigerian nurses toward coronavirus: An online cross-sectional survey. J Clin Sci 2022;19:2-9 |
How to cite this URL:
Abazie OH, Mobolaji-Olajide OM, Odikpo LC, Duke EU, Gbahabo DD, Musa-Malikki U A. Knowledge, attitude, and anxiety of Nigerian nurses toward coronavirus: An online cross-sectional survey. J Clin Sci [serial online] 2022 [cited 2023 Jun 2];19:2-9. Available from: https://www.jcsjournal.org/text.asp?2022/19/1/2/339144 |
| Introduction | |  |
The increasing incidence of coronavirus corona virus disease-2019 (COVID-19) has become a major public health concern. The current outbreak of COVID, tagged COVID-19, was first reported in December 2019 in Wuhan in China. The disease defied geographical boundaries with the epidemic size doubling every 7.4 days,[1] and by April 3, 2020, over one million cases had been diagnosed in 184 territories in six continents.[2] Old age and patients with preexisting illnesses (such as hypertension, cardiac disease, lung disease, cancer, or diabetes) have been identified as potential risk factors for severe disease and mortality.[3],[4]
This rapid spread had continued to stimulate and create more fear, anxiety, and panic among nurses who are at the fore front of providing care for the infected individuals. Nurses happened to be the most vulnerable group at risk of contracting this new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to the fact that they are with the patient almost all the time to provide adequate care. The burden of providing this care unlike in other conditions is so enormous and had contributed to the major burden of nursing care.[5] Therefore, for nurse's productivity to be improved during this COVID era, for adequate protection of the nurses and enhancement of their caring role toward COVID-19-infected individuals, the health-care authorities must look for a way of alleviating the level of stress and anxiety faced by this group of health-care providers.
Although the exact mode of transmission of the virus has not been determined, it is stated by the WHO that the virus can be transmitted via air droplets and fomites during close and unprotected contact between an infected person and a healthy person.[6] Furthermore, the Centers for Disease Control and Prevention noted that SARS-CoV-2 is transmitted from person to person through close contact (within 6 ft), from an infected person via respiratory droplets during coughing or sneezing or when touching a surface or an object that is contaminated with the virus, including touching one's eyes, nose, or mouth.[7] In most cases, those infected with COVID-19 experience none or mild-to-moderate symptoms that are alleviated within several weeks of isolation. However, in contrast, it can cause severe respiratory syndrome or death, particularly in older people or patients with chronic health condition.[8]
However, looking at the nurses as one of the frontline providers in treating patients with COVID-19, they are described as a susceptible group to the spreading of the infection.[2] The WHO on July 27, 2020, estimated that close to 10% of all COVID-19 cases globally, which accounts for nearly 1.5 million cases, were related to health-care practitioners (HCPs), where nurses form the larger population. However, this figure is possibly underestimated, as, at that time, no systematic reporting or other measures were in place.[9] Indeed, information released by the International Council of Nurses (ICN) reported that until June 2020, nearly 230,000 HCPs worldwide had acquired COVID-19, with over 600 nurses' dying.[10]
It is clear that the knowledge of any condition is paramount to the ability of the nurses to provide adequate care and promote quick recovery of clients/patients; in the same vein, the knowledge of disease conditions will have a way of influencing nurses' attitudes and practices. It is well established that transmission of the disease among nurses is associated with overcrowding, absence of isolation room facilities, and environmental contamination. With the epidemics, more nurses are expected to care for these patients in the hospitals, isolation centers, and even in the homes. Incorrect attitudes by the nurses directly increase the risk of COVID-19 infection, so its spread and emergence cause anxiety, confusion, and dread among nurses who are under enormous pressure when working with patients with COVID-19. However, at the same time, the fact that the information about the virus was newly discovered at that time required the information obtained to be transferred to the application area quickly. This situation has led to the nurses' concerns and fears about how to cope with the virus. A good knowledge in infection prevention measures would do a lot of good in the ability of the nurses to care for these patients. For this reason, understanding the knowledge and concerns they have in the epidemic situation is important for managing the pandemic and predicting the outcomes of COVID-19 in Nigeria. This will reduce the nurses' anxiety and improve the knowledge, attitude, and practice of nurses toward COVID-19. In addition, authorities need to comply in treating this virus by implementing control measures and other precautions. This study therefore explores the knowledge, attitude, and anxiety of Nigerian nurses toward COVID-19 to enable the needed support in providing adequate care to the patients.
