Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Knowledge, Attitude, Performance and Associated

Factors Towards Nursing Documentation Among
Nurses in Public Hospitals, Sana'a City, Yemen
Fouad Hussein Ali Alhawri1, Krishna Gopal Rampal1, Abdelkodose Mohammed Hussen Abdulla1
1: Faculty of Medicine, University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor, Malaysia

*Corresponding author: Abdelkodose Mohammed Hussen Abdulla

Abstract:- I. BACKGROUND

Background: The aim of this study was to assess Documentation is a specialized device that helps in the
knowledge, attitude, and performance (KAP) as well as trading of data put away between guardians. Quality
to study the associated factors towards nursing records documentation advances organized, predictable and viable
among the nurses in Al-Jomhori hospital authority, correspondence between medical care suppliers.
Sana'a city, Yemen. In nursing healthcare systems
documentation is a powerful tool to ensure Nursing documentation is a critical and effective tool
communication between health workers and continuity in health care systems to ensure quality of care and
of the care for better patient outcomes. In addition, coordination between health professionals for better results
knowledge, performance and attitude of nurses’ towards for patients. The coordination of patient and quality of care
nursing documentation will effect on the quality of is influenced by the knowledge, attitude and performance of
patients’ care. nurses in relation to nursing documentation. This study
therefore aimed to evaluate the knowledge, attitude and
Methods: A cross sectional study was conducted among performance as well as to study the associated factors with
115 nurses of Al-Jomhori hospital authority in Sana'a nursing documentation among nurses in public hospitals in
city, Yemen. The participants were selected by simple Sana'a city Yemen.
random sampling technique. A validated questionnaire
was used to collect the data with internal reliability of II. INTRODUCTION
Cronbach’s Alpha was 72.5% for knowledge,
performance and attitude questions. SPSS version 23 One of the most used models in the medical field is the
was used for analysis. knowledge, attitude and performance (KAP) model. The
KAP model suggests that the attitude and experience of the
Results: The overall response rate was 100%. Among individual towards the behaviors defines any activities
115 respondents about 46.01% had good knowledge, 68.2 (behaviors) (Alzghoul and Abdullah 2016). Nursing records
% of participants had positive attitude (agree) and are often regarded by a nurse as a written record of acts or a
36.78% of participants had bad nursing documentation mission performed and are usually written in a sequential
performance (always). Gender and training were found manner. The deliberation and information used to help
to be statistically significant with KAP of nurses. nursing practices or tasks are not captured by this
chronological format of documenting tasks. Paper
Conclusion: Findings of this study demonstrated that documentation systems also produce incomplete and
knowledge, performance and attitude among nurses inaccurate health records which make it difficult to measure
working in Sana'a public hospitals on nursing the outcomes and retrieve data (Turley 1992).
documentation were poor. Therefore, each public
hospital should recruit qualified nurses and should have The use of unstructured or narrative data and the
continuity plan for training to solve this problem. fragmentation of paper health records, restricts the use and
capacity to explain the interactions or relationships between
Keywords:- Nursing Documentation, Records, Knowledge, evaluation observations, nursing diagnoses, treatments and
Attitude and Performance of the nurses, Quality of Nursing anticipated results in nursing care (Müller‐Staub, Needham
Documentation. et al. 2007).

