Assessment of the Knowledge and Practice of Point-of-care Urinalysis in an Emergency Department in Ghana

Assessment of the Knowledge and Practice of Point-of-care Urinalysis in an Emergency Department in Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the Knowledge and Practice of Point-of-care Urinalysis in an Emergency Department in Ghana Davidson Iroko, Paa Kobina Forson, Joseph Bonney, George Oduro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4468538/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Point-of-care urinalysis (POCU) is a common procedure in many emergency departments (EDs). The aim of this study was to assess the knowledge and practice of POCU using a questionnaire and by direct observation. Methods This was a two-phase observational study at Komfo Anokye Teaching Hospital ED. In phase 1, participants were assessed using a 13-item questionnaire on knowledge and practice of POCU. This was recorded as “knowledge score.” In phase 2, participants were provided urine specimen to test blinded to research assistants who observed them and marked them based on a standardized 8-point checklist. This was also recorded as “performance score”. Demographic data such as age, sex, profession/rank and years of service were also collected. Results were analyzed using descriptive and inferential statistics. Results 120 and 147 ED staff (EDS) participated in phases 1 and 2 of the study respectively. The average knowledge and performance scores were 8.7 [Standard deviation (SD) = 2.1] and 5.0 [SD = 1.0] respectively. There was no relationship between knowledge score and working experience (r = 0.003, p = 0.97) but there was a weak positive relationship between knowledge score and number of sources of information (r = 0.26, p = 0.004). The commonest source of information on POCU was on-the-job training (70.8% of participants). Critical Care & Emergency Medicine Laboratory Diagnostics assessment knowledge practice point-of-care urinalysis emergency department Figures Figure 1 Figure 2 INTRODUCTION Point-of-care test (POCT) is a commonly used technology at various patient care areas including the Emergency Department (ED).[ 1 ][ 2 ] It refers to a laboratory medicine service using small analytical devices (including test kits and analysers), provided near patients rather than the traditional environment of a clinical laboratory. [ 3 ][ 4 ] POCT facilitates rapid diagnoses, faster treatment decisions, high-quality trend monitoring, and patient and physician satisfaction.[ 2 ][ 5 ][ 6 ] In the ED where patient management is time-sensitive these qualities endear POCTs to healthcare providers. However, there are quality issues with POCTs. They are less analytically sensitive, at risk of influence and busy staff who performed these tests are neither trained nor supervised. The lack of understanding of quality control and quality assurance is also a concern.[ 7 ][ 8 ][ 9 ] POCTs therefore, requires trained operators to ensure a good quality service.[ 2 ] Some studies have explored the knowledge and/or practice of POCTs. Many of these studies, however, are subjective, cut across various POCT types and/or not specific to the ED.[ 7 ][ 9 ][ 12 ][ 13 ] Point-of-care urinalysis (POCU) is a common practice in the ED. To the best of our knowledge no study has been conducted to objectively assess ED staff knowledge and practice of POCU. AIM The primary aim was to assess the knowledge and practice of ED staff in POCU through self-administered questionnaire and direct observation. METHODS This was a prospective cross-sectional study, conducted at the Komfo Anokye Teaching Hospital (KATH) ED which has an annual census of about 25000 patients.[ 14 ] Patients who present to the ED are categorised into coloured triage groups based on the South African Triage Scale: Red-Emergency, Orange-Very Urgent, Yellow-Urgent and Green-Non-Urgent. ED manages patients in the Yellow to Red categories; patients in the Green category are seen in a separate clinic. The study population was a convenience sample of doctors and nurses who work in KATH ED. This was done in two phases. Even though the sample populations were different for each phase, there was considerable overlap. The total nursing staff strength in the ED during the study period was 237. Out of this, 113 worked at the Red, Orange and Yellow areas where this study took place.[ 15 ] On the other hand, the total number of ED doctors was 40.[ 16 ] This number did not capture doctors from other departments of the hospital who ran shifts at the Red, Orange and Yellow areas of the ED and therefore participated in the study. In phase 1, data was collected using a self-administered questionnaire after obtaining informed consent from each participant. The questionnaire captured demographics (such as age, sex, profession and rank, and number of working years), knowledge of technique and interpretation of dipstick and source of knowledge (See appendix). Participants could choose more than one source of knowledge. The set of 13 questions on the knowledge, technique and interpretation of urine dipstick were chosen by a general consensus by authors based on standard guidelines for conducting and interpreting urinalysis.[ 17 ] The questions were also pre-tested on some clinical staff who work at Ho Teaching Hospital and modified based on the feedback received. Data for the study was collected over a 3-day period. Phase 2 was conducted after completion of phase 1. This involved the participants actually performing the test. Consent was waived for the performance of POCU because it is a routine ED procedure in KATH especially for medical conditions and also participants were blinded to this aspect of the study. Each participant was approached by a trained research assistant (RA) with a urine specimen collected from randomly selected patient for testing. Another RA stationed in the ED observed the performance of POCU by the ED staff and marked the steps using a standardised checklist (see appendix). This checklist was adapted from the local laboratory procedure. No ED staff received any prior training on the procedure and participants were blinded to the observation by the RAs. Profession and rank of each participant was collected after the procedure. There was continuous monitoring of the RAs by a co-investigator who was medically trained throughout the study period and care was taken to test each participant only once. Data was collected over a 6-week period in order to capture as many ED staff as possible. Participant characteristics and test results were reported as simple frequency tables, mean, standard deviation as appropriate. The statistical analyses were performed using Microsoft Excel 2019. For all tests, p < 0.05 was considered statistically significant. This study was approved by the Committee on Human Research, Publications and Ethics of the Kwame Nkrumah University of Science and Technology/ Komfo Anokye Teaching Hospital (Ref. no. CHRPE/AP/460/16). RESULTS The total number of participants in the questionnaire and actual performance of POCU were 120 and 147 respectively. Table 1 summarises the demographic characteristics and test results of the participants. The doctor to nurse ratio for the questionnaire is 1:1 while more nurses