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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2021  |  Volume : 32  |  Issue : 2  |  Page : 497-504
Knowledge of acute kidney injury among Pakistani nurses: A cross-sectional survey


1 Department of Pharmacy, The University of Lahore, Pakistan
2 Department of Pharmacy Services, District Headquarter Hospital (DHQ) Pakpattan, Pakpattan, Pakistan
3 Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
4 Department of Internal Medicine, University of Medical Sciences, Ondo, Nigeria
5 Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia

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Date of Web Publication11-Jan-2022
 

   Abstract 


Nurses are increasingly being regarded as the nucleus of the health care system, as well as serving as an advocate for health-care consumers. Therefore, adequate acute kidney injury (AKI) knowledge of nurses would definitely have a positive impact on an early diagnosis, management, and outcome of AKI. This cross-sectional study was aimed to assess the knowledge of AKI among nurses working at public and private hospitals at Lahore and Sialkot, Pakistan. The study was conducted from October 2017 to March 2018. A convenient sampling method was used and data were gathered using a self-administered questionnaire. The median knowledge score of the study population (n = 200) was 29, with majority (78.5%) having moderate knowledge (score 26–38). Only 2.5% of nurses had good AKI knowledge whereas 19.0% were found to have poor knowledge. Nurses’ age, rank, and their departments had no significant impact on the knowledge scores. Furthermore, there was no significant difference of knowledge among participants who had previously attended any seminar/special training session regarding AKI and those who had not. In conclusion, majority of Pakistani nurses had moderate AKI knowledge. Therefore, in-service training sessions on AKI should be conducted to equip nurses with up-to-date AKI knowledge.

How to cite this article:
Salman M, Ul Mustafa Z, Asif N, Oluseyi A, Saed A, Nawaz A, Tariq N, Javaid F, Masood A, Tariq F, Khan YH, Mallhi TH. Knowledge of acute kidney injury among Pakistani nurses: A cross-sectional survey. Saudi J Kidney Dis Transpl 2021;32:497-504

How to cite this URL:
Salman M, Ul Mustafa Z, Asif N, Oluseyi A, Saed A, Nawaz A, Tariq N, Javaid F, Masood A, Tariq F, Khan YH, Mallhi TH. Knowledge of acute kidney injury among Pakistani nurses: A cross-sectional survey. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jan 28];32:497-504. Available from: https://www.sjkdt.org/text.asp?2021/32/2/497/335462



   Introduction Top


Acute kidney injury (AKI), previously known as acute renal failure (ARF), is recognized as a syndrome. In 1918, William MacNider used this term for the first time in a condition of acute mercury poisoning, but it became an ideal term in the early 2000s when ARF was redefined with the now widely acknowledged criteria known as Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease (RIFLE).[1],[2] RIFLE criteria were modified by AKI Network group in 2007.[3] Recently, based on both above-mentioned definition and classification system, Kidney disease Improving Global Outcomes (2012) proposed another criteria which defined AKI as either of the following: (1) An increase in serum creatinine of >0.3 mg/dL (>26.5 μmol/L) within two days, (2) increase in serum creatinine >1.5 times baseline, which is known or presumed to have occurred within the prior seven days, (3) urine volume <0.5 mL/kg/h for 6 h. AKI is a significant health problem in developed as well as developing countries.[4] It is common in the hospitalized population, particularly in intensive care units, and is associated with a high death rate or chronic complications, such as chronic kidney disease and other organ dysfunction.[4],[5],[6],[7] Early diagnosis and proper management of AKI is pivotal to avoid complications, reduce length of hospital stay, and economic burden not only on patients and their families but also health care system. Previous data indicate that knowledge of health-care professionals regarding AKI is inadequate.[8],[9],[10]

Nurses are increasingly being regarded as the nucleus of the health care system, as well as serving as an advocate for health care consumers. Therefore, adequate AKI knowledge of nurses would definitely have a positive impact on an early diagnosis, management and outcome of AKI. The current study was intended to assess the knowledge of AKI among nurses working at public and private hospitals of Pakistan.


   Methods Top


Study design, settings, and population

A cross-sectional survey was conducted over a period of six months (October 2017–March 2018) at both private and government hospitals (Children’s Hospital, Jinnah Hospital, Sir Ganga Raam Hospital, Bajwa Hospital, Ghurki Hospital, Gulab Devi Hospital, Mission Hospital Sialkot, Mayo Hospital, Civil Hospital Sialkot, Kot Khawaja Hospital, Abu Huraira Trust Hospital) of two large cities of Punjab, namely Lahore and Sialkot. A convenient sampling technique was employed and nurses working in the intensive care units, pediatrics, nephrology units, neurology units, A&E units of study settings were approached by the investigators. Nurses having at least six months of experience and those willing to participate were included in this study. Those who were on training and not consented to participate were excluded.

