Assessment of Knowledge and Attitude among Faculty of Nursing Students Regarding Blood Donation

Introduction

Blood is vital fluid that acts as nutrients transport throughout the body to perform its functions (Nataba, 2019). Blood donation occurs when a person has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation (separation of whole-blood components). Donation may be of whole blood (WB) or of specific components directly (the latter called aphaeresis) (Frasiska et al., 2016) Blood donors can be differentiated into voluntary, family replacement, and paid donors. About 108 million blood donations are collected worldwide. More than half of these are collected in high-income countries, home to 18% of the world’s population
(Al-Mutairi et al., 2015).

Blood donation can be started safely from 17 years of age, so it is important that the young generation can be motivated to do this harmless task. In order to motivate students, first we should be aware of the knowledge, attitude and practices towards blood donation. Such studies are important to understand various factors that affect recruitment and retention of blood donors, to know the potential reasons that restrict them from doing this simple but lifesaving task, and to know the reasons that motivate the donors to donate blood. This can further help in planning proper and creative ways to recruit regular voluntary donors (Ugwu et al., 2019).    

In a developing country like ours, lack of knowledge, blood donor recruitment and retention strategy and various misconceptions have resulted in a limited number of voluntary donors. This challenge can be tackled by adopting such recruitment methods that can overcome the misconceptions and also motivate the public to donate at an early age, so that they become lifelong voluntary donors (Ugwu et al., 2019).  Some people believe that it is a national and religious duty while others stated that they would only donate if a family member or a friend is in need. (Al-Haqqan et al., 2016).      

A positive attitude among nursing students will bring change in the attitude of blood donation among patients during care and can be a core group to educate many friends and relative about the need for blood donation. There is also need to encourage, inspire, and motivate stu­dents to donate blood voluntarily and become a professional donor
(Singh et al., 2015).

Community Health Nurses are clinically responsible for the donation session, with the care of the donors and the safety of the blood being their main priority. It also has the role of the nurses to supervise the donor careers that carry out a function similar to that of healthcare assistants in hospitals, and to ensure they deliver a first-class service. As well as providing clinical leadership for the teams nurses are also required to provide medical assessment expertise and have a critical role to play in the care before, during, and after donate blood and selection of donors as their suitability to certain level (Goda, 2017).

Significance of the study

 “Blood connects us all” - was the theme for the World Blood Donor Day 14 June 2016. Blood transfusion is an important concern for the society, as it is lifesaving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases, and malignancies (Razdan et al., 2018).

In spite of, extensive efforts and a number of blood donation programs being organized worldwide, availability of adequate and safe blood still remains short to meet the increased demand in developing countries. The major challenge was recruitment of voluntary, non-remunerated blood donors. Literatures identified that many factors are responsible such as, lack of knowledge, negative attitudes, and inconvenience for facilities. Increase level of knowledge and positive attitude towards voluntary blood donation in young people is highest priority (Tadesse et al., 2018).  

The World Health Organization (WHO) recommends that, for any country to meet the minimum demand for blood, collection should be at least from 1% of the population, on average, high income countries have 9 times higher donation rate compared to low-income countries (Elias et al., 2016).

Aim of the Study

This study aims to assess knowledge and attitude among nursing students regarding blood donation.

Research Questions:

1. What is the level of knowledge of nursing students regarding blood donation?
2. What is the attitude of nursing students regarding blood donation?

Subjects and Methods

Research Design:

A descriptive research design was used for this study.

Setting:

This study conducted in the Faculty of Nursing at Minia University for all grades. Total number of students in data collection year (2017- 2018) were one thousand four hundred seventy-five (1475). 

Subjects:

A stratified random sample was collected, from first, second, third & fourth academic year students of Faculty of Nursing.

Sample size:

The sample size was calculated according to this formula:

Formula: 𝑛 = 𝑡2× (1 − 𝑝)/𝑚².

Description

• 𝑛 = required sample size.
• 𝑡 = confidence level at 95% (standard value of 1.96).
• 𝑝 = expected prevalence of students' blood donor (50%).
• 𝑚 = margin of error at 5% (standard value of 0.05).
• 𝑛 = (1.96)²× 0.8(1 − 0.8)/ (0.05)². 𝑛 = ∼384

Accordingly, the minimum sample size needed was 384 students, then we added additional number of students, 10 % of the calculated sample to guard against non-response so the sample was 422, and it was distributed equally between 1st, 2nd, 3rd & 4th academic year students of Faculty of Nursing.