than doctors were observed for the actual performance of the dipstick (1.5:1). Questionnaire Based on the 13-item on the questionnaire the mean knowledge score for all participants is 8.7 (Standard deviation [SD] = 2.1). The distribution is shown in Fig. 1 . The question for which the ED staff displayed the highest knowledge level was on “the accuracy of urine dipstick can be affected if the dipstick is old/expired” (90.8% of respondents answered “true”). The question with lowest knowledge level was “if urine testing will be delayed the urine sample should be refrigerated at 2-8 o C” (40.0% answered “true”). See Table 2 . Most (84 respondents) specified “on-the-job training” as one of their sources of information on POCU. The rest of the sources with their corresponding number of respondents are “part of school curriculum” (68), “read from book/literature” (23), “formal training” (8) and “others” (9). Table.1 Sociodemographic characteristics and test results of participants Characteristic Questionnaire Performance of dipstick n (%) Mean SD* n (%) Age (years ) 29.9 4.3 Sex Male 67 (55.8) - Female 53 (44.2) - Working experience (years) 4.2 3.8 10 5 (4.2) - Not stated 2 (1.7) - Profession and rank Doctors House officer 35 (29.2) 33 (22.5) Medical officer 9 (7.5) 5 (3.4) Resident 13 (10.8) 19 (12.9) EM physician specialist 2 (1.7) 3 (2.0) Nurses Enrolled nurse - 3 (2.0) Staff nurse 14 (11.7) 13 (8.8) Senior staff nurse 18 (15.0) 28 (19.1) Nursing officer 11 (9.2) 21 (14.3) Senior nursing officer 17 (14.2) 20 (13.6) Principal nursing officer 1 (0.8) 2 (1.4) Total 120 (100) 147 (100) *SD = standard deviation, n = frequency Knowledge score and working experience There is no statistically significant relationship between working experience and knowledge score evident by the calculated Pearson’s correlation coefficient, r (117) = 0.003 (p = 0.97). Knowledge score and number of sources The distribution of participants with 1, 2, 3 and 4 sources of information on POCU were 67 (55.8%), 38 (31.7%), 12 (10%) and 2 (1.7%) respectively. One participant did not state his/her source of knowledge (0.8%). There is a weak positive relationship between number of sources of information on POCU and knowledge score, r (118) = 0.26 (p = 0.004). Table 2 Outcome of questionnaire test and observation of POCU POCU knowledge score questions Correctly answered Frequency (%) What is the proper way of using a dipstick? a. Totally immerse it in urine, remove it immediately, when withdrawing the strip, wipe the edge against the rim of the vessel to remove excess urine. b. Pour the urine over it, turn it on its side on filter paper to absorb the runoff and keep chemicals from running onto the adjacent patch. c. All of the above. Correct answer: a 56 (46.7) The accuracy of urine dipstick can be affected if the dipstick is old/expired. True/False [Correct answer: True] 109 (90.8) If urine testing will be delayed, the urine sample should be refrigerated at 2-8 o C. True/False [Correct answer: True] 48 (40.0) The urine sample can be centrifuged prior to testing. True/False Correct answer: False 77 (64.2) The accuracy of the urine dipstick can be affected if the test stripes are exposed to air. True/False [Correct answer: True] 69 (57.5) Which of the following is false? a. The urinalysis strip is read by comparing the reaction colours of the test areas with colours on the label and assigning the value of the nearest colour block. b. Strip read time is not critical for optimal results. c. Urine left at room temperature for prolonged period of time can result in microbial proliferation with resultant change in pH. Correct answer: b 79 (65.8) You can add a chemical preservative if urine will not be tested immediately. True/False [Correct answer: False] 89 (74.2) The point-of-care urine dipstick is useful as a a. Screening tool b. Diagnostic tool c. All of the above Correct answer: c 79 (65.8) Positive urine glucose suggests that blood glucose is above normal. True/False [Correct answer: True] 89 (74.2) A positive dipstick test for nitrite is highly suggestive of infection. True/False [Correct answer: True] 81 (67.5) High dose of vitamin C may give false negative results for blood glucose. True/False [Correct answer: True] 59 (49.2) Cloudy urine may suggest infection (urinary tract infection). True/False [Correct answer: True] 101 (84.2) Urine specific gravity may give some idea of the hydration status of a patient. True/False [Correct answer: True] 104 (86.7) POCU performance steps Correctly performed steps Frequency (%) Mixed urine specimen well just before testing 17 (11.6) Removed one strip from the bottle and replaced the cap immediately 133 (90.5) Did not touch the test pads of the strip 87 (59.2) Completely immerse test pads of the strip into the specimen and then remove immediately 133 (90.5) While removing the strip from the specimen, run the edge of the strip against the rim of the urine container to remove excess urine OR Immediately after removing the strip, turns it on its side on filter paper to absorb runoff and keep chemicals from running onto the adjacent patch 24 (16.3) Held the strip in a horizontal position to prevent possible mixing of chemicals from adjacent test pads 113 (76.9) Compared the reagent test strip areas to the Colour Chart on the side of the bottle 144 (98.0) Observed read time for results 89 (58.5) Direct observation Majority (59.2%) of the ED staff observed for the performance of POCU were nurses. No staff had either all steps correct or wrong. The most correctly performed step was “compared the reagent test strip areas to the colour chart on the side of the bottle” (98%) and the least correctly performed step was “mixed urine specimen well just before testing” (11.6%). See Table 2 . The mean “performance score” based on the 8-item observation checklist was 5.0 (SD = 1.0). Comparing the knowledge and performance scores The doctors had relatively higher mean knowledge score compared to the nurses. The mean performance score was similar for both doctors and nurses. See Table 3 . There was no statistically significant difference in the knowledge score among the various professional ranks (in both doctors and nurses’ groups, p > 0.05) and the performance score among the nurses (p > 0.05). However, there was statistically significant difference in the performance score among the rank of doctors (calculated p = 0.03). See Table 3 . Table 3. Professional rank versus knowledge and performance scores Professional ranks Knowledge score Performance score N Mean (SD) Range ANOVA n Mean (SD) Range ANOVA Min Max p-value F Min Max p-value F Doctors 0.95 0.12 0.03 3.11 House officer 35 8.9 (2.4) 3 13 33 4.7 (0.9) 3 7 Medical Officer 9 9.1 (2.4) 4 12 5 5.8 (1.3) 4 7 Resident 13 8.6 (2.1) 4 12 18 5.1 (1.1) 3 7 EM physician specialist 2 9.5 (5) 6 13 3 6 (0) 6 6 Nurses 0.54 0.79 0.20 1.50 Enrolled nurse - - - - 3 4.3 (0.6) 4 5 Staff nurse 14 8.9 (1.2) 7 11 13 4.8 (1.2) 3 7 Senior staff nurse 18 8.7 (2.1) 5 11 28 4.9 (0.9) 3 7 Nursing officer 11 8.7 (2.2) 4 11 21 5.1 (0.9) 3 6 Senior nursing officer 17 8.3 (1.6) 5 11 20 5.5 (0.9) 4 7 Principal nursing officer 1 6 6 6 2 5.5 (0.7) 5 6 Abbreviations: n = frequency, SD = standard deviation, Min = minimum value, Max = maximum value, ANOVA = analysis of variance DISCUSSION To the best of our knowledge this is the first study that not only objectively assessed the knowledge but also evaluated the practical performance of POCU in the ED. The mean POCU knowledge score of ED staff was 8.7, (representing 66.9% of total knowledge score) and that of performance score was 5 (representing 62.5% of total performance score). We did not find any study which directly looked at the assessment of the knowledge and practice of POCU during our literature search. However, gauging this result by a criteria used to assess level of knowledge and practice of ED triaging, where score of 80% is high,[ 18 ] one can conclude that the mean POCU scores for this study were moderate. This cannot be satisfactory particularly for the performance score because all the steps listed on the observation checklist if not done properly may lead to wrong test result. It is only one step i.e. “replacing cap immediately after taking out a test strip”, that will not affect the outcome of the index strip but the subsequent ones, if not done properly.