Beruflich Dokumente
Kultur Dokumente
abstract
Background: Nurses are integral to bioterrorism preparedness, but nurses bioterrorism preparedness knowledge has not been evaluated well.
Methods: Missouri Nurses Association members (1,528)
were studied in the summer of 2006 to assess their bioterrorism knowledge and the perceived benefits of education as
well as barriers to education.
Results: The response rate was 31%. Most respondents
(60%, n = 284) received no bioterrorism education. Nurses
who were nurse practitioners (t = -2.42, p < .05), were male
(t = -2.99, p < .01), or were on a planning committee (t =
-1.96, p = .05) had received more education than other nurses. The most commonly cited barrier to education (46.6%,
n = 221) was not knowing where to obtain training. One third
of respondents (31.2%) reported no interest in receiving bioterrorism education in the future. Nurses average score on
the knowledge test was 73%. The most commonly missed
questions pertained to infection control and decontamination
procedures.
Conclusion: Bioterrorism preparedness training should
be offered through continuing education and nursing school
curricula.
J Contin Educ Nurs 2010;41(2):67-76.
67
Methods
The current study was a cross-sectional design consisting of a mailed survey sent to a convenience sample
of registered nurses in Missouri. The instrument, with a
cover letter and a self-addressed stamped envelope, was
mailed to all 1,528 MONA members in July 2006. Missouri nurses were chosen as the sample because MONA
distributed a free bioterrorism educational CD-ROM
program to their members in 2005. It was believed that
many of the MONA members would have participated
in the free bioterrorism preparedness program sent to
them; thus, they would have had at least one opportunity to receive bioterrorism-related education. The cover
letter gave an Internet address for an online version of
the survey administered through Test Pilot on a secure
server so that subjects had the option of completing the
survey online; the questions for the online and penciland-paper surveys were identical.
Surveys were coded so that participation could be
tracked; surveys did not include names or other identifying information. A modified Dillmans Total Design
Method was used to maximize response rates (Dillman,
2007). Three weeks after the instruments were mailed, a
reminder postcard was sent to nonresponders to encourage them to return their surveys or complete the instrument online. Nonresponders were sent a second copy
of the survey and a cover letter approximately 14 weeks
after the initial mailing to maximize the response rate.
The Saint Louis University institutional review board
reviewed and approved the study.
Instrument
The instrument measured bioterrorism preparedness
knowledge, perceived benefits of this education and
barriers to receiving bioterrorism preparedness education, and bioterrorism preparedness education received.
Knowledge-based questions were derived from existing core competencies for bioterrorism and emergency
readiness (Columbia School of Nursing, 2001, 2003a,
2003b; International Nursing Coalition for Mass Casualty Education, 2003). Questions on perceived benefits
of bioterrorism preparedness education and barriers to
this education and participation in bioterrorism education were derived from two bioterrorism surveys used in
earlier studies (Shadel et al., 2003, 2004) and from a literature review. A group of eight researchers from across
the country with expertise in bioterrorism provided
feedback on the content validity of the instrument. The
content validity index was computed for each item; items
with a content validity index of less than 0.80 were deleted (Lynn, 1986). Of the original 98 items, 16 were revised
and 35 were deleted, so that the final instrument had 62
Data Collection
Survey questions regarding perceived benefits of bioterrorism preparedness education and barriers to this education were based on a five-point Likert-type scale (strongly
disagree to strongly agree). Scores on the 6 perceived benefit questions and 14 perceived barrier items were summed
to provide overall scores for benefits and barriers subscales. Higher scores on these subscales indicated a higher
perceived benefit to receiving training (maximum score:
30) or a higher number of perceived barriers to education
participation (maximum score: 70), respectively.
Coefficients for internal consistency, Cronbachs alpha, were calculated for the perceived benefits and perceived barriers subscales. Cronbachs alpha was .86 for
perceived benefits, .91 for perceived barriers, and .88 for
bioterrorism knowledge, providing evidence of internal
consistency for these subscales. Cronbachs alpha could
not be calculated for the four education participation
items because, conceptually, it would not be expected that
the items on the education participation subscale would
be internally consistent (Ferketich, 1990). Cronbachs alpha also could not be calculated for internal consistency
of the entire survey because the questionnaire items did
not conceptually fit together into an overall construct
and there was no associated total score (Knapp, 1991).
