Knowledge, Attitude, Practice, and Associated Factors toward Ostomy Care among Surgical Nurses

Knowledge, Attitude, Practice, and Associated Factors toward Ostomy Care among Surgical Nurses | 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 Knowledge, Attitude, Practice, and Associated Factors toward Ostomy Care among Surgical Nurses Ulluvis Hewage Tharushi Uthpala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7917966/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Apr, 2026 Read the published version in BMC Nursing → Version 1 posted 12 You are reading this latest preprint version Abstract Background Ostomy care represents a vital component of postoperative recovery. As surgical nurses play a pivotal role in facilitating patient adaptation to ostomies; their knowledge, attitudes, and practices significantly impact patient outcomes and quality of life. Gaps in knowledge among nurses in ostomy care are not well-documented. Objectives To assess knowledge, attitude, and practices and associated factors of intestinal stoma care among surgical nurses in selected teaching hospitals, Colombo district in Sri Lanka. Methods A descriptive cross-sectional study was conducted among 317 surgical nurses from three teaching hospitals in Colombo district, Sri Lanka. Participants were selected using a random sampling method. Data was collected through a validated self-administered questionnaire, with knowledge and practice levels categorized as high, moderate, or poor. Attitude levels categorized as good, general, poor. Associations between knowledge, attitude and practice levels and demographic factors were analyzed using the chi-square test. Results The mean knowledge was 73.27 (± 13.79). The mean practice score was 65.82(± 20.04). The mean attitude score was 67.95 (± 6.31). Age was a notable factor, with participants aged 52–60 years scoring significantly higher in Knowledge ( p = 0.024), while practice scores were significantly higher in participants aged 32–41 years, 42–51 years, and 52–60 years ( p < 0.001). Gender differences were observed in attitude, where females scored significantly higher than males ( p = 0.005). Participation in an in-service program for ostomy care was significantly associated with improved Knowledge ( p = 0.035), Attitude ( p = 0.035), and Practice ( p = 0.002) scores. In addition, reading the scientific literature on ostomy care was linked to higher knowledge scores ( p = 0.014). Conclusions The study revealed a generally positive knowledge level, moderate practice level and good attitude level among surgical nurses, with areas for improvement. Targeted interventions, including structured training programs and access to updated guidelines, are essential for enhancing stoma care knowledge and practices and attitudes towards stoma care. Attitude Associated factors Knowledge Nursing education Practice Stoma care Surgical nurses Introduction The nursing field, particularly within surgical specialties, demands a nuanced understanding of diverse patient care aspects, including the management of ostomies (Kim & Lee 2023 ) Ostomy care represents a vital component of postoperative recovery (Ahmad Q, et al., 2010 ). As surgical nurses play a pivotal role in facilitating patient adaptation to ostomies; their knowledge, attitudes, and practices significantly impact patient outcomes and quality of life (Alenezi A, Kimpton A, McGrath I, and Livesay K., 2022 ). Ostomy surgeries are generally performed to divert feces or urine from the body due to several systemic diseases that result in a need for specialized nursing interventions to promote maximum patient outcomes (Alenezi A, Kimpton A, McGrath I, and Livesay K., 2022 ). Nurses play a very important role in the education of patients regarding ostomy management, thereby increasing their potential to adjust to changes in lifestyle and also in the prevention of complications such as skin irritation or infection (Abd El-Rahman et al, 2020 ). The integration of knowledge, attitude, and practice regarding ostomy care is essential for surgical nurses in view of recent studies showing gaps in confidence and education in wound management (Adee et al, 2020 ). As surgical nursing moves forward, it becomes very critical to have constant training and support for the nurses in ostomy care, enforcing the need for an all-inclusive approach that covers both clinical and emotional care aspects for the patient in this specialty area (Adee et al, 2020 ). The surgical nurse needs to understand the importance of ostomy care as this may directly affect the patient's outcome and quality of life (Naseh L, Shahriari M, and Hayrabedian A, Moeini M, 2023). Knowledge in this area covers the appropriate process of stoma management, skin protection, and patient education regarding ostomy supplies. A step-by-step approach in teaching helps these nurses develop the necessary skills to cope with the demands of different types of ostomies, thus paving the way to better self-care among patients (Ahmed & Khalid, 2010 ). For example, educational interventions aimed at nursing staff have been shown to enhance their competence in ostomy care significantly and, in turn, impact the patient's potential to adhere to self-management (Alenezi A et al., 2022 ). In addition, the lack of standardized guidelines, noted in various studies, has brought out the need for focused education and continued support of nursing professionals, bringing into light that complete ostomy care is teamwork between health professionals and families (Woo BFY, Goh YS, and Zhou W., 2022). The evaluation of the knowledge of surgical nurses in ostomy management is very important for the delivery of quality care to patients and for the improvement of clinical outcomes. According to some studies, inadequate knowledge may lead to complications in ostomy care and negatively affect patients' quality of life (Dincer M and Çıtlak G., 2019 ). While surgical nurses are usually in the forefront of patient education, most nurses reportedly feel unprepared to effectively manage ostomies because of lack of training and resources (Dalmolin A et al., 2020 ) (Danielsen et al, 2013 ). Knowledge includes areas of assessment in recognizing ostomy types, care techniques, and strategies on how to educate patients (Danielsen AK, Burcharth J, and Rosenberg J., 2013) (Ketelaers et al. 2023 ). It is also important to increase the competencies of nurses in ostomy management, as this would directly affect not only clinical practice but also the attitudes and confidence of nurses when caring for patients with ostomies (Wen X, Wang F, Li X, and Gu H., 2021 ). Systemic review and closure of gaps in knowledge by healthcare institutions may cultivate a culture of continuous improvement that will eventually benefit patient outcomes in ostomy care (Brown H et al., 2004 ). The understanding of the attitudes toward ostomy care among surgical nurses is very instrumental in enhancing patient outcomes in post-operative management (Kedir S, Gebremariam T, and Assefa B., 2021 ). Positive attitudes greatly affect the quality of care received by patients with ostomies, since nurses play a vital role in education, emotional support, and physical care (Clendon J, and Walker L., 2012 ) (Jayarajah & Samarasekera, 2017 ). It is evidenced in research that a sound knowledge base goes hand in hand with positive attitudes nurses who are better informed about ostomy procedures and care techniques are found to express more confidence and empathy when interacting with patients (Woo BFY et al., 2022 ). On the other hand, attitudes may change regarding experience, training, and support from the organization (Naseh L et al., 2023 ). For instance, some nurses exhibit uneasiness or even hesitancy in discussing issues related to ostomy because of lack of experience or proper training, which ultimately hampers the process of reassuring patients and impacts their healing process adversely (Khalilzadeh Ganjalikhani et al. 2019 ) (Mansour & Alenezi, 2016 ). Therefore, creating an environment that supports ongoing education and healthy interaction with ostomy care is crucial for enhancing both the attitudes of the nurses and patient satisfaction (Dalmolin A et al., 2020 ) (Ngo et al. 2023 ). The attitudes and perceptions of surgical nurses toward patients with ostomies play a very important role in the quality of care provided in clinical settings (Kedir S, Gebremariam T, and Assefa B., 2021 ). Attitudes can be understood since they influence not only the therapeutic relationship between nurses and patients but also the treatment outcome (Kedir S, Gebremariam T, and Assefa B., 