ORIGINAL ARTICLE
‘Let’s talk about sex’ – A Knowledge, Attitudes and Practice study among Paediatric Nurses about Teen Sexual Health in Hong Kong Benjamin Hon-Kei Yip, Xiao-Tong Sheng, Vivian Wai-Yen Chan, Lilian Hiu-Lei Wong, Susanna Wai-Yee Lee and Anisha Anna Abraham
Aims and objectives. To explore the knowledge, attitudes and practices of paediatric nurses in Hong Kong towards adolescent sexual health issues. Background. In Hong Kong, teens are becoming more sexually permissive. As a result, early sexual activity, Sexually transmitted diseases (STD) and unplanned pregnancies among adolescents are increasing. Paediatric nurses are potentially excellent sexual health educators; however, studies in other countries have reported that nurses have inadequate knowledge and skills about sexual health. Little is known about the knowledge, attitudes and practices of nurses in Hong Kong related to teen sexual health. Design. This is a cross-sectional survey study. The survey was developed after an extensive literature review and partially adapted from previously validated questionnaires on nursing needs, knowledge, attitude and practice. Methods. An anonymous self-administered questionnaire in Chinese was distributed to 500 nurses in Hong Kong attending a local paediatric conference. Participants (n = 394) were recruited using convenience sampling methods. Survey data were analysed using descriptive statistics, correlation tests and logistic regression analyses. Results. The majority of nurses had a high awareness of the importance of sexual healthcare, but rarely felt knowledgeable or comfortable discussing sexual health issues with adolescents. Higher comfort level was associated with higher frequency of practice with an average adjusted odds ratios of 264. Inadequate or lack of training (394%) was the most significant barrier in providing adolescent sexual health screening and counselling. Conclusion. Nurses’ clinical practices towards adolescent’s sexual health issues were influenced by their perceived comfort level followed by their self-ranked knowledge and training experience. Further specific training on communication, counselling and general sexual health should be provided to nurses in Hong Kong.
Authors: Benjamin Hon-Kei Yip, BRBS, MS, PhD, Research Assistant Professor, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Xiao-Tong Sheng, MPH, MPH Candidate, JC School of Public Health and Primary Care, The Chinese University of Hong Kong; Vivian Wai-Yen Chan, BSc, Research Assistant, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Lilian Hiu-Lei Wong, FHKCPaed, MD, Pediatrician (private practice), Hong Kong Paediatric Foundation, Hong Kong; Susanna Wai-Yee Lee, RN, President of The Asia Pacific Paediatric Nurses Associa-
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600, doi: 10.1111/jocn.12869
What does this paper contribute to the wider global clinical community?
• Paediatric nurses’ comfort and
• •
attitudes towards teen sexual health were significantly associated with their actual clinical practice in Hong Kong. Training in teen sexual health issues should be part of routine paediatric nursing education. Further studies in Hong Kong are recommended to investigate how to apply knowledge in supporting effective clinical practices such as providing more training on sexual health through seminars, field visit or workshops.
tion, Hong Kong Paediatric Foundation, Hong Kong; Anisha Anna Abraham, MD, MPH, FAAP, Clinical Professional Consultant, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China and Associate Professor, Georgetown University Hospital, Washington, DC, USA and School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong Correspondence: Anisha Anna Abraham, Professor, 4/F, School of Public Health, Room 402, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong Kong. Telephone: + 852 2252-8462. E-mail: [email protected]
2591
BH-K Yip et al.
Relevance to clinical practice. Nurses’ comfort level was the most important factor influencing their clinical practice with teens. Further specific training should be provided to nurses in Hong Kong to improve adolescent sexual health.
Key words: adolescent health, Chinese adolescents, counselling, education, knowledge, nurse practitioners, nursing practice, paediatrics, sexual health Accepted for publication: 25 March 2015
Introduction Sexual health is a state of physical, mental and social wellbeing; and not merely the absence of disease, dysfunction or infirmity (World Health Organization (WHO) 2014). Adolescents who engage in unprotected sexual activity may have a greater likelihood of early pregnancy and sexual transmitted infections (STIs) which entail significant risks to physical and psychosocial health (Canadian Paediatric Society 2014). Therefore, it is important to provide sexual education to adolescents.