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Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Quality nursing documentation enables efficient Knowledge "occurs when an individual (or other
contact between caregivers, which facilitates care continuity decision-making unit) is exposed to the existence of an
and autonomy. Using different audit instruments, the quality innovation and gains an understanding of how it functions,"
of nursing documentation was assessed, reflecting according to (Rogers 2003). They wouldn't see the need for
differences in the perception of the quality of documentation it or have the potential to accept innovation if people do not
among researchers across countries and settings (Wang, acquire knowledge about a new innovation; on the other
Hailey et al. 2011). Nursing documentation exists as a hand, if they do not see the necessity for a new innovation,
regular fact of the work of nurses. Some view it as evidence they wouldn’t explore the knowledge. Individuals can seek
of nursing activity and others disregard it as misrepresenting their peers' input to check if their attitude and thinking
nursing care (Heartfield 1996). towards a new innovation is rational. The consequence of
the stage of persuasion is the development by the person of
The coordination and quality of care depend on the unfavorable or a favorable attitude towards the innovation
communication between nurses and other healthcare under consideration. Knowledge and a positive attitude
members as a team in order to ensure continuity of care for toward creativity should not be expected to lead to adoption.
their patients. However, since there is a great deal of There are many developments that people are
misunderstanding and lack of information about the knowledgeable and have favorable attitudes toward, but are
procedure and quality of nursing documentation, its not expressed in their performance (Rogers 2003).
importance as a significant reference point in the healthcare
system is undermined (Jefferies, Johnson et al. 2010) & The low KAP of nursing care documentation by nurses
(Machudo and Mohidin 2015). have adverse effects on patients' health care, healthcare
workers and are associated with the issue such as
There are currently a range of frameworks available to inappropriate or double medication management, absence of
support nursing records, such as problem-oriented medications, and risk of legal damage will become high
approaches, narrative diagrams, clinical pathways and (Kebede, Endris et al. 2017). Unfortunately the public
concentration notes. Many nurses also face challenges such hospitals in Yemen, although it is declared the nursing care
as lack of knowledge about nursing documentation, poor outlines, the assessment, preparation and evaluation of care
attitudes, time shortages and workload to maintain reliable must be clearly recorded, the nurses' knowledge,
and legally prudent documentation. This includes performance and attitude on nursing documentation still low
insufficient communication between members of the health (ALHAWRI1, et al. 2020). In addition, nurses’ knowledge,
care team which have a negative effect on the quality of performance and attitude towards nursing documentation is
nursing records (Petkovšek-Gregorin and Skela-Savič 2015) poor however, no attention concerning this issue was given
& (Blair and Smith 2012). for public hospitals. Hence, this study aimed to quantify the
level of nurses’ KAP regarding nursing documentation and
Although both electronic and paper-based nursing to identify the associated factors towards nursing
documentation have different principles, including documentation.
specificity, objectivity, clearing and clarity, respecting
confidentiality, comprehensive, and factuality, but the III. METHODOLOGY
insufficient knowledge and attitude of nurses to record
nursing care by implanting these principles typically makes A cross-sectional study was conducted among 115
nursing records of low quality (Alkouri, AlKhatib et al. nurses in Al-Jomhori hospital authority in Sana'a city,
2016). As several studies have shown that most nurses have Yemen. The participants were selected by simple random
an insufficient knowledge of documentation and attitude sampling technique. A pre-tested and validated self-
globally as well as inadequate information and their acts are administered structured questionnaire was used to collect the
either properly documented or not recorded at all, creating a data with internal reliability of Cronbach’s Alpha value 72.5
major problem when it comes to assessing healthcare %. SPSS version 23 was used for data analysis. Descriptive
(Nakate, Dahl et al. 2015). statistics and ANOVA were used. The dependent variables
were knowledge, attitude and performance of nurses
Nurses carry a great load of both coordinating and whereas the independent variables were nurses' socio-
executing the plan of the interdisciplinary team to record demographic characteristics.
services and progress towards goals, as documentation is
framework that provides a detailed account of a patient's IV. RESULTS
care (Adams 2015) & (Keenan, Yakel et al. 2008).
Documentation of nursing care is important for early  Characteristics and socio-demographic of the
identification of the worsening condition of patients participants
accompanied by efficient response and communication by Totally 115 nurses from Al-Jomhori hospital authority
members of the interdisciplinary care team leading to in Sana'a city were included in the study. Table 1 shows that
reduced mortality in hospitals. Nurses should report what majority of the nurses (60.9 %) were at age range of 20 to
they see and not what they expect (Collins, Cato et al. 30 years, 32.2 % of the nurses were at the age range
2013). between 30 to 40 years, and there are 4.3 % of nurses were
less than 20 years of age, while 2.6% were at the age of 41
years and above. Majority of nurses were male (69.6%).

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Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Most of them were married (59.1%) while 40.9% of nurses 23.5% had a longer working experience of 11 to 15 years,
were identified as single. Majority of nurses (88.7%) had a while only 2.6% of nurses had a working experience of 16
diploma in nursing. About 45.2% of the nurses had a to 20 years. However, majority of the nurses (53.9%) had
working experience between 1 to 5 years, and 28.7% of not received any training on nursing documentation (Table
nurses had a working experience between 6 to 10 years, and 1).

Table 1. Characteristics and socio-demographic of the participants

Variable N (%)
Age
less than 20 Y 5 (4.3%)
20 - 30 Y 70 (60.9%)
31 - 40 Y 37 (32.2%)
41 - 50 Y 3 (2.6%)
Gender
Male 80 (69.6%)
Female 35 (30.4%)
Marital Status
Single 47 (40.9%)
Married 68 (59.1%)
Educational
Diploma 102 (88.7%)
Bachelor 13 (11.3%)
Experience
less than 5 Y 52 (45.2%)
6 - 10 Y 33 (28.7%)
11 - 15 Y 27 (23.5%)
16 – 20 Y 3 (2.6%)
Training
Yes 53 (46.1%)
No 62 (53.9%)

Table 2. Knowledge of the nurses about Nursing Documentation..

Variable Correct (%) Incorrect (%)
What is the most important reason for nursing documentation? 68.7 31.3
Which one of the following statements is wrong? 61.7 38.3
Which reporting measures should be implemented at the end of the shift? 60.0 40.0
Which one is more important in documentation of PRN medication effects? 53.0 47.0
How to fill out drug cards? 47.8 52.2
What is the impact of priority in documentation? 47.0 53.0
Which record is correct? 42.6 57.4
Which one is incorrect about nursing documentation? 40.9 59.1
Which of the following is true about the documentation? 40.0 60.0
How to correct the report after pouring tea on it? 35.7 64.3
What did you do when you want to correct a wrong record? 28.7 71.3
How to document patients who refuse to take the medicines? 26.1 73.9

Table 2 shows the mean percentage of the correctly answered questions by the nurses was 46.01% and the percentage of
incorrectly answered questions was 53.98%.