Tools for Data Collection:

Tools for data collection consisted of three tools:

Tool I: A structured interview questionnaire designed by the investigator to collect data includes two parts:

Part 1: Demographic Characteristics of the student, it consisted of (4) items age, gender, class year, residence.

Part 2: Student^'s previous history regarding blood donation, included (4) questions to assess  previous history regarding blood donation : If the student ever donated blood, been asked questions before donating blood, how many times, when was the last time he/she donated bloodand where was the last time he/she donated blood .

Tool II:  Knowledge Assessment Tools:  consisted of (31) closed ended  questions to assess of student knowledge about blood donation such as: have attended seminars on blood donation, have information on blood donation, what is the amount of blood contained in the human body, what are the components of blood, what is the right age for blood donate, what is the appropriate weight for the person who donate blood, amount of blood a person can donate in a single time, blood group and types, different types of blood donors…etc.

Tool III: Blood donation Attitude Scale. This scale developed by Manikandan, et al., (2013). The scale included statements to assess students’ attitude regarding blood donation. It consisted of 20 statements. All statements have response format (agree/ disagree or neutral) as: blood donation is charitable or voluntary, I think blood donation is a positive behavior, parents should be informed before donation of blood, I think blood donation can lead to anemia.

Scoring system:

Scoring system for tool II student’s knowledge about blood donation, each correct response took two scores, wrong answer took one score and the not known response took (zero). The total score < 37.2 scores (less than 60%) was considered as unsatisfactory while score of 37.2 scores (60% and more) was considered as satisfactory level

While scoring system for tool III Blood donation Attitude Scale, was carried out by using 3-point Likert scale. agree = 2, neutral = 1 disagree = 0.  Positive attitude statement was scored from two (for participants who agreed) to zero (for participants who disagreed). The opposite of this scoring was used for the negative attitude statements. Accordingly, the total score ranged between zero to 40 points. The total score < 24 scores (less than 60%) was considered as negative attitude while score 24 scores (60% and more) was considered as positive attitude about blood donation.

Validity and Reliability

The tool tested for content validity by a jury of five experts in the field of the study to test the content validity of tools and necessary modifications was done. Reliability of the tools was performed to confirm its consistency by using Cornbrash's alpha test to tools II and III were 0.847 & 0.901 respectively

Pilot Study

Pilot study was carried out on (10%) of sample 42 students from nursing students selected randomly from different academic years to check and ensure the clarity of Arabic questionnaires, identify the obstacle and problems that may encountered during data collection and to estimate the time needed to complete the questionnaires items and included in the study.

Data collection procedure

An official permission was obtained from the Dean of Faculty of Nursing and Vice-dean for education and Student Affairs and from Academic Departmental Heads of Faculty of Nursing. An oral agreement was taken from the students who participate in the study after explaining the aim of the study.  Confidentiality of obtained data was maintained and ensure for every student before starting data collection. Arabic translation of the study tool was done. Data was collected from the student at the beginning of academic year after permission of the nursing educators two days for each year's students during their clinical area.

The time consumed to fill the questionnaires was between 20 to 30 minutes. The investigator stayed with the students until the questionnaires were completed to ensure objectivity of the responses and to ensure that all item was answered. Data collection started at the beginning of October 2018 to the end of February 2019.

Ethical and Legal Considerations

A written initial approval was obtained from the Research Ethical Committee of the Faculty of Nursing, Minia University, official permission was obtained to collect necessary data from the Dean of Faculty of Nursing and Vice-dean for education and Student Affairs and from Academic Departmental Heads of Faculty of Nursing.

 The Students were informed that their participation in this study is completely voluntary and there is no harm if they choose not to participate and no individual information is shared outside of the research. Oral informed consent was obtained from each participating nursing student after explaining the nature and benefits of the study. Each assessment sheet was coded, and student names not appeared on the sheets for the purpose of privacy and confidentiality.

