Nurses and nursing students’ knowledge regarding blood transfusion: A comparative cross-sectional study

Rakhi GAUR, Shiv Kumar MUDGAL, Neha SUYAL, Suresh Kumar SHARMA, Rajat AGARWAL, Ritu RAJ, Chaturvedi JITENDER

1College of Nursing, AIIMS, Deoghar, Jharkhand, India; 2Government Nursing College, Haldwani, Uttarakhand, India; 3College of Nursing, AIIMS, Jodhpur, Rajasthan, India; 4Department of CTVS, AIIMS, Deoghar, Jharkhand, India; 5Department of Medicine, AIIMS, Deoghar, Jharkhand, India; 6Department of Neurosurgery, AIIMS, Rishikesh, Uttarakhand, India

Nurses and nursing students’ knowledge regarding blood transfusion: A comparative cross-sectional study

Rakhi GAUR1, Shiv Kumar MUDGAL1, Neha SUYAL2, Suresh Kumar SHARMA3, Rajat AGARWAL4, Ritu RAJ5, Chaturvedi JITENDER6

1College of Nursing, AIIMS, Deoghar, Jharkhand, India;2Government Nursing College, Haldwani, Uttarakhand, India;3College of Nursing, AIIMS, Jodhpur, Rajasthan, India;4Department of CTVS, AIIMS, Deoghar, Jharkhand, India;5Department of Medicine, AIIMS, Deoghar, Jharkhand, India;6Department of Neurosurgery, AIIMS, Rishikesh, Uttarakhand, India

ABSTRACTObjective:The objective of this study is to measure and compare the knowledge of nursing students and nurses on blood transfusion in an Indian context.Materials and Methods:The present comparative, cross-sectional study enrolled 296 nurses and 177 nursing students through a purposive sampling from a medical university hospital and different nursing institutions. The data were collected in the month of June and July of year 2021, using a self-structured questionnaire. The questionnaire had two sections: Section-I contained demographic data (8 items for nurses and 5 for students) and section-II included 26 items that assessed nurses’ and nursing students’ knowledge on blood transfusion.Results:Findings indicated that nurses and nursing students had insufficient knowledge about blood transfusion. Nurses, however, had significantly greater total blood transfusion knowledge scores than nursing students (16.51 ± 3.85 vs. 12.10 ± 3.28;P＜ 0.001). The marital status (adjusted odds ratio [AOR] =0.456, 95% confidence interval [CI] 0.244, 0.853;P= 0.037), educational level (AOR = 5.072, 95% CI 1.982, 9.634 (P= 0.003); AOR = 6.540, 95% CI 2.54, 16.871;P= 0.001) and work experience (AOR = 0.216, 95% CI 0.067, 0.702 [P= 0.037]; AOR = 0.331, 95% CI 0.135, 0.811;P= 0.013) were the significant predictors of the level of knowledge among nurses. The attendance in any educational programme on blood transfusion (AOR = 0.225, 95% CI: 0.062, 0.818;P= 0.041) was a significant predictor of the level of knowledge among nursing students.Conclusion:Nurses and nursing students have unsatisfactory knowledge on blood transfusion; emphasizing the critical need for immediate and successful teaching activities in this area.

Keywords:Blood transfusion, comparative, knowledge, nurses, nursing students

Address for correspondence:Dr. Shiv Kumar MUDGAL, College of Nursing, AIIMS, Deoghar, Jharkhand, India.

E?mail: shiv.nur@aiimsdeoghar.edu.in

Submitted:30-Apr-2022

Revised:08-Aug-2022

Accepted:15-Aug-2022

Published:29-Sep-2022

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How to cite this article:Gaur R, Mudgal SK, Suyal N, Sharma SK, Agarwal R, Raj R, et al. Nurses and nursing students' knowledge regarding blood transfusion: A comparative cross-sectional study. J Integr Nurs 2022;4:137-44.