[ 19 ][ 20 ] Our study suggested that working experience (represented in this study by the number of working years) does not have any impact on knowledge of POCU (r = 0.003, p = 0.97). Also, there was no statistically significant difference in the knowledge score and performance score for all the various ranks (p > 0.05) except for the doctors where there was a statistically significant difference in the performance score only (p = 0.03). These findings go against the common notion that “practice makes perfect” or better put long practice makes perfect. Some studies in clinical practice give the impression that factual knowledge or professional education has more impact on clinical performance and knowledge than working experience alone.[ 10 ][ 21 ] For instance, a systematic review of empirical studies evaluating the relationship between clinical experience and performance showed that physicians who have been in practice for many years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care. This review cited reasons that physicians' “toolkits” are created during training and may not be updated regularly and that older physicians seem less likely to adopt newly proven therapies and may be less receptive to new standards of care.[ 21 ] Another review which looked at 8 articles with the aim to examine the independent roles of factual knowledge and working experience in triage decisions by emergency nurses observed that factual knowledge appears to play a more important role than years of emergency nursing or triage experience.[ 10 ] Even though our findings showed that there was no association between working experience and knowledge of POCU, and there was no difference in the mean knowledge scores for both doctors and nurses, we observed statistical difference in the mean performance score for the doctor ranks. Higher mean performance score was generally seen with higher professional rank of doctors. (See Table 3 ). Thus, one may argue that professional education played some role in the trend seen in performance scores among the doctors, but the non-proportional representation of the professional ranks could mean that this finding may be due to chance. Several reasons could be responsible for our finding. Ericsson in a review differentiated between mere experience and deliberate practise as a possible explanation for the contradictory trends in the relationship between working experience and knowledge or clinical/skills performance as found in many studies. He noted that after some years of training and experience, one’s performance becomes more automatic and less pliable to change unless it is coupled with deliberate practice.[ 22 ] This may be a contributing factor to the lack of association between working experience and knowledge and practice of POCU that we found in our study. To explain further, there is more to working experience than working years alone. The number of working years of the participants in our study does not necessarily translate into number of working years in the ED and the frequency of performance of POCU. It is likely the senior ED staff leave the routine performance of POCU to the juniors, therefore negatively affecting their knowledge and performance of this skill. An observational study involving 319 emergency nurses, noted a significant correlation between nurses’ perceived competency level and frequency in which they performed the clinical skills (r = 0.735; p < 0.001).[ 23 ] Learned skills diminishes with non-use.[ 24 ] Improvement in performance is seen when there are opportunities for repetition and refinement of the procedure, the given task has well-defined goals, there is motivation to improve and feedback is given.[ 22 ][ 25 ] Our study demonstrated that having more sources of information is associated with higher knowledge (r = 0.26, p = 0.004). Studies in other fields have shown that multiple number of sources do not always lead to higher level of knowledge. What seems to be important is the right or appropriate source of information.[ 26 ][ 27 ] The commonest source of knowledge of POCU was on-the-job training. It is a hands-on way of teaching and learning where the existing environment, tools, and skills training available in the workplace are used to train employees to do their job – on the job.[ 28 ] It is associated with improved performance and competency because participants have the opportunity for repetition and sharpening of skills.[ 25 ][ 29 ][ 30 ] It fosters teamwork among trainees and trainers and is also cost-effective.[ 31 ][ 32 ] Since on-the-job training is frequently provided by co-workers,[ 28 ][ 32 ] it stands to reason that in the absence of a quality of care or quality assurance system, negative knowledge and practices including inappropriate knowledge and performance of POCU could be transferred to new staff. We were, however, unable to determine whether this contributed to the trend in our study. On-the-job training could be structured or unstructured. Structured on-the-job training involves a trainee performing a practical assignment according to a training plan and being supervised by an experienced coach or supervisor.[ 33 ] It is said to be more efficient and cost-effective than unstructured on-the-job training.[ 34 ] Jalavu et al carried out an audit of 3 POCTs (blood glucose, blood gases and urinalysis) best practices among doctors and nurses at a tertiary hospital in South Africa and observed inadequate training and lack of assessment of competency in performing these tests.