Current state and influencing factors in airbag management among emergency department nurses: A multicenter study

Table 1 The general information of the survey participants, n (%)

Characteristics variables	Frequency	Characteristics variables	Frequency
Sex		Professional title
Male	53 (10.9)	Nurse	99 (20.3)
Female	434 (89.1)	Nurse practitioner	271 (55.6)
Grade of a working hospital		Chief nurse practitioner	112 (23.0)
Grade 3, Class A	256 (52.6)	Deputy chief nurse practitioner	5 (1.0)
Grade 3, Class B	134 (27.5)	Work experience in the department
Grade 2, Class A	97 (19.9)	1 yr-3 yr	107 (22.0)
Educational status		4 yr-6 yr	88 (18.1)
Specialized secondary school	5 (1.0)	7 yr-10 yr	91 (18.7)
Junior college	124 (25.5)	11 yr-15 yr	111 (22.8)
Bachelor's degree	354 (72.7)	16 yr-20 yr	59 (12.1)
Master's degree and above	4 (0.8)	More than 21 yr	31 (6.4)
Department (of work)		Participation in specialized nurse or mechanical ventilation training
Emergency resuscitation room	256 (52.6)
Emergency intensive care unit	231 (47.4)	Yes	300 (61.6)
		No	187 (38.4)

Table 2 The scores of emergency department nurses' knowledge, attitude, and practice regarding airbag management, n (%)

Project	Score (points, mean ± SD)	Standardized score (points, mean ± SD )	Grade (frequency): Poor, Fair, Good
Knowledge	57.24 ± 21.85	60.26 ± 23.00	256 (52.6)	100 (20.5)	131 (26.9)
Belief	21.28 ± 3.21	88.65 ± 13.36	3 (0.6)	118 (24.2)	366 (75.2)
Practice	56.33 ± 14.88	75.10 ± 19.84	94 (19.3)	162 (33.3)	231 (47.4)

Table 3 The three lowest-scoring items in the dimensions of knowledge, attitude, and behavior regarding airbag management among emergency department nurses

Project	Score (points, mean ± SD)
The three entries with the lowest knowledge scores
Item 5 "Understanding venous pressure on the airway wall"	2.49 ± 1.40
Item 4 "Understanding arterial pressure on the airway wall"	2.54 ± 1.41
Item 7 "Understanding factors that increase airbag pressure"	2.83 ± 1.27
The three entries with the lowest belief scores
Item 8 "Agreement with the regular assessment of airbag pressure monitoring"	2.52 ± 0.56
Item 2 "Proactive learning about artificial airway airbags management"	2.58 ± 0.52
Item 3 "Participation in airbag-related training"	2.61 ± 0.50
The three items with the lowest practical scores
Item 8 "Flushing fluid accumulation from the airbag during airway management"	3.08 ± 1.52
Item 2 "Measuring airbag pressure before and after oral care and nasogastric feeding"	3.40 ± 1.33
Item 15 "Using an airbag leak test to assess upper airway patency before extubation"	3.44 ± 1.40

Table 4 Comparison of airbag management knowledge, attitude, and practice among emergency department nurses with different characteristics

