Evaluation of Primary Health Care Nurses’ Knowledge and Neonatal Screening Performance for Phenylketonuria in Alexandria

Evaluation of Primary Health Care Nurses’ Knowledge and Neonatal Screening Performance for Phenylketonuria in Alexandria | 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 Evaluation of Primary Health Care Nurses’ Knowledge and Neonatal Screening Performance for Phenylketonuria in Alexandria Esraa Ismail, Wafaa Elarousy, Shaymaa Badawe, Rasha Abohadida This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5220527/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 Introduction: Nurses play a crucial role in the primary prevention of phenylketonuria (PKU) within national screening programs for newborns. This is achieved through consult with the child's provider promptly to arrange a PKU test, accurate collection of blood samples at maternal and child health centers, enable early detection of potential cases. Aim : This study aimed to assess the level of primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria in Alexandria Methods : A descriptive research design was used. The study included all nurses (50 nurses) who are responsible for obtaining newborn screening test from 5 primary health care centers in Alexandria. Two tools were used to collect the necessary data: nurses' knowledge regarding phenylketonuria disease assessment sheet and nurses' performance about newborn screening for phenylketonuria observational checklist. Results : it was found that the mean age of participant was 42.94±5.0 and 52% of them had completed their technical level of education and the means years of experience was 17.64±4.84. The total mean score of nurses' knowledge regarding phenylketonuria screening was 16.24±1.99 with the mean percent score of 72.72±8.27. It was also found the total score of nurses' screening performance was 11.0±0.97 with the mean percent score of 64.71±5.70. A significant positive correlation was found between nurses’ knowledge and their screening performance with P = <0.001. Conclusion : It was concluded from this current study that majority of participant nurses had correct knowledge in neonatal screening and many aspects of phenylketonuria disease. Although the majority of nurses correctly performed many screening steps, they still need support in many steps especially related to infection control steps. knowledge nurses performance phenylketonuria Figures Figure 1 Figure 2 Introduction Phenylketonuria (PKU) is a rare inherited metabolic disorder in the phenylalanine (Phe) metabolism. It is caused by deficiency or absence of the phenylalanine hydroxylase enzyme. The normal function of phenylalanine hydroxylase is to catalyze the conversion of phenylalanine (Phe) to tyrosine (Tyr). This results in accumulation of abnormal amounts of Phe and reduction in Tyr in the blood. (1) The prevalence of PKU varies widely among ethnicities and geographic regions, affecting approximately 1 in 24,000 individuals worldwide. However, in the Middle East, some of the highest prevalence is in Egypt, Iran, and Jordan, where approximately 1:5,000 newborns are affected. (2) Phenylketonuria symptoms can manifest in varying degrees of severity. Infants diagnosed with PKU usually appear healthy at birth, with symptoms typically emerging around 6 months of age. If a child is untreated or inadequately treated, phenylalanine rises to toxic levels in the body especially in the brain causing infants to experience delays in motor skill development and exhibit lack of interest in their surroundings and subsequently significant neurodevelopmental sequelae including intellectual disability, mental retardation, seizures, learning disabilities, and emotional problems. (3) Phenylketonuria is diagnosed through performing serum Phe test between one and seven days after birth. Blood is obtained by pricking the heel of the newborn and analyzing it for phenylalanine concentration. Children with PKU need to keep Phe levels low. Therefore, keeping Phe levels between 120-360 μmol/L (2-6 mg/DL) for life is required. (4) Newborn screening plays a crucial role in identifying treatable disorders early, allowing for timely intervention and improved health outcomes. These screenings not only save lives but also enhance the quality of life for children and their families. (5) In Egypt, 1996, the first newborn screening for metabolic disorders in Alexandria governorate took place through a study conducted by the Medical Research Institute where newborns were screened for three treatable inborn errors of metabolism, namely phenylketonuria “PKU”, galactosemia and congenital hypothyroidism, aiming at early detection of these diseases and providing therapeutic regimens to guard against development of mental retardation. The results of this neonatal screening of 15,000 newborns showed a high frequency of Phenylketonuria (1:7000), and of hypothyroidism (1:3000) ,which convinced the health authorities in Egypt to start a mass neonatal screening program for PKU and hypothyroidism in all Egyptian governorates in 2003. (6,7) In 2023, an infographic showcasing the accomplishments of the President of the Republic's program for early detection of genetic diseases in newborns was released by The Ministry of Health and Population on its official Facebook page. The screening is carried out by blood sample analysis in cooperation with the Egyptian Centre for Diseases and Control (ECDC), followed by a second test to confirm the diagnosis if the first comes back positive. (8) Dietary management and pharmacologic treatment are essential for infants with PKU. Pharmacological treatments such as enzyme replacement therapy through viral delivery of protein fusions targeting the liver as well as enzyme substitution therapy where phenylalanine ammonia lyase is used as a substitute to PAH had been promising in recent years. ( 9 ) Dietary restriction of phenylalanine remains to be the mainstay of treatment for PKU . It should be instituted as soon as the diagnosis is confirmed and must be commenced from the neonatal period and adhered to for life. ( 10 ) The cornerstone for PKU dietary regimen is typically low in high protein either animal such as red meat, fish, poultry and milk and milk products or plant foods such as dried beans, peas and nuts. (1 1 ,1 2 ) It also may include specially formulated medical foods and protein substitutes that are phenylalanine-free or low in phenylalanine. (1 3 ,1 4 ) It is recommended that the child’s diet is well-planned to include a variety of fruits and vegetables to prevent micronutrient deficiencies commonly associated with restrictive diets. (1 5 ) Infants with PKU need a special formula that contain high protein and low phenylalanine. It can be used throughout life as a protein source that is extremely low in phenylalanine and balanced for the remaining essential amino acids. (1 6 ) Primary health care nurses play a crucial role in the primary prevention of PKU within national screening programs for newborns. This is achieved through consult with the child's provider promptly to arrange a PKU test. Accurate collection of blood samples at maternal and child health centers enables early detection of potential cases. Nurses must adhere to precise procedures when conducting neonatal screening. It is crucial for the nurse to be well-versed in obtaining accurate test results, ensuring that the baby has consumed protein from breast milk or formula before the blood sample is drawn. (1 6 ) Nurses are at the forefront of identifying cases and providing essential health education on the disease and dietary requirements, as well as ensuring proper specimen recording and analysis. It is imperative for PHC nurses to have a comprehensive understanding of PKU disease, screening procedures, sampling techniques, and overall management responsibilities within their respective centers and units. Significance of the Study and Research Gap Part of Egypt’s vision 2030 focuses on the rights of all Egyptians for healthy life with healthcare system capable of improving health conditions through early intervention, and preventive coverage. Nurses play an important role in early detection through being competent in adherence to neonatal screening procedure. Early detection is the key to manage phenylketonuria as the infants appear healthy at birth, and if untreated or inadequately treated, infants may experience developmental delays and intellectual disabilities that can affect the children’s entire life, children’s families, and the community. Overall, research in this area plays a crucial role in ensuring that primary health care nurses are equipped with the necessary knowledge and skills to effectively contribute to neonatal screening programs, thereby improving outcomes for newborns and their families. So, the aim of this study is to evaluate the primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria in Alexandria. Aim The aim of this study is to evaluate the primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria. Objectives 1. Assess primary health care nurses’ knowledge regarding phenylketonuria (PKU) and newborn screening test. 2. Evaluate primary health care nurses’ performance for phenylketonuria neonatal screening. Research Question : What is the primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria? Design A descriptive research design was used to accomplish this study. Settings : The study was conducted at 5 primary health care in Alexandria. Dana, El-seyouf, Smouha, El -Hadrah Qebli, and El -Agamy family health centers. Subjects: All nurses (65 nurses) who are responsible for obtaining newborn screening test for phenylketonuria in above mentioned primary health care centers in the Alexandria were invited to participate in the study, 5 of them refused to participate and another 5 withdrew from the study. Fifty nurses were participated in the study as follow: 8 nurses from Dana, 8 nurses from El-seyouf, 9 nurses from Smouha, 11 nurses from El-Hadrah Qebli and 14 from El-Agamy family health centers (refer to figure 1). Study Tools Two tools were used to collect the necessary data. The tools were developed by the researchers after reviewing of recent and relevant literatures. (1 7 ,1 8 ) Tool l : Nurses' knowledge regarding phenylketonuria disease assessment sheet . It included 3 parts. Part 1 included nurses' characteristics such as age, educational level, years of experiences and attendance of training courses/lectures or discussion regarding newborn screening program for phenylketonuria. Part 2 included nurses' knowledge about phenylketonuria disease such as definition, causes, symptoms and signs, diagnosis, prevention of potential complications, and different methods of treatment (dietary restriction, special medical formula and medical treatment in addition to available community services. Part 3: it included nurses' knowledge about phenylketonuria screening test regarding timing , benefits and follow up of tests. Nurses' knowledge in part 2 and 3 was scored as the follows: 1 for correct and complete answer, and zero for unknown or wrong answer. Tool II: Nurses' performance about newborn screening for phenylketonuria observational checklist. This tool was used to assess nurses' performance before, during, and after newborn screening for phenylketonuria. Performance was scored as the follows: 1 for correct steps while zero for incorrect or not done steps. Method 1. Approval from the Research Ethics Committee of the Faculty of Nursing at Alexandria University was obtained. 