[ 9 ] We believe structured on-the-job training can play an important role in addressing the deficiency in the knowledge and practice of POCTs in general. Limitations This study has several limitations. First, it is a single centre study. Second, convenient sampling approach was used. Even though we sampled more than half of the eligible ED staff, our finding may be biased by the non-proportional representation of all working years or professional ranks. Most of our participants were either in the beginning or middle level in the terms of working years. Third, selection bias might have occurred during determination of questions for the assessment of knowledge and practice of POCU in the questionnaire study. It is also possible that administering the questionnaires earlier could have introduced some bias to the outcome of observation. CONCLUSION The ED staff knowledge on POCU is generally above average. The actual performance even though is also above average cannot be satisfactory because every step must be right to get a correct test result. Working experience alone is not adequate in improving knowledge or skills of ED staff in POCU. More avenues for acquisition of knowledge is associated with higher knowledge of POCU. Continuous supervision, structured on-the-job training and re-evaluation may play some roles to keep health care providers on track and up to date on the knowledge and practice of POCU. 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Heal. , vol. 2, no. 1, p. e000138, 2017, doi: 10.1136/bmjgh-2016-000138. J. S. Robinson, B. R. Burkhalter, B. Rasmussen, and R. Sugiono, “Low-cost on-the-job peer training of nurses improved immunization coverage in Indonesia,” Bull. World Health Organ. , vol. 79, no. 2, pp. 150–158, 2001, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/11242822. A. M. Versloot and J. A. DeJong, “Organizational context of structured on-the-job training,” 1994. [Online]. Available: https://eric.ed.gov/?id=ED377323. H. D. Stolovitch and D. Ngoa-Nguele, “Structured on-the-Job Training in Developing Nations,” Adv. Dev. Hum. Resour. , vol. 3, no. 4, pp. 461–470, Nov. 2001, doi: 10.1177/15234220122238526. Appendix Appendix is not available with this version. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4468538","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306066714,"identity":"8e7ae6d1-4ee7-4e6c-b7a1-bf5339bcedfa","order_by":0,"name":"Davidson Iroko","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACNgYGZgYQlmBvANIGFqRo4TkA0iJBlEVQLRIJIA4RWvikDx82+MBgLSc58/nVDT8KJBj427sT8DuMLy05cQZDurG0dE7ZzR6gwyTOnN2AXwsPj/FhHobDifOkc9Ju8AC1GEjkEqtF8kzazT/EakkGaZktwX7sNpG2sCUbzjBIN5bsyWG7LWMgwUPQL/I9zIclPlRYy0kcP/7s5ps/NnL87b34tUCAAYjggZBEKIcD9gekqB4Fo2AUjIIRBAB9fDrSkQajfQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-3646-9495","institution":"Department of Anaesthesia and Critical Care, University of Health \u0026 Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Davidson","middleName":"","lastName":"Iroko","suffix":""},{"id":306066715,"identity":"4a45cfbb-b4dd-4273-9637-df43425d90eb","order_by":1,"name":"Paa Kobina Forson","email":"","orcid":"","institution":"Emergency Medicine Department, Komfo Anokye Teaching Hospital, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"Paa","middleName":"Kobina","lastName":"Forson","suffix":""},{"id":306066716,"identity":"552a69ce-ebaf-48b7-b52f-b39fcf8ee2f1","order_by":2,"name":"Joseph Bonney","email":"","orcid":"","institution":"Emergency Medicine Department, Komfo Anokye Teaching Hospital, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Bonney","suffix":""},{"id":306066717,"identity":"ee1c1bf3-c8f2-404e-ac44-51e49d0c2d58","order_by":3,"name":"George Oduro","email":"","orcid":"","institution":"Emergency Medicine Department, Komfo Anokye Teaching Hospital, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Oduro","suffix":""}],"badges":[],"createdAt":"2024-05-23 18:07:37","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4468538/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4468538/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57296707,"identity":"cf437f66-beb8-42ad-94f4-69b432525c58","added_by":"auto","created_at":"2024-05-28 19:56:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16136,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Knowledge score of participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4468538/v1/5c4e3a75c1a605a234268ecb.png"},{"id":57296929,"identity":"e528989f-222c-4d40-8fe8-cfb068f2e514","added_by":"auto","created_at":"2024-05-28 20:04:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13479,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of performance score of participants observed for POCU\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4468538/v1/9e32d62b269eaa61d5d2b317.png"},{"id":57297480,"identity":"67ba5bd7-4131-4efd-9a2a-5ee611063455","added_by":"auto","created_at":"2024-05-28 20:12:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":645665,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4468538/v1/28f5e9e6-60e2-41bb-865f-6083a8559618.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAssessment of the Knowledge and Practice of Point-of-care Urinalysis in an Emergency Department in Ghana\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePoint-of-care test (POCT) is a commonly used technology at various patient care areas including the Emergency Department (ED).[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] It refers to a laboratory medicine service using small analytical devices (including test kits and analysers), provided near patients rather than the traditional environment of a clinical laboratory. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePOCT facilitates rapid diagnoses, faster treatment decisions, high-quality trend monitoring, and patient and physician satisfaction.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In the ED where patient management is time-sensitive these qualities endear POCTs to healthcare providers. However, there are quality issues with POCTs. They are less analytically sensitive, at risk of influence and busy staff who performed these tests are neither trained nor supervised. The lack of understanding of quality control and quality assurance is also a concern.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] POCTs therefore, requires trained operators to ensure a good quality service.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSome studies have explored the knowledge and/or practice of POCTs. Many of these studies, however, are subjective, cut across various POCT types and/or not specific to the ED.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e][\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePoint-of-care urinalysis (POCU) is a common practice in the ED. To the best of our knowledge no study has been conducted to objectively assess ED staff knowledge and practice of POCU.\u003c/p\u003e\n\u003ch3\u003eAIM\u003c/h3\u003e\n\u003cp\u003eThe primary aim was to assess the knowledge and practice of ED staff in POCU through self-administered questionnaire and direct observation.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis was a prospective cross-sectional study, conducted at the Komfo Anokye Teaching Hospital (KATH) ED which has an annual census of about 25000 patients.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Patients who present to the ED are categorised into coloured triage groups based on the South African Triage Scale: Red-Emergency, Orange-Very Urgent, Yellow-Urgent and Green-Non-Urgent. ED manages patients in the Yellow to Red categories; patients in the Green category are seen in a separate clinic.\u003c/p\u003e \u003cp\u003eThe study population was a convenience sample of doctors and nurses who work in KATH ED. This was done in two phases. Even though the sample populations were different for each phase, there was considerable overlap. The total nursing staff strength in the ED during the study period was 237. Out of this, 113 worked at the Red, Orange and Yellow areas where this study took place.