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INTRODUCTION

Since the early nineteenth century, blood transfusion has been one of the most common therapies available, with millions of patients around the globe receiving blood and its components every year. According to the World Health Organization report, about 9 million individuals get blood components each year in 90 different countries.[1,2]Despite substantial advances in blood transfusion techniques, there are significant negative effects and risk factors that can lead to deterioration of the recipient’s health. However, there is no suitable framework for evaluating the competence of professionals involved in carrying blood transfusion to ensure maximum safety. According to the Serious Hazards of Transfusion, transfusion mistakes are responsible for about 70% of negative outcomes. Nurses play an important role in the blood transfusion system and having the requisite knowledge and skills is vital considering their close contact with patients. As a result, assessing this knowledge has been a popular topic of discussion among researchers.[2,3]

The knowledge and skills of the nurses are critical in ensuring the safety and effectiveness of this procedure. It may result in fatal complications if proper precautions are not followed during a blood transfusion. Acute hemolytic reactions, febrile events, and hypersensitivity are the most frequent acute reactions that occur quickly after the initiation of a blood transfusion. Furthermore, the incidence of these events is linked to considerable morbidity and mortality.[4,5]Human errors in hospital wards, such as bedside mixing of blood units, misidentification of donors and misinterpretation of screening results cause the majority of complications. The lack of knowledge and skill of such practices among the nursing staff is considered the root cause of these complications.[6]Nurses are increasingly being asked to have the adequate knowledge and competency on hemotherapy. Hence, it is very important that these competency and knowledge are inculcated from the very beginning, when an individual steps into this profession as a nursing student.[7]

Nurses with an evidence-based understanding of the technique of blood transfusion are more likely to administer safer blood transfusions and contribute to the avoidance of transfusion-related morbidity and mortality. Nurses must be thoroughly versed with this procedure in order to carry out safely. According to certain research, nurses lacked appropriate knowledge regarding blood transfusion guidelines/protocol, prevention of potential complications, and safe blood transfusion processes.[8-11]Assessing health care providers’ knowledge is crucial for creating training materials and schedules to ensure the quality and safety of blood, its components and transfusions.[12-14]Moreover, it was stressed that nurses’ knowledge and practice should be evaluated on a frequent basis.[12]

Taking all of this into consideration, it is necessary to determine the present state of knowledge on blood transfusion among nurses and nursing students. As an introduction to health care quality improvement programme, we conducted this study to assess and compare nurses’ and nursing students’ knowledge of blood transfusion, emphasizing their critical role in the transfusion procedure. These findings may serve as a guide for nurse managers, educators, and clinicians in developing routine in-service training to assure the safe blood transfusion practices. The present study was done with an objective to determine the level of knowledge about blood transfusion among nurses and nursing students, as well as the factors that influence their level of knowledge.

MATERIALS AND METHODS

This study was approved by the Institute Ethics Committee (IEC) of Pacific Medical College & Hospital, Udaipur District, India, with the approval number IEC/PMCH/21/236 on July 23, 2021.

Study design

This cross-sectional comparative-analytical study was performed during June and July of 2021.

Study settings

The current study was conducted in one teaching and referral hospital and five nursing colleges in India that are affiliated with a government medical university and are recognized by the Indian Nursing Council. Over 750 beds are split throughout medicine, surgery, emergency, neonatal, pediatric and dialysis wards, as well as coronary care, critical care, and neonatal intensive care units. The nursing staff has good exposure of broad specialties such as medicine, surgery, pediatrics, pulmonary medicine along with super specialties such as cardiology, neurology, endocrinology, and gastroenterology. The hospital has continuous inflow of patients from South-west Rajasthan, India, within a 300 km radius in this hospital; nursing and medical staff perform a variety of advanced medical and surgical treatments in collaboration with university-based medical experts who educate healthcare students.

Study population

The nurse’s population (n= 970) included all nurses employed in various treatment wards, including medicine, surgery, emergency and intensive care units. Nurses with minimum diploma in nursing or higher degree, minimum work experience of 6 months and direct involvement in patient care were selected for the study. The criteria of selection of nursing students (n= 277) were based on their enrolment in final year of bachelor’s degree at the time of data collection and lack of any formal hospital job experience. Dropping out of the study or submitting an incomplete questionnaire was considered as exclusion criteria.