2. Official letter was directed to the responsible authority of selected family health centers to facilitate research implementation after explaining the aim of the study. 3. Tool I, II were developed by the researchers after thorough reviewing of recent and relevant literatures. 4. Tools were tested for its content validity by five experts in the field of pediatric and community health nursing. 5. Reliability of the tools was done using Cronbach Coefficient Alpha test where r =0.866 for tool I and 0.848 for tool II. 6. A pilot study was carried out on 10 % nurses (5 nurses) to test the clarity and feasibility of the tools. Those nurses were excluded from the study subjects. 7. Nurse was observed individually by the researcher once during newborn screening using tool II. 8. Then, nurses were interviewed individually to assess their knowledge using tool I 9. Data were collected over a period of from September 2022 to July 2023. 10. After completion of data collection, the necessary statistical analysis was used. Ethical Considerations Witness informed consent was obtained from the head nurse of the selected primary health care centers after explaining the aim of the study for tool II. A written informed consent was obtained from each nurse after explanation of the aim of the study and assurance that the collected data is used only for the study purpose. Study subjects’ anonymity is maintained as well as confidentiality of the collected data. Subjects’ voluntary participation and their right to withdraw from the study at any time without penalty were assured. Dealing with the study subjects was based on mutual respect with no discrimination. Statistical Analysis Data were fed to the computer and analyzed using IBM SPSS software package version 23.0. One way ANOVA test was used to compare between more than two categories. Student t-test was used to compare two categories for normally distributed quantitative variables. Pearson coefficient was used to correlate between normally distributed quantitative variables. Significance of the obtained results was judged at the 5% level. Results Table 1 displays the distribution of the participant nurses according to their demographic characteristics. Concerning the number of nurses in family health centers; it was found that more than one quarter (28%) of participant nurses were from the El Agamy family health center followed by more than one fifth (22%) of nurses in El Hadra Qebli. Slightly less than one fifth (18%) of participant nurses were from Smouha and an equal percent of nurses (16%) were from Danna and Seyouf family health care centers. Additionally, it was found that nearly half of participant nurses’ (48%) aged from 41 to 50 years old, with a mean age of 42.94 ± 5.0. Considering educational level, it was observed that 52% of participant nurses had completed their technical level of education and slightly more than two thirds of them (68.0%) had more than 15 years of experience with means experience years of 17.64 ± 4.84. Regarding attending training courses about newborn screening program for Phenylketonuria. It was found that more than two-thirds (62%) of participant nurses attended training courses, and more than half of them obtained two training courses. Moreover, it was noticed that two days training course was reported by 51.6% of them. Table (2) highlights the nurses' knowledge regarding Phenylketonuria. It was revealed that, all participant nurses had correct knowledge about the definition, diagnosis, age of starting treatment, types of allowed foods, and time and Benefits of neonatal screening test. In addition, more than 80% of them had correct knowledge about degree of PKU severity, how long should the diet be used, types of allowed formula, giving breast milk, and available community services that support PKU children ( 82%, 84%, 84%, 94% & 94% respectively). On the hands, the participant nurses had incorrect knowledge about blood level of PKU to be achieved during the treatment (88%), name of missing enzyme (74%) and management of PKU (62%). Moreover, it was clear from the table that the total mean score of nurses' knowledge regarding Phenylketonuria screening was 16.24 ± 1.99 and the mean percent score was 72.72 ± 8.27. Table (3) portrays the nurses' screening performance for Phenylketonuria. It was revealed that, all participant nurses correctly performed the following steps: selection of puncture area, surface area to puncture, puncture heel at a 90-degree angle, seal blood containers, apply direct pressure on puncture site, label collection tubes and dispose of puncture device in sharps container. While the majority of them performed the following steps incorrectly: hand hygiene, administrate 25% sucrose’s and remove gloves (90, 80, 84% respectively). In addition, all the participant nurses did not perform hand hygiene after screening test. It was clear from the table that the total score of nurses' practice regarding Phenylketonuria was 11.0 ± 0.97 and the mean percent score of practice was 64.71 ± 5.70. Table (4) illustrates the correlation between nurses' knowledge and screening performance for Phenylketonuria. A significant positive correlation was found between nurses knowledge and practice (P < 0.001). Table (5 ) presents the relationship between nurses’ knowledge and screening performance for phenylketonuria with their characteristics. The result revealed that there were highly statistically significant relationships between the total mean score of the nurses’ knowledge with their level of education, years of experiences and attending training courses with P value of < 0.001. Moreover, a highly statistically significant differences were found between mean score of nurses’ screening performance and their age, level of education, years of experiences and attending training courses with P value of < 0.001, 0.003, < 0.001 and < 0.001 respectively. Table (6) displays the effect of nurses' characteristics on knowledge and practice through multiple linear regression analysis. It was found that significant relationships were found between the units, level of education, attendance training courses, and their nurse’s knowledge (P = 0.044, 0.032, < 0.001, and 0.003, respectively). On the other hand, the same table found that significant relationships were found between the attendance training courses and their nurses practice (P = 0.045). Table (7, 8) show the direct and indirect effects of study variables on nurses’ knowledge and practices. It was found that there were direct and significant relationships between nurses’ knowledge and the unit, level of education, years of experience and attendance training courses (P = 0.029, 0.019, < 0.001, and < 0.001, respectively). Moreover, it was revealed that there were direct and significant relationships between nurses’ practice and their knowledge, and their attendance training courses (P = 0.033, and 0.027, respectively). Table (1): Distribution of participant nurses according to their demographic characteristics (n = 50) Nurses characteristics No. % Family Health Centers Danna 8 16.0 El Agamy 14 28.0 El Seyouf 8 16.0 El Hadara Qebli 11 22.0 Smouha 9 18.0 Age (years) 30–40 20 40.0 41–50 24 48.0 > 50 6 12.0 Mean ± SD 42.94 ± 5.0 Level of education Diploma 24 48.0 Technical 26 52.0 Years of experience < 10 2 4.0 10 - <15 14 28.0 ≥ 15 34 68.0 Mean ± SD 17.64 ± 4.84 Attendance training courses about newborn screening program for Phenylketonuria Yes 31 62.0 No 19 38.0 Number of training courses (n = 31) Once 13 41.9 Two 18 58.1 Duration of each course (n = 31) One day 15 48.4 Two days 16 51.6 Table (2): The Nurses' knowledge levels regarding Phenylketonuria screening and disease (n = 50) Nurses knowledge regarding phenylketonuria Incorrect answer Correct answer No. % No. % - Definition of Phenylketonuria (PKU) 0 0.0 50 100.0 - Causes of PKU 11 22.0 39 78.0 - Clinical manifestation of PKU 14 28.0 36 72.0 - Name of missing enzyme is in PKU 37 74.0 13 26.0 - Early clinical manifestation that appear in neonates PKU 16 32.0 34 68.0 - Management of PKU 31 62.0 19 38.0 - Potential complications of PKU 29 58.0 21 42.0 - Age of starting treatment of PKU 0 0.0 50 100.0 - Age of start PKU symptoms 14 28.0 36 72.0 - Diets of PKU 27 54.0 23 46.0 - Degree of severity of PKU 9 18.0 41 82.0 - Types of restricted foods 13 26.0 37 74.0 - How long should the diet be used in PKU 8 16.0 42 84.0 - Types of allowed foods 0 0.0 50 100.0 - Types of allowed formula 8 16.0 42 84.0 - Diagnosis of PKU 0 0.0 50 100.0 - Give breast milk to a PKU infant 3 6.0 47 94.0 - Normal level of Phenylketonuria in the blood 21 42.0 29 58.0 - Level of Phenylketonuria in the blood to be achieved during the treatment 44 88.0 6 12.0 - Time of neonatal screening test 0 0.0 50 100.0 - Benefits of neonatal screening test 0 0.0 50 100.0 - Available community services that support PKU children 3 6.0 47 94.0 Total mean score of knowledge 16.24 ± 1.99 Mean percent score of knowledge 72.72 ± 8.27 Table (3): The nurses' screening performance for phenylketonuria (n = 50) Nurses practice regarding Phenylketonuria Not done Done No. % No. % - Preform hand hygiene and clean blue tray 45 90.0 5 10.0 - Collect equipment. Select the appropriate puncture device 5 10.0 45 90.0 - Administrate 25% sucrose’s and provide comfort measure 40 80.0 10 20.0 - Preform hand hygiene apply gloves and prepare equipment 29 58.0 21 42.0 - Nominate an area for puncture on the foot on medial lateral plantar surface 0 0.0 50 100.0 - Select the surface area to puncture. Continue in a stepping ladder pattern from the first puncture for subsequent blood sampling 0 0.0 50 100.0 - Clean foot with alcohol and allow 30 second to dry completely 36 72.0 14 28.0 - Puncture heel holding the puncture device at a 90-degree angle 0 0.0 50 100.0 - Wipe away fist drop of blood with gauze 21 42.0 29 58.0 - Collect blood in correct order of draw, gently agitating tubes between each drop while avoiding scraping and scooping 29 58.0 21 42.0 - Seal blood containers 0 0.0 50 100.0 - Apply direct pressure on puncture site 0 0.0 50 100.0 - Label collection tubes with correct 0 0.0 50 100.0 - Dispose of puncture device in sharps container 0 0.0 50 100.0 - Collect and dispose of remaining equipment 3 6.0 47 94.0 - Clean blue tray and remove gloves 42 84.0 8 16.0 - Preform hand hygiene after test 50 100.0 0 0.0 Total mean score of screening performance 11.0 ± 0.97 Mean percent score of screening performance 64.71 ± 5.70 Table (4): Correlation between nurses knowledge and screening performance for phenylketonuria (n = 50) R p Nurses’ knowledge and practice 0.764* < 0.001* r: Pearson coefficient *: Statistically significant at p ≤ 0.05 Table (5): Relationship between Nurses knowledge and Screening Performance for Phenylketonuria with their characteristics (n = 50) Nurses characteristics Knowledge Practice Age (years) 30–40 15.50 ± 1.54 10.40 ± 0.68 41–50 16.63 ± 2.16 11.29 ± 1.0 > 50 17.17 ± 2.04 11.83 ± 0.41 F(p) 2.664 (0.080) 9.668* (< 0.001*) Level of education Diploma 14.96 ± 2.10 10.58 ± 1.06 Technical 17.42 ± 0.81 11.38 ± 0.70 t(p) 5.404* (< 0.001*) 3.131* (0.003*) Years of experience < 10 13.0 ± 0.0 10.0 ± 1.41 10 - <15 14.57 ± 1.60 10.21 ± 0.89 ≥ 15 17.12 ± 1.49 11.38 ± 0.74 F(p) 18.931* (< 0.001*) 12.075* (< 0.001*) Attendance training courses about newborn screening program for Phenylketonuria Yea 17.19 ± 1.22 11.48 ± 0.68 No 14.68 ± 2.03 10.21 ± 0.85 t(p) 4.876* (< 0.001*) 5.838* (< 0.001*) F: One way ANOVA test t: Student t-test *: Statistically significant at p ≤ 0.05 Table (6): Multiple Linear Regression Analysis Showing the Effect of Nurses characteristics on knowledge and practice (n = 50) Nurses characteristics Knowledge Practice B Beta t p 95% CI B Beta t p 95% CI LL UL LL UL Age (years) -0.208 -0.070 -0.721 0.475 -0.787 0.372 0.318 0.221 1.714 0.094 -0.056 0.693 Level of education 0.787 0.200 2.215* 0.032* 0.071 1.504 0.134 0.070 0.556 0.581 -0.351 0.619 Years of experience 1.915 0.543 7.117* < 0.001* 1.373 2.457 0.390 0.227 1.541 0.131 -0.120 0.901 Attendance training courses (No) -1.555 -0.384 -3.150* 0.003* -2.550 -0.560 -0.725 -0.367 -2.068* 0.045* -1.432 -0.018 Knowledge - - - - - - 0.193 0.395 1.994 0.052 -0.002 0.388 R 2 = 0.835, Adjusted R 2 = 0.816, F = 44.450 * ,p < 0.001 * R 2 = 0.721, Adjusted R 2 = 0.682, F = 18.502 * , p < 0.001 * F,p: f and p values for the model R 2 : Coefficient of determination B: Unstandardized Coefficients Beta: Standardized Coefficients t: t-test of significance LL: Lower limit UL: Upper Limit *: Statistically significant at p ≤ 0.05 Table (7): Direct and Indirect Effect of the study variables on nurses’ knowledge and their practices Variable 1 Variable 2 Standardized regression weights S.E C.R p-value Knowledge ← Unit -0.215 0.131 -2.188* 0.029* Knowledge ← Age (years) -0.075 0.273 -0.761 0.447 Knowledge ← Level of education 0.251 0.337 2.338* 0.019* Knowledge ← Years of experience 0.586 0.255 7.511* < 0.001* Knowledge ← Attendance training courses -0.415 0.468 -3.324* < 0.001* Practice ← Knowledge 0.369 0.091 2.129* 0.033* Practice ← Unit 0.183 0.087 1.469 0.142 Practice ← Level of education 0.081 0.225 0.593 0.553 Practice ← Years of experience 0.228 0.237 1.645 0.100 Practice ← Attendance training courses -0.370 0.329 -2.207* 0.027* Practice ← Age (years) 0.220 0.174 1.830 0.067 Table (8): Direct and Indirect effect of study variables on nurses’ knowledge and their practices Variables Direct effect Indirect effect CI p-value Knowledge Unit -0.286 0.0 -0.322 - -0.250 0.029* Knowledge Age (years) -0.208 0.0 -0.268 - 0.148 0.447 Knowledge Level of education 0.787 0.0 0.732 - 0.842 0.019* Knowledge Years of experience 1.915 0.0 1.873 - 1.957 < 0.001* Knowledge Attendance training courses -1.555 0.0 -1.682 - -1.428 < 0.001* Practice Knowledge 0.193 0.0 0.136 - 0.250 0.033* Practice Unit 0.128 -0.055 -0.074 - 0.182 0.142 Practice Level of education 0.134 0.152 -0.082 - 0.186 0.553 Practice Years of experience 0.390 0.369 -0.048 - 0.438 0.100 Practice Attendance training courses -0.725 -0.300 -0.788 - -0.662 0.027* Practice Age (years) 0.318 -0.040 -0.090 - 0.447 0.067 Discussion Phenylketonuria is a genetic condition caused by a defect in gene that helps to produce the phenylalanine hydroxylase enzyme required for the breakdown of phenylalanine that results in rising levels of phenylalanine in blood and tissues. Elevating phenylalanine to dangerous levels in the body can lead to serious complications in children, especially mental retardation. Newborn screening identifies these children to start proper treatment and dietary management early which improves their quality of life. ( 19 ) The current study found that more than two-thirds of nurses attended training courses, and more than half of them obtained at least two training courses for two days of each course. This result could be related to the fact that continuous education and training programs enhance nurses’ knowledge and practices. It is also reflected in the attention of decision-makers to train the nurses about the national neonatal screening program for their crucial role in obtaining the screening test and to counsel and educate the families about the importance of the screening and the targeted diseases. The finding of the present study revealed that the nurses' total mean score of knowledge regarding phenylketonuria was 16.24 ± 1.99 and the mean percent score of knowledge was 67.67 ± 8.27. These results might be related to the availability of educational training for nurses which updated knowledge regarding phenylketonuria screening. This result is congruent with the study findings of Jose & Manalo ,2023 ( 20 ) who found that providing pediatric residents with an educational module resulted in significantly improved knowledge of neonatal screening. The study also highlighted the necessity to continuously educate healthcare workers on all aspects of neonatal screening so that they can in turn educate parents. On the other side, the finding of Joseph ,2017 ( 21 ) who studied the newborn screening challenges for NICU nurses, reported that NICU nurses face several challenges with the expansion of newborn screening programs and gain knowledge to answer questions posed by empowered parents and educate them appropriately. Regarding nurses practice toward the phenylketonuria screening test in this study, the nurses' total score of practice regarding phenylketonuria was 11.0 ± 0.97 and the mean percent score of practice was 64.71 ± 5.70. The results revealed that all nurses correctly performed all participant nurses correctly performed selection of puncture area, surface area to puncture, puncture heel at right angle, seal blood containers, apply direct pressure on puncture site, label collection tubes and dispose of puncture device correctly. These findings might be related to continue supervision and training courses for participant nurses that improved their performance in the steps of selection of a suitable site and withdrawal of a sample. Surprisingly, the majority of nurses did not perform the steps related to infection control correctly, such as performing hand hygiene before and after the screening test, cleaning the blue tray, and removing gloves, even though the hand hygiene facilities are available to all of them in all family health centers. This may be attributed to the overload of nurses with many neonates each day of screening. Moreover, the findings of the current study showed that most nurses had not performed correctly regarding administering 25% sucrose and providing comfort measures for pain management to the neonates. This may be attributed to the fact that nurses do not realize that screening procedures are painful procedures, and the neonates feel pain from them. The study finding of Khaton, 2016 ( 22 ) supports the current study and cites that only 16% of participant nurses know 9–13 steps of the PKU screening procedure correctly. On the other side, the study finding of Venegas et al., 2019 , ( 23 ) who studied the barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit, contradicts this study and cites that 53% of nurses used sucrose and 44% of them reported breastfeeding was supported in pain management. The findings of the current study revealed that a significant positive correlation was detected between nurses’ knowledge and practice. This finding could be related to the fact that knowledge is needed to support the practice in addition to continuous training courses for participant nurses to improve nurses’ knowledge and practices. The study findings of Said & Draz , 2019 ( 24 ) were congruent with the present study and cited that there was a statistically significant positive correlation between total knowledge of the participant nurses and total practice towards the management of children with phenylketonuria. In addition, the findings of the present study revealed that there were direct and significant relationships between nurses’ practice and their knowledge with their attendance training courses. This finding related to the fact that continuous education updated their nurses’ knowledge and improved their skills regarding neonatal screening performance for phenylketonuria. The study finding of Said & Draz , 2019 ( 24 ) was in the same line with the present study and cited that there is a positive statistical relationship between nurses' knowledge and practice post-program implementation. Furthermore, the results of this study found that the age of the participating nurses affected positively their knowledge and was statistically significant with their practice (P = 0.080 and < 0.001, respectively). Moreover, the results of the current study revealed that there were significant relationships between nurses’ knowledge and practices with their level of education (P = < 0.001, 0.003, respectively) and years of experience. These findings might be related to the fact that nurses’ age, their educational level, and years of experience were considered as factors affecting their knowledge and practice level during neonatal screening performance for phenylketonuria. The study findings of Khedr et al., 2022 ( 25 ) were consistent with the findings of the current study and mentioned that there was a statistically significant difference between the participant nurses’ total level of practice and their age, educational level, and years of experience. Study Limitation The limitation of the study was conducted in only 5 primary health care centers with a limited sample size of only 50 nurses which might limit the generalizability of the results. Conclusion and recommendations It was concluded from this current study that majority of participant nurses had correct knowledge in neonatal screening and many aspects of phenylketonuria disease. Although the majority of nurses correctly performed many screening steps, they still need support in many steps especially related to infection control steps. Practice Implications The identification of gaps either in knowledge or screening performance and highlighting areas where further training is needed. This can be achieved by continuous training for primary health care nurses to enhance the overall accuracy and efficiency of neonatal screening programs for PKU. Declarations Authors information ( 1 ) Lecturer, Pediatric Nursing Department, Faculty of Nursing, Alexandria University ( 2 ) Professor, Pediatric Nursing Department, Faculty of Nursing, Alexandria University ( 3 ) Lecturer, Community Health Nursing Department, Faculty of Nursing, Alexandria University Author Contribution • Esraa Mohammed Abd El-samie Ismail: background and statistical analysis• Wafaa Mohamed Elarousy: significant of the study, Methodology, abstract, conclusion and recommendation, finalization of the manuscript and publication process.• Shaymaa Saeed Mohamed Badawe: Ethical approval process, data collection, results section.• Rasha Mohamed Abohadida: discussion and revise the references section. Acknowledgement A special acknowledgement is directed to all mangers and staff nurses in the primary health care centers who participated in the study. References Casey, L. Caring for children with phenylketonuria. Canadian family physician Medecin de famille canadien: 2013; 59(8), 837–840. Elhawary A, AlJahdali A, Abumansour S, Elhawary N, GaboonN, Dandini M, Madkhali A, Alosaimi W, Alzahrani A, AljohaniF, Melibary M, Kensara A. Genetic etiology and clinical challenges of phenylketonuria. Human genomics: 2022; 16(1), 22. https://doi.org/10.1186/s40246-022-00398-9 Ashe K, Kelso W, Farrand S, Panetta J, Fazio T, De Jong G, Walterfang M. Psychiatric and Cognitive Aspects of Phenylketonuria: The Limitations of Diet and Promise of New Treatments. Frontiers in psychiatry: 2019; 10, 561. https://doi.org/10.3389/fpsyt.2019.0056. Van Spronsen J, Blau N, Harding C, Burlina A, Longo N, Bosch M. Phenylketonuria. Nature reviews. Disease primers: 2021; 7(1), 36. https://doi.org/10.1038/s41572-021-00267-0 Ding S, Han L. Newborn screening for genetic disorders: Current status and prospects for the future. Pediatric investigation: 2022; 6(4), 291–298. https://doi.org/10.1002/ped4.12343 El-Attar A, Elkaffas M, Aglan A, Naga S, Nabil A, Abdallah Y. Genomics in Egypt: Current Status and Future Aspects. Frontiers in genetics: 2022; 13, 797465. https://doi.org/10.3389/fgene.2022.797465 Temtamy A. The Development of Human Genetics at the National Research Centre, Cairo, Egypt: A Story of 50 Years. Annu. Rev. Genom. Hum. Genet: 2019; 20 (1), 1–19. 