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] On the other hand, the total number of ED doctors was 40.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] This number did not capture doctors from other departments of the hospital who ran shifts at the Red, Orange and Yellow areas of the ED and therefore participated in the study.\u003c/p\u003e \u003cp\u003eIn phase 1, data was collected using a self-administered questionnaire after obtaining informed consent from each participant. The questionnaire captured demographics (such as age, sex, profession and rank, and number of working years), knowledge of technique and interpretation of dipstick and source of knowledge (See appendix). Participants could choose more than one source of knowledge. The set of 13 questions on the knowledge, technique and interpretation of urine dipstick were chosen by a general consensus by authors based on standard guidelines for conducting and interpreting urinalysis.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The questions were also pre-tested on some clinical staff who work at Ho Teaching Hospital and modified based on the feedback received. Data for the study was collected over a 3-day period.\u003c/p\u003e \u003cp\u003ePhase 2 was conducted after completion of phase 1. This involved the participants actually performing the test. Consent was waived for the performance of POCU because it is a routine ED procedure in KATH especially for medical conditions and also participants were blinded to this aspect of the study. Each participant was approached by a trained research assistant (RA) with a urine specimen collected from randomly selected patient for testing. Another RA stationed in the ED observed the performance of POCU by the ED staff and marked the steps using a standardised checklist (see appendix). This checklist was adapted from the local laboratory procedure. No ED staff received any prior training on the procedure and participants were blinded to the observation by the RAs. Profession and rank of each participant was collected after the procedure. There was continuous monitoring of the RAs by a co-investigator who was medically trained throughout the study period and care was taken to test each participant only once. Data was collected over a 6-week period in order to capture as many ED staff as possible.\u003c/p\u003e \u003cp\u003eParticipant characteristics and test results were reported as simple frequency tables, mean, standard deviation as appropriate. The statistical analyses were performed using Microsoft Excel 2019. For all tests, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003e This study was approved by the Committee on Human Research, Publications and Ethics of the Kwame Nkrumah University of Science and Technology/ Komfo Anokye Teaching Hospital (Ref. no. CHRPE/AP/460/16).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe total number of participants in the questionnaire and actual performance of POCU were 120 and 147 respectively. Table\u0026nbsp;1 summarises the demographic characteristics and test results of the participants.\u003c/p\u003e \u003cp\u003eThe doctor to nurse ratio for the questionnaire is 1:1 while more nurses than doctors were observed for the actual performance of the dipstick (1.5:1).\u003c/p\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003cp\u003eBased on the 13-item on the questionnaire the mean knowledge score for all participants is 8.7 (Standard deviation [SD]\u0026thinsp;=\u0026thinsp;2.1). The distribution is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe question for which the ED staff displayed the highest knowledge level was on \u0026ldquo;the accuracy of urine dipstick can be affected if the dipstick is old/expired\u0026rdquo; (90.8% of respondents answered \u0026ldquo;true\u0026rdquo;). The question with lowest knowledge level was \u0026ldquo;if urine testing will be delayed the urine sample should be refrigerated at 2-8\u003csup\u003eo\u003c/sup\u003eC\u0026rdquo; (40.0% answered \u0026ldquo;true\u0026rdquo;). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eMost (84 respondents) specified \u0026ldquo;on-the-job training\u0026rdquo; as one of their sources of information on POCU. The rest of the sources with their corresponding number of respondents are \u0026ldquo;part of school curriculum\u0026rdquo; (68), \u0026ldquo;read from book/literature\u0026rdquo; (23), \u0026ldquo;formal training\u0026rdquo; (8) and \u0026ldquo;others\u0026rdquo; (9).\u003c/p\u003e \u003cp\u003eTable.1 Sociodemographic characteristics and test results of participants\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePerformance of dipstick\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSD*\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e \u003cem\u003e(years\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking experience\u003c/b\u003e \u003cem\u003e(years)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession and rank\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eDoctors\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (22.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEM physician specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eNurses\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnrolled nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior staff nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior nursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (13.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrincipal nursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e120 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e147 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e*SD\u0026thinsp;=\u0026thinsp;standard deviation, n\u0026thinsp;=\u0026thinsp;frequency\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eKnowledge score and working experience\u003c/p\u003e \u003cp\u003eThere is no statistically significant relationship between working experience and knowledge score evident by the calculated Pearson\u0026rsquo;s correlation coefficient, r (117)\u0026thinsp;=\u0026thinsp;0.003 (p\u0026thinsp;=\u0026thinsp;0.97).\u003c/p\u003e \u003cp\u003eKnowledge score and number of sources\u003c/p\u003e \u003cp\u003eThe distribution of participants with 1, 2, 3 and 4 sources of information on POCU were 67 (55.8%), 38 (31.7%), 12 (10%) and 2 (1.7%) respectively. One participant did not state his/her source of knowledge (0.8%).\u003c/p\u003e \u003cp\u003eThere is a weak positive relationship between number of sources of information on POCU and knowledge score, r (118)\u0026thinsp;=\u0026thinsp;0.26 (p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcome of questionnaire test and observation of POCU\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePOCU knowledge score questions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrectly answered\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the proper way of using a dipstick?\u003c/p\u003e \u003cp\u003ea. Totally immerse it in urine, remove it immediately, when withdrawing the strip, wipe the edge against the rim of the vessel to remove excess urine.