Effectiveness of an educational program on nurses’ knowledge about management therapy for snakebite in the emergency department

Abstract

BACKGROUND:

Snakebite is a serious life-threatening health crisis in many parts of the world. Snakebite is still a major cause of morbidity and mortality, especially in areas where a considerable portion of the population works primarily in agriculture, which raises the risk of coming into contact with snakes. Health professionals should have a thorough understanding of the most efficient approaches to managing the occurrence of snakebites. To assess nurses’ knowledge about management therapy for snakebites and assess the efficacy of an educational program designed to improve nurses’ understanding of management therapy measures for snakebites while working in the emergency department.

MATERIALS AND METHODS:

The current study employed a quasi-experimental design. The sample size is 70 nurses in the emergency department utilizing a pre-test/post-test methodology to assess changes between the control group (35) and the study group (35) after implementing the educational program. The research was conducted between December 2023 and March 2024. The study population was all emergency department (E.D.) staff nurses available during data collection. It worked in E.D. for over a year in Al-Shamiya General Hospital—Diwaniyah Health Directorate, Iraq.

RESULT:

The educational program demonstrates a remarkable impact on the knowledge of the nurses in the study group, as evidenced by the substantial and statistically significant difference in post-test scores (P < .001).

CONCLUSION:

At post-evaluation, the knowledge of emergency department nurses regarding management therapy for snakebite had been enhanced after the implementation of the educational program.

Introduction

Throughout the world, a snakebite is regarded as one of the most serious health-related issues. There are 5.4 million poisonous snakebites worldwide, of which about 2.5 million are deadly and cause 1,25,000 fatalities each year.[1,2] About 8000–10,000 people are bitten by venomous snakes in the United States each year; 15 of those cases result in death (0.16%). The death rate in Iraq is officially recorded as 25 per 100,000 individuals. An annual average of 150 victims are treated across multiple hospitals, resulting in a mortality rate ranging from 7 to 15%. Snakebites are most prevalent in warm climates characterized by a high concentration of snakes and a preponderance of agricultural activities.[3] Patients whose snakes have been bitten often administer inappropriate first-aid techniques before seeking medical attention and rely on conventional treatments.[4,5,6] The mortality rate from snakebite is a result of people’s ignorance of how to treat victims properly.[7] Pain, edema, and congestion that may indicate tourniquets or constriction bands can bring on local envenoming.[8] Herbal remedies, when consumed, may make you throw up. A research inquiry has revealed shortcomings in scientific understanding regarding the proper management of snakebites and a need for more awareness regarding the critical nature of this matter for students pursuing medical, pharmacy, nursing, and emergency medicine degrees.[9] The victim’s local swellings and problems can be greatly reduced with prompt resuscitation and administration of ASV, hence reducing the need for surgical care.[8] Therefore, our study aims to enhance emergency nurses’ knowledge of how to administer optimally and provide the best therapeutic management for victims of snakebites, thus reducing the mortality rate of victims and saving their lives as quickly as possible. The innovation in this study is to design an educational program consisting of lectures, according to the World Health Organization, to improve nurses’ knowledge of therapeutic measures for snakebites in the emergency department. A lack of awareness can harm healthcare delivery, especially in emergencies such as snakebites. As a result, this study emphasizes the importance of raising the knowledge and competence of health workers in these fields in managing snakebite cases and their ability to deal with such types of emergencies. It was the first study conducted in an educational program in Iraq regarding therapeutic measures for snakebite. The difference between this study and previous studies is that many of the earlier studies were descriptive studies and dealt with assessing knowledge, as there was a knowledge gap in caregivers’ knowledge without implementing any educational program to improve that knowledge. Among the recommendations of previous studies was the implementation of academic programs and workshops to improve health staff knowledge.[4,5,6]

Materials and Methods

Study design and setting

The current study employed a quasi-experimental design, utilizing a pre-test/post-test methodology to assess changes between the control group and the study group after the implementation of the educational program. The research was carried out in the training and development hall of the Diwaniyah Health Directorate of Al-Shamiya General Hospital. The study was conducted between December 2023 and February 2024.