| Methods | | |
This is a cross-sectional, online quantitative survey that utilized multistage sampling technique to assessed knowledge, attitude, and anxiety toward coronavirus among Nigerian nurses. Six geopolitical zones in Nigeria were used for the study. Purposive sampling method was used to select two states from the six geopolitical zones (states with high cases of coronavirus). Two isolation centers/hospitals from each state were selected by simple random method. Consecutive recruitment method was applied in selecting the mails of the nurses that participated in the study because of the lock down.
Using Naing formula[11] for sample size calculation, the total population of nurses working in Nigeria are 250,000,[12] with confidential level of 95% and margin of error 5% =384. The instrument used for data collection was a self-administered questionnaire with four sections: (a) sociodemographic variable, (b) knowledge of COVID-19, (c) attitude of Nigerian nurses toward nursing care during COVID-19, (d) anxiety level of the nurses caring for patients before COVID-19, and (e) anxiety level of the nurses caring for patients during COVID-19. Only 209 (74.5%) filled questionnaire were received after 6 weeks of data collection.
Ethical approval was obtained from the Health and Research Ethical Committee of Lagos University Teaching Hospital. The informed consent form was presented with the questionnaire to the Nurses that agreed to participate in the study. Confidentiality and other ethical principles were adhered to in the course of data collection and analysis. Data were collected using Google Forms via e-mail, WhatsApp, and Instagram. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20 software (IBM, North Castle (Armonk), New York, United state America). Descriptive data of participants were presented in tables, charts, percentages, means, and standard deviation, while the inferential data were tested with Chi-square at a significance level of P = 0.05. The mean of the correct options on knowledge of coronavirus questions was determined; scores below the mean were rated poor, while scores above the mean were rated as good knowledge. Attitude scores below the mean were adjudged negative, while scores above were considered positive. The level of anxiety was determined using Generalized Anxiety Disorder Assessment (GAD-7).[13] Total score for the seven items ranges from 0 to 21. For the interpretation, score of 0 is no anxiety (not at all sure), 1–7: mild (several days), and 8–14: moderate (over half the day), while 15–21 was severe anxiety (nearly every day).
Setting
Nigeria is made up of six geopolitical zones. From the six geopolitical zones, two states were selected and three isolation centers/hospitals from each of the states were selected for the study. The zones and states included were North central zone where Niger and Nassarawa states were chosen; South-Western zone where, Lagos and Ogun were chosen; North-West zone from where Kaduna and Kano states were selected; South–south zone from where Cross River and Akwa Ibom were selected, North-East zone where Bauchi and Taraba were taken, and South-East zone from where Imo and Anambra states were selected.
| Results | | |
[Table 1] shows that 170 (81.3%) were female, while 39 (18.7%) were male, the mean age of the respondents was 41.61 ± 8.21 years, majority had B. Sc/B. N. Sc 107 (51.2%). Mean year of experience was 13.1 ± 8.44 years [Table 1].
All the respondents have heard of coronavirus and mass media was the source for 140 (67%) and 115 (55%) were not yet trained to care for coronavirus patients. Majority knew the signs and symptoms of the disease and that it is spread via respiratory droplets. Only 78 (37.3%) knew that it is not only the elderly, with chronic illnesses that develop severe cases of coronavirus. The mean of knowledge was 10.67 ± 1.197 [Table 2].
One hundred and nineteen (57%) of the nurses had good knowledge of coronavirus [Figure 1].