\u003c/p\u003e \u003cp\u003eb. Pour the urine over it, turn it on its side on filter paper to absorb the runoff and keep chemicals from running onto the adjacent patch.\u003c/p\u003e \u003cp\u003ec. All of the above.\u003c/p\u003e \u003cp\u003eCorrect answer: a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe accuracy of urine dipstick can be affected if the dipstick is old/expired. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (90.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf urine testing will be delayed, the urine sample should be refrigerated at 2-8\u003csup\u003eo\u003c/sup\u003eC. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe urine sample can be centrifuged prior to testing. True/False\u003c/p\u003e \u003cp\u003eCorrect answer: False\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (64.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe accuracy of the urine dipstick can be affected if the test stripes are exposed to air. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (57.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich of the following is false?\u003c/p\u003e \u003cp\u003ea. The urinalysis strip is read by comparing the reaction colours of the test areas with colours on the label and assigning the value of the nearest colour block.\u003c/p\u003e \u003cp\u003eb. Strip read time is not critical for optimal results.\u003c/p\u003e \u003cp\u003ec. Urine left at room temperature for prolonged period of time can result in microbial proliferation with resultant change in pH.\u003c/p\u003e \u003cp\u003eCorrect answer: b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou can add a chemical preservative if urine will not be tested immediately. True/False [Correct answer: False]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (74.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe point-of-care urine dipstick is useful as a\u003c/p\u003e \u003cp\u003ea. Screening tool\u003c/p\u003e \u003cp\u003eb. Diagnostic tool\u003c/p\u003e \u003cp\u003ec. All of the above\u003c/p\u003e \u003cp\u003eCorrect answer: c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive urine glucose suggests that blood glucose is above normal. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (74.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA positive dipstick test for nitrite is highly suggestive of infection. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (67.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh dose of vitamin C may give false negative results for blood glucose. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCloudy urine may suggest infection (urinary tract infection). True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (84.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine specific gravity may give some idea of the hydration status of a patient. True/False [Correct answer: True]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (86.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePOCU performance steps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrectly performed steps\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed urine specimen well just before testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (11.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemoved one strip from the bottle and replaced the cap immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (90.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not touch the test pads of the strip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (59.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompletely immerse test pads of the strip into the specimen and then remove immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (90.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhile removing the strip from the specimen, run the edge of the strip against the rim of the urine container to remove excess urine\u003c/p\u003e \u003cp\u003eOR\u003c/p\u003e \u003cp\u003eImmediately after removing the strip, turns it on its side on filter paper to absorb runoff and keep chemicals from running onto the adjacent patch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeld the strip in a horizontal position to prevent possible mixing of chemicals from adjacent test pads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompared the reagent test strip areas to the Colour Chart on the side of the bottle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (98.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObserved read time for results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (58.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDirect observation\u003c/p\u003e \u003cp\u003eMajority (59.2%) of the ED staff observed for the performance of POCU were nurses. No staff had either all steps correct or wrong.\u003c/p\u003e \u003cp\u003eThe most correctly performed step was \u0026ldquo;compared the reagent test strip areas to the colour chart on the side of the bottle\u0026rdquo; (98%) and the least correctly performed step was \u0026ldquo;mixed urine specimen well just before testing\u0026rdquo; (11.6%). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe mean \u0026ldquo;performance score\u0026rdquo; based on the 8-item observation checklist was 5.0 (SD\u0026thinsp;=\u0026thinsp;1.0).\u003c/p\u003e \u003cp\u003eComparing the knowledge and performance scores\u003c/p\u003e \u003cp\u003eThe doctors had relatively higher mean knowledge score compared to the nurses. The mean performance score was similar for both doctors and nurses. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference in the knowledge score among the various professional ranks (in both doctors and nurses\u0026rsquo; groups, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and the performance score among the nurses (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, there was statistically significant difference in the performance score among the rank of doctors (calculated p\u0026thinsp;=\u0026thinsp;0.03). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \n\u003cp\u003eTable 3. Professional rank versus knowledge and performance scores\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional ranks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMax\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMax\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDoctors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHouse officer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.9 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.7 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedical Officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.8 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.6 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEM physician specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNurses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnrolled nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStaff nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.9 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.8 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSenior staff nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.7 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.9 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNursing officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.7 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSenior nursing officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.5 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrincipal nursing officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.5 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: \u003cem\u003en\u003c/em\u003e = frequency, SD = standard deviation, Min = minimum value, Max = maximum value, ANOVA = analysis of variance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo the best of our knowledge this is the first study that not only objectively assessed the knowledge but also evaluated the practical performance of POCU in the ED.