An integrative approach to understanding nurses' knowledge, attitudes, and practices

In contemporary healthcare systems, the quality of healthcare is one of key preconditions for patient safety and successful treatment outcomes. Perioperative nurses play an important role in ensuring a high quality and safe care practice, and the assessment of the structure, process and outcomes of their work allows for the identification of areas for improvement. The purpose of this study was to assess knowledge, attitudes and practices of perioperative nurses regarding different aspects of care quality according to Donabedian. The study was implemented as a cross-sectional study of the total available sample of 29 perioperative nurses (scrub nurses) employed in all surgical theatres of the General Hospital in Kruševac, in the period from 10 June to 15 July 2022. A standardised and validated 65-question questionnaire, based on the Donabedian's quality of care model was used for data collection, encompassing the domains of structure, process and outcome. Questions were grouped by themes that encompassed socio-demographic data, education, knowledge, practice and attitudes regarding quality of care. The obtained data were analysed using descriptive statistics. Study findings suggest that the structure of perioperative care has gaps in the field of training newly employed staff, internal control, number and competencies of nurses, as well as in availability of equipment and materials. Work processes are mostly harmonised with aseptic practices and practices of proper handling of instruments, but needs for improvement have been identified in the fields of teamwork, communication, and more consistent implementation of protocols. In the outcomes domain, nurses recognise the significance of continual professional development, acquisition of additional knowledge and skills, as well as psychological and physical endurance in everyday work. These results indicate that there is a need for a systemic approach to the improvement of perioperative care quality through continual training, reinforcement of internal control, improvement of team cooperation and adequate valuation of the nurses' work. Improvement of structures, processes and outcomes contributes to a safer, more efficient and higher quality care, professional development of nurses and greater patient satisfaction.