10.1146/annurev-genom-083118-015201. State Information Services (SIS). Newborns examined as part of Egypt's initiative for early detection of genetic diseases; Egypt Today: 2023. Available at: 267K newborns examined as part of Egypt's initiative for early detection of genetic diseases - EgyptToday. Viecelli M, Harbottle P, Wong P, et al. (Treatment of phenylketonuria using minicircle-based naked-DNA gene transfer to murine liver. Hepatology:2014;60(1):1035-43. Al Hafid N, Christodoulou J. Phenylketonuria: A review of current and future treatments. Translational pediatrics: 2015; 4(4), 304–317. https://doi.org/10.3978/j.issn.2224-4336.2015.10.07 MacDonald A, van Wegberg J, Ahring K, Beblo S, Bélanger-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts C, Leuzzi V, Maillot F, Muntau C, Rocha C, Romani C, Trefz F, van Spronsen J. PKU dietary handbook to accompany PKU guidelines. Orphanet journal of rare diseases:2020; 15(1), 171. https://doi.org/10.1186/s13023-020-01391-y Russo L, Puleo S, Cavella S, Scala I, Fidaleo M, Di Monaco R. Advancements in food science for Phenylketonuria (PKU) management: a comprehensive review. Critical Reviews in Food Science and Nutrition: 2024; 1–15. https://doi.org/10.1080/10408398.2024.2360075 Newby C. Introducing a granule-based protein substitute to the diet of a child with phenylketonuria to address reluctance to ingest phenylalanine-free protein substitute: A case report. Nutrition and Health: 2024; 30(1):35-38. doi:10.1177/02601060231184934 Maler V, Goetz A, El Khalil P, Meunier F, Maillot F. Aspartame and phenylketonuria: An analysis of the daily phenylalanine intake of aspartame-containing drugs marketed in France. Orphanet Journal of Rare Diseases : 2023;18 (1):142. doi: 10.1186/s13023-023-02770-x Van Wegberg J, MacDonald K, Ahring A, Bélanger-Quintana, N, Blau M , Bosch A , Burlina J, Campistol F, Feillet M, Giżewska, et al. The complete European guidelines on phenylketonuria: Diagnosis and treatment. Orphanet Journal of Rare Diseases: 2017; 12 (1):162. doi: 10.1186/s13023-017-0685-2 Singh H, Rohr F, Frazier D, Cunningham A, Mofidi S, Ogata B, Splett L, Moseley K, Huntington K, Acosta B, Vockley J, Van Calcar C. Recommendations for the nutrition management of phenylalanine hydroxylase deficiency. Genet Med: 2014; 16( 2), p121-31. Borrajo, G. Newborn Screening for Phenylketonuria: Latin American Consensus Guidelines. Journal of Inborn Errors of Metabolism& Screening:2016, Volume 4: 1–5 DOI: 10.1177/2326409816682764 Öztürk F, et al. Assessment of parents´ knowledge regarding phenylketonuria and its affecting factors: a cross-sectional study. Pan African Medical Journal. 2022;41(308). 10.11604/pamj.2022.41.308.25936 Baraka M, Gouda, S. Upgrading Mothers' Knowledge and Practice Regarding the Care of their Children Suffering from Phenylketonuria. Egyptian Journal of Health Care, March, 2022 EJHC Vol.13 No. 1 Jose P, Manalo E. Newborn Screening Knowledge, Attitudes and Practices among Obstetrics-Gynecology Residents, Pediatric Residents, and Newborn Screening Nurses in a Tertiary Government Hospital in the Philippines during the COVID-19 Pandemic. J. Neonatal Screen. 2023, 9(2), 19; https://doi.org/10.3390/ijns9020019 Joseph R. Expanded Newborn Screening Challenges to NICU Nurses. Advances in Neonatal Care: (2017); 17(3): p 151-161. | DOI: 10.1097/ANC.0000000000000381. Khaton S.Effect of Educational Intervention on Primary Health Care Nurses' Knowledge Regarding Phenylketonuria disorder and PKU test. Nursing and Health Sciences : 2016 ;5:45-58 DOI:10.9790/1959-0506014558 Venegas C, Taljaard M, Reszel J , Harrison D. Barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit. Nursing. Volume, June 2019, Pages 139-144. Said H, Draz S. The Effect of Empowerment Program for Nurses Regarding Management of Children with Phenylketonuria. Evidence-Based Nursing Research:2019; Vol. 1(4). doi: 10.47104/ebnrojs3.v1i4.107. Khedr H, Al-Sharkawi S, Tantawi R. Assessment of Nurses’ Competency Level Regarding the Care of Infants with Congenital Anomalies of Central Nervous System. Egyptian Journal of Health Care, 2022 Vol. 13. (3). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5220527","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369366354,"identity":"65c4104b-1c35-42af-a726-84f57b24c0df","order_by":0,"name":"Esraa Ismail","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Esraa","middleName":"","lastName":"Ismail","suffix":""},{"id":369366355,"identity":"485344d8-4e87-4a4d-bfa2-01072a838134","order_by":1,"name":"Wafaa Elarousy","email":"data:image/png;base64,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","orcid":"","institution":"Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Wafaa","middleName":"","lastName":"Elarousy","suffix":""},{"id":369366356,"identity":"e07a1bc2-4418-4d8c-9f62-06e97051aced","order_by":2,"name":"Shaymaa Badawe","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Shaymaa","middleName":"","lastName":"Badawe","suffix":""},{"id":369366357,"identity":"9fa020bf-6c51-46f5-9121-ee14aab04045","order_by":3,"name":"Rasha Abohadida","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Rasha","middleName":"","lastName":"Abohadida","suffix":""}],"badges":[],"createdAt":"2024-10-07 20:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5220527/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5220527/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67443395,"identity":"3357857f-3ec7-4c83-92ab-0cd34dddea85","added_by":"auto","created_at":"2024-10-25 06:17:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19495,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSampling Flow Chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5220527/v1/2193041782fd8195ce1d0fc5.png"},{"id":67443396,"identity":"d0b9f0e8-fb9d-43c4-90cc-2b1bb9332c43","added_by":"auto","created_at":"2024-10-25 06:17:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":114561,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStructure Equation Modeling (n = 50)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eModel fit parameters CFI; IFI; RMSEA (1.000; 1.000; 0.104).\u003c/p\u003e\n\u003cp\u003eCFI = Comparative fit index; IFI = incremental fit index; and RMSEA = Root Mean Square Error of Approximation.\u003c/p\u003e\n\u003cp\u003eModel ; significance 12.042* (\u0026lt;0.001*)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5220527/v1/f19d29df0fcbc0b151697a26.png"},{"id":69605472,"identity":"f1a1a558-9f5d-49e8-b694-d49db1fa06cb","added_by":"auto","created_at":"2024-11-22 07:17:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1498250,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5220527/v1/c340c687-2f1f-480f-9de0-a3c3db766f8f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Primary Health Care Nurses’ Knowledge and Neonatal Screening Performance for Phenylketonuria in Alexandria","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhenylketonuria (PKU) is a rare inherited metabolic disorder in the phenylalanine (Phe) metabolism. It is caused by deficiency or absence of the phenylalanine hydroxylase enzyme. The normal function of phenylalanine hydroxylase is to catalyze the conversion of phenylalanine (Phe) to tyrosine (Tyr). This results in accumulation of abnormal amounts of Phe and reduction in Tyr in the blood.\u003csup\u003e(1)\u0026nbsp;\u003c/sup\u003eThe prevalence of PKU varies widely among ethnicities and geographic regions, affecting approximately 1 in 24,000 individuals worldwide. However, in the Middle East, some of the highest prevalence is in Egypt, Iran, and Jordan, where approximately 1:5,000 newborns are affected.\u003csup\u003e\u0026nbsp;(2)\u0026nbsp;\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePhenylketonuria symptoms can manifest in varying degrees of severity. Infants diagnosed with PKU usually appear healthy at birth, with symptoms typically emerging around 6 months of age. If a child is untreated or inadequately treated, phenylalanine rises to toxic levels in the body especially in the brain causing infants to experience delays in motor skill development and exhibit lack of interest in their surroundings and subsequently significant neurodevelopmental sequelae including intellectual disability, mental retardation, seizures, learning disabilities, and emotional problems.\u003csup\u003e(3)\u0026nbsp;\u003c/sup\u003ePhenylketonuria is diagnosed through performing serum Phe test between one and seven days after birth. Blood is obtained by pricking the heel of the newborn and analyzing it for phenylalanine concentration. Children with PKU need to keep Phe levels low. Therefore, keeping Phe levels between 120-360 \u0026mu;mol/L (2-6 mg/DL) for life is required.\u003csup\u003e\u0026nbsp;(4)\u0026nbsp;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNewborn screening plays a crucial role in identifying treatable disorders early, allowing for timely intervention and improved health outcomes. These screenings not only save lives but also enhance the quality of life for children and their families.\u003csup\u003e(5)\u0026nbsp;\u003c/sup\u003eIn Egypt, 1996, the first newborn screening for metabolic disorders in Alexandria governorate took place through a study conducted by the Medical Research Institute where newborns were screened for three treatable inborn errors of metabolism, namely phenylketonuria \u0026ldquo;PKU\u0026rdquo;, galactosemia and congenital hypothyroidism, aiming at early detection of these diseases and providing therapeutic regimens to guard against development of mental retardation. \u0026nbsp;The results of this neonatal screening of 15,000 newborns showed a high frequency of Phenylketonuria (1:7000), and of hypothyroidism (1:3000) ,which convinced the health authorities in Egypt to start a mass neonatal screening program for PKU and hypothyroidism in all Egyptian governorates in 2003.\u003csup\u003e(6,7)\u0026nbsp;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2023, an infographic showcasing the accomplishments of the President of the Republic\u0026apos;s program for early detection of genetic diseases in newborns was released by The Ministry of Health and Population on its official Facebook page. The screening is carried out by blood sample analysis in cooperation with the Egyptian Centre for Diseases and Control (ECDC), followed by a second test to confirm the diagnosis if the first comes back positive.\u003csup\u003e\u0026nbsp;(8)\u0026nbsp;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDietary management and pharmacologic treatment are essential for infants with PKU. Pharmacological treatments such as enzyme replacement therapy through viral delivery of protein fusions targeting the liver as well as enzyme substitution therapy where phenylalanine ammonia lyase is used as a substitute to PAH had been promising in recent years.\u003csup\u003e\u0026nbsp;(\u003cspan dir=\"RTL\"\u003e9\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003e Dietary restriction of phenylalanine remains to be the mainstay of treatment for PKU . It should be instituted as soon as the diagnosis is confirmed and must be commenced from the neonatal period and adhered to for life.