Study design
This descriptive cross-sectional study was performed to assess the ability and knowledge of nurses in Riyadh city, Saudi Arabia regarding the management of tracheostomy-related complications.
Study participants and sample size
Inclusion criteria
Study participants were nurses from different departments of Riyadh hospitals, including both adult and pediatric sections.
Exclusion criteria
Nurses practicing outside Riyadh city, nursing students, interns, and other health care providers were excluded from the study.
Ethical consideration
This study was reviewed and approved by the ethical research committee of the Institutional Review Board at Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia (HAPO-01-R-0011, Project No. 118–2021). All methods were performed in accordance with the relevant guidelines and regulations. The responses to the online survey were anonymous, with no tracking of e-mail addresses or identifying information. Electronic informed consent was obtained from all the participants—a consent statement was present at the beginning of the survey, with the ‘Yes’ option allowing the participant to continue. Participation was voluntary, with the option to withdraw at any time.
Sampling procedure
The sample size was calculated using a Krejcie and Morgan table to determine the appropriate sample size [7]. Based on the total number of 75,000 practicing nurses in Riyadh in 2018 [8], the estimated population size for this study was 382.
Data collection procedure
An electronic questionnaire designed by the authors was created on Google forms and sent as an email to randomly selected registered nurses from the nursing staff database in the Saudi commission for health specialties, which includes all registered nurses licensed to practice in Saudi Arabia. The study background and purpose were explained in the email. Of a total of 500 nurses, 395 responded, with a response rate of 79%. Data were collected from September 2021 to February 2022.
Data collection instrument
As the data collection tools used in previous studies failed to address our objectives, the senior authors (FA and EH) created a survey to collect data for this study. Questions were designed after thoroughly reviewing the current literature and guidelines on the subject [9,10,11,12,13]. The tool was administered to clinical experts (tracheostomy team nurses, intensive care physicians, otolaryngologists) and academic experts to assess the suitability of all content to be measured. The content validity ratio of the instrument was considered in this study after being rated by experts using the content validity ratio formula as follows: (CVR) = [(E – (N/2))/(N/2)], where (N) and (E) stand for the total number of experts and number of experts who rated the instrument as essential, respectively. The CVR from the instrument of this study was 0.85, which was closer to 1.0; hence, the instrument was considered valid.
The final version of the questionnaire comprised 32 questions divided into the following four domains: (1) demographic data of participants (4 questions), (2) practice settings and experience (4 questions), (3) basic knowledge of tracheostomy tube components and indications (13 questions), and (4) management of tracheostomy complications (11 questions) (Supplementary Material, Additional File 1).
The knowledge of nurses regarding managing tracheostomy-related complications was assessed using their responses to 21 of the 33 questions (13 and 8 questions from the third and fourth domains, respectively), whereby correct answers were identified and coded with 1, and incorrect answers were coded with 0. All questions were single-answer except for six questions with multiple correct answers, including questions 1 (10 correct answers), 9 (4 correct answers), 14 (3 correct answers), 18 (5 correct answers), 20 (6 correct answers), and 21 (3 correct answers). The Knowledge Questionnaire comprised 49 points representing all correct answers. A total knowledge score ranging from 1 to 49 points was generated, with a higher score indicating greater knowledge of managing tracheostomy-related complications.
Data analysis
Data were analyzed using SPSS version 26 (IBM Corp, Armonk, NY, USA). Demographic characteristics, practice settings, basic knowledge, and management of complications were analyzed using descriptive statistics with numbers, percentages, and means ± standard deviations. The differences in knowledge scores according to the socio-demographic characteristics of participants were calculated using the Mann–Whitney Z-test and Kruskal–Wallis H-test. Additionally, normality was examined using the Shapiro–Wilk and Kolmogorov–Smirnov tests. As knowledge scores were non-normally distributed, nonparametric tests were performed. Statistical significance was set at p < 0.05.
To determine the knowledge level of nurses, we generated a score percentage for each nurse (points achieved/49 total points × 100) and categorized them as follows: > 75%, good knowledge; 50–75%, average or moderate knowledge; and < 50%, poor knowledge regarding the management of tracheostomy-related complications.