Ethical consideration

Permission to conduct this study was obtained from the management of hospitals. This study was conducted as per the rules laid down by the Declaration of Helsinki 1964 and its later amendments. A verbal consent was taken from every participant and they were made secure that their information would remain confidential.

Outcome measures

Knowledge of nurses regarding AKI was assessed by self-administered questionnaire. This questionnaire was a modified version of what was developed and used in a previous study by Adejumo et al.[8] The questionnaire comprised of two sections. Section A was comprised of eight questions on sociodemographic information. Section B had 51 questions to assess the knowledge of nurses about AKI and 1 question to assess the willingness of nurses to attend seminar/update course on management of AKI. A score of 1 point was given to each correct answer and 0 point was given to each wrong answer. The maximum score obtainable was 51 and the score obtained by each participant was converted to percentage. Study participants scoring <50% of the total score were considered as having poor knowledge of AKI, 50%–75% as having moderate knowledge of AKI and >75% as having good knowledge regarding AKI.


   Statistical Analysis Top


Data were entered and analyzed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA). Frequency and percentages were calculated for categorical variables whereas the median and interquartile range for skewed continuous variables. Mann-Whitney U-test and Kruskal-Wallis H test were used to compare the median values of continuous variables, with a P <0.05 was considered statistically. Moreover, post hoc analysis was done using Bonferroni correction to determine significant differences among trichotomous and multinomus variables.


   Results Top


A total of 340 nurses were approached, of them, 115 refused to participate. Of 225 nurses who gave consent to participate in the study, 25 nurses returned incompletely filled-out questionnaires, therefore, 200 questionnaires were included in the final analysis. The demographic data of the study participants are shown in [Table 1]. The median (interquartile range) age of the study participants was 26 (7). Majority (98.5%) of participants were female head nurses having one to five years of experience. Most of the nurses reported that they did not have any special training or previously attended any seminar/lectures regarding AKI.
Table 1: Demographic details of study participants.

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The frequency of correct and incorrect responses to the knowledge items regarding AKI are shown in [Table 2]. The median (interquartile range) knowledge score was 29 (4), with the majority of study participants having moderate knowledge (knowledge score 26–38). Only 2.5% of nurses had good AKI knowledge whereas 19.0% were found to have poor knowledge. Comparison of the AKI knowledge among different variables is shown in [Table 3]. Participants’ age, rank, and their departments in the hospital had no significant impact on the knowledge scores. Moreover, there was no significant difference of knowledge scores among participants who had previously attended any seminar/lectures/ special training session regarding AKI and those who had not. Post hoc analysis with Bonferroni correction revealed that nursing having one to five years of experience had better AKI knowledge score than those who did not indicate their experience [Table 4].
Table 2: Frequency of right and wrong responses to the items regarding the acute kidney injury knowledge.

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Table 3: Comparison of knowledge scores among demographic variables.

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Table 4: Post hoc analysis of knowledge scores among different categories of nursing experience.

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   Discussion Top


This study sought to assess the knowledge of Pakistani nurses working in different units of public and private hospitals. Our main results revealed that the knowledge of the majority of Pakistani nurses regarding AKI was moderate. Moreover, participants’ age, rank, department, and previously attended special training sessions/lectures on AKI did not have any impact on the knowledge.