\u003c/p\u003e \u003cp\u003eThe mean POCU knowledge score of ED staff was 8.7, (representing 66.9% of total knowledge score) and that of performance score was 5 (representing 62.5% of total performance score). We did not find any study which directly looked at the assessment of the knowledge and practice of POCU during our literature search. However, gauging this result by a criteria used to assess level of knowledge and practice of ED triaging, where score of \u0026lt;\u0026thinsp;60% is low, 60\u0026ndash;80% is moderate and \u0026gt;\u0026thinsp;80% is high,[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] one can conclude that the mean POCU scores for this study were moderate. This cannot be satisfactory particularly for the performance score because all the steps listed on the observation checklist if not done properly may lead to wrong test result. It is only one step i.e. \u0026ldquo;replacing cap immediately after taking out a test strip\u0026rdquo;, that will not affect the outcome of the index strip but the subsequent ones, if not done properly.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e][\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study suggested that working experience (represented in this study by the number of working years) does not have any impact on knowledge of POCU (r\u0026thinsp;=\u0026thinsp;0.003, p\u0026thinsp;=\u0026thinsp;0.97). Also, there was no statistically significant difference in the knowledge score and performance score for all the various ranks (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) except for the doctors where there was a statistically significant difference in the performance score only (p\u0026thinsp;=\u0026thinsp;0.03). These findings go against the common notion that \u0026ldquo;practice makes perfect\u0026rdquo; or better put long practice makes perfect. Some studies in clinical practice give the impression that factual knowledge or professional education has more impact on clinical performance and knowledge than working experience alone.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] For instance, a systematic review of empirical studies evaluating the relationship between clinical experience and performance showed that physicians who have been in practice for many years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care. This review cited reasons that physicians' \u0026ldquo;toolkits\u0026rdquo; are created during training and may not be updated regularly and that older physicians seem less likely to adopt newly proven therapies and may be less receptive to new standards of care.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Another review which looked at 8 articles with the aim to examine the independent roles of factual knowledge and working experience in triage decisions by emergency nurses observed that factual knowledge appears to play a more important role than years of emergency nursing or triage experience.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Even though our findings showed that there was no association between working experience and knowledge of POCU, and there was no difference in the mean knowledge scores for both doctors and nurses, we observed statistical difference in the mean performance score for the doctor ranks. Higher mean performance score was generally seen with higher professional rank of doctors. (See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Thus, one may argue that professional education played some role in the trend seen in performance scores among the doctors, but the non-proportional representation of the professional ranks could mean that this finding may be due to chance.\u003c/p\u003e \u003cp\u003eSeveral reasons could be responsible for our finding. Ericsson in a review differentiated between mere experience and deliberate practise as a possible explanation for the contradictory trends in the relationship between working experience and knowledge or clinical/skills performance as found in many studies. He noted that after some years of training and experience, one\u0026rsquo;s performance becomes more automatic and less pliable to change unless it is coupled with deliberate practice.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] This may be a contributing factor to the lack of association between working experience and knowledge and practice of POCU that we found in our study.\u003c/p\u003e \u003cp\u003eTo explain further, there is more to working experience than working years alone. The number of working years of the participants in our study does not necessarily translate into number of working years in the ED and the frequency of performance of POCU. It is likely the senior ED staff leave the routine performance of POCU to the juniors, therefore negatively affecting their knowledge and performance of this skill. An observational study involving 319 emergency nurses, noted a significant correlation between nurses\u0026rsquo; perceived competency level and frequency in which they performed the clinical skills (r\u0026thinsp;=\u0026thinsp;0.735; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Learned skills diminishes with non-use.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Improvement in performance is seen when there are opportunities for repetition and refinement of the procedure, the given task has well-defined goals, there is motivation to improve and feedback is given.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e][\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study demonstrated that having more sources of information is associated with higher knowledge (r\u0026thinsp;=\u0026thinsp;0.26, p\u0026thinsp;=\u0026thinsp;0.004). Studies in other fields have shown that multiple number of sources do not always lead to higher level of knowledge. What seems to be important is the right or appropriate source of information.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e][\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe commonest source of knowledge of POCU was on-the-job training. It is a hands-on way of teaching and learning where the existing environment, tools, and skills training available in the workplace are used to train employees to do their job \u0026ndash; on the job.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] It is associated with improved performance and competency because participants have the opportunity for repetition and sharpening of skills.