Background Majer et al. (1992) found that school nurses could play a significant role in the prevention of early pregnancy, STDs and HIV/AIDS due to their specific expertise in counselling, assessment, practical understanding and professional knowledge of sexual health. Paediatric nurses are potentially excellent sexual health educators, but many studies have reported that they have inadequate knowledge and skills about sexual health (Jolley 2001, Jo & Mullan 2006). In fact, many nurses do not believe they are sufficiently knowledgeable to provide sexual education (Shuman & Bohachick 1987), and are poorly trained to have sexual health discussions (Haboubi & Lincoln 2003). Other barriers for nurses include failure to make time to discuss patients’ sexuality concerns, and lack of resources and support in delivering sexual health-related care (Jolley 2001, Glasier et al. 2006, Magnan & Reynolds 2006). In Hong Kong, teens are becoming more sexually permissive and liberated, and sexual activity, STDs and unplanned pregnancies among teenagers are increasing. The rates of reported sexual activity among adolescents have increased over the last 10 years (FPAHK 2007, 2012). For instance, from 2001–2006 the rate of junior high or high school boys who experienced sexual intercourse increased from 87% to 132, an increase in more than 50% (FPAHK 2007). The Family Planning Association is the only organisation providing comprehensive data on adolescent sexual health in Hong
2592
Kong (FPAHK 2008, 2014). In the Family Planning Association of Hong Kong (FPAHK) Youth Sexuality Study in 2011, approximately 50% of surveyed young women in Hong Kong had an abortion, and 600% had experienced their first abortion below 21 years of age (FPAHK 2012). A retrospective study also indicated that approximately two-thirds of women in Hong Kong used emergency contraception with last sexual activity. (Lo and Ho 2012). Overall, there has been a growing demand for sex education among young people in Hong Kong (FPAHK 2014). Also, there is a lack of a coordinated effort from healthcare professionals to provide education in Hong Kong (Ho 1993, Kong et al. 2009). Nurses are often considered first-line health advocates and educators for teens in Hong Kong. In fact, adolescent health is part of the required core training for paediatric nurses in Hong Kong and nurses also receive some ongoing education on sexual health issues in their workplaces and through professional organisations. Previous study has shown that health training for local nursing students’ KAP in providing sexual and reproductive health was inadequate (Kong et al. 2009). However, little recent information on whether the training is adequate and what is the actual knowledge, attitudes and practices of nurses in Hong Kong related to teen sexual health. The primary objective of this study was to determine the knowledge, attitudes and practices of paediatric nurses regarding teen sexual health in an Asian country such as Hong Kong which is likely to have more stigma and barriers to the discussion of sexual health compared to more western countries where previous studies have been published. The second objective of the study was to identify the relationships between associated factors and nurses’ clinical practices. Three hypotheses were tested: (1) Nurses’ sociodemographic characteristics were significantly associated with their clinical practices related to teen sexual health. (2) Nurses’ knowledge was significantly associated with their clinical practices related to teen sexual health. (3) Nurses’ attitude was significantly associated with their clinical practices related to teen sexual health. The findings of © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600
Original article
this study could provide potential strategies to enhance nurses’ sexual health-related counselling, and probably lead to an improvement in adolescent sexual health in Hong Kong.
Materials and methods Overview of design The design was a cross-sectional survey of knowledge, attitudes and practices (KAP) on eight sexual health domains: contraception, STD’s, teenage pregnancy, lesbian/gay/bisexual/transgender (LGBT) issue, sexual abuse, general sex education, counselling on sexual issues and Human papilloma virus (HPV) vaccine. The target population were all actively registered paediatric nurses in Hong Kong.
Study instrument A self-administered anonymous questionnaire was developed to address the research questions. The design was based on an extensive literature review and partially adapted from previously published US survey involving nursing needs assessments and nursing knowledge, attitudes and practices (Blum & Bearinger 1990). The Chinese version of the survey was reviewed by two healthcare providers fluent in Chinese and English for content and clarity and piloted on a small group of nurses prior to administration. The questionnaire was comprised of four sections. Section I involved socio-demographic information including age group, gender, marital status, preparation of educational materials and certification, years of experience with adolescent populations, work settings and previous training on adolescent health and sexual health issues. Section II comprised a knowledge assessment with 20 questions (approximately three questions in each of the eight sexual health domains). The maximum score for the knowledge assessment was 20. Section III included attitude measures related to selfranked knowledge, perceived comfort and importance level, as well as information regarding the most appropriate sexual education providers for teen sexual health. Section IV consisted of nurses’ actual practices, barriers in practice, possible learning areas, as well as, preferred training formats.
