Study design. This descriptive study was conducted between September 15, 2017, and February 15, 2018, to identify nurses’ knowledge, attitudes, and practices pertaining to UI and related obstacles. The study sample comprised 475 nurses employed in intensive care units, urology, neurology, and neurosurgery inpatient services and urology, gynecology, and obstetrics outpatient clinics in 2 private, 4 state, and 2 university hospitals in a metropolitan city in Turkey.
Inclusion criteria stipulated participants must be registered nurses and agree to participate in the study. The recruited nurses were informed of the purpose and plan of the study, and written consent was obtained from all nurses.
Data collection. The data collection form comprised 4 sections covering demographic characteristics, implementation, knowledge, and obstacles to care (see Table 1). These sections were developed by the researchers based on the existing literature.6,7,10,12 The descriptive characteristics section contained 25 questions about nurses’ age, experience, employment unit, postgraduate specialty training in UI, care offered to incontinence patients, and methods used for incontinence treatment. The implementation section contained 7 questions about using an assessment tool for UI and nursing interventions practiced. The obstacles section contained 12 items about the obstacles reported by nurses in offering care for UI patients; nurses were asked to respond agree, disagree, or no idea. No total score was used when evaluating the obstacle questions; evaluation was based on the answers to each item. The UI knowledge section was developed by the researchers based on the existing literature6,7,10,12 and included 24 questions measuring nurses’ knowledge of UI and UI types, which conditions lead to incontinence, the effects of UI on the individual, and treatment (see Table 2). The 24 questions comprised 12 true and 12 false statements to which participants responded true, false, and I don’t know (I don’t know responses were scored as false). Correct answers were given 1 point and incorrect answers were given 0 points, yielding a range of possible scores from 0–24 points. Participants who correctly answered 70% or more of the knowledge questions were considered by the authors to have sufficient knowledge; Cronbach’s alpha was 0.70. Four (4) experts were consulted when preparing the data collection form, and it was finalized in line with their opinions. The content validity of the data collection form was 0.84.
Urinary Incontinence Attitude Scale (UIAS). This scale was developed by Yuan et al,21and validity and reliability testing for use in Turkey was conducted by Ugurlucan et al.23 The instrument comprises 15 questions on attitudes toward UI measured on a 4-item Likert-type scale. Items 1 through 4 measure attitudes toward lower urinary tract symptoms, item 5 measures attitude to prevention of urinary incontinence; items 6 through 10 measure attitude toward treatment, and items 11 through 15 measure attitude toward UI management. Scores range from 15 to 60 points; higher scores indicate a positive attitude. Yuan et al21 determined the Cronbach’s alpha values to be 0.65 for nurses and 0.70 for community members. In terms of the validity and reliability of the Turkish translation of the scale, the Cronbach’s alpha value was 0.72.23 In this study, the Cronbach’s alpha value was 0.70 and considered acceptable.
Ethical considerations. Approval for the study was obtained from the Clinical Studies Ethical Board (Approval No. 02, dated 10.02.2017), and consent was obtained from the respective institutions for the study. The nurses were informed of the purpose of the study and the study plan, and their informed consent was obtained before starting the study. The participants were asked not to write their names on the data collection forms, and confidentiality was maintained by assigning a number to each form.
Data collection/procedure. The researchers consulted with nurses in charge of the clinics and arranged suitable hours to reach all nurses for appointments. At the predetermined times, the study purpose was explained to the study volunteers, and persons who agreed to participate provided their written informed consent and completed the data collection forms. Completion of the questionnaires took an average of 15 to 20 minutes.
Data analysis. Data were input directly from the study instruments into SPSS, version 21 (IBM Corp, Armonk, NY), and analyzed by 2 researchers. The third researcher controlled the data and removed surveys from the analysis if 2 or more items of data were missing. The knowledge scores of the participants were obtained by summing the point scores for 24 items, and the attitude scores were calculated using the score obtained for the 4-item Likert-type scale, ranging between 15 and 60 points. Higher scores reflected greater knowledge and more positive attitudes. Frequency, ratio, mean, and standard deviation values were calculated for the descriptive statistics. The Mann-Whitney U test and the Kruskal-Wallis test were used for independent samples for the knowledge questions and total UIAS scores according to the independent variables. Spearman’s correlation was used to determine the correlation between knowledge and attitude scores. Statistical significance was accepted at P <.05.