Study Participant and sampling

The study population was all emergency department staff nurses available during data collection time who had worked in the E.D. for more than one year in Al-Shamiya General Hospital—Diwaniyah Health Directorate, Iraq. The researchers employed nonprobability purposive sampling to select 70 nurses in the emergency department nurse, the control group (35), and the study group (35) from the Diwaniyah Health Directorate of Al-Shamiya General Hospital.

Inclusion and exclusion criteria

It included all permanent nurses in the emergency department at Al-Shamiya General Hospital. Inclusion criteria were nurses working in the emergency department for at least one year and being present during the study period. Exclusion criteria: Staff nurses who did not cooperate to fill out the questionnaire administered to newly recruited nurses were excluded.

Data collection tools and technique

The data were collected using the research instrument and the educational program application. The implementation occurred at the Al-Shamiya General Hospital emergency department in Diwaniyah Governorate between December 2023 and February 2024. To assess the efficacy of the educational program aimed at enhancing the management therapy knowledge of emergency department nurses regarding snakebites, which was developed, designed, and validated, the researcher modified the questionnaire, added the necessary elements to it, deleted some inappropriate elements, translated and re-translated it from the original English version into Arabic, and used verification tools. The conclusion of this research work[10] consists of two parts and includes the following:

Part One: Social and demographic characteristics of nurses. This section was devoted to collecting social and demographic information from nurses using a self-report questionnaire sheet containing (five) items, such as gender, age, educational attainment, years of emergency experience, and attendance at the training course. Part Two: Nurses’ knowledge of nursing management. This section assessed nurses’ understanding of nursing management for snakebites. Each MCQ question has four answer options, with one correct answer containing (12) multiple-choice questions. The curriculum and study instruments are validated by a panel of 13 experts, each with at least 10 years of experience in their field. The reliability of the study instrument was tested utilizing the Cronbach’s alpha technique. And the Statistical Package for Social Science Program (SPSS) version 26.0 is observed. It was determined by assessing (10) nurses in ED AL-Diwaniyah governorate, Iraq, using a test-and-retest procedure. Cronbach’s alpha analysis shows a good evaluation of the knowledge scale (0.736), which means that the questions demonstrated appropriate internal consistency and equivalent measurability. (12) The Pearson correlation analysis in this table shows good evaluation for the knowledge scale (0.776), indicating that the questionnaires had adequate reliability and equivalence measurability to score the scale’s items; a dichotomous scale was used for the knowledge scale and scored as follows: correct answer(1) and incorrect answer(0).

Ethical considerations

The ethical permission (Ethics Committee Permission Number: (21/12/2023—4320) Before data collection began, approval was obtained from the relevant University of Baghdad, College of Nursing, the Clinical Research Ethics Committee, the Faculty of Nursing, and the ethical boards of the selected institutions. Participation was voluntary, with written informed consent from nurses who were promised to keep their responses confidential.

Statistical analysis

Descriptive and inferential statistical methods were used. The descriptive analysis was reported using frequency, percentage, mean, and standard deviation. The Chi-square test was used to describe their degree of knowledge regarding first-aid and snakebite management at the emergency room and assess the impact of an educational program on their Knowledge. A P value of less than 0.05 indicates statistical significance. All data were analyzed using SPSS Statistics (version 0.26).

Result

The mean age of nurses in the study group is 26.7 ± 5 years, as indicated in Table 1. In contrast, the age of nurses in the control group is 26.8 ± 5 years. Eighty-two percent of the nurses in the control group, or 80% of the study group, fall within the age range of 22 to 30 years.

Table 1.