The instrument measured bioterrorism education by
asking participants about two types of educational initiatives: traditional education (i.e., in-service training or
lectures) and reading journal articles. An overall bioterrorism education participation score was calculated by
adding the education variables (receipt of traditional education and journal articles read), providing a continuous variable. Scores for bioterrorism education participation were limitless. Other bioterrorism preparedness
education items included whether the respondent had
watched or participated in the free nursing bioterrorism
preparedness CD-ROM program that MONA sent to
its members in 2005 and the intent to pursue bioterrorism preparedness education in the future.
The bioterrorism knowledge component of the questionnaire consisted of 38 true-or-false items, with one
point awarded for each correct answer; higher scores in-
69
Table 1
N (%)
Age (yr)
< 30
11 (2.4)
31 to 40
20 (4.3)
41 to 50
144 (31.3)
51 to 60
190 (41.3)
> 61
95 (20.7)
Gender
Female
Male
446 (96.7)
15 (3.3)
24 (5.2)
Associates degree
30 (6.4)
Bachelors degree
97 (20.8)
Masters degree
Doctorate
275 (59.0)
40 (8.6)
Nurse practitioner
Yes
165 (35.4)
No
301 (64.6)
Work setting
Ambulatory care
98 (22.0)
Academic/research
79 (17.7)
Retired
50 (11.2)
Medical-surgical
33 (7.4)
Administration
31 (7.0)
Community/public health
25 (5.6)
Mental health
24 (5.4)
Emergency department
19 (4.3)
Critical care
18 (4.0)
Long-term care
18 (4.0)
Obstetrics
16 (3.6)
Home health
9 (2.0)
School (K-12)
9 (2.0)
Pediatrics
7 (1.6)
Infection control
5 (1.1)
Operating room
5 (1.1)
Work location
70
Urban
164 (36.9)
Rural
151 (34.0)
Suburban
129 (29.1)
Type of institution
For-profit
124 (29.4)
Not-for-profit
298 (70.6)
Table 2
M (SD)a
Frequency of
Agreement With
Statement
N (%)b
4.63 (0.65)
450 (94.90)
Getting better prepared for bioterrorism will decrease my familys risk of getting sick or
dying after an attack
4.33 (0.77)
420 (88.60)
Getting better prepared for bioterrorism will decrease my chances of getting sick or dying
after an attack
4.32 (0.80)
417 (88.00)
Getting better prepared for bioterrorism will decrease my patients risk of getting sick or
dying after an attack
4.26 (0.80)
405 (85.40)
Getting better prepared for bioterrorism will increase my chances of detecting an attack
before surveillance would recognize it
4.07 (0.94)
369 (77.80)
3.98 (1.03)
344 (72.60)
3.15 (1.42)
221 (46.60)
3.37 (1.28)
210 (44.30)
2.56 (1.23)
115 (34.30)
2.76 (1.24)
161 (34.00)
2.72 (1.21)
124 (27.20)
2.47 (1.19)
113 (23.80)
2.51 (1.19)
103 (21.70)
2.29 (1.11)
71 (15.00)
2.07 (1.15)
66 (13.90)
1.98 (1.07)
59 (12.40)
2.46 (0.97)
46 (9.70)
1.77 (1.05)
40 (8.40)
2.28 (0.98)
36 (7.60)
2.07 (0.98)
30 (6.40)
Note. a1 = strongly disagree; 2 = disagree somewhat; 3 = neutral; 4 = agree somewhat; 5 = strongly agree. bAgree somewhat or strongly agree.
Results
Overall, 474 of 1,528 (31.0%) petitioned participants
responded to the survey. Most respondents were female
(96.7%, n = 446), had a bachelors degree or higher (79.8%,
n = 372), worked at a not-for-profit institution (70.6%,
71
Table 3
Academic
Survey Item
M (SD)
Clinical Fields
Infection Control
and Public
Health
M (SD)
M (SD)
Retired
n
M (SD)
103
3.04 (0.90)
240
3.03 (0.81)
27
2.30 (0.82)
39
110
6.37 (28.60)
256
3.20 (14.90)
30
3.47 (7.07)
50
1.26 (3.56)
NS
110
2.63 (3.79)
256
2.59 (8.04)
30
7.70 (16.72)
50
1.22 (1.62)
< .01
Knowledge scorec,e,g,h
110
28.6 (2.76)
256
27.82 (3.68)
30
28.6 (2.58)
50
110
3.37 (1.31)
253
3.47 (1.28)
30
2.73 (1.51)
42
< .05
Note. aItems had various denominators because of inconsistent or missing data, such as selecting more than one answer option. b1 = in the next
month; 2 = in the next 6 months; 3 = in the next year; 4 = I do not plan to pursue bioterrorism education. cMaximum knowledge score = 38. d1 = strongly
disagree; 2 = disagree somewhat; 3 = neutral; 4 = agree somewhat; 5 = strongly agree. eSignificant difference between academic and retired. fSignificant
difference between clinical fields and infection control and public health. gSignificant difference between clinical fields and retired. hSignificant difference between infection control and public health and retired. iSignificant difference between infection control and public health and academic. NS = not
significant.