2021 ). Such factors as past training, personal experiences, and familiarity with ostomy care significantly shape nurses' perceptions (Kedir S, Gebremariam T, and Assefa B., 2021 ). Many surgical nurses view ostomies as stigmatizing, which may make them reluctant to openly discuss related issues with patients, thus creating barriers to effective communication (Nieves CBL., 2017). A lack of confidence in ostomy care skills also lead to feelings of anxiety when interacting with patients, further solidifying negative views (Alenezi A et al., 2022 ). By creating an atmosphere that promotes continual learning and open discussion of ostomy care, healthcare systems can improve attitudes among surgical nurses and ultimately improve support, empowerment, and satisfaction among patients as they journey with their ostomy (Akyüz E et al., 2022 ). Methods Study Design and Setting This descriptive cross-sectional study aimed to evaluate surgical nurses' knowledge, attitudes, and practices regarding stoma care in three teaching hospitals in Colombo district, Sri Lanka. Study Population The study population included all registered nurses working in surgical specialty units in three teaching hospitals in Colombo district, Sri Lanka. All registered nurses working in surgical wards for one year or more were eligible to participate, regardless of gender. Nurses on maternity or medical leave during the data collection period were excluded. Sample Size and Sampling Technique The required sample size was calculated using Daniel’s formula (1999), yielding a total of 422 participants after accounting for a 10% non-response rate. A simple random sampling technique was employed. All eligible nurses were listed and assigned numbers, and participants were selected using a random number table. Data Collection Techniques and Tools Data was collected using a pre-tested, self-administered questionnaire designed by the researchers. The questionnaire comprised four sections: Section A comprised Sociodemographic details, including age, gender, marital status, hospital of employment, education level, and work experience. Section B was dedicated to obtaining Knowledge about stoma care, assessed through 14 questions. Section C evaluated the Practices related to stoma care, measured using multiple-choice questions. The final section was utilized to obtain nurses’ Attitudes toward stoma care, assessed through 17 statements rated on a 5-point Likert scale. The questionnaire underwent a thorough validation process to ensure its effectiveness and reliability. Content validity was established through a detailed review by an expert panel, ensuring the tool's alignment with the study objectives. To confirm face validity, the questionnaire was piloted with 15 nurses from the target population. Their feedback was incorporated to enhance clarity and relevance, making the questions more practical and user-friendly. Reliability was assessed using Cronbach’s alpha, yielding satisfactory results; 0.712 for the knowledge section, 0.716 for the attitude section, and an excellent score of 0.871 for the practice section, indicating a high level of internal consistency across the tool. Data Analysis Collected data was carefully cleaned to address any errors or incomplete responses, ensuring accuracy and consistency. The cleaned dataset was analyzed using SPSS (version 26). Descriptive statistics, including frequencies, means, medians, and standard deviations, were used to summarize the collected data. Knowledge scores were calculated by awarding one point for each correct response, with total scores converted into percentages and categorized as good (> 75%), satisfactory (50%–75%), or poor (< 50%). To explore relationships among knowledge, attitudes, and practices (KAP), Chi-square test was employed. Findings Socio-demographic characteristics Table 1 indicates the socio-demographic characteristics of staff nurses. The majority of them belong to the 22–31 age category. Majority of staff nurses were females. Majority of them had diploma in Nursing as their highest educational qualification. The majority of them had 1–10 years working experience in clinical settings. Table 1 Socio-demographic characteristics of the participants (n = 317) Characteristics Frequency (n) Percentage (%) Age 22yrs – 31yrs 169 53.3 32yrs − 41yrs 98 30.9 42yrs – 51yrs 32 10.10 52yrs-60yrs 18 5.7 Gender Male 55 17.4 Female 254 80.1 Prefer not to say 08 2.5 Education level Diploma in Nursing 205 64.7 BSc. In Nursing 104 32.8 Postgraduate 6 1.9 Masters, 2 0.6 Working experience 20 years 18 5.7 Knowledge, attitude, and practice toward ostomy care The mean scores for knowledge, attitudes, and practices regarding ostomy care are presented in Table 2 . The mean knowledge score was 73.27 (± 13.79) with a range of 0–100. Attitudes toward ostomy care showed a mean score of 67.95 (± 6.31), ranging from 17 to 85. The practice score had a mean of 65.82 (± 20.04) and ranged from 0–100. Table 2 Knowledge, attitude, and practice toward ostomy care Variable Mean (SD) Range Knowledge score 73.27 (± 13.79) 00 -100 Attitude score 67.95 (± 6.31) 17–85 Practice score 65.82 (± 20.04) 00–100 Factors associated with Knowledge, attitude, and practice toward ostomy care Table 3 indicates the association between the socio-demographic characteristics with knowledge, attitude and practice respectively. There is a relationship between mean value of knowledge, practice and attitude score of staff nurses towards intestinal stoma care with the age group of staff nurses. Also, there is a relationship between gender and mean value of attitude score of staff nurses. There is a relationship between the participation for courses related to the ostomy care with the mean value of practice score. There is a relationship between mean value of knowledge, practice and attitude score of staff nurses towards intestinal stoma care with the participation of in-service programs related to the intestinal stoma care by staff nurses. There is a relationship between having ostomy care guidelines in the ward and mean value of attitude score of staff nurses. score. Also, there is a relationship between the knowledge regarding the scientific literature on ostomy care and mean value of knowledge score of staff nurses. Table 3 Factors associated with Knowledge, attitude, and practice toward ostomy care Item Knowledge Attitude Practice Age Mean p Mean p Mean p 22yrs – 31yrs 72.02 ± 14.40 0.024 67.55 ± 7.16 0.420 60.78 ± 20.59 0.000* 32yrs − 41yrs 72.95 ± 12.94 68.21 ± 5.57 69.27 ± 17.89 42yrs – 51yrs 76.56 ± 14.08 68.03± 4.57 73.61 ± 20.10 52yrs-60yrs 81.34 ± 8.53 70.05 ± 3.87 80.24 ± 8.98 Gender Male 73.37 ± 15.27 0.851 65.45 ± 6.83 0.005 66.06 ± 22.36 0.868 Female 73.34 ± 13.53 68.46 ± 6.13 65.66 ± 19.52 Education level Diploma in Nursing 73.27 ± 13.54 0.808 68.28 ± 6.00 0.404 65.96 ± 19.95 0.422 BSc. In Nursing 72.93 ± 14.61 67.19 ± 6.94 65.04 ± 20.27 Postgraduate 78.57 ± 7.82 70.33 ± 4.22 77.77 ± 1.00 Masters or higher 75.00 ± 15.15 67.50 ± 9.19 55.55 ± 47.14 Working experience 20 years 76.27 ± 15.49 69.00 ± 5.04 72.83 ± 20.24 Ever had a course on ostomy care No 72.41 ± 14.19 0.254 68.43 ± 6.47 0.587 61.99 ± 19.99 0.000* Yes 74.52 ± 13.14 67.26 ± 6.03 71.40 ± 18.82 Ever participate in an in-service program for ostomy care No 71.65 ± 13.88 0.035 68.70 ± 6.25 0.035 62.33 ± 19.24 0.002* Yes 74.90 ± 13.55 67.020 ± 6.31 69.33 ± 20.27 Do you have ostomy care guidelines in your ward? No 72.08 ± 13.53 0.201 69.36 ± 5.62 0.001 64.95 ± 18.79 0.521 Yes 74.10 ± 13.95 66.97 ± 6.59 66.42 ± 20.89 Ever read scientific literature on ostomy care No 71.12 ± 14.71 0.014 68.35 ± 6.34 0.320 63.54 ± 19.84 0.074 Yes 74.95 ± 12.82 67.64 ± 6.29 67.60 ± 20.07 Discussion The current study investigated the knowledge, attitude, practice, and the associated factors toward ostomy care among surgical ward nurses regarding ostomy care. The predominance of young nurses aged 22–31 years (53.3%) aligns with global nursing workforce trends, where younger cohorts are increasingly entering the profession[16]. The significant female representation (80.1%) reflects the traditional gender distribution in nursing, consistent with global patterns[17]. The finding that 64.7% of nurses held a Diploma in Nursing indicates that diploma-level education remains the predominant qualification among Sri Lankan nurses. The current findings provide valuable insights into the association between knowledge and attitudes with a positive correlation between Knowledge and Attitude scores (r = 0.127, p < 0.05). Higher knowledge levels are associated with improved attitudes and practices (r = 0.520, p < 0.05), and