Distribution of nurses according to their sociodemographic characteristics and professional characteristics

Characteristics		Study group				Control group
		F		%		F		%
Age (year)
20—less than 30		28		80		29		82.9
30—less than 40		4		11.4		4		11.4
40 and more		3		8.6		2		5.7
Total		35		100		35		100
Mean±SD		26.8±5				26.7±5
Sex
Male		20		57.1		20		57.1
Female		15		42.9		15		42.9
Total		35		100		35		100
Level of education
Secondary school		6		17.1		5		14.3
Diploma		17		48.6		17		48.6
Bachelor		10		28.6		11		31.4
Postgraduate		2		5.7		2		5.7
Years of experience in emergency
1		27		77.1		27		77.1
2		6		17.2		5		14.3
3 and more		2		5.7		3		8.6
Total		35		100		35		100
Participation in training course
Not participated		25		71.4		25		71.4
One course		10		28.6		10		28.6
Total		35		100		35		100

f: Frequency, %: Percentage, SD: Standard deviation

Concerning the gender composition of nurses, the study results indicate that 57.1% of the nurses in both groups are male, while the remaining 57.1% are female.

The results suggest that the percentage of nurses with a diploma in nursing is the highest, with 48.6% of the participants in the study group and the same proportion in the control group reporting such a qualification.

The number of years of experience in the emergency department suggests that nurses are still inexperienced, as 77.1% of the nurses in the control group and 77.1% in the study group had only one year of experience. Concerning engagement in educational courses, more than 28.6% of nurses in the study and control groups indicated that they had completed at least one course (28.6%).

Based on the data presented in the table, it can be observed that the pre-test knowledge of nursing personnel in the study group regarding the management of snakebites needed to be improved (94.3%). In contrast, the post-test knowledge was satisfactory (77.1%). The results of the control group indicate that nurses demonstrate a deficient level of knowledge on both the pre-test and post-test (100%).

The table shows that the educational program significantly improves the knowledge of the nurses in the study group, as evidenced by the high and statistically significant difference in the post-test scores (P = .001). No significant difference in nurses’ knowledge regarding the post-test is observed in the control group (P = .019).

Discussion

The results of the analysis of the data from the current study indicate that the average age of nurses participating in the study in both groups, representing the majority of participants, is within the age range of 22 to 30 years. This result is corroborated by a study,[9] which found that most respondents were 20 to 25 years old. Regarding the gender composition of nurses, the study results indicate that most of the participants of the nurses in both groups are male. According to this study, which was corroborated by,[11,12,13] most emergency nurses identified as male. Alternative research contradicts the findings of a previous study,[14,15] which indicated that the proportion of female participants is greater than that of male participants. Regarding educational attainment, the research results suggest that the most substantial percentage of nurses possess a diploma in nursing. The result of the current study agrees with the findings of a study conducted by others,[14] which demonstrated that a higher proportion of nursing staff were graduates of secondary nursing school. Another study disagrees with a study[16] that reported that most nurses held a bachelor’s degree. The results in Table 2 revealed a significant difference between the control and experimental groups regarding management mean score concerning nurses at P value (=0.019). The result agrees with another study[17] that stated the educational program enhanced the emergency nurse’s understanding of managed treatment for snakebite injuries. Another study concurs with these results and found significant gaps in knowledge regarding snakebites. However, only 38% of the students who participated assessed the need for knowledge regarding snakebites as high. That indicates a lack of understanding regarding the significance of snakebites as a serious medical issue that significantly increases morbidity and mortality.[5] Other research agrees with the study’s conclusion that the knowledge scores of nurses were inadequate across all knowledge items in the pre-test, which increased significantly immediately following the program.[17,18] The result of the study is consistent with the findings of another study[6] that shows the majority of respondents believed that treating snakebites with conventional medicine or herbs is beneficial to most people. Another study conducted by[19] disagreed with these results, which discovered that a sizable portion of participants in Nepal did not think of consulting a faith healer or quack for treatment following a snakebite. Other related studies indicate that 75% of snakebite victims in Pakistan, 61% in Maharashtra, India, and 86% of victims in Bangladesh[20] still consult traditional healers. A different study covered that most participants favored modern allopathic therapy over conventional treatment for snakebites; 80.8% stated that their preference stemmed from a government hospital’s accessibility.[21] The results of the present study contrast with others[4]; most people can differentiate between venomous and nonpoisonous snakes; in a different study, 98% of participants could do so simply by observing the snake.[22] The result contrasts with another study,[23] where 66.5% of participants knew where Kinaye’s medical facilities for treating snakebites were located. Knowledge gaps were related to age, profession, and educational attainment. Apart from the fact that most illiterate people were ignorant, it was also noted that those with higher levels of education knew more about different kinds of snakes than those with lower levels of education; the same finding was reported in the study conducted by.[24] The results in Table 3 significantly improved the nurse’s knowledge study group in the post-test at P value (=0.019). These results are consistent with the study’s findings, which indicate how ignorant the general public is about how to treat snake envenomation. Additionally, it demonstrates a total ignorance of the government’s relief programs for people bitten by snakes.[7] Another study[9] indicated that education training improved mostly nursing students’ knowledge regarding emergency medicine. Other research supports these studies, which showed a good level of immunization in their experimental group.[25] The findings consist of a study conducted by another investigation,[26,27] which showed that nursing staff members’ had moderate levels in pre-test and improvement in post-test regarding infection control as a result of the training program’s implementation.