\u003csup\u003e\u0026nbsp;(\u003cspan dir=\"RTL\"\u003e10\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003e The cornerstone for PKU dietary regimen is typically low in high protein either animal such as red meat, fish, poultry and milk and milk products or plant foods such as dried beans, peas and nuts.\u003csup\u003e\u0026nbsp;(1\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e,1\u003cspan dir=\"RTL\"\u003e2\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003e It also may include specially formulated medical foods and protein substitutes that are phenylalanine-free or low in phenylalanine.\u003csup\u003e\u0026nbsp;(1\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e,1\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e)\u003c/sup\u003e It is recommended that the child\u0026rsquo;s diet is well-planned to include a variety of fruits and vegetables to prevent micronutrient deficiencies commonly associated with restrictive diets.\u003csup\u003e\u0026nbsp;(1\u003cspan dir=\"RTL\"\u003e5\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003eInfants with PKU need a special formula that contain high protein and low phenylalanine. It can be used throughout life as a protein source that is extremely low in phenylalanine and balanced for the remaining essential amino acids.\u003csup\u003e\u0026nbsp;(1\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrimary health care nurses play a crucial role in the primary prevention of PKU within national screening programs for newborns. This is achieved through consult with the child\u0026apos;s provider promptly to arrange a PKU test. Accurate collection of blood samples at maternal and child health centers enables early detection of potential cases. Nurses must adhere to precise procedures when conducting neonatal screening. It is crucial for the nurse to be well-versed in obtaining accurate test results, ensuring that the baby has consumed protein from breast milk or formula before the blood sample is drawn. \u003csup\u003e(1\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e)\u0026nbsp;\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNurses are at the forefront of identifying cases and providing essential health education on the disease and dietary requirements, as well as ensuring proper specimen recording and analysis. It is imperative for PHC nurses to have a comprehensive understanding of PKU disease, screening procedures, sampling techniques, and overall management responsibilities within their respective centers and units.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSignificance of the Study and Research Gap\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePart of Egypt\u0026rsquo;s vision 2030 focuses on the rights of all Egyptians for healthy life with healthcare system capable of improving health conditions through early intervention, and preventive coverage. Nurses play an important role in early detection through being competent in adherence to neonatal screening procedure. Early detection is the key to manage phenylketonuria as the infants appear healthy at birth, and if untreated or inadequately treated, infants may experience developmental delays and intellectual disabilities that can affect the children\u0026rsquo;s entire life, children\u0026rsquo;s families, and the community. Overall, research in this area plays a crucial role in ensuring that primary health care nurses are equipped with the necessary knowledge and skills to effectively contribute to neonatal screening programs, thereby improving outcomes for newborns and their families. So, the aim of this study is to evaluate the primary health care nurses\u0026rsquo; knowledge and neonatal screening performance for phenylketonuria in Alexandria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to evaluate the primary health care nurses\u0026rsquo; knowledge and neonatal screening performance for phenylketonuria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Assess primary health care nurses\u0026rsquo; knowledge regarding phenylketonuria (PKU) and newborn screening test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Evaluate primary health care nurses\u0026rsquo; performance\u0026nbsp;for phenylketonuria neonatal screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Question\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhat is the primary health care nurses\u0026rsquo; knowledge and neonatal screening performance for phenylketonuria?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive research design was used to accomplish this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSettings\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted at 5 primary health care in Alexandria. Dana, El-seyouf, Smouha, El -Hadrah Qebli, and El -Agamy family health centers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll nurses (65 nurses) who are responsible for obtaining newborn screening test for phenylketonuria in above mentioned primary health care centers in the Alexandria were invited to participate in the study, 5 of them refused to participate and another 5 withdrew from the study. \u0026nbsp;Fifty nurses were participated in the study as follow: 8 nurses from Dana, 8 nurses from El-seyouf, 9 nurses from Smouha, 11 nurses from \u0026nbsp;El-Hadrah Qebli and 14 from El-Agamy family health centers (refer to \u003cstrong\u003efigure 1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo tools were used to collect the necessary data. The\u0026nbsp;tools were developed by the researchers after reviewing of recent and relevant literatures.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e(1\u003cspan dir=\"RTL\"\u003e7\u003c/span\u003e,1\u003cspan dir=\"RTL\"\u003e8\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool l : Nurses\u0026apos; knowledge regarding phenylketonuria disease assessment sheet\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt included 3 parts. Part 1 included nurses\u0026apos; characteristics such as age, educational level, years of experiences and attendance of training courses/lectures or discussion regarding newborn screening program for phenylketonuria. Part 2 included nurses\u0026apos; knowledge about phenylketonuria disease such as definition, causes, symptoms and signs, diagnosis, prevention of potential complications, and different methods of treatment (dietary restriction, special medical formula and medical treatment in addition to available community services. Part 3: it included nurses\u0026apos; knowledge about phenylketonuria screening test regarding timing , benefits and follow up of tests. Nurses\u0026apos; knowledge in part 2 and 3 was scored as the follows: \u0026nbsp;1 for correct and complete answer, and zero for unknown or wrong answer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool II: Nurses\u0026apos; performance about newborn screening for phenylketonuria observational checklist.\u0026nbsp;\u003c/strong\u003eThis tool was used to assess nurses\u0026apos; performance before, during, and after newborn screening for phenylketonuria. Performance was scored as the follows: 1 for correct steps while zero for incorrect or not done steps. \u0026nbsp;\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e1. Approval from the Research Ethics Committee of the Faculty of Nursing at Alexandria University was obtained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp;Official letter was directed to\u0026nbsp;the responsible authority\u0026nbsp;of selected family health centers to facilitate research implementation after explaining the aim of the study.\u003c/p\u003e\n\u003cp\u003e3. Tool I, II were developed by the researchers after thorough reviewing of recent and relevant literatures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Tools were tested for its content validity by five experts in the field of pediatric and community health nursing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. Reliability of the tools\u0026nbsp;was done using Cronbach Coefficient Alpha test where r =0.866 for tool I and 0.848 for tool II. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6. A pilot study was carried out on 10 % nurses (5 nurses) to test the clarity and feasibility of the tools. Those nurses were excluded from the study subjects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. Nurse was observed individually by the researcher once during newborn screening using tool II.\u003c/p\u003e\n\u003cp\u003e8. Then, nurses were interviewed individually to assess their knowledge using tool I\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e9.\u0026nbsp;Data were collected over a period of from September 2022 to July 2023.\u003c/p\u003e\n\u003cp\u003e10. After completion of data collection, the necessary statistical analysis was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ethical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Witness informed consent was obtained from the head nurse of the selected primary health care centers after explaining the aim of the study for tool II. A written informed consent was obtained from each nurse after explanation of the aim of the study and assurance that the collected data is used only for the study purpose. Study subjects’ anonymity is maintained as well as confidentiality of the collected data. Subjects’ voluntary participation and their right to withdraw from the study at any time without penalty were assured. Dealing with the study subjects was based on mutual respect with no discrimination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were fed to the computer and analyzed using IBM SPSS software package version 23.0. One way ANOVA test was used to compare between more than two categories. Student t-test was used to compare two categories for normally distributed quantitative variables. Pearson coefficient was used to correlate between normally distributed quantitative variables. Significance of the obtained results was judged at the 5% level.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e displays the distribution of the participant nurses according to their demographic characteristics. Concerning the number of nurses in family health centers; it was found that more than one quarter (28%) of participant nurses were from the El Agamy family health center followed by more than one fifth (22%) of nurses in El Hadra Qebli. Slightly less than one fifth (18%) of participant nurses were from Smouha and an equal percent of nurses (16%) were from Danna and Seyouf family health care centers.\u003c/p\u003e \u003cp\u003eAdditionally, it was found that nearly half of participant nurses\u0026rsquo; (48%) aged from 41 to 50 years old, with a mean age of 42.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0. Considering educational level, it was observed that 52% of participant nurses had completed their technical level of education and slightly more than two thirds of them (68.0%) had more than 15 years of experience with means experience years of 17.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84.\u003c/p\u003e \u003cp\u003eRegarding attending training courses about newborn screening program for Phenylketonuria. It was found that more than two-thirds (62%) of participant nurses attended training courses, and more than half of them obtained two training courses. Moreover, it was noticed that two days training course was reported by 51.6% of them.