Sample size calculation The aim of the survey was to detect a correlation of 015. Using a two-sided test, 5% significance level test, © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600
HK paediatric nurses KAP: youth sex education
(a = 005) with power of 80% the required sample was calculated at 347.
Data collection The data were collected by research investigators using a convenience sampling approach at a one day long local paediatric conference with an estimated attendance of 500 paediatric nurses in July, 2011. A trained professional explained the aim of the self-administered anonymous questionnaire to the conference attendees prior to the start of the study. No money or financial incentive was given to the surveyed participants. The questionnaire took approximately 15 minutes to fill out. Participants returned the completed surveys to designated collection boxes at the conference site. The response rate was approximately 788% (n = 394). Given the sample size of 394 with an estimated target population of 1300 and setting the response distribution of the practices to be 500% as the most conservative assumption, the margin of error was calculated to be 42% with a 95% confidence level (CI).
Measurements Nurses’ knowledge level were assessed by questions on contraception, STDs, teenage pregnancy, sexual abuse and general sexual education. The score ranged from 0–20. Nurses’ attitude on the eight sexual health domains was assessed by three self-reported questions: self-ranked knowledge, perceived importance and comfort level. Three levels of knowledge (low, medium or high) were used to indicate nurses’ response to the attitude questions. Actual clinical practice was defined as nurses’ self-reported frequency (never, seldom, sometimes and very often) of sexual health discussion with patients.
Data analysis Spearman correlation test and regression analysis were conducted for each sexual health domain. The Spearman correlation test was conducted to identify the correlation of all the potential pairs of knowledge, attitudes and practices. Logistic regression was applied to identify important predictors (i.e. socio-demographic characteristics, knowledge and attitudes) of practices (high frequency vs. low frequency) by using stepwise approach. The total knowledge score was used as there was no knowledge sub-score for LGBT, consultations and HPV vaccine. All statistical tests were two-sided at 95% CI based on the overall model fitting. Odds ratios (OR) were calibrated by the estimated regression coefficient.
2593
BH-K Yip et al.
ence number: 096-11), the Chinese University of Hong Kong (CUHK), in June 2011.
Ethical approval Ethical approval was obtained from the Survey and Behavioural Research Ethics Committee (SBREC) (Refer-
Results Socio-demographic characteristics
Table 1 Characteristics of the study respondents (n = 394) Socio-demographic characteristics Gender Male Female Marital status Single Married Separated Divorced Age group ≤25 26–35 36–45 46–55 ≥56 Highest educational degree Certificate Diploma Baccalaureate Postgraduate diploma Master Years since completion highest degree of training 1–5 years 6–10 years 11–15 years 16–20 years 21+ years Years of experience working with adolescents 1–5 years 6–10 years 11–15 years 16–20 years 21 + years Percentage of time working with adolescents 50% Work settings Private hospital Hospital Authority Department of Health School Setting (including University/institution) NGOs Previous training in adolescent health No Yes
n
%*
7 386
18 980
152 222 2 6
386 563 05 15
40 82 125 113 18
102 208 317 287 46
58 57 209 13 57
147 145 530 33 145
130 83 76 37 66
330 211 193 94 168
124 53 88 76 48
315 135 223 193 122
206 58 60 64
523 147 152 162
3 219 163 5 4
08 556 414 13 10
334 57
848 145
*Total percentages may not add up to 100% due to missing data.