Project	Knowledge score	Test statistic	P value	Belief score	Test statistic	P value	Practical score	Test statistic	P value
Sex		-0.2912	0.772		-1.2982	0.195		0.4592	0.647
Male	56.32 ± 24.75			20.74 ± 3.38			57.32 ± 16.92
Female	57.35 ± 21.50			21.34 ± 3.18			56.21 ± 14.63
Grade of a working hospital		2.7841	0.063		2.4881	0.084		1.8201	0.163
Grade 3, Class A	55.55 ± 21.79			21.00 ± 3.25			55.96 ± 15.04
Grade 3, Class B	57.25 ± 20.43			21.42 ± 3.14			55.22 ± 15.03
Grade 2, Class A	61.68 ± 23.46			21.81 ± 3.13			58.82 ± 14.11
Educational status		2.6711	0.047		1.3661	0.253		3.1881	0.024
Specialized secondary school	53.40 ± 24.74			22.80 ± 1.79			61.40 ± 17.56
Junior college	60.80 ± 21.98			21.24 ± 3.32			59.38 ± 13.71
Bachelor's degree	55.84 ± 21.67			21.23 ± 3.19			55.09 ± 15.14
Master's degree and above	76.25 ± 14.38			24.00 ± 0.00			64.50 ± 9.68
Professional title		1.6071	0.187		2.3001	0.077		3.4081	0.018
Nurse	55.80 ± 21.77			21.47 ± 3.22			60.14 ± 13.65
Nurse practitioner	56.15 ± 21.90			20.96 ± 3.25			54.68 ± 15.54
Chief nurse Practitioner	60.79 ± 21.72			21.83 ± 3.03			56.99 ± 13.89
Deputy chief nurse practitioner	65.60 ± 19.50			22.20 ± 3.03			55.00 ± 11.34
Department		-4.4882	< 0.001		-4.5182	< 0.001		-6.9092	< 0.001
Emergency resuscitation room	53.10 ± 21.17			20.67 ± 3.36			52.14 ± 15.56
Emergency intensive care unit	61.83 ± 21.73			21.95 ± 2.90			60.97 ± 12.59
Work experience in the department		2.3291	0.042		1.4751	0.196		2.0041	0.077
1 yr-3 yr	55.31 ± 23.00			21.29 ± 3.32			58.48 ± 14.88
4 yr-6 yr	54.73 ± 21.45			20.61 ± 3.40			55.24 ± 15.09
7 yr-10 yr	54.34 ± 21.81			21.22 ± 3.06			52.57 ± 16.15
11 yr-15 yr	58.38 ± 21.16			21.32 ± 3.09			57.05 ± 13.80
16 yr-20 yr	62.95 ± 19.49			21.81 ± 3.20			58.41 ± 13.01
More than 21 yr	64.65 ± 23.35			22.06 ± 2.94			56.45 ± 13.50
Participation in specialized nurse or mechanical ventilation training		9.6352	< 0.001		5.7992	< 0.001		7.9382	< 0.001
Yes	63.87 ± 21.69			21.94 ± 2.95			60.31 ± 13.53
No	46.61 ± 17.51			20.21 ± 3.33			49.94 ± 14.76

¹F value.

²t value.

Table 5 The fitting indexes of the path analysis model

Fit indices	χ2	DF	χ2/DF	Root mean square error of approximation	Comparative fit index	Tucker-Lewis index	Standardized residual mean root
Fitted values	3291.278	1003	3.281	0.068	0.907	0.901	0.047
Reference value	—	—	1-5	< 0.08	> 0.90	> 0.90	< 0.05

DF: Degrees of freedom.

Table 6 Path analysis and hypothesis testing results

Hypothesis	Relationship between variables	Estimate	Standard error	T value	P value	Decision
H1	Knowledge: Belief	0.387	0.044	8.764	< 0.01	Accepted
H2	Knowledge: Practice	0.428	0.040	10.587	< 0.01	Accepted
H3	Belief: Practice	0.219	0.041	5.338	< 0.01	Accepted
H4	Educational status: Knowledge	-0.038	0.042	-0.884	0.376	Rejected
H5	Department: Knowledge	0.200	0.041	4.911	< 0.01	Accepted
H6	Work experience in the department: Knowledge	0.131	0.042	3.104	< 0.01	Accepted
H7	Participation in specialized nurse or mechanical ventilation training: Knowledge	0.366	0.039	9.472	< 0.01	Accepted
H8	Department: Belief	0.119	0.043	2.781	< 0.01	Accepted
H9	Participation in specialized nurse or mechanical ventilation training: Belief	0.091	0.046	1.999	< 0.05	Accepted
H10	Educational status: Practice	-0.024	0.039	-0.609	0.543	Rejected
H11	Professional title: Practice	-0.097	0.039	-2.482	< 0.05	Significant negative correlation
H12	Department: Practice	0.147	0.037	4.015	< 0.01	Accepted
H13	Participation in specialized nurse or mechanical ventilation training: Practice	0.122	0.038	3.208	< 0.01	Accepted

Table 7 Path analysis effect decomposition of factors influencing airbag management knowledge, attitude, and practice among emergency department nurses (standardized path coefficient)

Dependent variable	Independent variable	Direct effect	Overall effect ranking
Knowledge	Participation in specialized nurse or mechanical ventilation training	0.366	1
	Department	0.200	2
	Work experience in the department	0.131	3
Belief	Knowledge	0.387	1
	Department	0.119	2
	Participation in specialized nurse or mechanical ventilation training	0.091	3
Practice	Knowledge	0.428	1
	Belief	0.219	2
	Department	0.147	3
	Participation in specialized nurse or mechanical ventilation training	0.122	4
	Professional title	-0.97	5