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2)\u003c/b\u003e highlights the nurses' knowledge regarding Phenylketonuria. It was revealed that, all participant nurses had correct knowledge about the definition, diagnosis, age of starting treatment, types of allowed foods, and time and Benefits of neonatal screening test. In addition, more than 80% of them had correct knowledge about degree of PKU severity, how long should the diet be used, types of allowed formula, giving breast milk, and available community services that support PKU children ( 82%, 84%, 84%, 94% \u0026amp; 94% respectively). On the hands, the participant nurses had incorrect knowledge about blood level of PKU to be achieved during the treatment (88%), name of missing enzyme (74%) and management of PKU (62%). Moreover, it was clear from the table that the total mean score of nurses' knowledge regarding Phenylketonuria screening was 16.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99 and the mean percent score was 72.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3)\u003c/b\u003e portrays the nurses' screening performance for Phenylketonuria. It was revealed that, all participant nurses correctly performed the following steps: selection of puncture area, surface area to puncture, puncture heel at a 90-degree angle, seal blood containers, apply direct pressure on puncture site, label collection tubes and dispose of puncture device in sharps container. While the majority of them performed the following steps incorrectly: hand hygiene, administrate 25% sucrose\u0026rsquo;s and remove gloves (90, 80, 84% respectively). In addition, all the participant nurses did not perform hand hygiene after screening test. It was clear from the table that the total score of nurses' practice regarding Phenylketonuria was 11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 and the mean percent score of practice was 64.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4)\u003c/b\u003e illustrates the correlation between nurses' knowledge and screening performance for Phenylketonuria. A significant positive correlation was found between nurses knowledge and practice (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(5\u003c/b\u003e) presents the relationship between nurses\u0026rsquo; knowledge and screening performance for phenylketonuria with their characteristics. The result revealed that there were highly statistically significant relationships between the total mean score of the nurses\u0026rsquo; knowledge with their level of education, years of experiences and attending training courses with P value of \u0026lt;\u0026thinsp;0.001. Moreover, a highly statistically significant differences were found between mean score of nurses\u0026rsquo; screening performance and their age, level of education, years of experiences and attending training courses with P value of \u0026lt;\u0026thinsp;0.001, 0.003, \u0026lt;\u0026thinsp;0.001 and \u0026lt;\u0026thinsp;0.001 respectively.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(6)\u003c/strong\u003e \u003cp\u003edisplays the effect of nurses' characteristics on knowledge and practice through multiple linear regression analysis. It was found that significant relationships were found between the units, level of education, attendance training courses, and their nurse\u0026rsquo;s knowledge (P\u0026thinsp;=\u0026thinsp;0.044, 0.032, \u0026lt;\u0026thinsp;0.001, and 0.003, respectively). On the other hand, the same table found that significant relationships were found between the attendance training courses and their nurses practice (P\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(7, 8)\u003c/strong\u003e \u003cp\u003eshow the direct and indirect effects of study variables on nurses\u0026rsquo; knowledge and practices. It was found that there were direct and significant relationships between nurses\u0026rsquo; knowledge and the unit, level of education, years of experience and attendance training courses (P\u0026thinsp;=\u0026thinsp;0.029, 0.019, \u0026lt;\u0026thinsp;0.001, and \u0026lt;\u0026thinsp;0.001, respectively). Moreover, it was revealed that there were direct and significant relationships between nurses\u0026rsquo; practice and their knowledge, and their attendance training courses (P\u0026thinsp;=\u0026thinsp;0.033, and 0.027, respectively).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1): Distribution of participant nurses according to their demographic characteristics (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurses characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Health Centers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDanna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEl Agamy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEl Seyouf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEl Hadara Qebli\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmouha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 - \u0026lt;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e17.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses about newborn screening program for Phenylketonuria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of training courses (n\u0026thinsp;=\u0026thinsp;31)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of each course (n\u0026thinsp;=\u0026thinsp;31)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.6\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\u003e \u003cb\u003eTable\u0026nbsp;(2): The Nurses' knowledge levels regarding Phenylketonuria screening and disease (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurses knowledge regarding phenylketonuria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIncorrect answer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCorrect answer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Definition of Phenylketonuria (PKU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Causes of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Clinical manifestation of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Name of missing enzyme is in PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Early clinical manifestation that appear in neonates PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Management of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Potential complications of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Age of starting treatment of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Age of start PKU symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Diets of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Degree of severity of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Types of restricted foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- How long should the diet be used in PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Types of allowed foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Types of allowed formula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Diagnosis of PKU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Give breast milk to a PKU infant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Normal level of Phenylketonuria in the blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Level of Phenylketonuria in the blood to be achieved during the treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Time of neonatal screening test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Benefits of neonatal screening test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Available community services that support PKU children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal mean score of knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean percent score of knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e72.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\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 \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3): The nurses' screening performance for phenylketonuria (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurses practice regarding Phenylketonuria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNot done\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDone\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Preform hand hygiene and clean blue tray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Collect equipment. Select the appropriate puncture device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Administrate 25% sucrose\u0026rsquo;s and provide comfort measure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Preform hand hygiene apply gloves and prepare equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Nominate an area for puncture on the foot on medial lateral plantar surface\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Select the surface area to puncture. Continue in a stepping ladder pattern from the first puncture for subsequent blood sampling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Clean foot with alcohol and allow 30 second to dry completely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Puncture heel holding the puncture device at a 90-degree angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Wipe away fist drop of blood with gauze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Collect blood in correct order of draw, gently agitating tubes between each drop while avoiding scraping and scooping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Seal blood containers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Apply direct pressure on puncture site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Label collection tubes with correct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dispose of puncture device in sharps container\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Collect and dispose of remaining equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Clean blue tray and remove gloves\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Preform hand hygiene after test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal mean score of screening performance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean percent score of screening performance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e64.