a moderate positive correlation was noted between Attitude and Practice scores (r = 0.193, p < 0.05). The mean score for knowledge (73.27 ± 13.79) indicated a generally positive disposition among nurses towards ostomy care. However, the presence of a significant proportion of respondents with moderate levels (40.4%) and poor (5.7%) suggests that there is a need for improvement in the overall competency of nursing staff in this area. These results align with previous studies that have highlighted the critical role of education in enhancing nurses' knowledge regarding ostomy care. According to the previous literature, ostomy care training significantly improved the quality of life and reduced anxiety among patients, underscoring the importance of equipping nurses with the necessary skills, knowledge and good attitudes to support their patients effectively [20]. Similarly, another study found that structured well- educated nurses with more experiences are more likely to prioritize patient privacy and provide comprehensive care for ostomy patients, which is essential for fostering a supportive environment Akyüz et al. [19]. In contrast with current findings Kedir et al. [21] identified only 45.6% of nurses had good knowledge regarding ostomy care in Ethiopia. When compared to Ethiopia, nurses in the current setting have a good knowledge. Despite the generally positive findings, the study also highlights areas of concern. A notable percentage of nurses exhibited poor knowledge and practical skills, which contrast with the findings of a study by Ketelaers et al. [22] found that lack of education and training programs for nurses contribute to gaps in knowledge and practice, which can adversely affect patient care. Furthermore, according to the previous literature of Alenezi et al. [2] indicateded that nurses who have specialized training in ostomy care reported higher confidence levels in their knowledge, skills and attitudes, improving the need for targeted educational interventions. The analysis of knowledge, practice and attitude levels among surgical nurses regarding ostomy care reveals significant associations with various socio-demographic characteristics. The current findings indicate that age, participation in specialized in-training programs, having ostomy care guidelines in the ward, and reading scientific papers related to ostomy care significantly influence knowledge level. A statistically significant association was found between age and knowledge, with participants aged 52–60 years scoring significantly higher in Knowledge (p = 0.024), while Practice scores were significantly higher in participants aged 32–41 years, 42–51 years, and 52–60 years (p < 0.001). Gender differences were observed in Attitude, where females scored significantly higher than males (p = 0.005). Participation in an in-service program for ostomy care was significantly associated with improved Knowledge (p = 0.035), Attitude (p = 0.035), and Practice (p = 0.002) scores. Additionally, reading the scientific literature on ostomy care was linked to higher Knowledge scores (p = 0.014). This suggests that younger nurses may be more up-to-updated with current practices, possibly due to recent training or exposure to education programs. Conversely, older nurses might not have had equivalent opportunities to update their knowledge, emphasizing the need for targeted interventions for experienced staff. Previous studies have mentioned that healthcare professionals who actively engage with scientific literature tend to have better knowledge scores, as they are more informed about the latest practices and guidelines [24]. This suggests that fostering a culture of continuous learning and encouraging nurses to stay updated with current research can significantly enhance their knowledge and capabilities. Conclusions Based on the results, this study underscores the generally satisfactory knowledge level of surgical nurses regarding ostomy care, with a majority demonstrating high knowledge, moderate level of practice and good attitude towards ostomy care. Nurses aged 32–41 years showed a significantly good level of practice. Younger nurses, participation in in-service training programs, access to ostomy care guidelines, and engagement with scientific literature were significantly associated with higher knowledge levels. These findings highlight the critical role of targeted educational interventions and continuous professional development to enhance knowledge, skills and attitudes. In addition, the study emphasizes the importance of providing accessible workplace resources, such as ostomy care guidelines, and fostering a culture of self-directed learning to bridge knowledge gaps. Addressing these factors is essential to ensure nurses are well-prepared to deliver high-quality, evidence-based care for ostomy patients, ultimately improving patient outcomes and the overall standard of care. Abbreviations SPSS - Statistical Package for Social Sciences BSc - Bachelor of Science Declarations Ethics approval and consent to participate Ethics approval for this study was conducted by the Ethics review committee of the research department at the Faculty of Medicine, University of Colombo (EC24021). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality and provided written consent prior to participation. Participation was voluntary and respondents could withdraw at any time without consequence. Consent for publication Not applicable Availability of data and materials The SPSS coded data set was uploaded as a supplementary document. Competing interests The authors declared no competing interest. Funding The current study is self-funded and did not receive any funding support Authors' contributions UHTU was responsible for the study's conceptualization, project administration, and methodology. UHTU was involved in the study's implementation and data collection processes. UHTU conducted the formal analysis, interpreted the findings, and authored the initial draft of the manuscript. UHTU revised the manuscript, ensured its organization, and contributed to refining its content. All authors reviewed the manuscript thoroughly and provided their approval for the final version, ensuring its accuracy and quality. Acknowledgments We extend our heartfelt gratitude to the Dean of the Faculty of Nursing, University of Colombo, for granting permission to conduct this study. Additionally, we sincerely thank the administration of the selected hospital and the nursing officers for their support and cooperation. References Abd El-Rahman W, Mekkawy M, sayed samia, Ayoub M. Effect of Nursing Instructions on Self Care for Colostomy Patients. Assiut Sci Nurs J. 2020;8:96–105. Adee et al. Stoma care: procedures, appliences and nursing considerations. BNJ. 2020;29(22). Ahmad Q, Saeed M, Muneera M, Ahmed M, Khalid K. indications and complications of intestinal stomas – a tertiary care hospital experience. Biomedica. 2010;26. Ahmed MS, Khalid K. INDICATIONS AND COMPLICATIONS OF INTESTINAL STOMAS – A TERTIARY CARE HOSPITAL EXPERIENCE. 2010;26:144–7. Akyüz E, Erdemir F, Uğurlu Z, Üstündağ Ç. Perceptions and Experiences of Privacy Among Persons With an Ostomy Receiving Treatment and Care. J Wound Ostomy Cont Nurs. 2022;49:455–61. Alenezi A, Kimpton A, McGrath I, Livesay K. Confidence, skills and barriers to ostomy patient care by nursing staff in Saudi Arabia. Nurs Forum (Auckl). 2022;57:403–11. Brown H, Nurse S, Centre QM, Randle J. Living with a stoma: a review of the literature. 2004. Clendon J, Walker L. Being young’: a qualitative study of younger nurses’ experiences in the workplace. Int Nurs Rev. 2012;59:555–61. Dalmolin A, Girardon-Perlini NMO, Beuter M, Gomes E da, Moraes S, Niestsche JT. EA. Knowledge and practices of nursing professionals in caring for ostomates. Rev Bras Enferm. 2020;73. Danielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Colorectal Dis. 2013;15. Dincer M, Çıtlak G. Indications and Complications of Stoma Formations in Emergency Surgery. 2019;04:139–42. Jayarajah U, Samarasekera DN. RESEARCH ARTICLE A cross - sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia. BMC Res Notes. 2017;4–11. Kedir S, Gebremariam T, Assefa B. Knowledge and Attitude Toward Ostomy Care and its Associated Factors Among Nurses Working in Southeast Oromia Governmental Hospitals, Ethiopia, 2021: An Institutional Based Cross-Sectional Study. SSRN Electron J. 2021. Ketelaers SHJ, van Ham N, van Pelt KAAJ, Timmers T, Nieuwenhuijzen GAP, Rutten HJT, et al. The development and implementation of an interactive application for new ostomy patients. Colorectal Dis. 2023;25:1228–37. Khalilzadeh Ganjalikhani M, Tirgari B, Roudi Rashtabadi O, Shahesmaeili A. Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy. Int Wound J. 2019;16:1383–90. Kim DH, Lee K-H. Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study. Front Surg. 2023;10. Mansour EA, Alenezi AN. Impact of Stoma Care Education in Minimizing the Incidence of Stoma Skin Complications. Bahrain Med Bull. 2016;38:151–3. Naseh L, Shahriari M, Hayrabedian A, Moeini M. Nurses’ viewpoints on factors affecting ostomy care: A qualitative content analysis. Nurs Open. 2023;10:5261–70. Ngo TD, Hawks M, Nguyen TTT, Nguyen TNH, Nguyen HT, Mai NTT. Self-care knowledge in patients with intestinal stomas in a selected hospital in the south of Viet Nam: A descriptive cross-sectional study. Belitung Nurs J. 2023;9:331–8. Nieves CB las, Díaz CC, Celdrán-Mañas M, Morales-Asencio JM, Hernández-Zambrano SM, Hueso-Montoro C. Ostomy patients’ perception of the health care received. Rev Lat Am Enfermagem. 2017;25. Wen X, Wang F, Li X, Gu H. Study on the Knowledge, Attitude, and Practice (KAP) of Nursing Staff and Influencing Factors on COVID-19. Front Public Health. 2021;8. Woo BFY, Goh YS, Zhou W. Understanding the gender gap in advanced practice nursing: A qualitative study. J Nurs Manag. 2022;30:4480–90. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Apr, 2026 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 17 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers invited by journal 13 Nov, 2025 Editor assigned by journal 10 Nov, 2025 Submission checks completed at journal 08 Nov, 2025 First submitted to journal 08 Nov, 2025 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-7917966","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549329097,"identity":"11409cf8-d728-40ae-912a-7839fa4b22a4","order_by":0,"name":"Ulluvis Hewage Tharushi Uthpala","email":"data:image/png;base64,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","orcid":"","institution":"University of Colombo","correspondingAuthor":true,"prefix":"","firstName":"Ulluvis","middleName":"Hewage Tharushi","lastName":"Uthpala","suffix":""}],"badges":[],"createdAt":"2025-10-22 08:13:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7917966/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7917966/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-026-04675-z","type":"published","date":"2026-04-22T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96710039,"identity":"a6d97175-60cb-4968-a6eb-d35e846be110","added_by":"auto","created_at":"2025-11-25 10:09:57","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97009,"visible":true,"origin":"","legend":"","description":"","filename":"Mnauscriptv2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/2e0da344a7a64b19886a3963.docx"},{"id":96708672,"identity":"75ab71b9-7030-4097-9765-dbe4ef93cce0","added_by":"auto","created_at":"2025-11-25 10:05:02","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4808,"visible":true,"origin":"","legend":"","description":"","filename":"295b4828e9a34af4948c32ff21fb6a9b.json","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/0e21c8fc227eb699f3af7f3e.json"},{"id":96623279,"identity":"eeb0a2c7-d9c4-48ae-92ef-e1f162c933e8","added_by":"auto","created_at":"2025-11-24 11:09:22","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79914,"visible":true,"origin":"","legend":"","description":"","filename":"295b4828e9a34af4948c32ff21fb6a9b1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/44267ffef9b54c1ef51b1131.xml"},{"id":96623278,"identity":"266e995d-f2ac-4f0f-b8f1-46c772058392","added_by":"auto","created_at":"2025-11-24 11:09:22","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76563,"visible":true,"origin":"","legend":"","description":"","filename":"295b4828e9a34af4948c32ff21fb6a9b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/6e42ee8621a55a7bde7927c5.xml"},{"id":96623275,"identity":"4f7947eb-23a3-4927-8a47-eec333314b0a","added_by":"auto","created_at":"2025-11-24 11:09:22","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83818,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/718827af1e03e6d75326b138.html"},{"id":107929108,"identity":"8cc7b875-880c-4949-8f48-20f303eef1ae","added_by":"auto","created_at":"2026-04-27 16:13:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":341369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7917966/v1/804777b9-9b21-417e-9a41-5a4ab28b48d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitude, Practice, and Associated Factors toward Ostomy Care among Surgical Nurses","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe nursing field, particularly within surgical specialties, demands a nuanced understanding of diverse patient care aspects, including the management of ostomies (Kim \u0026amp; Lee \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) Ostomy care represents a vital component of postoperative recovery (Ahmad Q, et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). As surgical nurses play a pivotal role in facilitating patient adaptation to ostomies; their knowledge, attitudes, and practices significantly impact patient outcomes and quality of life (Alenezi A, Kimpton A, McGrath I, and Livesay K., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOstomy surgeries are generally performed to divert feces or urine from the body due to several systemic diseases that result in a need for specialized nursing interventions to promote maximum patient outcomes (Alenezi A, Kimpton A, McGrath I, and Livesay K., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Nurses play a very important role in the education of patients regarding ostomy management, thereby increasing their potential to adjust to changes in lifestyle and also in the prevention of complications such as skin irritation or infection (Abd El-Rahman et al, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The integration of knowledge, attitude, and practice regarding ostomy care is essential for surgical nurses in view of recent studies showing gaps in confidence and education in wound management (Adee et al, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As surgical nursing moves forward, it becomes very critical to have constant training and support for the nurses in ostomy care, enforcing the need for an all-inclusive approach that covers both clinical and emotional care aspects for the patient in this specialty area (Adee et al, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe surgical nurse needs to understand the importance of ostomy care as this may directly affect the patient's outcome and quality of life (Naseh L, Shahriari M, and Hayrabedian A, Moeini M, 2023). Knowledge in this area covers the appropriate process of stoma management, skin protection, and patient education regarding ostomy supplies. A step-by-step approach in teaching helps these nurses develop the necessary skills to cope with the demands of different types of ostomies, thus paving the way to better self-care among patients (Ahmed \u0026amp; Khalid, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). For example, educational interventions aimed at nursing staff have been shown to enhance their competence in ostomy care significantly and, in turn, impact the patient's potential to adhere to self-management (Alenezi A et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In addition, the lack of standardized guidelines, noted in various studies, has brought out the need for focused education and continued support of nursing professionals, bringing into light that complete ostomy care is teamwork between health professionals and families (Woo BFY, Goh YS, and Zhou W., 2022).