Table 3: mean of Attitude and performance of Nurses Regarding Nursing Documentation

Attitude Performance
Level Mean Level Mean
Agree 68.28 Always 36.78
No Idea 16.24 Often 23
Completely Agree 9.89 Never 20.48
Disagree 4.46 No Idea 10.27
Completely Disagree 1.15 Rarely 9.48

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Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table 3 shown that the chosen "Agree" has the higher mean percentage (68.28%), and the 32 nurses has no "Idea with"
(16.24 %) percentage. Table 3 proves that 36.78% of the participants do nursing documentation "always", while 23 % of the
nurses practice it "often" and 20.48% were not doing Nursing Documentation.

Table 4: Knowledge, attitude and Performance of the Nurses regarding Gender, Educational level, Marital Status and Training
Male (n = 80) Female (n = 35)
Gender Mean Std. Deviation Mean Std. Deviation
Knowledge, Attitude and Performance (KAP) of the 73.01 10.61 70.22 11.6
nurses about Nursing Documentation
Diploma (n = 102) Bachelor (n = 13)
Educational level
Mean Std. Deviation Mean Std. Deviation
Knowledge, Attitude and Performance (KAP) of the 64.96 13.27 65.8 14.1
nurses about Nursing Documentation
Single (n = 47) Married (n = 68)
Marital Status
Mean Std. Deviation Mean Std. Deviation
Knowledge, Attitude and Performance (KAP) of the 70.9 11.5 72.9 10.5
nurses about Nursing Documentation
Yes (n = 53) No (n = 62)
Training
Mean Std. Deviation Mean Std. Deviation
Knowledge, Attitude and Performance (KAP) of the 74.46 10.45 70.19 11.05
nurses about Nursing Documentation

From Table 4 above mean score of male = 73.01 ± In contrast the findings of our study was higher than
10.61, while the mean score of female = 70.22 ± 11.6, there the percentage that has been reported by researchers from
was a significant differences between the mean scores. That Iran (14.1%) (Jasemi, Zamanzadeh et al. 2012). This might
is means the KAP of the male nurses were better than be due to instrument difference also both wards and
female nurses regarding nursing documentation. The mean outpatient services were included in the current study, but
score of nurses that has bachelor degree = 65.8 ±14.1, whilst the previous study was carried out only in the medical-
who has diploma degree = 64.96 ± 13.27. The mean score of surgical ward.
KAP of married nurses = 72.9 ± 10.5, however single nurses
= 70.9 ± 11.5. Mean score of nurses that are already trained  Attitude of nurses towards nursing documentation
= 74.46 ± 10.45. The findings of this study indicated that (Agree =
68.28%) of nurses had favorable attitude towards nursing
V. DISCUSSION documentation. These findings were consonant with studies
conducted in Zambia 56% (Malama 2015) and Addis Ababa
 Knowledge of nurses towards nursing documentation 55.7% (Hailu 2017). However, this study finding was higher
In our study 46.02% of the participants had correct than studies conducted in Zambia (54 %) (Andualem,
answer regarding the knowledge about nursing Asmamaw et al. 2019) and Uganda (54%) (Nakate, Dahl et
documentation which less than other studies conducted in al. 2015). However, our study finding was lower than a
Zambia 60% (Andualem, Asmamaw et al. 2019) and Addis study conducted in the USA (80%) (Moody, Slocumb et al.
Ababa public hospitals 50% (MULUGETA 2015). 2004). This variances may could be due to poor attention
towards nursing documentation and they don’t consider it as
As compared with the percentages McDonald's part of responsibility and professional duties. However, the
standard of learning outcome measured criteria, which study results revealed very low percentage regarding
scores the level of knowledge/practice composite as very (completely agree = 9.89%), which that is the lower one
low if < 60%, low if percentage between 60 to 69.99%, compared with previous studies. It is important to encourage
moderate for 70 to 79.99%, high for 80 to 89.99% and very nurses to improve their attitude towards nursing records as it
high if the percentage between 90 to 100%. helps quality of patients care.

Therefore, our study percentage (46.01%) indicated  Performance of nurses towards nursing documentation
low knowledge of nurses regarding nursing documentation. In our study only (Always = 36.78%) of participants
Our finding was lower as compared to a study conducted in had good nursing documentation performance. Our finding
Iraq (56%) (Hameed and Allo 2014). This discrepancy in was similar to a study conducted in Gondar 37.4% (Kebede,
findings may be due to accessibility of reading materials Endris et al. 2017). In addition, this study finding was lower
about nursing documentation and the tool differences. It has than studies in London 47% (Law, Akroyd et al. 2010) and
been also low as compared with a study carried out in Addis Ababa 47.8% (Hailu 2017). Moreover, the finding
Uganda 91.2% (Kizza 2012). This disparity may be due to was very lower than studies in Iran 100% (Aghdam, Jasemi
the difference in job environment and work load that nurses et al. 2009), Jamaican hospital 98% (Blake‐Mowatt, Lindo
had high patient load and unfavorable working environment et al. 2013). The possible reasons for this discrepancy may
in the current study compared to the previous studies. include organizational set up and tool differences difference

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Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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