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\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 \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4): Correlation between nurses knowledge and screening performance for phenylketonuria (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNurses\u0026rsquo; knowledge and practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.764*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cp\u003er: Pearson coefficient\u003c?p\u003e\u003cp\u003e*: Statistically significant at p ≤ 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eTable\u0026nbsp;(5): Relationship between Nurses knowledge and Screening Performance for Phenylketonuria with their characteristics (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurses characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF(p)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.664 (0.080)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e9.668* (\u0026lt;\u0026thinsp;0.001*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003et(p)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5.404* (\u0026lt;\u0026thinsp;0.001*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.131* (0.003*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 - \u0026lt;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF(p)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e18.931* (\u0026lt;\u0026thinsp;0.001*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e12.075* (\u0026lt;\u0026thinsp;0.001*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses about newborn screening program for Phenylketonuria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003et(p)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.876* (\u0026lt;\u0026thinsp;0.001*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.838* (\u0026lt;\u0026thinsp;0.001*)\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 \u003cp\u003eF: One way ANOVA test t: Student t-test *: Statistically significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(6): Multiple Linear Regression Analysis Showing the Effect of Nurses characteristics on knowledge and practice (n\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"13\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNurses characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBeta\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBeta\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eLL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eUL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eLL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eUL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.215*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.117*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttendance training courses (No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.150*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2.068*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-1.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\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 \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.835, Adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.816, F\u0026thinsp;=\u0026thinsp;44.450\u003csup\u003e*\u003c/sup\u003e,p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.721, Adjusted R\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.682, F\u0026thinsp;=\u0026thinsp;18.502\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e,\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eF,p: f and p values for the model\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eR\u003csup\u003e2\u003c/sup\u003e: Coefficient of determination\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eB: Unstandardized Coefficients\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eBeta: Standardized Coefficients\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003et: t-test of significance\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eLL: Lower limit UL: Upper Limit\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003e*: Statistically significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e \u003cb\u003eTable\u0026nbsp;(7): Direct and Indirect Effect of the study variables on nurses\u0026rsquo; knowledge and their practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariable 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized regression weights\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS.E\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eC.R\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eUnit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.188*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.338*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.511*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.324*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.129*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eUnit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.207*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.027*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026larr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.067\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\u003e \u003cb\u003eTable\u0026nbsp;(8): Direct and Indirect effect of study variables on nurses\u0026rsquo; knowledge and their practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.033*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAttendance training courses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.027*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003ePhenylketonuria is a genetic condition caused by a defect in gene that helps to produce the phenylalanine hydroxylase enzyme required for the breakdown of phenylalanine that results in rising levels of phenylalanine in blood and tissues. Elevating phenylalanine to dangerous levels in the body can lead to serious complications in children, especially mental retardation. Newborn screening identifies these children to start proper treatment and dietary management early which improves their quality of life. \u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe current study found that more than two-thirds of nurses attended training courses, and more than half of them obtained at least two training courses for two days of each course. This result could be related to the fact that continuous education and training programs enhance nurses’ knowledge and practices. It is also reflected in the attention of decision-makers to train the nurses about the national neonatal screening program for their crucial role in obtaining the screening test and to counsel and educate the families about the importance of the screening and the targeted diseases.\u003c/p\u003e \u003cp\u003eThe finding of the present study revealed that the nurses' total mean score of knowledge regarding phenylketonuria was 16.24 ± 1.99 and the mean percent score of knowledge was 67.67 ± 8.27. These results might be related to the availability of educational training for nurses which updated knowledge regarding phenylketonuria screening. This result is congruent with the study findings of \u003cb\u003eJose \u0026amp; Manalo ,2023\u003c/b\u003e\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e who found that providing pediatric residents with an educational module resulted in significantly improved knowledge of neonatal screening. The study also highlighted the necessity to continuously educate healthcare workers on all aspects of neonatal screening so that they can in turn educate parents. On the other side, the finding of \u003cb\u003eJoseph ,2017\u003c/b\u003e\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e who studied the newborn screening challenges for NICU nurses, reported that NICU nurses face several challenges with the expansion of newborn screening programs and gain knowledge to answer questions posed by empowered parents and educate them appropriately.\u003c/p\u003e \u003cp\u003eRegarding nurses practice toward the phenylketonuria screening test in this study, the nurses' total score of practice regarding phenylketonuria was 11.0 ± 0.97 and the mean percent score of practice was 64.71 ± 5.70. The results revealed that all nurses correctly performed all participant nurses correctly performed selection of puncture area, surface area to puncture, puncture heel at right angle, seal blood containers, apply direct pressure on puncture site, label collection tubes and dispose of puncture device correctly. These findings might be related to continue supervision and training courses for participant nurses that improved their performance in the steps of selection of a suitable site and withdrawal of a sample. Surprisingly, the majority of nurses did not perform the steps related to infection control correctly, such as performing hand hygiene before and after the screening test, cleaning the blue tray, and removing gloves, even though the hand hygiene facilities are available to all of them in all family health centers. This may be attributed to the overload of nurses with many neonates each day of screening.\u003c/p\u003e \u003cp\u003eMoreover, the findings of the current study showed that most nurses had not performed correctly regarding administering 25% sucrose and providing comfort measures for pain management to the neonates. This may be attributed to the fact that nurses do not realize that screening procedures are painful procedures, and the neonates feel pain from them. The study finding of \u003cb\u003eKhaton, 2016\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e supports the current study and cites that only 16% of participant nurses know 9–13 steps of the PKU screening procedure correctly. On the other side, the study finding of \u003cb\u003eVenegas et al., 2019\u003c/b\u003e, \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e who studied the barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit, contradicts this study and cites that 53% of nurses used sucrose and 44% of them reported breastfeeding was supported in pain management.\u003c/p\u003e \u003cp\u003eThe findings of the current study revealed that a significant positive correlation was detected between nurses’ knowledge and practice. This finding could be related to the fact that knowledge is needed to support the practice in addition to continuous training courses for participant nurses to improve nurses’ knowledge and practices. The study findings of \u003cb\u003eSaid\u003c/b\u003e \u0026amp; \u003cb\u003eDraz\u003c/b\u003e, \u003cb\u003e2019\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e were congruent with the present study and cited that there was a statistically significant positive correlation between total knowledge of the participant nurses and total practice towards the management of children with phenylketonuria.\u003c/p\u003e \u003cp\u003eIn addition, the findings of the present study revealed that there were direct and significant relationships between nurses’ practice and their knowledge with their attendance training courses. This finding related to the fact that continuous education updated their nurses’ knowledge and improved their skills regarding neonatal screening performance for phenylketonuria. The study finding of \u003cb\u003eSaid\u003c/b\u003e \u0026amp; \u003cb\u003eDraz\u003c/b\u003e, \u003cb\u003e2019\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e was in the same line with the present study and cited that there is a positive statistical relationship between nurses' knowledge and practice post-program implementation.\u003c/p\u003e \u003cp\u003eFurthermore, the results of this study found that the age of the participating nurses affected positively their knowledge and was statistically significant with their practice (P = 0.080 and \u0026lt; 0.001, respectively). Moreover, the results of the current study revealed that there were significant relationships between nurses’ knowledge and practices with their level of education (P = \u0026lt; 0.001, 0.003, respectively) and years of experience. These findings might be related to the fact that nurses’ age, their educational level, and years of experience were considered as factors affecting their knowledge and practice level during neonatal screening performance for phenylketonuria. The study findings of \u003cb\u003eKhedr et al., 2022\u003c/b\u003e \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e were consistent with the findings of the current study and mentioned that there was a statistically significant difference between the participant nurses’ total level of practice and their age, educational level, and years of experience.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitation\u003c/h2\u003e \u003cp\u003eThe limitation of the study was conducted in only 5 primary health care centers with a limited sample size of only 50 nurses which might limit the generalizability of the results.