Review of Related Literature

According to Al-Dossary et. al (2020) in their study titled “Awareness,

Attitudes, Prevention, and Perceptions of COVID-19 Outbreak among Nurses in
Saudi Arabia” The study examined nurses’ awareness, attitudes, and perceptions
during the COVID-19 outbreak in Saudi Arabia. Due to limited literature pertaining to
COVID-19, results were compared with other related corona virus, such as MERS-
CoV and SARS-CoV. Several findings were highlighted in the study.
Based on the results, more than half of the nurses (65.4%) received their
COVID-19 information from the MOH. This is similar to other studies conducted in
Saudi Arabia, in which 50% of the nurses received their health information from the
MOH website about other coronavirus diseases such as MERS-CoV. The MOH
strives to increase accessibility to health materials and information delivery, with the
aim to improve healthcare providers’ awareness, perception, and awareness (MOH,
2020). Aldohyan et al. noted that healthcare workers from primary care settings in
Saudi Arabia received information through the MOH website. MOH information is
considered scientififically reliable, validated, up to date and similar to the mandates of
WHO guidelines. Previous studies reported that disease information from, for
example, social media may not be scientififically valid. One issue this study revealed
is that 25% of the nurses worked 12 h/day before the COVID-19 outbreak. After the
COVID pandemic began, that increased to 46.2%. This may be a result of increased
hospital admission, variations in inpatient needs, or unforeseen understanding.
According to Thompson, nurses working longer than 12-hour shifts are at higher risk
for fatigue and burnout, leading to compromised quality patient care. Banakhar stated
that nurses working for 12 h affffects their well-being, and increases stress, fatigue,
and anxiety compared to an 8 h shift. One study among European nurses working
more than 12 h describes the quality of nursing care provided to patients on their unit
as poor, assesses patient safety as fair, and accounts additional care instruments and
equipment left uncompleted on their last shift in comparison with nurses working ≤ 8
h and no more than their contracted hours. Longer working hours might affect the
efficiency and effectiveness of the workforce in delivering high-quality, safe care.
A recent study in China about healthcare providers working longer hours due
to the spread of COVID-19 conveyed high symptom rates of depression, insomnia,
and work stress. An international study reported that when nurses wear personal
protective equipment (PPE), they usually take 4–6 working hours without a break.
This is very critical to nurses’ well-being, since longer hours wearing PPE can cause
fatigue, stress, and exhaustion, making healthcare providers prone to causing medical
errors. Hence, nursing administration should organize staffing and scheduling to avoid
mental and physical health impairment. Important in this study is that nurses had
awareness and had high positive perceptions about COVD-19. This could be because
the MOH constantly updates its website and obligates healthcare providers to be
aware of COVID-19 updates. It is worth noting that nurses working in Saudi have
experience with other coronavirus diseases, such as MERS. Lessons learned treating
these infections may strengthen nurses’ ability to prepare, adapt, and effectively
respond to any disease outbreak. Studies show nurses in other countries with a
COVID-19 outbreak, such as Iran, Saudi Arabia , and Korea [30] with MERS-CoV,
had higher perception and awareness levels.
According to Aldohyan, insufficient awareness of infectious diseases could
lead to inappropriate infection control and precaution measures. Thus, providing
educational programs about COVID-19 could increase awareness and improve
infection control and prevention. Nevertheless, caution should be used when
interpreting the previous studies, since they used different tools and participants,
which might affect awareness and perception levels. Further studies about awareness
and perception using a validated tool are warranted.
Nurses in this study reported higher preventive practices in dealing with
COVID-19. These findings affirm a previous study among healthcare workers on
MERS-CoV in Saudi, and a recent study about COVID-19 in India among students
and health care workers, in which, due to constant exposure and previous outbreak
experience with similar coronavirus disease, this nurses were able to practice in their
full clinical capacity and use preventive measures. Better preventive practices in these
findings
could be elucidated by the fact that educational campaigns, particularly the MOH in
Saudi Arabia,focused more on signs and symptoms of COVID-19, which may have
enhanced preventive practices.In establishing efficient methodologies to support
healthcare professionals, it is vital to realize their attitudes as well as their specific
sources of anxiety and fear.
In this study, nurses had a positive perception of COVID-19 management and
prevention.
This implies that nurses are confifident in existing infection prevention and control
programs. This also could be explained by the respondents’ view that they possessed
greater awareness about prevention. This agrees with a previous study that showed a
positive perception from healthcare workers when dealing with a MERS-CoV
outbreak in Saudi Arabia.
Additionally, work experience affects attitude towards COVID-19, according
to this study. Specifically, nurses with 11 to 20 years’ experience have a better
attitude than those with less than 10 years. It is worth considering that the longer the
work experience, this better they are equipped in handling patients. It could also be
safe to say that more work experience translates to increased awareness of COVID-
19, better preventive skills, and improved patient care. Kieft, de Brouwer, Francke,
and Delnoij stated that the work experience nurses have, this more opportunity to
practice critically and provide quality patient care. This might be interpreted as work
experience can shape awareness, attitudes, perception, and preventive behavior, and
create a strong nursing practice, resulting in more positive patient experiences.
Finally, non-Saudi nurses self-reported higher perception, prevention, and
attitudes towards COVID-19 than Saudi nurses. This is expected, since most of the
front-line nurses in the country are expatriates. Most Saudi nurses occupy managerial
and supervisory positions, with their main focus on staff management, recruitment,
budgeting, scheduling, discharge planning, developing educational plans, and records
management, but not direct patient care. This is something to address, because there is
a Saudi policy to ensure Saudi nationals are prepared to fill important positions when
non-Saudi nurses leave the country.