[Table 3] shows that 164 (78.4%) nurses agreed that every patient is coronavirus positive until proved negative and 205 (98.1%) agreed that there must be running water and liquid soap in all hospital wards and there must be personal protective equipment (PPE) in all hospital wards. Majority, 192 (91.9%), agreed that without PPE nurses should not attempt caring for the patients, 207 (99.0%) agreed that the hospital wards must be disinfected continuously, and 204 (97.6%) agreed that social and physical distance should be observed in the hospital wards. | Table 3: Attitude of Nigerian nurses toward nursing care during coronavirus
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One hundred and forty-eight (70.8%) of the respondents had positive attitude toward nursing care during coronavirus pandemic [Figure 2]. | Figure 2: Attitude of Nurses toward nursing care during coronavirus in Nigeria
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[Table 4] shows the respondents anxiety levels before coronavirus using the GAD-7. Majority of the nurses were not at all sure of feeling nervous, anxious, or on edge, not being able to stop or control worrying, worrying too much about different things, and they have trouble relaxing. Only 10 (4.8) of the nurses were nearly every day feeling so restless that it is hard to sit still, 12 (5.7) nearly every day were becoming easily annoyed or irritable, and 18 (8.6) nearly every day were feeling afraid as if something awful might happen. The mean anxiety ± standard deviation (SD) was 1.88 ± 0.82. | Table 4: Anxiety level of nurses before the emergence of coronavirus pandemic
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[Table 5] shows the respondents' anxiety levels during coronavirus using the GAD-7. Majority of the respondents had different levels of anxiety ranging from mild to moderate and to severe. Only 86 (41.1%) of the respondents did not feel nervous, anxious, on edge or to stop worrying when they remember COVID-19, while 95 (45.5%) did not feel afraid as if something awful might happen. However, 128 (61.2%) of the respondents did not feel so restless that it is hard to sit still and 121 (57.9%) did not become easily annoyed or irritable at the present situation. The mean anxiety ± SD was 2.33 ± 0.96. | Table 5: Anxiety level among Nigerian nurses during coronavirus pandemic
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[Table 6] shows that the anxiety levels of the respondents increased during coronavirus pandemic, 26 (12.4%) had moderate anxiety before (with a score of 8–14 GAD-7), but they increased to 51 (24.4%) during coronavirus pandemic. Only 11 (5.3%) had severe anxiety before, but they increased to 30 (14.4%) with a score of 15–21 GAD-7 during the pandemic. However, 98 (46.9%) had mild anxiety with a score of 1–7 GAD– 7 before, but the number decreased to 85 (40.7%) during the coronavirus pandemic, while 74 (35.4%) had no anxiety before which decreased to 43 (20.6%) representing a score of 0 GAD-7. | Table 6: Level of anxiety among nurses Nigerian before and during coronavirus
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There is no significant association between overall knowledge and anxiety level before coronavirus pandemic among nurses in Nigeria with P = 0.79 [Table 7]. Furthermore, there is no significant association between overall knowledge and anxiety level during coronavirus pandemic among nurses in Nigeria with P = 0.27 [Table 8]. | Table 7: Relationship between overall knowledge and anxiety level before coronavirus pandemic among nurses in Nigeria
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 | Table 8: Relationship between overall knowledge and anxiety level during coronavirus pandemic among nurses in Nigeria
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Gender and age had a significant relationship with level of anxiety during coronavirus among nurses in Nigeria with P = 0.01 and P = 0.02, respectively [Table 9]. | Table 9: Relationship between the Nurses' sociodemographic variables and level of anxiety during coronavirus
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| Discussion | | |
The nurses in the study group showed good knowledge of coronavirus. All the respondents have heard of coronavirus, were knowledgeable about the signs and symptoms, and mass media was their major source of information although many were not yet trained to care for coronavirus patients. On the overall, the nurses are very much aware of the COVID-19 disease that was declared a pandemic by WHO in 2020. This knowledge is a veritable tool for the survival and protection of the health workers from being infected. This finding was similar to the report of the previous study by Ogolodom et al.[14] where it was observed that majority of the respondents in their own study were highly aware of the pandemic although their most common source of their information was through colleagues which was not the case in the present study. The finding also was supported in other studies by Alrubaiee et al.[15],[16],[17],[18] which reported that majority of the respondents had adequate knowledge, obtained their information via social networks and news media, but they had never attended lectures/discussions about COVID-19 which was very similar to the findings in this present study. Good knowledge was also seen in a similar study.[19] The similarity found in this study with the previous studies reviewed could be as a result of similarity in participants' characteristics.