Discussion
The findings of the current study indicate that the
Missouri nurses who participated believe that bioterrorism preparedness education is beneficial for a variety of
reasons, including advancing knowledge and decreasing
their family members risk of getting sick or dying after a bioterrorism attack. However, despite the reported
perceived benefits to receiving education, the majority of
Missouri nurses in the current study indicated that they
have not attended any bioterrorism preparedness-related
in-services or lectures. One third of Missouri nurses in
the current study also reported that they have not read
any journal articles related to bioterrorism preparedness
or bioterrorism-related agents or diseases. The reasons
for low participation in bioterrorism-related training
programs are unclear, but are likely associated with a
lack of awareness about available educational opportunities (a frequently cited barrier). Nurse practitioners,
73
reported on nurses knowledge of clinical questions related to bioterrorism and found that the level of knowledge was low (De Felice et al., 2008; Katz et al., 2006;
Rose & Larrimore, 2002).
The bioterrorism knowledge test used in the current
study was developed from bioterrorism core competencies (Gebbie & Quereshi, 2002) and thus measured a different component of bioterrorism knowledge than has
been studied before (i.e., clinical knowledge about bioterrorism agents) in nursing students in Italy (De Felice
et al., 2008). However, the findings were similar. Nurses
need to improve their bioterrorism preparedness knowledge to provide competent care during a bioterrorism
incident. Educational content should focus on the core
competencies, particularly the areas identified in the current study as being the most frequently missed.
The current study has a few notable strengths. It is
the first study to examine nurses perceived benefits of
receiving bioterrorism-related education and perceived
barriers to receiving this education, delineate the amount
and types of bioterrorism preparedness education that
nurses have received, and evaluate U.S. nurses knowledge of nonclinical bioterrorism preparedness issues.
A few limitations of the study must also be noted. One
limitation is the potential issue of nonresponder bias. Individual characteristics of the nonresponders could not
be assessed directly, a common issue in survey research.
Another limitation is that participants were all members
of MONA; thus, the findings may not be generalizable
to all nurses nationwide. It is possible that nurses in other parts of the United States or in other countries may
have responded differently to the survey questions, had
higher knowledge scores, or received more bioterrorism
education than nurses in Missouri. However, previous
research indicated that knowledge of bioterrorism preparedness in health care providers in a variety of occupations, locations, and work settings is generally poor (De
Felice et al., 2008; Kerby et al., 2005; Mosca et al., 2005;
Wisniewski et al., 2004). These findings provide some
evidence of the generalizability of the current findings.
However, the generalizability of the findings of the current study outside of Missouri or to non-nurses is unknown. In addition, the findings may not be generalizable to all nurses in Missouri. It is possible that MONA
members are different from non-MONA members in
terms of their interest in, participation in, and access to
bioterrorism preparedness education. MONA members include a wide variety of nurses working in various nursing fields or specialties and are likely reflective
of the nursing population in general, but this cannot be
known. Another limitation of the current study is the
high proportion of nurse participants who reported hav-
75
Conclusion
Bioterrorism preparedness has become essential for
nurses in all areas of expertise and practice, yet many
nurses are not participating in bioterrorism preparedness educational opportunities. Some barriers to nurses
participation in bioterrorism preparedness education
have been outlined in the current article. Interventions
must be implemented to address these barriers so that
nurses in all specialties and work settings have access
to bioterrorism preparedness training opportunities. A
variety of educational program formats, such as in-services, lectures, journal articles, and online courses need
to be developed to meet nurses needs. Bioterrorism
preparedness training should be made available through
continuing education programs and also should become
a component of nursing school curricula using the identified core competencies as a basis for educational development. Participation in bioterrorism preparedness
key points
Bioterrorism
Rebmann, T., Mohr, L. B. (2010). Bioterrorism Knowledge and
Educational Participation of Nurses in Missouri. The Journal of
Continuing Education in Nursing, 41(2), 67-76.
1
2
3
Copyright of Journal of Continuing Education in Nursing is the property of SLACK Incorporated and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.