Reference:
Al-Dossary R. et al (2020) Awareness, Attitudes, Prevention, and Perceptions
of COVID-19 Outbreak among Nurses in Saudi Arabia retrieved from
doi:10.3390/ijerph17218269 Retrieved from March 6, 2021

According to Al Throbaity and Alshammari (2020) in their study “Nurses on

the Frontline against the COVID-19 Pandemic: An Integrative Review” states that
despite the impact on healthcare providers, excellent management of a pandemic
depends on the level of preparedness of healthcare providers, including nurses. This
means that if it was impossible to be ready before a crisis or disaster, responsible
people will do all but the impossible to save lives. Nurses are on the frontline and are
responsible for providing holistic care for all types of patients. Considering the fact
that nurses constitute the majority of healthcare providers, they have a critical
function in healthcare systems. In crises, they have more tasks to satisfy patients and
their families; therefore, nurses must be well equipped with essential knowledge and
skills in managing crises involving clinical treatment, decontamination, isolation,
communication, triaging, psychological support, and palliative care if necessary.
However, when they respond to a crisis such as COVID-19, they face problems that
hinder them from caring for the infected patients.
indicates that there is a shortage in the number of nurses when dealing with the mass
of patients affected by the coronavirus. Moreover, the severity of this problem is not
just a shortage of trained nurses providing full care for patients in isolation or
intensive care units with COVID-19. Indeed, this problem is quite obvious regarding
other issues of emergencies and disasters. In addition, the problem becomes clear in
normal daily routine. The suggested solution for improving staffing for COVID-19
might involve a call for all experts – retired or staff nurses who have essential
knowledge, skills, and attitudes – to help provide holistic care for patients infected
with COVID-19. This will ensure that hospitals can increase their capacity and
receive more patients when nurses are available.

Reference:
Al Throbaity and Alshammari (2020. Nurses on the Frontline against the
COVID-19 Pandemic: An Integrative Review.
https://www.karger.com/Article/Fulltext/509361
 According to Dalky et, al (2020). In their study “Assessment of the
Awareness, Perception, Attitudes, and Preparedness of Health-care Professionals
Potentially Exposed to COVID-19 in the United Arab Emirates” states that COVID-
19 is still a life-threatening infection spread worldwide and continues to be an
international concern. A total of 23,025,622 infected cases and 800,420 deaths were
reported globally as of August 23, 2020. Therefore, there is still a need to assess and
improve hospital HCPs awareness and preparedness against COVID-19 in the UAE.
Due to the crucial role of hospital HCPs in controlling and preventing the spread of
COVID-19 outbreak, this research provides an insight into the level of awareness,
perception, attitude, and self-preparedness of hospital HCPs against COVID-19
during the outbreak in the UAE, 2020. show that the majority of hospital HCPs had
the right level of knowledge towards the COVID-19 outbreak; this includes the
infection symptoms, the mode of transmission, the diagnosis procedure, and the risk
factors. Such a result is in line with previous studies. 8,15,20 Knowing the symptoms
helps hospital HCPs to recognize the threat and take the necessary actions and is
considered essential in management21 and controlling the spread of COVID-19.17 This
contradicted Bhagavathula et al’s study that was conducted in the first week of March
2020, when COVID-19 had just become a global pandemic, it included 529 health-
care workers globally.19 However, in the current study, there was a lack of knowledge
regarding some of the risk factors that may indicate potential positive COVID-19,
such as having diarrhea and contact with possible infected patients. This highlights
the need to include such possible risk factors for positive COVID-19 in future
training.

The current approach to COVID-19 is to control the source of infection; use

appropriate preventive measures, and provide early diagnosis and isolation. 22 This fact
was reflected by the response of participants about preventive measures, as nearly all
hospital HCPs were aware of the appropriate use of PPE, isolation procedures, and
hand washing. The intensive training could have a primary influence on such a high
level of knowledge. These findings are similar to the results of previous studies.