2594
In this study, a total of 394 questionnaires were collected (response rate 788%). As shown in Table 1, most of the nurses were female (980%) and married (563%). Only 102% of them were 25 years old or below and more than half (650%) were above 36 years old. The majority (703%) had a baccalaureate or higher degree of education. The years since their completion of highest degree of training were equally distributed. One-third of respondents had
‘Let’s talk about sex’ – A Knowledge, Attitudes and Practice study among Paediatric Nurses about Teen Sexual Health in Hong Kong Benjamin Hon-Kei Yip, Xiao-Tong Sheng, Vivian Wai-Yen Chan, Lilian Hiu-Lei Wong, Susanna Wai-Yee Lee and Anisha Anna Abraham
Aims and objectives. To explore the knowledge, attitudes and practices of paediatric nurses in Hong Kong towards adolescent sexual health issues. Background. In Hong Kong, teens are becoming more sexually permissive. As a result, early sexual activity, Sexually transmitted diseases (STD) and unplanned pregnancies among adolescents are increasing. Paediatric nurses are potentially excellent sexual health educators; however, studies in other countries have reported that nurses have inadequate knowledge and skills about sexual health. Little is known about the knowledge, attitudes and practices of nurses in Hong Kong related to teen sexual health. Design. This is a cross-sectional survey study. The survey was developed after an extensive literature review and partially adapted from previously validated questionnaires on nursing needs, knowledge, attitude and practice. Methods. An anonymous self-administered questionnaire in Chinese was distributed to 500 nurses in Hong Kong attending a local paediatric conference. Participants (n = 394) were recruited using convenience sampling methods. Survey data were analysed using descriptive statistics, correlation tests and logistic regression analyses. Results. The majority of nurses had a high awareness of the importance of sexual healthcare, but rarely felt knowledgeable or comfortable discussing sexual health issues with adolescents. Higher comfort level was associated with higher frequency of practice with an average adjusted odds ratios of 264. Inadequate or lack of training (394%) was the most significant barrier in providing adolescent sexual health screening and counselling. Conclusion. Nurses’ clinical practices towards adolescent’s sexual health issues were influenced by their perceived comfort level followed by their self-ranked knowledge and training experience. Further specific training on communication, counselling and general sexual health should be provided to nurses in Hong Kong.
Authors: Benjamin Hon-Kei Yip, BRBS, MS, PhD, Research Assistant Professor, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Xiao-Tong Sheng, MPH, MPH Candidate, JC School of Public Health and Primary Care, The Chinese University of Hong Kong; Vivian Wai-Yen Chan, BSc, Research Assistant, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Lilian Hiu-Lei Wong, FHKCPaed, MD, Pediatrician (private practice), Hong Kong Paediatric Foundation, Hong Kong; Susanna Wai-Yee Lee, RN, President of The Asia Pacific Paediatric Nurses Associa-
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600, doi: 10.1111/jocn.12869
What does this paper contribute to the wider global clinical community?
• Paediatric nurses’ comfort and
• •
attitudes towards teen sexual health were significantly associated with their actual clinical practice in Hong Kong. Training in teen sexual health issues should be part of routine paediatric nursing education. Further studies in Hong Kong are recommended to investigate how to apply knowledge in supporting effective clinical practices such as providing more training on sexual health through seminars, field visit or workshops.
tion, Hong Kong Paediatric Foundation, Hong Kong; Anisha Anna Abraham, MD, MPH, FAAP, Clinical Professional Consultant, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China and Associate Professor, Georgetown University Hospital, Washington, DC, USA and School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong Correspondence: Anisha Anna Abraham, Professor, 4/F, School of Public Health, Room 402, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong Kong. Telephone: + 852 2252-8462. E-mail: [email protected]
2591
BH-K Yip et al.
Relevance to clinical practice. Nurses’ comfort level was the most important factor influencing their clinical practice with teens. Further specific training should be provided to nurses in Hong Kong to improve adolescent sexual health.
Key words: adolescent health, Chinese adolescents, counselling, education, knowledge, nurse practitioners, nursing practice, paediatrics, sexual health Accepted for publication: 25 March 2015
Introduction Sexual health is a state of physical, mental and social wellbeing; and not merely the absence of disease, dysfunction or infirmity (World Health Organization (WHO) 2014). Adolescents who engage in unprotected sexual activity may have a greater likelihood of early pregnancy and sexual transmitted infections (STIs) which entail significant risks to physical and psychosocial health (Canadian Paediatric Society 2014). Therefore, it is important to provide sexual education to adolescents.