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and recommendations","content":"\u003cp\u003eIt was concluded from this current study that majority of participant nurses had correct knowledge in neonatal screening and many aspects of phenylketonuria disease. Although the majority of nurses correctly performed many screening steps, they still need support in many steps especially related to infection control steps.\u003c/p\u003e\u003ch2\u003ePractice Implications\u003c/h2\u003e\u003cp\u003eThe identification of gaps either in knowledge or screening performance and highlighting areas where further training is needed. This can be achieved by continuous training for primary health care nurses to enhance the overall accuracy and efficiency of neonatal screening programs for PKU.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAuthors information\u003c/h2\u003e \u003cp\u003e \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e Lecturer, Pediatric Nursing Department, Faculty of Nursing, Alexandria University\u003c/p\u003e \u003cp\u003e \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e Professor, Pediatric Nursing Department, Faculty of Nursing, Alexandria University\u003c/p\u003e \u003cp\u003e \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e Lecturer, Community Health Nursing Department, Faculty of Nursing, Alexandria University\u003c/p\u003e \u003c/div\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e\u0026bull; Esraa Mohammed Abd El-samie Ismail: background and statistical analysis\u0026bull; Wafaa Mohamed Elarousy: significant of the study, Methodology, abstract, conclusion and recommendation, finalization of the manuscript and publication process.\u0026bull; Shaymaa Saeed Mohamed Badawe: Ethical approval process, data collection, results section.\u0026bull; Rasha Mohamed Abohadida: discussion and revise the references section.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eA special acknowledgement is directed to all mangers and staff nurses in the primary health care centers who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCasey, L. Caring for children with phenylketonuria. Canadian family physician Medecin de famille canadien: 2013; 59(8), 837\u0026ndash;840.\u003c/li\u003e\n\u003cli\u003eElhawary A, AlJahdali A, Abumansour S, Elhawary N, GaboonN, Dandini M, Madkhali A, Alosaimi W, Alzahrani A, AljohaniF, Melibary M, Kensara A. Genetic etiology and clinical challenges of phenylketonuria. Human genomics: 2022; 16(1), 22. https://doi.org/10.1186/s40246-022-00398-9\u003c/li\u003e\n\u003cli\u003eAshe K, Kelso W, Farrand S, Panetta J, Fazio T, De Jong G, Walterfang M. Psychiatric and Cognitive Aspects of Phenylketonuria: The Limitations of Diet and Promise of New Treatments. Frontiers in psychiatry: 2019; 10, 561. https://doi.org/10.3389/fpsyt.2019.0056.\u003c/li\u003e\n\u003cli\u003eVan Spronsen J, Blau N, Harding C, Burlina A, Longo N, Bosch M. Phenylketonuria. Nature reviews. Disease primers: 2021; 7(1), 36. https://doi.org/10.1038/s41572-021-00267-0\u003c/li\u003e\n\u003cli\u003eDing S, Han L. Newborn screening for genetic disorders: Current status and prospects for the future. Pediatric investigation: 2022; 6(4), 291\u0026ndash;298. https://doi.org/10.1002/ped4.12343\u003c/li\u003e\n\u003cli\u003eEl-Attar A, Elkaffas M, Aglan A, Naga S, Nabil A, Abdallah Y. Genomics in Egypt: Current Status and Future Aspects. Frontiers in genetics: 2022; 13, 797465. https://doi.org/10.3389/fgene.2022.797465\u003c/li\u003e\n\u003cli\u003eTemtamy A. The Development of Human Genetics at the National Research Centre, Cairo, Egypt: A Story of 50 Years. Annu. Rev. Genom. Hum. Genet: 2019; 20 (1), 1\u0026ndash;19. 10.1146/annurev-genom-083118-015201.\u003c/li\u003e\n\u003cli\u003eState Information Services (SIS). Newborns examined as part of Egypt\u0026apos;s initiative for early detection of genetic diseases; Egypt Today: 2023. Available at: 267K newborns examined as part of Egypt\u0026apos;s initiative for early detection of genetic diseases - EgyptToday.\u003c/li\u003e\n\u003cli\u003eViecelli M, Harbottle P, Wong P, et al. (Treatment of phenylketonuria using minicircle-based naked-DNA gene transfer to murine liver. Hepatology:2014;60(1):1035-43.\u003c/li\u003e\n\u003cli\u003eAl Hafid N, Christodoulou J. Phenylketonuria: A review of current and future treatments. Translational pediatrics: 2015; 4(4), 304\u0026ndash;317. https://doi.org/10.3978/j.issn.2224-4336.2015.10.07\u003c/li\u003e\n\u003cli\u003eMacDonald A, van Wegberg J, Ahring K, Beblo S, B\u0026eacute;langer-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts C, Leuzzi V, Maillot F, Muntau C, Rocha C, Romani C, Trefz F, van Spronsen J. PKU dietary handbook to accompany PKU guidelines. Orphanet journal of rare diseases:2020; 15(1), 171. https://doi.org/10.1186/s13023-020-01391-y\u003c/li\u003e\n\u003cli\u003eRusso L, Puleo S, Cavella S, Scala I, Fidaleo M, Di Monaco R. Advancements in food science for Phenylketonuria (PKU) management: a comprehensive review. Critical Reviews in Food Science and Nutrition: 2024; 1\u0026ndash;15. https://doi.org/10.1080/10408398.2024.2360075\u003c/li\u003e\n\u003cli\u003eNewby C. Introducing a granule-based protein substitute to the diet of a child with phenylketonuria to address reluctance to ingest phenylalanine-free protein substitute: A case report. Nutrition and Health: 2024; 30(1):35-38. doi:10.1177/02601060231184934\u003c/li\u003e\n\u003cli\u003eMaler V, Goetz A, El Khalil P, Meunier F, Maillot F. Aspartame and phenylketonuria: An analysis of the daily phenylalanine intake of aspartame-containing drugs marketed in France. Orphanet Journal of Rare Diseases : 2023;18 (1):142. doi: 10.1186/s13023-023-02770-x\u003c/li\u003e\n\u003cli\u003eVan Wegberg J, MacDonald K, Ahring A, B\u0026eacute;langer-Quintana, N, Blau M , Bosch A , Burlina J, Campistol F, Feillet M, Giżewska, et al. The complete European guidelines on phenylketonuria: Diagnosis and treatment. Orphanet Journal of Rare Diseases: 2017; 12 (1):162. doi: 10.1186/s13023-017-0685-2\u003c/li\u003e\n\u003cli\u003eSingh H, Rohr F, Frazier D, Cunningham A, Mofidi S, Ogata B, Splett L, Moseley K, Huntington K, Acosta B, Vockley J, Van Calcar C. Recommendations for the nutrition management of phenylalanine hydroxylase deficiency. Genet Med: 2014; 16( 2), p121-31.\u003c/li\u003e\n\u003cli\u003eBorrajo, G. Newborn Screening for Phenylketonuria: Latin American Consensus Guidelines. Journal of Inborn Errors of Metabolism\u0026amp; Screening:2016, Volume 4: 1\u0026ndash;5 DOI: 10.1177/2326409816682764\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zt\u0026uuml;rk F, et al. Assessment of parents\u0026acute; knowledge regarding phenylketonuria and its affecting factors: a cross-sectional study. Pan African Medical Journal. 2022;41(308). 10.11604/pamj.2022.41.308.25936\u003c/li\u003e\n\u003cli\u003eBaraka M, Gouda, S. Upgrading Mothers\u0026apos; Knowledge and Practice Regarding the Care of their Children Suffering from Phenylketonuria. Egyptian Journal of Health Care, March, 2022 EJHC Vol.13 No. 1\u003c/li\u003e\n\u003cli\u003eJose P, Manalo E. Newborn Screening Knowledge, Attitudes and Practices among Obstetrics-Gynecology Residents, Pediatric Residents, and Newborn Screening Nurses in a Tertiary Government Hospital in the Philippines during the COVID-19 Pandemic. J. Neonatal Screen. 2023, 9(2), 19; https://doi.org/10.3390/ijns9020019\u003c/li\u003e\n\u003cli\u003eJoseph R. Expanded Newborn Screening Challenges to NICU Nurses. Advances in Neonatal Care: (2017); 17(3): p 151-161. | DOI: 10.1097/ANC.0000000000000381.\u003c/li\u003e\n\u003cli\u003eKhaton S.Effect of Educational Intervention on Primary Health Care Nurses\u0026apos; Knowledge Regarding Phenylketonuria disorder and PKU test. Nursing and Health Sciences : 2016 ;5:45-58 DOI:10.9790/1959-0506014558\u003c/li\u003e\n\u003cli\u003eVenegas C, Taljaard M, Reszel J , Harrison D. Barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit. Nursing. Volume, June 2019, Pages 139-144.\u003c/li\u003e\n\u003cli\u003eSaid H, Draz S. The Effect of Empowerment Program for Nurses Regarding Management of Children with Phenylketonuria. Evidence-Based Nursing Research:2019; Vol. 1(4). doi: 10.47104/ebnrojs3.v1i4.107.\u003c/li\u003e\n\u003cli\u003eKhedr H, Al-Sharkawi S, Tantawi R. Assessment of Nurses\u0026rsquo; Competency Level Regarding the Care of Infants with Congenital Anomalies of Central Nervous System. Egyptian Journal of Health Care, 2022 Vol. 13. (3).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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":"knowledge, nurses, performance, phenylketonuria","lastPublishedDoi":"10.21203/rs.3.rs-5220527/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5220527/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Nurses play a crucial role in the primary prevention of phenylketonuria (PKU) within national screening programs for newborns. This is achieved through consult with the child's provider promptly to arrange a PKU test, accurate collection of blood samples at maternal and child health centers, enable early detection of potential cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e: This study aimed to assess the level of primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria in Alexandria\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A descriptive research design was used. The study included all nurses (50 nurses) who are responsible for obtaining newborn screening test from 5 primary health care centers in Alexandria. Two tools were used to collect the necessary data: nurses' knowledge regarding phenylketonuria disease assessment sheet and nurses' performance about newborn screening for phenylketonuria observational checklist. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: it was found that the mean age of participant was 42.94±5.0 and 52% of them had completed their technical level of education and the means years of experience was 17.64±4.84. The total mean score of nurses' knowledge regarding phenylketonuria screening was 16.24±1.99 with the mean percent score of 72.72±8.27. It was also found the total score of nurses' screening performance was 11.0±0.97 with the mean percent score of 64.71±5.70. A significant positive correlation was found between nurses’ knowledge and their screening performance with P = \u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: It was concluded from this current study that majority of participant nurses had correct knowledge in neonatal screening and many aspects of phenylketonuria disease. Although the majority of nurses correctly performed many screening steps, they still need support in many steps especially related to infection control steps.\u003c/p\u003e","manuscriptTitle":"Evaluation of Primary Health Care Nurses’ Knowledge and Neonatal Screening Performance for Phenylketonuria in Alexandria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-25 06:17:32","doi":"10.21203/rs.3.rs-5220527/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":"e47188ce-69bb-4d11-a6e6-35b657583aea","owner":[],"postedDate":"October 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-22T07:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-25 06:17:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5220527","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5220527","identity":"rs-5220527","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}