Sample size determination and sampling technique

We calculated the required sample size for cross-sectional research using the “N=N/(1 + ne)2”method, presuming a 95% confidence interval (CI) and a 5% type I error rate.[15]Based on an anticipated population of 277 final-year nursing students and 970 nurses, a minimum of 163 nursing students and 282 nurses were deemed sufficient to power the study and allow for more precise results. One hundred and eighty nursing students in their final year of bachelor’s degree, and 310 nurses, were contacted with the intention of participation in the study.

A total of 177 nursing students and 296 nurses finally agreed to participate and were finally included in the study.

Instrument and data collection

The current study employed a researcher-created questionnaire to assess nurses’ and nursing students’ knowledge of blood transfusion on the basis of previous researches.[3,6,13]To determine the questionnaire’s validity and reliability, a panel of faculty members remarked on the questionnaire’s items and the content validity ratio was determined. Then, the relevant content validity index was computed. A test-retest approach was utilized to measure the questionnaire’s reliability (r= 0.9). The questionnaire was divided into two sections: The first section contained demographic data (8 items for nurses and 5 for students). The second section included 26 items that assessed nurses’ and nursing students’ knowledge of blood transfusion procedures (correct and wrong). Each accurate response received one mark, whereas an incorrect response received zero marks. In the present study participants scored more than 60% of total marks were considered having adequate knowledge on blood transfusion.

After obtaining approval from the IEC and consent from the competent authorities, data was collected. During the end of the nurses’ shifts and following the completion of nursing students’ lectures, the researchers delivered questionnaires to the participants in both the groups. The questionnaire took approximately 20 min to complete. It took 2 months to finish the entire data collection process.

Statistical analysis

After data collection, it was imported into SPSS version 26 (IBM Corp., Armonk, New York, USA). By viewing, calculating frequencies, and categorizing the data, they were cleansed. The calculations of frequencies and proportions were made. Demographic characteristics were quantified using descriptive statistics (i.e. standard deviation, mean, minimum, and maximum). The categorical variables were associated statistically. For nonparametric distributions in intragroup comparisons, the Wilcoxon signed-rank test was utilized. Nonparametric distributions such as the Mann-WhitneyUtest and Kruskal-Wallis were utilized in the intergroup comparisons. Then, multiple logistic regressions were used to determine the presence of distinct predictor variables. AP＜ 0.05 was judged significant.

RESULTS

Socio-demographic characteristics of nurses and nursing students

Table 1 depicts information about all participants (nurses and nursing students). Nurses were aged between 21 and 34 years (mean 26.75 ± 3.28) and half of participants (148, 50.0%) were married. More than half of the participants were females (n= 165, 55.7%) and the majority of the participants (n= 213, 72.0%) had a bachelor degree in nursing. Majority of the participants (n= 122, 41.2%) belonged to rural background; had 1-3 years of working experience (n= 109, 36.8%) in profession and approximately half of them were working in general ward (n= 156, 52.7%). Surprisingly, majority of them (n= 205, 69.3%) did not attend any educational program related to blood transfusion.

The nursing students’ average age was 23.05 ± 0.89 years (range 22 - 27 years). Females made up somewhat more than three-quarters of the nursing students (n= 136, 76.8%). Just more than half (n= 89, 50.3%) of students belonged to rural background, following with urban (n= 55, 31.1%) and semi urban background (n= 33, 18.6%). Most of them (n= 171, 96.6%) were unmarried and approximately two-third (n= 110, 62.1%) of them had not attended any educational programme related to blood transfusion [Table 1].

Factors associated with knowledge of nurses and nursing students

A Kruskal-Wallis and Mann-Whitney test found statistically significant differences in the mean knowledge scores of nurses based on their residence (P= 0.018), marital status (P= 0.000), educational level (P= 0.000), working experience (P= 0.017) and whether they had ever attended any educational programme related to blood transfusion (P= 0.005) while mean knowledge scores of nurses were not having significant difference on the basis of age category, gender, and working area [Table 1].