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e][\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e][\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] It fosters teamwork among trainees and trainers and is also cost-effective.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e][\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] Since on-the-job training is frequently provided by co-workers,[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e][\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] it stands to reason that in the absence of a quality of care or quality assurance system, negative knowledge and practices including inappropriate knowledge and performance of POCU could be transferred to new staff. We were, however, unable to determine whether this contributed to the trend in our study.\u003c/p\u003e \u003cp\u003eOn-the-job training could be structured or unstructured. Structured on-the-job training involves a trainee performing a practical assignment according to a training plan and being supervised by an experienced coach or supervisor.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] It is said to be more efficient and cost-effective than unstructured on-the-job training.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] Jalavu et al carried out an audit of 3 POCTs (blood glucose, blood gases and urinalysis) best practices among doctors and nurses at a tertiary hospital in South Africa and observed inadequate training and lack of assessment of competency in performing these tests.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] We believe structured on-the-job training can play an important role in addressing the deficiency in the knowledge and practice of POCTs in general.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, it is a single centre study. Second, convenient sampling approach was used. Even though we sampled more than half of the eligible ED staff, our finding may be biased by the non-proportional representation of all working years or professional ranks. Most of our participants were either in the beginning or middle level in the terms of working years. Third, selection bias might have occurred during determination of questions for the assessment of knowledge and practice of POCU in the questionnaire study. It is also possible that administering the questionnaires earlier could have introduced some bias to the outcome of observation.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe ED staff knowledge on POCU is generally above average. The actual performance even though is also above average cannot be satisfactory because every step must be right to get a correct test result.\u003c/p\u003e \u003cp\u003eWorking experience alone is not adequate in improving knowledge or skills of ED staff in POCU. More avenues for acquisition of knowledge is associated with higher knowledge of POCU.\u003c/p\u003e \u003cp\u003eContinuous supervision, structured on-the-job training and re-evaluation may play some roles to keep health care providers on track and up to date on the knowledge and practice of POCU. Further research is required to directly evaluate the effectiveness of on-the-job training on knowledge and performance of POCTs, including POCU in the ED.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eN. 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Heal.\u003c/em\u003e, vol. 2, no. 1, p. e000138, 2017, doi: 10.1136/bmjgh-2016-000138.\u003c/li\u003e\n\u003cli\u003eJ. S. Robinson, B. R. Burkhalter, B. Rasmussen, and R. Sugiono, \u0026ldquo;Low-cost on-the-job peer training of nurses improved immunization coverage in Indonesia,\u0026rdquo; \u003cem\u003eBull. World Health Organ.\u003c/em\u003e, vol. 79, no. 2, pp. 150\u0026ndash;158, 2001, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/11242822.\u003c/li\u003e\n\u003cli\u003eA. M. Versloot and J. A. DeJong, \u0026ldquo;Organizational context of structured on-the-job training,\u0026rdquo; 1994. [Online]. Available: https://eric.ed.gov/?id=ED377323.\u003c/li\u003e\n\u003cli\u003eH. D. Stolovitch and D. Ngoa-Nguele, \u0026ldquo;Structured on-the-Job Training in Developing Nations,\u0026rdquo; \u003cem\u003eAdv. Dev. Hum. Resour.\u003c/em\u003e, vol. 3, no. 4, pp. 461\u0026ndash;470, Nov. 2001, doi: 10.1177/15234220122238526.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Appendix","content":"\u003cp\u003eAppendix is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Komfo Anokye Teaching Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"assessment, knowledge, practice, point-of-care urinalysis, emergency department","lastPublishedDoi":"10.21203/rs.3.rs-4468538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4468538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003ePoint-of-care urinalysis (POCU) is a common procedure in many emergency departments (EDs). The aim of this study was to assess the knowledge and practice of POCU using a questionnaire and by direct observation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a two-phase observational study at Komfo Anokye Teaching Hospital ED. In phase 1, participants were assessed using a 13-item questionnaire on knowledge and practice of POCU. This was recorded as \u0026ldquo;knowledge score.\u0026rdquo; In phase 2, participants were provided urine specimen to test blinded to research assistants who observed them and marked them based on a standardized 8-point checklist. This was also recorded as \u0026ldquo;performance score\u0026rdquo;. Demographic data such as age, sex, profession/rank and years of service were also collected. Results were analyzed using descriptive and inferential statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e120 and 147 ED staff (EDS) participated in phases 1 and 2 of the study respectively. The average knowledge and performance scores were 8.7 [Standard deviation (SD)\u0026thinsp;=\u0026thinsp;2.1] and 5.0 [SD\u0026thinsp;=\u0026thinsp;1.0] respectively. There was no relationship between knowledge score and working experience (r\u0026thinsp;=\u0026thinsp;0.003, p\u0026thinsp;=\u0026thinsp;0.97) but there was a weak positive relationship between knowledge score and number of sources of information (r\u0026thinsp;=\u0026thinsp;0.26, p\u0026thinsp;=\u0026thinsp;0.004). The commonest source of information on POCU was on-the-job training (70.8% of participants).\u003c/p\u003e","manuscriptTitle":"Assessment of the Knowledge and Practice of Point-of-care Urinalysis in an Emergency Department in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-28 19:56:26","doi":"10.21203/rs.3.rs-4468538/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87b480b7-8f8d-4ebd-a57d-7cdf7374c30e","owner":[],"postedDate":"May 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":32342183,"name":"Critical Care \u0026 Emergency Medicine"},{"id":32342184,"name":"Laboratory Diagnostics"}],"tags":[],"updatedAt":"2024-05-28T19:56:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-28 19:56:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4468538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4468538","identity":"rs-4468538","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}