In the current study, Pakistani nurses’ were found to have moderate knowledge regarding AKI which was comparable to the findings of earlier studies conducted among nurses.[8],[9],[10],[11] Moreover, a study conducted among non-nephrology doctors also revealed that a higher proportion (69.2%)had moderate knowledge of AKI and only 1.2% had good knowledge.[9] There were significant misconceptions regarding AKI among nurses. Only 30% and 24.5% gave correct response to the questions that urine output and serum creatinine can be normal in patients suffering from AKI respectively. Similar to these findings, Adejumo et al also reported that less than 22% of nurses in Nigeria chose correct answers regarding aforementioned questions about clinical presentation of AKI.[8] Another study conducted among Brazilian nurses showed that 57.2% of their study population were unable to identify AKI clinical manifestations.[11] Consistent with the findings of the previous study among nurses, we also found that majority of nurses knew that heart disease, chronic hypertension, and diabetes mellitus were the significant contributors to AKI, but less than 42% of nurses gave correct answers regarding liver disease and elderly patients as risk factors for acute renal impairment.[8] Our findings also revealed significant deficiencies in the knowledge of nurses about nephrotoxic agents, highlighting the need of the active involvement of clinical pharmacists and pharmacologists to equip nurses with up-to-date knowledge on drug-induced AKI. Regarding the types of AKI, majority of nurses knew that the etiology of AKI could be prerenal (77%) and intra-renal (65.5%) but only around 47% knew that it could be post-renal which was comparable to the findings of an earlier study reporting that significantly more nurses knew about prerenal and renal than postrenal type of AKI.[8] Furthermore, in the present study, a wide majority of Pakistani nurses were unfamiliar with the terminologies of oliguric and nonoliguric AKI. Consistent with the findings of earlier studies in both nurses and non-nephrology doctors, we also found that the knowledge of our study population regarding the definition and staging criteria of AKI was far from satisfactory.[8],[9] It was positive that a great majority of nurses in the current gave correct responses regarding the signs and parameters to be monitored closely/regularly in AKI. Overall, our findings showed that there is a need to improve nurses’ knowledge regarding AKI. This is also important to accomplish the International Society of Nephrology vision of zero deaths by year 2025. A wide majority (92.5%) of nurses included in this study were willing to attend seminars on AKI. Therefore, seminars/workshops and in-practice training sessions on AKI and its management should be frequently conducted.

The study had few limitations. First, the study was conducted in the selected private and government hospitals of only two metropolitan cities of Punjab (Lahore and Sialkot), so the findings may not be easily generalized to the nursing population of the whole country. However, this study provides much-needed data regarding AKI knowledge among Pakistani nurses. Second, a convenient sampling technique was used which may result in selection bias. Finally, we used a self-administered questionnaire, hence results should be cautiously interpreted. We recommend a large- scale multicenter study to assess knowledge of AKI among Pakistani nurses. Furthermore, the study endorsed the incorporation of lectures on AKI at both undergraduate and postgraduate nursing levels.


   Conclusions Top


The study showed that majority of the Pakistani nurses working in different units of public and private hospitals had moderate knowledge of AKI. Since there are misconceptions about some aspects of AKI, we recommend regular in-service training sessions on AKI. We also recommend incorporation of AKI lectures in both nursing undergraduate and postgraduate curriculum.

Conflict of interest: None declared.



 
   References Top

1.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative Workgroup. Acute renal failure – Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group Crit Care 2004;8:R204-12.  Back to cited text no. 1
    
2.
Macedo E, Bouchard J, Mehta RL. Renal recovery following acute kidney injury. Curr Opin Crit Care 2008;14:660-5.  Back to cited text no. 2
    
3.
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.  Back to cited text no. 3
    
4.
Li PK, Burdmann EA, Mehta RL, World Kidney Day Steering Committee 2013. Acute kidney injury: Global health alert. Arab J Nephrol Transplant 2013;6:75-81.  Back to cited text no. 4
    
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Lafrance JP, Miller DR. Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 2010;21:345-52.  Back to cited text no. 5
    
6.
Murugan R, Kellum JA. Acute kidney injury: What’s the prognosis? Nat Rev Nephrol 2011; 7:209-17.  Back to cited text no. 6
    
7.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005; 294:813-8.  Back to cited text no. 7
    
8.
Adejumo OA, Akinbodewa AA, Alli OE, Pirisola OB, Abolarin OS. Knowledge of acute kidney injury among nurses in two government hospitals in Ondo City, Southwest Nigeria. Saudi J Kidney Dis Transpl 2017;28:1092-8.  Back to cited text no. 8
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9.
Adejumo O, Akinbodewa A, Alli O, Olufemi P, Olatunji A. Assessment of knowledge of acute kidney injury among non-nephrology doctors in two government hospitals in Ondo City, Southwest, Nigeria. Ethiop J Health Sci 2017;27:147-54.  Back to cited text no. 9
    
10.
Dushimiyimana V. Knowledge of Nurses in the Early Detection and Management of Acute Kidney Injury in a Selected Hospital in Rwanda (Doctoral Dissertation, University of Rwanda); 2017.  Back to cited text no. 10
    
11.
Nascimento RA, Assunção MS, Silva JM Jr., et al. Nurses’ knowledge to identify early acute kidney injury. Rev Esc Enferm USP 2016;50: 399-404.  Back to cited text no. 11
    

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Correspondence Address:
Muhammad Salman
Department of Pharmacy, The University of Lahore, Lahore
Pakistan
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DOI: 10.4103/1319-2442.335462

PMID: 35017344

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