\u003c/p\u003e\u003cp\u003eThe evaluation of the knowledge of surgical nurses in ostomy management is very important for the delivery of quality care to patients and for the improvement of clinical outcomes. According to some studies, inadequate knowledge may lead to complications in ostomy care and negatively affect patients' quality of life (Dincer M and \u0026Ccedil;ıtlak G., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). While surgical nurses are usually in the forefront of patient education, most nurses reportedly feel unprepared to effectively manage ostomies because of lack of training and resources (Dalmolin A et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (Danielsen et al, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Knowledge includes areas of assessment in recognizing ostomy types, care techniques, and strategies on how to educate patients (Danielsen AK, Burcharth J, and Rosenberg J., 2013) (Ketelaers et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It is also important to increase the competencies of nurses in ostomy management, as this would directly affect not only clinical practice but also the attitudes and confidence of nurses when caring for patients with ostomies (Wen X, Wang F, Li X, and Gu H., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Systemic review and closure of gaps in knowledge by healthcare institutions may cultivate a culture of continuous improvement that will eventually benefit patient outcomes in ostomy care (Brown H et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe understanding of the attitudes toward ostomy care among surgical nurses is very instrumental in enhancing patient outcomes in post-operative management (Kedir S, Gebremariam T, and Assefa B., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Positive attitudes greatly affect the quality of care received by patients with ostomies, since nurses play a vital role in education, emotional support, and physical care (Clendon J, and Walker L., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) (Jayarajah \u0026amp; Samarasekera, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). It is evidenced in research that a sound knowledge base goes hand in hand with positive attitudes nurses who are better informed about ostomy procedures and care techniques are found to express more confidence and empathy when interacting with patients (Woo BFY et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). On the other hand, attitudes may change regarding experience, training, and support from the organization (Naseh L et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). For instance, some nurses exhibit uneasiness or even hesitancy in discussing issues related to ostomy because of lack of experience or proper training, which ultimately hampers the process of reassuring patients and impacts their healing process adversely (Khalilzadeh Ganjalikhani et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) (Mansour \u0026amp; Alenezi, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Therefore, creating an environment that supports ongoing education and healthy interaction with ostomy care is crucial for enhancing both the attitudes of the nurses and patient satisfaction (Dalmolin A et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (Ngo et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe attitudes and perceptions of surgical nurses toward patients with ostomies play a very important role in the quality of care provided in clinical settings (Kedir S, Gebremariam T, and Assefa B., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Attitudes can be understood since they influence not only the therapeutic relationship between nurses and patients but also the treatment outcome (Kedir S, Gebremariam T, and Assefa B., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Such factors as past training, personal experiences, and familiarity with ostomy care significantly shape nurses' perceptions (Kedir S, Gebremariam T, and Assefa B., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Many surgical nurses view ostomies as stigmatizing, which may make them reluctant to openly discuss related issues with patients, thus creating barriers to effective communication (Nieves CBL., 2017). A lack of confidence in ostomy care skills also lead to feelings of anxiety when interacting with patients, further solidifying negative views (Alenezi A et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). By creating an atmosphere that promotes continual learning and open discussion of ostomy care, healthcare systems can improve attitudes among surgical nurses and ultimately improve support, empowerment, and satisfaction among patients as they journey with their ostomy (Aky\u0026uuml;z E et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003e This descriptive cross-sectional study aimed to evaluate surgical nurses' knowledge, attitudes, and practices regarding stoma care in three teaching hospitals in Colombo district, Sri Lanka.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population included all registered nurses working in surgical specialty units in three teaching hospitals in Colombo district, Sri Lanka. All registered nurses working in surgical wards for one year or more were eligible to participate, regardless of gender. Nurses on maternity or medical leave during the data collection period were excluded.\u003c/p\u003e\n\u003ch3\u003eSample Size and Sampling Technique\u003c/h3\u003e\n\u003cp\u003e The required sample size was calculated using Daniel\u0026rsquo;s formula (1999), yielding a total of 422 participants after accounting for a 10% non-response rate. A simple random sampling technique was employed. All eligible nurses were listed and assigned numbers, and participants were selected using a random number table.\u003c/p\u003e\n\u003ch3\u003eData Collection Techniques and Tools\u003c/h3\u003e\n\u003cp\u003eData was collected using a pre-tested, self-administered questionnaire designed by the researchers. The questionnaire comprised four sections: Section A comprised Sociodemographic details, including age, gender, marital status, hospital of employment, education level, and work experience. Section B was dedicated to obtaining Knowledge about stoma care, assessed through 14 questions. Section C evaluated the Practices related to stoma care, measured using multiple-choice questions. The final section was utilized to obtain nurses\u0026rsquo; Attitudes toward stoma care, assessed through 17 statements rated on a 5-point Likert scale.\u003c/p\u003e\u003cp\u003eThe questionnaire underwent a thorough validation process to ensure its effectiveness and reliability. Content validity was established through a detailed review by an expert panel, ensuring the tool's alignment with the study objectives. To confirm face validity, the questionnaire was piloted with 15 nurses from the target population. Their feedback was incorporated to enhance clarity and relevance, making the questions more practical and user-friendly. Reliability was assessed using Cronbach\u0026rsquo;s alpha, yielding satisfactory results; 0.712 for the knowledge section, 0.716 for the attitude section, and an excellent score of 0.871 for the practice section, indicating a high level of internal consistency across the tool.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eCollected data was carefully cleaned to address any errors or incomplete responses, ensuring accuracy and consistency. The cleaned dataset was analyzed using SPSS (version 26).\u003c/p\u003e\u003cp\u003eDescriptive statistics, including frequencies, means, medians, and standard deviations, were used to summarize the collected data. Knowledge scores were calculated by awarding one point for each correct response, with total scores converted into percentages and categorized as good (\u0026gt;\u0026thinsp;75%), satisfactory (50%\u0026ndash;75%), or poor (\u0026lt;\u0026thinsp;50%). To explore relationships among knowledge, attitudes, and practices (KAP), Chi-square test was employed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eFindings\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e indicates the socio-demographic characteristics of staff nurses. The majority of them belong to the 22\u0026ndash;31 age category. Majority of staff nurses were females. Majority of them had diploma in Nursing as their highest educational qualification. The majority of them had 1\u0026ndash;10 years working experience in clinical settings.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;317)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\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\u003e22yrs \u0026ndash; 31yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32yrs \u0026minus;\u0026thinsp;41yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e42yrs \u0026ndash; 51yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e52yrs-60yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\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\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to say\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\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 in Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBSc. In Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMasters,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking 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;1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eKnowledge, attitude, and practice toward ostomy care\u003c/h3\u003e\n\u003cp\u003eThe mean scores for knowledge, attitudes, and practices regarding ostomy care are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean knowledge score was 73.27 (\u0026plusmn;\u0026thinsp;13.79) with a range of 0\u0026ndash;100. Attitudes toward ostomy care showed a mean score of 67.95 (\u0026plusmn;\u0026thinsp;6.31), ranging from 17 to 85. The practice score had a mean of 65.82 (\u0026plusmn;\u0026thinsp;20.04) and ranged from 0\u0026ndash;100.