Table 2.

Assessment of nurses’ knowledge about management therapy for snakebite injury among the study and control group

Levels of knowledge		Study group (n=35)																Control group (n=35)
		Pre-test								Post-test								Pre-test								Post-test
		f		%		M		SD		f		%		M		SD		f		%		M		SD		f		%		M		SD
Poor		33		94.3		2.17		1.445		0		0		9.34		1.454		35		100		1.51		0.887		35		100		1.77		1.165
Fair		2		5.7						8		22.9						0		0						0		0
Good		0		0						27		77.1						0		0						0		0
Total		35		100						35		100						35		100						35		100

f: Frequency, %: Percentage, M: Mean of total score, SD Standard deviation. Poor=0–4, Fair=4.1–8, Good=8.1–12

Table 3.

Effectiveness of an educational program on nurses’ knowledge about management therapy of snakebite at emergency department among study and control group

Knowledge		Study group (n=35)												Control group (n=35)
		M.		SD		t		df		P		Sig.		M.		SD		t		Df		P		Sig.
Pre-test		7.91		2.853		43.524		34		0.001		H.S		7.46		2. 680		2.463		34		0.019		N.S
Post-test		30.11		3.367										7.57		2.547

M: Mean, t=t-test, df=Degree of freedom, P=Probability, Sig. =Significance, HS=High Significant, N.S=Not significant

Limitations and recommendation

Deficiencies in emergency department knowledge regarding management therapy for snakebites have been documented. Training, educational programs, course coordination, and supplementary assistance may benefit victims’ assessment and efficient administration. Therefore, the emergency nurse must initiate educational programs to guarantee that the greatest number of nurses receive instruction. Advantages of the program: The emergency nursing staff’s understanding of snakebite management therapy has been expanded. The nurse acquires knowledge from the program without engaging in clinical practices, which constitutes a weakness.

Conclusion

The majority of the participants are within the first age group. Most participants are males with average years of experience, with one year of experience among 77.1% in the study group. The comprehensive evaluation of nurses’ knowledge indicates that the study group nurses demonstrated inadequate knowledge during the pre-test. However, by the time the post-test arrived, they had improved to a satisfactory level of expertise, signifying substantial changes in their knowledge level. After the evaluation, emergency department nurses’ knowledge regarding snakebite nursing management increased since the educational program was implemented. It demonstrates that the presented program was highly beneficial and statistically significant.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.