Reference
According to Dalky et, al (2020). Assessment of the Awareness, Perception,
Attitudes, and Preparedness of Health-care Professionals Potentially Exposed to
COVID-19 in the United Arab Emirates. https://doi.org/10.2147/JMDH.S278479

According to Papagiannis, D. et al., (2020) in their study titled “Assessment of

KNOWLEDGE, attitudes, and practices towards NEW CORONAVIRUS (SARS-
CoV-2) of health care professionals in Greece before the OUTBREAK Period”. This
study highlights a high level of knowledge concerning SARS-CoV-2 among Greek
health care workers and this was significantly associated with positive attitudes and
practices towards preventive health measures. The high level of knowledge of health
professionals about SARS-CoV-2 may be considered to have contributed
considerably to the successful management of the pandemic in Greece. The vast
majority of the subjects included in the study had a high level of knowledge
concerning SARS-CoV-2 infection and transmission suggesting that most participants
had been informed of COVID-19. Despite the high level of knowledge, almost 1 in 4
respondents did not wash their hands before and after touching a patient, and after
touching patient surroundings, suggesting that health educational campaigns need to
aggressively engage health care practitioners in preventive strategies. More than 80%
of subjects identified COVID-19 as a potentially deadly and serious health issue but
less than half of them were willing to be vaccinated against SARS-CoV-2, indicating
that even if a vaccine is developed early, many health care workers will not choose to
be immunized against SARS-CoV-2.
KAP surveys are commonly used to identify knowledge gaps and behavioral
patterns in order to implement effective interventions. There is a need for deep
understanding and identification of factors that may influence attitudes and practices
towards COVID-19. They observed that knowledge scores were high among the
participants of the study with only 11.06% of the health care workers exhibiting low
knowledge scores, even though their survey was conducted before the WHO
recognized the COVID-19 outbreak as a pandemic and just before the first case of
COVID-19 was registered in Greece on the 25th of February. The population
consisted of health care workers which may at least explain the high level of
knowledge. However, previously published data from a KAP survey during COVID-
19 in the general population in China revealed a high rate of correct answers in the
knowledge questionnaire that the authors attributed to the high educational level of
the participants and the severity of the public health program. Furthermore, previous
studies revealed heterogeneous results on the knowledge, attitudes, and practices of
health care workers towards Ebola and Zika viruses. In particular, Oladimeji et al.
reported satisfactory knowledge of Ebola virus disease but without a corresponding
level of good practices among Nigerian health care workers.
The knowledge score was significantly associated with attitudes and practices
scores. Patients with a high level of knowledge exhibited more positive attitudes and
perceptions towards preventive measures and were engaged in more prevention
practices. Others have previously reported similar associations when performing KAP
surveys in other infectious diseases. Better knowledge may result in positive
perceptions and attitudes and therefore in good practices, thus aiding in the prevention
and management of infectious diseases. This study was conducted early during the
pandemic and may help to set international public health campaigns priorities in order
to address the most misunderstood and hazardous practices.
One of the most disturbing findings of this study was that only 1 in 4 health care
practitioners washed their hands after touching a patient, and after touching patient
surroundings, despite the fact that 94.1% of the respondents knew that SARS-CoV-2
transmission could be reduced with hand washing. Although the modes of SARS-
CoV-2 transmission have not been fully determined, studies have proven that the
disease is primarily transmitted when in close contact of a carrier or a patient via
respiratory droplets produced with coughing or sneezing. Hand washing is
recommended for the general population in order to prevent disease transmission.
Soap and water seem to annihilate SARS-CoV-2 like other viruses. For health care
practitioners, hand hygiene is mandatory in order to prevent infections, both for
oneself and for the patients. Given the low rank of practices towards hand hygiene in
our population, the immediate organization of a campaign aimed at health care
workers that addresses hand hygiene seems mandatory.
Another important aspect of this study is that very few health care workers
(43.3%) would be vaccinated for SARS-CoV-2 if there was an available vaccine. To
date, the only available measures for the prevention of transmission in the community
is hand washing, respiratory hygiene, social distancing, and self-isolation. Given that
health care workers cannot perform self-isolation, they are at high risk of getting
exposed to SARS-CoV-2 and possibly transmitting the virus to their patients. In Italy,
20% of the health practitioners have been infected, while in China. 3300 health
workers have been infected and 22 have died Access to personal protective equipment
for health care workers is a major concern in many countries due to shortages
associated with the acceleration of the pandemic. The safety of health practitioners is
of great importance and the implementation of a vaccine would aid significantly in
this direction.

Reference:

Papagiannis, D. et al., (2020, July 08). Assessment of KNOWLEDGE, attitudes, and

practices towards NEW CORONAVIRUS (SARS-CoV-2) of health care
professionals in Greece before the OUTBREAK Period. Retrieved March 06,
2021, from https://www.mdpi.com/1660-4601/17/14/4925/html.