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge, attitude, and practice toward ostomy care\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.27 (\u0026plusmn;\u0026thinsp;13.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e00 -100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitude score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e67.95 (\u0026plusmn;\u0026thinsp;6.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u0026ndash;85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e65.82 (\u0026plusmn;\u0026thinsp;20.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e00\u0026ndash;100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with Knowledge, attitude, and practice toward ostomy care\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicates the association between the socio-demographic characteristics with knowledge, attitude and practice respectively. There is a relationship between mean value of knowledge, practice and attitude score of staff nurses towards intestinal stoma care with the age group of staff nurses. Also, there is a relationship between gender and mean value of attitude score of staff nurses. There is a relationship between the participation for courses related to the ostomy care with the mean value of practice score. There is a relationship between mean value of knowledge, practice and attitude score of staff nurses towards intestinal stoma care with the participation of in-service programs related to the intestinal stoma care by staff nurses. There is a relationship between having ostomy care guidelines in the ward and mean value of attitude score of staff nurses. score. Also, there is a relationship between the knowledge regarding the scientific literature on ostomy care and mean value of knowledge score of staff nurses.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with Knowledge, attitude, and practice toward ostomy care\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ePractice\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\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\u003e22yrs \u0026ndash; 31yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.02\u0026thinsp;\u0026plusmn;\u0026thinsp;14.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.55\u0026thinsp;\u0026plusmn;\u0026thinsp;7.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e60.78\u0026thinsp;\u0026plusmn;\u0026thinsp;20.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32yrs \u0026minus;\u0026thinsp;41yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e69.27\u0026thinsp;\u0026plusmn;\u0026thinsp;17.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e42yrs \u0026ndash; 51yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e76.56\u0026thinsp;\u0026plusmn;\u0026thinsp;14.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.03\u0026plusmn;\u003c/p\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e73.61\u0026thinsp;\u0026plusmn;\u0026thinsp;20.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e52yrs-60yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e81.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e70.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e80.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.37\u0026thinsp;\u0026plusmn;\u0026thinsp;15.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e65.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e66.06\u0026thinsp;\u0026plusmn;\u0026thinsp;22.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.34\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e65.66\u0026thinsp;\u0026plusmn;\u0026thinsp;19.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma in Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e73.27\u0026thinsp;\u0026plusmn;\u0026thinsp;13.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e65.96\u0026thinsp;\u0026plusmn;\u0026thinsp;19.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBSc. In Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.93\u0026thinsp;\u0026plusmn;\u0026thinsp;14.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.19\u0026thinsp;\u0026plusmn;\u0026thinsp;6.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e65.04\u0026thinsp;\u0026plusmn;\u0026thinsp;20.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e78.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e70.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e77.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMasters or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e75.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.50\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e55.55\u0026thinsp;\u0026plusmn;\u0026thinsp;47.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking 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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e71.59\u0026thinsp;\u0026plusmn;\u0026thinsp;15.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e66.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e63.63\u0026thinsp;\u0026plusmn;\u0026thinsp;23.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e64.88\u0026thinsp;\u0026plusmn;\u0026thinsp;19.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e69.16\u0026thinsp;\u0026plusmn;\u0026thinsp;17.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e76.27\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e69.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e72.83\u0026thinsp;\u0026plusmn;\u0026thinsp;20.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver had a course on ostomy care\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.41\u0026thinsp;\u0026plusmn;\u0026thinsp;14.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.587\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e61.99\u0026thinsp;\u0026plusmn;\u0026thinsp;19.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e74.52\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.26\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e71.40\u0026thinsp;\u0026plusmn;\u0026thinsp;18.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver participate in an in-service program for ostomy care\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e71.65\u0026thinsp;\u0026plusmn;\u0026thinsp;13.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e62.33\u0026thinsp;\u0026plusmn;\u0026thinsp;19.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e74.90\u0026thinsp;\u0026plusmn;\u0026thinsp;13.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.020\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e69.33\u0026thinsp;\u0026plusmn;\u0026thinsp;20.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you have ostomy care guidelines in your ward?\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.08\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e69.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e64.95\u0026thinsp;\u0026plusmn;\u0026thinsp;18.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e74.10\u0026thinsp;\u0026plusmn;\u0026thinsp;13.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e66.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e66.42\u0026thinsp;\u0026plusmn;\u0026thinsp;20.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver read scientific literature on ostomy care\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e71.12\u0026thinsp;\u0026plusmn;\u0026thinsp;14.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e63.54\u0026thinsp;\u0026plusmn;\u0026thinsp;19.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e74.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e67.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e67.60\u0026thinsp;\u0026plusmn;\u0026thinsp;20.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study investigated the knowledge, attitude, practice, and the associated factors toward ostomy care among surgical ward nurses regarding ostomy care.\u003c/p\u003e\u003cp\u003eThe predominance of young nurses aged 22\u0026ndash;31 years (53.3%) aligns with global nursing workforce trends, where younger cohorts are increasingly entering the profession[16]. The significant female representation (80.1%) reflects the traditional gender distribution in nursing, consistent with global patterns[17]. The finding that 64.7% of nurses held a Diploma in Nursing indicates that diploma-level education remains the predominant qualification among Sri Lankan nurses.