Background Majer et al. (1992) found that school nurses could play a significant role in the prevention of early pregnancy, STDs and HIV/AIDS due to their specific expertise in counselling, assessment, practical understanding and professional knowledge of sexual health. Paediatric nurses are potentially excellent sexual health educators, but many studies have reported that they have inadequate knowledge and skills about sexual health (Jolley 2001, Jo & Mullan 2006). In fact, many nurses do not believe they are sufficiently knowledgeable to provide sexual education (Shuman & Bohachick 1987), and are poorly trained to have sexual health discussions (Haboubi & Lincoln 2003). Other barriers for nurses include failure to make time to discuss patients’ sexuality concerns, and lack of resources and support in delivering sexual health-related care (Jolley 2001, Glasier et al. 2006, Magnan & Reynolds 2006). In Hong Kong, teens are becoming more sexually permissive and liberated, and sexual activity, STDs and unplanned pregnancies among teenagers are increasing. The rates of reported sexual activity among adolescents have increased over the last 10 years (FPAHK 2007, 2012). For instance, from 2001–2006 the rate of junior high or high school boys who experienced sexual intercourse increased from 87% to 132, an increase in more than 50% (FPAHK 2007). The Family Planning Association is the only organisation providing comprehensive data on adolescent sexual health in Hong
2592
Kong (FPAHK 2008, 2014). In the Family Planning Association of Hong Kong (FPAHK) Youth Sexuality Study in 2011, approximately 50% of surveyed young women in Hong Kong had an abortion, and 600% had experienced their first abortion below 21 years of age (FPAHK 2012). A retrospective study also indicated that approximately two-thirds of women in Hong Kong used emergency contraception with last sexual activity. (Lo and Ho 2012). Overall, there has been a growing demand for sex education among young people in Hong Kong (FPAHK 2014). Also, there is a lack of a coordinated effort from healthcare professionals to provide education in Hong Kong (Ho 1993, Kong et al. 2009). Nurses are often considered first-line health advocates and educators for teens in Hong Kong. In fact, adolescent health is part of the required core training for paediatric nurses in Hong Kong and nurses also receive some ongoing education on sexual health issues in their workplaces and through professional organisations. Previous study has shown that health training for local nursing students’ KAP in providing sexual and reproductive health was inadequate (Kong et al. 2009). However, little recent information on whether the training is adequate and what is the actual knowledge, attitudes and practices of nurses in Hong Kong related to teen sexual health. The primary objective of this study was to determine the knowledge, attitudes and practices of paediatric nurses regarding teen sexual health in an Asian country such as Hong Kong which is likely to have more stigma and barriers to the discussion of sexual health compared to more western countries where previous studies have been published. The second objective of the study was to identify the relationships between associated factors and nurses’ clinical practices. Three hypotheses were tested: (1) Nurses’ sociodemographic characteristics were significantly associated with their clinical practices related to teen sexual health. (2) Nurses’ knowledge was significantly associated with their clinical practices related to teen sexual health. (3) Nurses’ attitude was significantly associated with their clinical practices related to teen sexual health. The findings of © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600
Original article
this study could provide potential strategies to enhance nurses’ sexual health-related counselling, and probably lead to an improvement in adolescent sexual health in Hong Kong.
Materials and methods Overview of design The design was a cross-sectional survey of knowledge, attitudes and practices (KAP) on eight sexual health domains: contraception, STD’s, teenage pregnancy, lesbian/gay/bisexual/transgender (LGBT) issue, sexual abuse, general sex education, counselling on sexual issues and Human papilloma virus (HPV) vaccine. The target population were all actively registered paediatric nurses in Hong Kong.
Study instrument A self-administered anonymous questionnaire was developed to address the research questions. The design was based on an extensive literature review and partially adapted from previously published US survey involving nursing needs assessments and nursing knowledge, attitudes and practices (Blum & Bearinger 1990). The Chinese version of the survey was reviewed by two healthcare providers fluent in Chinese and English for content and clarity and piloted on a small group of nurses prior to administration. The questionnaire was comprised of four sections. Section I involved socio-demographic information including age group, gender, marital status, preparation of educational materials and certification, years of experience with adolescent populations, work settings and previous training on adolescent health and sexual health issues. Section II comprised a knowledge assessment with 20 questions (approximately three questions in each of the eight sexual health domains). The maximum score for the knowledge assessment was 20. Section III included attitude measures related to selfranked knowledge, perceived comfort and importance level, as well as information regarding the most appropriate sexual education providers for teen sexual health. Section IV consisted of nurses’ actual practices, barriers in practice, possible learning areas, as well as, preferred training formats.