According to the results of a Kruskal-Wallis and Mann-Whitney test, there were no statistically significant difference in the mean knowledge scores of nursing students based on their age (P= 0.143), gender (P= 0.504), residence (P= 0.538), marital status (P= 0.775), and whether they had attended any educational programme on blood transfusion (P= 0.140) [Table 1].

Level of knowledge of blood transfusion

On the 26-items knowledge questionnaire, nurses’ knowledge scores ranged 3-26, with mean score of 16.51 ± 3.85 while nursing students knowledge scores ranged 6-21, with mean score of 12.10 ± 3.28; there was statistically significant difference between nurses’ and nursing students’ knowledge regarding blood transfusion (P＜ 0.001). It was showed in Table 2 that 58.4% nurses and only 11.9% nursing students had adequate knowledge regarding blood transfusion [Table 2].

Table 1: Association of demographic characteristics of nurses and nursing students with blood transfusion knowledge

Table 2: Comparison of the level of blood transfusion adequate knowledge between nurses and nursing students

Factors predicting the level of knowledge among nurses

The researchers employed multivariable logistic regression to find the determinants of blood transfusion knowledge. As a result, coefficients were calculated as crude and adjusted odds ratio (AOR) in relation to the referent category. The participants’ marital status and educational level were revealed to be significant predictors. As a result, unmarried nurses were 54.6% less likely than married nurses to have good knowledge (AOR = 0.456, 95% CI 0.244, 0.853). Nurses who had higher education level B.Sc. (N) and M.Sc. (N) were 5.072 and 6.540 times more likely to have better knowledge, respectively, than those who had diploma in nursing (AOR = 5.072, 95% CI 1.982, 9.634; AOR = 6.540, 95% CI 2.54, 16.871). Surprisingly, nurses with more than 6 years of experience and 3-5 years of experience were 78.4% and 66.9% less likely to have good knowledge, respectively, than those who had ＜1 year of experience (AOR = 0.216, 95% CI 0.067, 0.702; AOR = 0.331, 95% CI 0.135, 0.811) [Table 3].

Factors predicting the level of knowledge among nursing students

Bivariate logistic regression analysis and multivariate logistic regression analysis showed that except ever attended any educational programme related to blood transfusion; none of socio-demographic characteristics of nursing students were statistically significant predicting knowledge on blood transfusion. Accordingly, nursing students who had not attended any educational programme on blood transfusion were 77.5% less likely to had good knowledge than those who ever attended (AOR = 0.225, 95% CI 0.062, 0.818) [Table 4].

Table 3: Logistic regression of knowledge with sociodemographic status of the nurses (n=296)

Table 4: Logistic regression of knowledge with sociodemographic status of the nursing students (n=177)

DISCUSSION

Nurses are the most important members of the human chain engaged in the multi-step blood transfusion procedure because of their close contact to the patients. To maintain patient safety, it is necessary for them to have a theoretical and practical awareness of the numerous stages involved in blood transfusion. The purpose of this study was to evaluate and compare nurses’ and nursing students’ knowledge toward blood transfusion in the Indian context, with the intention of promoting and integrating material for a sustainable training programme and increased emphasis on blood transfusion in nursing curricula.

Our findings indicate that 58.4% of nurses and just 11.9% of nursing students meet the 60% cutoff criteria required for adequate knowledge in blood transfusion.[16]Similarly, earlier research has revealed that nurses and nursing students’ overall awareness of blood transfusion is poor to moderate.[16-19]According to studies, possible explanations for nursing students’ lack of understanding include insufficient training in pediatric pain treatment in nursing curriculum.[20,21]Limited options for registered nurses to receive continuous education on this subject may also contribute to these results.[22,23]These findings emphasize the importance of enhancing nurses’ and nursing students’ awareness on blood transfusions.

Our findings demonstrated a statistically significant difference in the mean of blood transfusion knowledge scores between the two groups. The knowledge of blood transfusions among nurses was significantly greater than that of nursing students. While there are no researches to compare our findings with when it comes to blood transfusion knowledge, there are studies on pediatric pain management knowledge among nurses and nursing students that show a comparable knowledge gap.[24]These findings contrast with those of another study,[25]which found that nursing students scored much higher than nurses. This disparity could be due to the participants’ backgrounds. The notion that knowledge learned in nursing education programme may be enhanced during practice might be used to justify these findings.