\u003c/p\u003e\u003cp\u003eThe current findings provide valuable insights into the association between knowledge and attitudes with a positive correlation between Knowledge and Attitude scores (r\u0026thinsp;=\u0026thinsp;0.127, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Higher knowledge levels are associated with improved attitudes and practices (r\u0026thinsp;=\u0026thinsp;0.520, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and a moderate positive correlation was noted between Attitude and Practice scores (r\u0026thinsp;=\u0026thinsp;0.193, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean score for knowledge (73.27\u0026thinsp;\u0026plusmn;\u0026thinsp;13.79) indicated a generally positive disposition among nurses towards ostomy care. However, the presence of a significant proportion of respondents with moderate levels (40.4%) and poor (5.7%) suggests that there is a need for improvement in the overall competency of nursing staff in this area.\u003c/p\u003e\u003cp\u003eThese results align with previous studies that have highlighted the critical role of education in enhancing nurses' knowledge regarding ostomy care. According to the previous literature, ostomy care training significantly improved the quality of life and reduced anxiety among patients, underscoring the importance of equipping nurses with the necessary skills, knowledge and good attitudes to support their patients effectively [20].\u003c/p\u003e\u003cp\u003eSimilarly, another study found that structured well- educated nurses with more experiences are more likely to prioritize patient privacy and provide comprehensive care for ostomy patients, which is essential for fostering a supportive environment Aky\u0026uuml;z et al. [19].\u003c/p\u003e\u003cp\u003eIn contrast with current findings Kedir et al. [21] identified only 45.6% of nurses had good knowledge regarding ostomy care in Ethiopia. When compared to Ethiopia, nurses in the current setting have a good knowledge. Despite the generally positive findings, the study also highlights areas of concern. A notable percentage of nurses exhibited poor knowledge and practical skills, which contrast with the findings of a study by Ketelaers et al. [22] found that lack of education and training programs for nurses contribute to gaps in knowledge and practice, which can adversely affect patient care.\u003c/p\u003e\u003cp\u003eFurthermore, according to the previous literature of Alenezi et al. [2] indicateded that nurses who have specialized training in ostomy care reported higher confidence levels in their knowledge, skills and attitudes, improving the need for targeted educational interventions.\u003c/p\u003e\u003cp\u003eThe analysis of knowledge, practice and attitude levels among surgical nurses regarding ostomy care reveals significant associations with various socio-demographic characteristics. The current findings indicate that age, participation in specialized in-training programs, having ostomy care guidelines in the ward, and reading scientific papers related to ostomy care significantly influence knowledge level.\u003c/p\u003e\u003cp\u003eA statistically significant association was found between age and knowledge, with participants aged 52\u0026ndash;60 years scoring significantly higher in Knowledge (p\u0026thinsp;=\u0026thinsp;0.024), while Practice scores were significantly higher in participants aged 32\u0026ndash;41 years, 42\u0026ndash;51 years, and 52\u0026ndash;60 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gender differences were observed in Attitude, where females scored significantly higher than males (p\u0026thinsp;=\u0026thinsp;0.005). Participation in an in-service program for ostomy care was significantly associated with improved Knowledge (p\u0026thinsp;=\u0026thinsp;0.035), Attitude (p\u0026thinsp;=\u0026thinsp;0.035), and Practice (p\u0026thinsp;=\u0026thinsp;0.002) scores. Additionally, reading the scientific literature on ostomy care was linked to higher Knowledge scores (p\u0026thinsp;=\u0026thinsp;0.014). This suggests that younger nurses may be more up-to-updated with current practices, possibly due to recent training or exposure to education programs. Conversely, older nurses might not have had equivalent opportunities to update their knowledge, emphasizing the need for targeted interventions for experienced staff.\u003c/p\u003e\u003cp\u003e Previous studies have mentioned that healthcare professionals who actively engage with scientific literature tend to have better knowledge scores, as they are more informed about the latest practices and guidelines [24]. This suggests that fostering a culture of continuous learning and encouraging nurses to stay updated with current research can significantly enhance their knowledge and capabilities.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBased on the results, this study underscores the generally satisfactory knowledge level of surgical nurses regarding ostomy care, with a majority demonstrating high knowledge, moderate level of practice and good attitude towards ostomy care. Nurses aged 32\u0026ndash;41 years showed a significantly good level of practice. Younger nurses, participation in in-service training programs, access to ostomy care guidelines, and engagement with scientific literature were significantly associated with higher knowledge levels. These findings highlight the critical role of targeted educational interventions and continuous professional development to enhance knowledge, skills and attitudes. In addition, the study emphasizes the importance of providing accessible workplace resources, such as ostomy care guidelines, and fostering a culture of self-directed learning to bridge knowledge gaps. Addressing these factors is essential to ensure nurses are well-prepared to deliver high-quality, evidence-based care for ostomy patients, ultimately improving patient outcomes and the overall standard of care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSPSS - Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eBSc - Bachelor of Science\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for this study was conducted by the Ethics review committee of the research department at the Faculty of Medicine, University of Colombo (EC24021). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality and provided written consent prior to participation. Participation was voluntary and respondents could withdraw at any time without consequence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SPSS coded data set was uploaded as a supplementary document.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no competing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study is self-funded and did not receive any funding support\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUHTU was responsible for the study\u0026apos;s conceptualization, project administration, and methodology. UHTU was involved in the study\u0026apos;s implementation and data collection processes. UHTU conducted the formal analysis, interpreted the findings, and authored the initial draft of the manuscript. UHTU revised the manuscript, ensured its organization, and contributed to refining its content. All authors reviewed the manuscript thoroughly and provided their approval for the final version, ensuring its accuracy and quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our heartfelt gratitude to the Dean of the Faculty of Nursing, University of Colombo, for granting permission to conduct this study. Additionally, we sincerely thank the administration of the selected hospital and the nursing officers for their support and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbd El-Rahman W, Mekkawy M, sayed samia, Ayoub M. Effect of Nursing Instructions on Self Care for Colostomy Patients. Assiut Sci Nurs J. 2020;8:96\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdee et al. Stoma care: procedures, appliences and nursing considerations. BNJ. 2020;29(22).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmad Q, Saeed M, Muneera M, Ahmed M, Khalid K. indications and complications of intestinal stomas \u0026ndash; a tertiary care hospital experience. Biomedica. 2010;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed MS, Khalid K. INDICATIONS AND COMPLICATIONS OF INTESTINAL STOMAS \u0026ndash; A TERTIARY CARE HOSPITAL EXPERIENCE. 