Statistical analysis

The collected data were analyzed using Statistical Package for Social Sciences (SPSS) IBM 25 for windows. Data were collected, tabulated.  Quantitative data were presented by mean (standard deviation) , while qualitative data presented by frequency distribution. The Chi-square test was used to compare between proportions. Test of significance were considered as: insignificant (NS) P.value ≥ 0.05, * significant P.value < 0.05, and ** highly significant P<0.01.

Results

Table (1): Socio Demographic characteristics of the studied nursing students (n = 422).

Table 1 shows that 54.5% of the studied nursing students aged between 20- 21 years with mean ± SD (20.05 ± 1.3) years, 74.2% of them was female, 27.5% of them was in 3rd year academic year and 68.7% of them comes from rural area.

Table (2): Frequency distribution of the studied nursing students regarding previous history of blood donation (n = 422).

Table 2 presents that 84.4% of the studied nursing students don't previous blood donation, 40.4% of them the main causes of its was anemia. Concerning number of donations 74.2% of nursing student donated one time, 66.7% of them reported they asked before donation, and 40.9% the main question was about level of hemoglobin. Regarding causes of blood donation 65.2% of them was to help the people, 57.6% of them last time of donation was less than one year and 68.2% of them donated in blood donation car.

Figure (1): Distribution of the studied nursing students regarding attended previous workshop (n = 422).

Figure (1): demonstrates that 20.4% of the studied nursing students attended previous workshop, and 79.6% of them don't attended any previous workshop.

Table (3.a): Frequency distribution of the studied nursing students regarding their general knowledge about blood donation (n = 422).

Table 3.a shows that 98.2% of the studied nursing students answered correctly components of blood, 94.5% and 88.2% of them answered correctly precautions after and before blood transfusion respectively, but 36.3% of them know their blood group.

Table (3.b): Frequency distribution of nursing students regarding their knowledge about donor eligibility (n = 422).

Table 3.b presents that 97.6% of nursing students answered correctly pregnant women can donated or not, 94.5% of them know normal blood pressure for donated person and 929% of them answered correctly if a person on medications for chronic disease donate or not.

Table (3.c): Frequency distribution of nursing students regarding their knowledge about consequences of donation (n = 422).

Table 3.c shows that 33.4% of nursing students answered correctly time of compensated red blood cells, 32.9% and 32.5% of them answered correctly time of compensated the amount of iron lost during donation and plasma

Figure (2): Frequency distribution of the studied nursing students regarding their total knowledge level about blood donation

(n = 422).

Figure (2): illustrates that more than one third (37.7%) of the studied nursing students had satisfactory knowledge about blood donation and 62.3% of them had unsatisfactory knowledge.

Table (4): Frequency distribution of the studied nursing students regarding their attitude about blood donation (n = 422).

Table 4 shows that 97.6% of the studied nursing students agreed with blood donation is a volunteer work, 94.5% of them agreed with it’s a positive behavior, 90.0% of them agreed with they checked blood before donation limit increasing the infectious disease and 87.0% of them agreed with they felled empathy with the patient need blood donation.

Figure (3): Frequency distribution of the studied nursing students regarding their attitude about blood donation (n = 422).

Figure (3): illustrates that the majority (90.3%) of the studied nursing students had positive attitude towards blood donation and 9.7% of them had negative attitude.

Table (5): Relations between the studied nursing student's total knowledge levels and their demographic data (n = 422).

**Highly significant P<0.01

Table (5): shows that there was highly statistically significant difference between the studied nursing students' knowledge and their age (p value >  0.0001) as 21.4 % of those who had a satisfactory knowledge level were in age group (22-23 years) versus 10.3% who had an unsatisfactory knowledge level.

Also, there was a statistical significant difference between different academic years and their knowledge level as by increasing the academic year, the knowledge level increase (p = 0.0001).

Table (6): Relations between the studied nursing students’ attitude and their demographic data (n = 422).

Table (6): presents that there was no statistically significant difference between the studied nursing students' attitude and their demographic data.

Table (7): Relations between the studied nursing students total knowledge levels and their attitude (n = 422).

**Highly significant P<0.01

Table (7): cleared that there was highly statistically significant difference between the studied nursing students' knowledge and their attitude toward blood donation as 95.6% of those who had a satisfactory knowledge level had positive attitude versus 12.9% of those who had unsatisfactory knowledge level had negative attitude.