Nurses with a bachelor’s or master’s degree in nursing scored significantly more on knowledge tests than nurses with a diploma in nursing. This finding is consistent with those of Duarte et al.[18]and Encan and Akin[10]who reported that nurses with a bachelor’s degree in nursing had significantly greater knowledge scores than those with a diploma in nursing. Perhaps the content and duration of training have an effect on the knowledge acquisition. Similarly, participants who were residing in cities outperformed those who lived in semi-urban and rural areas, which is consistent with the findings of Mudgal’s[26]and Dubeyet al.’s studies.[27]This could be explained by the participants’ increased and easy access to learning resources for updating their skills and knowledge available in urban areas.

In contrast to the findings of Duarteet al.[10]and Dubeyet al.,[27]nurses with less experience in the present study scored significantly greater than those with more experience. These surprising results might be explained by the fact that nurses who had less experience might be careful in applying transfusion practice more cautiously. Another explanation could be that nurses with less experience answered questions according to their theoretical knowledge rather than their real practice.

Nurses’ knowledge regarding blood transfusion was significantly higher among those who had attended any educational programme than their counterpart. These findings are in line to the results of Dubeyet al.[27]and Sindhulina and Joseph,[28]whereby nurses who received in-service education on the subject had a significantly higher knowledge scores compared to those who had not attended it. This research demonstrated that continuing education enhances nurses’ ability to do efficient practice of blood transfusions. This indicates the importance of close monitoring, designing education programme tailored to the educational needs of nurses, and increasing in-service blood transfusion instruction in clinical settings.

There was no statistically significant difference between the knowledge scores and the socio-demographic variables of nursing students in this study. The possible reasons might be that all students are studying in final year, following standard curricula and practical training. In multivariate analysis, nursing students who attended any educational programme on blood transfusion had significantly higher knowledge score than those who had not attended educational programme. These results demonstrate the importance and further need of educational programs in addition to the standard curriculum. The students should be encouraged to participate in such programs.

Strengths and limitations of the study

Based on existing literature, this may be the pioneer study of its kind in India and Southeast Asia, to the best of the authors’ knowledge. The sample size employed in this study indicates that the investigation was well powered to

confirm the findings, which can be applicable to other similar scenarios. The inclusion of a varied range of educational institutions and healthcare institutes adds to the study’s credibility. One of the study’s flaws was that participants were recruited purposely rather than randomly primarily on their accessibility and availability at the research settings. Despite these limitations, this study gives valuable information about nurses’ and nursing students’ knowledge of blood transfusion in the Indian context.

Implications

The current practice of nursing education, policy, and future research are all implicated by the study findings. Blood transfusion practice and measures should be reinforced in the nursing curriculum. The multiple approaches to education that aim to transform good knowledge to safe clinical practice should be used and measures should be taken for participation in such programme. Nurses should be motivated to involve in self-directed learning as well as continuing professional education to increase their awareness of blood transfusion. Any revisions in existing blood transfusion guidelines should be communicated and followed to guide nursing practice. Qualitative research methods should be used in future studies to better understand the elements that influence nurses’ and nursing students’ knowledge about the issues. Observational studies on the approach in which blood is transfused in hospitalized patients may potentially be informative and contribute in the creation of future educational initiatives.

CONCLUSION

Nurses and final year nursing students have inadequate knowledge of blood transfusion, highlighting the necessity for immediate and effective training activities in this field. The governing authorities should take immediate action like including training courses to give the necessary expertise regarding blood transfusions and measures to ensure maximum participation. Nursing school curricula should be updated to include transfusion medicine for the better delivery of good and clinically sound nurses to the healthcare. There should be implementation of regular medical education activities among the nurses to augment their current knowledge and expertise. There should be regular questionnaires among the nursing staff to test their knowledge of blood transfusion and personnel lacking in any area should be updated. The implementation of these measures can be vital in minimizing human errors in practice of blood transfusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.