2010;26:144\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAky\u0026uuml;z E, Erdemir F, Uğurlu Z, \u0026Uuml;st\u0026uuml;ndağ \u0026Ccedil;. Perceptions and Experiences of Privacy Among Persons With an Ostomy Receiving Treatment and Care. J Wound Ostomy Cont Nurs. 2022;49:455\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlenezi A, Kimpton A, McGrath I, Livesay K. Confidence, skills and barriers to ostomy patient care by nursing staff in Saudi Arabia. Nurs Forum (Auckl). 2022;57:403\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown H, Nurse S, Centre QM, Randle J. Living with a stoma: a review of the literature. 2004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClendon J, Walker L. Being young\u0026rsquo;: a qualitative study of younger nurses\u0026rsquo; experiences in the workplace. Int Nurs Rev. 2012;59:555\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalmolin A, Girardon-Perlini NMO, Beuter M, Gomes E da, Moraes S, Niestsche JT. EA. Knowledge and practices of nursing professionals in caring for ostomates. Rev Bras Enferm. 2020;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDanielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Colorectal Dis. 2013;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDincer M, \u0026Ccedil;ıtlak G. Indications and Complications of Stoma Formations in Emergency Surgery. 2019;04:139\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJayarajah U, Samarasekera DN. RESEARCH ARTICLE A cross - sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia. BMC Res Notes. 2017;4\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKedir S, Gebremariam T, Assefa B. Knowledge and Attitude Toward Ostomy Care and its Associated Factors Among Nurses Working in Southeast Oromia Governmental Hospitals, Ethiopia, 2021: An Institutional Based Cross-Sectional Study. SSRN Electron J. 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKetelaers SHJ, van Ham N, van Pelt KAAJ, Timmers T, Nieuwenhuijzen GAP, Rutten HJT, et al. The development and implementation of an interactive application for new ostomy patients. Colorectal Dis. 2023;25:1228\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhalilzadeh Ganjalikhani M, Tirgari B, Roudi Rashtabadi O, Shahesmaeili A. Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy. Int Wound J. 2019;16:1383\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim DH, Lee K-H. Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study. Front Surg. 2023;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMansour EA, Alenezi AN. Impact of Stoma Care Education in Minimizing the Incidence of Stoma Skin Complications. Bahrain Med Bull. 2016;38:151\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaseh L, Shahriari M, Hayrabedian A, Moeini M. Nurses\u0026rsquo; viewpoints on factors affecting ostomy care: A qualitative content analysis. Nurs Open. 2023;10:5261\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNgo TD, Hawks M, Nguyen TTT, Nguyen TNH, Nguyen HT, Mai NTT. Self-care knowledge in patients with intestinal stomas in a selected hospital in the south of Viet Nam: A descriptive cross-sectional study. Belitung Nurs J. 2023;9:331\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNieves CB las, D\u0026iacute;az CC, Celdr\u0026aacute;n-Ma\u0026ntilde;as M, Morales-Asencio JM, Hern\u0026aacute;ndez-Zambrano SM, Hueso-Montoro C. Ostomy patients\u0026rsquo; perception of the health care received. Rev Lat Am Enfermagem. 2017;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWen X, Wang F, Li X, Gu H. Study on the Knowledge, Attitude, and Practice (KAP) of Nursing Staff and Influencing Factors on COVID-19. Front Public Health. 2021;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoo BFY, Goh YS, Zhou W. Understanding the gender gap in advanced practice nursing: A qualitative study. J Nurs Manag. 2022;30:4480\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Attitude, Associated factors, Knowledge, Nursing education, Practice, Stoma care, Surgical nurses","lastPublishedDoi":"10.21203/rs.3.rs-7917966/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7917966/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOstomy care represents a vital component of postoperative recovery. As surgical nurses play a pivotal role in facilitating patient adaptation to ostomies; their knowledge, attitudes, and practices significantly impact patient outcomes and quality of life. Gaps in knowledge among nurses in ostomy care are not well-documented.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003e To assess knowledge, attitude, and practices and associated factors of intestinal stoma care among surgical nurses in selected teaching hospitals, Colombo district in Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive cross-sectional study was conducted among 317 surgical nurses from three teaching hospitals in Colombo district, Sri Lanka. Participants were selected using a random sampling method. Data was collected through a validated self-administered questionnaire, with knowledge and practice levels categorized as high, moderate, or poor. Attitude levels categorized as good, general, poor. Associations between knowledge, attitude and practice levels and demographic factors were analyzed using the chi-square test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean knowledge was 73.27 (\u0026plusmn;\u0026thinsp;13.79). The mean practice score was 65.82(\u0026plusmn;\u0026thinsp;20.04). The mean attitude score was 67.95 (\u0026plusmn;\u0026thinsp;6.31). Age was a notable factor, with participants aged 52\u0026ndash;60 years scoring significantly higher in Knowledge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), while practice scores were significantly higher in participants aged 32\u0026ndash;41 years, 42\u0026ndash;51 years, and 52\u0026ndash;60 years (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gender differences were observed in attitude, where females scored significantly higher than males (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). Participation in an in-service program for ostomy care was significantly associated with improved Knowledge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), Attitude (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), and Practice (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) scores. In addition, reading the scientific literature on ostomy care was linked to higher knowledge scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe study revealed a generally positive knowledge level, moderate practice level and good attitude level among surgical nurses, with areas for improvement. Targeted interventions, including structured training programs and access to updated guidelines, are essential for enhancing stoma care knowledge and practices and attitudes towards stoma care.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude, Practice, and Associated Factors toward Ostomy Care among Surgical Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 11:09:18","doi":"10.21203/rs.3.rs-7917966/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-18T04:31:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T16:39:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T05:30:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T20:07:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232992423369662391421397849225003212192","date":"2025-11-17T09:10:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83707750883451723768459425259427135993","date":"2025-11-13T15:35:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150458520964290794183913808127954105","date":"2025-11-13T15:22:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34398665442679804903811297089251493090","date":"2025-11-13T10:38:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-13T08:01:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-10T05:31:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-08T10:33:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-11-08T10:31:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"97b97cb9-674d-4353-8465-7da0cff9e1fa","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:11:20+00:00","versionOfRecord":{"articleIdentity":"rs-7917966","link":"https://doi.org/10.1186/s12912-026-04675-z","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2026-04-22 15:57:34","publishedOnDateReadable":"April 22nd, 2026"},"versionCreatedAt":"2025-11-24 11:09:18","video":"","vorDoi":"10.1186/s12912-026-04675-z","vorDoiUrl":"https://doi.org/10.1186/s12912-026-04675-z","workflowStages":[]},"version":"v1","identity":"rs-7917966","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7917966","identity":"rs-7917966","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}