Regarding the attitude of nurses toward nursing care during COVID-19 disease, finding from the study on the overall showed that the nurses had a positive attitude toward the disease and same was reported in a similar study[20],[21] who saw that the health workers held optimistic attitude with regard to COVID-19. Most of the nurses agreed that without PPE, no nursing care for the patients should be initiated as shortage of PPE remains one of the things that exposes the nurses and other health-care workers (HCW) to infection. According to the previous study,[20] there is a need for concerted effort to be made in this regard as COVID-19 has no cure yet; therefore, adequate PPE should be provided to the nurses in other to save them from the danger of being infected. Contrary to the result of the findings also,[19],[21] previous studies reported that a significant proportion of respondents had a poor attitude to nursing care which may be also linked to the shortage of PPE and fear of death as a result of the infection.
On the anxiety of nurses before and during COVID-19 period, the nurse's anxiety levels before the emergence of coronavirus using the GAD-7 showed that the majority of the respondents were not feeling nervous, anxious, or on edge, not being able to stop or control worrying, worrying too much about different things, or having trouble relaxing. Only few of the nurses were somewhat afraid and nearly every day becoming easily annoyed or irritable but not related to the present pandemic. This was not the case with the emergence of COVID-19, using the same assessment tool, nurses' anxiety levels during coronavirus pandemic were found to increase, from mild to moderate and to severe. Those who had no anxiety and mild anxiety levels decreased, while those with moderate and severe anxiety levels also increased with the emergence of COVID-19 showing of a truth that the nurses were really anxious although on different levels with regard to the COVID-19 disease. Similar report was given[14] which states that fear of infection and lack of indemnity are factors militating against effective dispensation of statutory obligations; hence, most health workers showed unwillingness to effectively carry out their duties in the face of COVID-19 pandemic. However, previous studies[22],[23] also saw anxiety among participants in their own study. Although this anxiety might be more among health workers, they are at the front line in treating patients with COVID-19 and are more susceptible to this spreading infection.[2] With increasing infection rate of HCW as reported by the WHO and ICN, nurses might have positive attitude but demonstrate unwillingness to work[24] as a result of fear of being infected by the disease.[25]
Hypotheses tested showed there is no significant relationship between the overall knowledge and anxiety level before and during coronavirus pandemic among nurses in Nigeria; hence, their level of knowledge of the disease had not significantly influenced the anxiety they experienced before and during the present pandemic. Gender and age only among all the demographic variables had significant relationships with level of anxiety during coronavirus pandemic among nurses in Nigeria.
By implication, nurses have good knowledge and positive attitude toward COVID-19 but demonstrated increased levels of anxiety toward the disease, which they perceived not to be in existence before the inception of the disease. There is a need for adequate support to be given to them in other to boost their moral and reduce their anxiety, especially by providing adequate PPE to prevent them from been infected, infecting their family, and also to avoid preventable deaths from COVID-19.
The limitation to the study is difficulty in getting adequate responses as a lot of time was taken to make sure the respondents got to respond to the questions, and yet, the required sample size could not be reached after a long waiting period of nil inflow of responses. The analysis was then conducted with the present sample size obtained.
| Conclusion | | |
As COVID-19 continues to ravage the global world, adequate knowledge with positive attitude may not be enough to reduce the anxiety level experienced by HCW especially nurses, hence the need for adequate psychosocial support and provision of PPE for the workers in other to keep them safe for optimum health workforce.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]
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