An online cross-sectional survey was conducted between March and June 2023. All study procedures were approved by the Medical Ethics Committee of Second Affiliated Hospital of Army Medical University, PLA (2022-430-01).
Instruments
This study referred to the swallowing disorder knowledge questionnaire constructed by Rhoda, and based on the evidence summary conducted by the previous research group, combined with our previous clinical qualitative interviews [9], a preliminary draft of the questionnaire was drafted. After the initial draft was produced, six experts (one chief orthopaedic physician from a tertiary hospital, two deputy chief orthopaedic nurses, two deputy chief brain surgery nurses, and one deputy chief otolaryngologist) were invited to screen and modify each entry. Experts reviewed and modified the relevance and adaptability of each knowledge item, deleting a total of 6 knowledge items, adding 5 knowledge items, and modifying 3 knowledge items, ultimately forming a survey questionnaire.
The survey questionnaire consisted of four parts as follows: (1) General information. There were 18 items, including the hospital where the nurses worked, the level of the hospital, whether it was a teaching hospital, age, sex, initial education level, highest education level, professional title, nursing years, length of service in orthopaedics, position, number of times the nurses had received swallowing disorder-related training (lectures or online), and total duration of swallowing disorder-related training. (2) Orthopaedic nurses' knowledge questionnaire on swallowing disorders after anterior cervical spine surgery. There were a total of 30 items in the questionnaire, all of which were multiple-choice questions. If the answer was correct, 1 point was given, and if the answer was incorrect or could not be judged, 0 points were given. The total score was 30 points. The higher the score, the better the knowledge mastery. Scores less than 60% of the total score (< 18 points) were considered poor, 60% to < 90% (18–27 points) were considered moderate, and 90–100% (27–30 points) were considered good. (3) Poststroke swallowing disorder nursing belief questionnaire for orthopaedic nurses. There were 8 items in total, using the Likert 5-level scoring method. "Greatly agree" was 5 points, "agree" was 4 points, “neutral”” was 3 points, “disagree” was 2 points, and "greatly disagree" was 1 point, with a total score of 5–40 points. The higher the score, the better the nurse's belief in nursing care for swallowing disorders after stroke. If the score was less than 50% of the total score (< 20 points), it was recorded as poor, 50% to < 75% (20–29 points) was recorded as moderate, and 75–100% (30–40 points) was recorded as good. (4) Neurological nurses' questionnaire on nursing behaviours for dysphagia after stroke. There were a total of 12 items, using the Likert 5-level scoring method. “always” was 5 points, "often" was 4 points, “sometimes” was 3 points, "rarely" was 2 points, and "never" was 1 point, with a total score of 0–60 points. The survey subjects were asked to answer based on their daily work situation. The higher the score, the better the nursing behaviour of nurses towards swallowing disorders after stroke. If the score was less than 50% of the total score (< 30 points), it was recorded as poor, 50% -<75% (30–45 points) was recorded as moderate, and 75% -100% (45–60 points) was recorded as good. The survey questionnaire was ultimately evaluated for content validity by 6 experts. The content validity was evaluated using a 4-point method, where 1 = irrelevant, 2 = somewhat relevant, 3 = relevant, and 4 = very relevant. The content validity index calculated using the average of all items was 0.93, indicating good content validity. The Cronbach’s α coefficient of the questionnaire was 0.897. Before distributing the survey questionnaire, 30 orthopaedic nurses were selected with a reasonable distribution of age and professional titles, and retests were conducted at 2-week intervals to assess the reliability of the retest. Pearson’s correlation coefficient was 0.827, indicating the high retest reliability of the questionnaire.
Data collection
The questionnaire survey was conducted using Questionnaire Star, and the purpose and importance of the research were described in the questionnaire description. Completion of all items was mandatory, and those nurses who had missing responses could not submit the questionnaire. Each IP address could only be submitted once to ensure the reliability of the obtained data. There was one person in charge at each of the 17 hospitals who sent the questionnaire to eligible orthopaedic nurses in this hospital through WeChat. Nurses answered through WeChat on their mobile phones, submitted the questionnaire, and researchers downloaded and collected the questionnaires from the platform. A total of 324 questionnaires were collected, with 324 valid questionnaires and a 100% effective response rate.
Statistical analysis
All data were exported from Questionnaire Star to SPSS 21.0 statistical software for logical error checking, and statistical analysis was conducted after confirming that all questionnaires were valid. The measurement data with a normal distribution and uniform variance are expressed as the means ± standard deviations (x ± s). The comparison between two groups was performed by the t test, and the comparison between multiple groups was performed by analysis of variance. The counting data are represented by frequencies, composition ratios (%), or percentages (%), and categorical variables are described as percentages and were compared using the chi-square test. Pearson correlation analysis was used to analyse the correlation between age and dysphagia nursing knowledge, attitude and behaviour scores and the correlation among nurses' dysphagia knowledge, attitude and behaviour scores. Spearman correlation analysis was used to analyse the correlation between age and neurological work years and dysphagia nursing knowledge, belief and practice scores. P < 0.05 indicated a statistically significant difference.