Sample size calculation The aim of the survey was to detect a correlation of 015. Using a two-sided test, 5% significance level test, © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2591–2600
HK paediatric nurses KAP: youth sex education
(a = 005) with power of 80% the required sample was calculated at 347.
Data collection The data were collected by research investigators using a convenience sampling approach at a one day long local paediatric conference with an estimated attendance of 500 paediatric nurses in July, 2011. A trained professional explained the aim of the self-administered anonymous questionnaire to the conference attendees prior to the start of the study. No money or financial incentive was given to the surveyed participants. The questionnaire took approximately 15 minutes to fill out. Participants returned the completed surveys to designated collection boxes at the conference site. The response rate was approximately 788% (n = 394). Given the sample size of 394 with an estimated target population of 1300 and setting the response distribution of the practices to be 500% as the most conservative assumption, the margin of error was calculated to be 42% with a 95% confidence level (CI).
Measurements Nurses’ knowledge level were assessed by questions on contraception, STDs, teenage pregnancy, sexual abuse and general sexual education. The score ranged from 0–20. Nurses’ attitude on the eight sexual health domains was assessed by three self-reported questions: self-ranked knowledge, perceived importance and comfort level. Three levels of knowledge (low, medium or high) were used to indicate nurses’ response to the attitude questions. Actual clinical practice was defined as nurses’ self-reported frequency (never, seldom, sometimes and very often) of sexual health discussion with patients.
Data analysis Spearman correlation test and regression analysis were conducted for each sexual health domain. The Spearman correlation test was conducted to identify the correlation of all the potential pairs of knowledge, attitudes and practices. Logistic regression was applied to identify important predictors (i.e. socio-demographic characteristics, knowledge and attitudes) of practices (high frequency vs. low frequency) by using stepwise approach. The total knowledge score was used as there was no knowledge sub-score for LGBT, consultations and HPV vaccine. All statistical tests were two-sided at 95% CI based on the overall model fitting. Odds ratios (OR) were calibrated by the estimated regression coefficient.
2593
BH-K Yip et al.
ence number: 096-11), the Chinese University of Hong Kong (CUHK), in June 2011.
Ethical approval Ethical approval was obtained from the Survey and Behavioural Research Ethics Committee (SBREC) (Refer-
Results Socio-demographic characteristics
Table 1 Characteristics of the study respondents (n = 394) Socio-demographic characteristics Gender Male Female Marital status Single Married Separated Divorced Age group ≤25 26–35 36–45 46–55 ≥56 Highest educational degree Certificate Diploma Baccalaureate Postgraduate diploma Master Years since completion highest degree of training 1–5 years 6–10 years 11–15 years 16–20 years 21+ years Years of experience working with adolescents 1–5 years 6–10 years 11–15 years 16–20 years 21 + years Percentage of time working with adolescents 50% Work settings Private hospital Hospital Authority Department of Health School Setting (including University/institution) NGOs Previous training in adolescent health No Yes
n
%*
7 386
18 980
152 222 2 6
386 563 05 15
40 82 125 113 18
102 208 317 287 46
58 57 209 13 57
147 145 530 33 145
130 83 76 37 66
330 211 193 94 168
124 53 88 76 48
315 135 223 193 122
206 58 60 64
523 147 152 162
3 219 163 5 4
08 556 414 13 10
334 57
848 145
*Total percentages may not add up to 100% due to missing data.
2594
In this study, a total of 394 questionnaires were collected (response rate 788%). As shown in Table 1, most of the nurses were female (980%) and married (563%). Only 102% of them were 25 years old or below and more than half (650%) were above 36 years old. The majority (703%) had a baccalaureate or higher degree of education. The years since their completion of highest degree of training were equally distributed. One-third of respondents had
