Highlights:
What is current knowledge?
All nurses have good knowledge and attitude towards oxygen therapy
What is new here?
This research show that not all nurses have good knowledge and attitude towards oxygen therapy
Introduction
Oxygen is listed as a core item on the World Health Organization's (WHO) model of essential medicines (1(. Oxygen therapy provides oxygen at concentrations higher than the level found in the atmosphere (>21%) )2(. It is a key instrument for resuscitating pre-hospital trauma patients during evaluation and transportation (3,4(, preventing and managing hypoxemia and saving the lives of patients with heart and lung diseases if used at an appropriate time and in an appropriate amount according to the WHO updated guidelines )2, 5(.
The optimal amount and method of oxygen delivery varies depending on patient’s underlying medical condition. The selection of appropriate oxygen delivery device and oxygen flow rate depends on many factors including patient’s age, therapeutic goals and patient’s tolerance )6(. Oxygen should be prescribed to achieve a target saturation of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnia respiratory failure )7, 8(.
Oxygen can develop skin breakdown around the mask or the cannula and easily dehydrate exposed membranes in the upper respiratory tract unless patients are orally rehydrated and/or provided with mouth care, along with humidification, which can mobilize secretions and enhance patient comfort (9(. Although oxygen therapy is one of the most widely used resuscitation methods, it may be harmful to patients if used inappropriately. Pulmonary oxygen toxicity and oxygen-induced hypercapnia are two major side effects of oxygen therapy (8(. Therefore, oxygen should be administered by trained staff.
Nurses are the primary healthcare personnel who monitor oxygen therapy and can contribute to reducing adverse effects of supplemental oxygen therapy )10(Based on studies conducted in different countries, there is a knowledge and practice gap on oxygen therapy among practicing nurses in hospitals )11–13(. The present study aimed to determine the knowledge and practice of nurses on oxygen therapy in the Harari region, Ethiopia.
Methods
This institutional-based, cross-sectional study was conducted from April 1 to April 30, 2021. The study included all nurses (n=446) working in three public hospitals in the Harari region, Ethiopia. Data were collected using a self-administered questionnaire designed by Lema et al. (13) with some modifications. After confirming content validity, the reliability of questionnaire were assessed via a pilot survey. The questionnaire consisted of three sections; demographic information (such as gender, age and marital status), oxygen therapy knowledge (9 items) and oxygen therapy practice (19 items). A checklist was used to assess the practice of nurses on oxygen administration. The checklist consisted of nineteen items regarding the processes before (5 items), during (11 items) and after (3 items) oxygen therapy.
The collected data were analyzed in SPSS (version 20) using descriptive statistics.
Results
Out of 446 subjects, 422 participated in the study (94.62% response rate). The mean age of nurses was 33±1.76 years. The majority of subjects were 20-29 years old (40.5%) and had a Bachelor’s degree (69.9%),4-6 years of work experience (35.5%) and their mean work experience was 5 years (Table 1).
The mean knowledge score of nurses about oxygen therapy was 7.51±1.45. All nurses were aware of indications for supplemental oxygen therapy. In addition, 385 nurses (91.23%) knew about the range of oxygen saturation at rest for adults <70 years (95-98%). Moreover, 375 nurses (88.86%) answered untreated pneumothorax as the contraindication for oxygen therapy. Based on the results, nurses had 38.51% of nurses had poor knowledge of oxygen therapy (Table 2).
The mean practice score of nurses about oxygen therapy was 4.37±1.76. Based on the results, only 47.5% of the nurses had good practice and the majority (52.5%) of nurses had poor practice level about supplemental oxygen administration (Table 3).
We also found that gender, age, education level, marital status and work experiences had no significant association with knowledge of nurses on oxygen therapy (Table 4).
 


Discussion
In this study, 61.49% of nurses had good knowledge about oxygen therapy, which is higher than the levels reported from Debre Tabor General Hospital, Ethiopia (48%) (14), CMC hospital in Punjab, India (52%) (15), Beirut, Lebanon (55.1%) (16) and Orotta National Referral Hospital in Asmara, Eretria (56.7%) (17). However, previous studies in Rwanda (73.8%) (18), Egypt (76%) (19) and Addis Ababa, Ethiopia (63.8%) (20) reported higher levels of knowledge about oxygen therapy among nurses. This discrepancy might be due to the difference in sample size, study setting and study period.
According to the results, 47.5% of the nurses had good practice level about oxygen therapy. This finding is greater than the rates reported by studies conducted in Addis Ababa, Ethiopia (43.4%) (20), Debra Tabor General Hospital, Ethiopia (33%) (14), the University Teaching Hospital of Kigali, Rwanda (32.3%) (18), Eritrean hospitals (45%) (17) and Addis Ababa, Ethiopia (43.4%) (20). However, in a study in Egypt (19) and Iran (21), 58% and 74.5% of nurses had good practice level on oxygen therapy, respectively. This might be due to unavailability of oxygen administration guidelines and insufficient training on oxygen therapy.
In our study, the nurses had poor knowledge about normal oxygen saturation, contraindications of oxygen therapy and sign and symptoms of oxygen toxicity. About half of the nurses did not follow patients’ vital signs during and after oxygen administration. In addition, more than 75% of the participants did not wash hands before and after the procedure. Furthermore, one third of the subjects did not adjust oxygen flow rate according to the prescription. 
There was some limitation in our study, the present study was a cross sectional design so it did not show temporal relationships. In addition, our study did not include nurses working in private hospitals, which questions the generalizability of our results.
Conclusion
  More than half of nurses working in public hospitals of the Harari region do not have good practice about oxygen therapy. Moreover, 38.51% of the nurses do not have good knowledge about oxygen therapy. These findings indicate a clear knowledge and practice gap among nurses in the study area, which can negatively affect patients’ safety. Therefore, it is recommended to promote knowledge and practice of nurses about oxygen therapy through in-service training and workshops.
 
Acknowledgements
  The author is grateful to the participants and those who helped us in data collection.

Funding source

None

Ethical statement

  Ethical clearance was obtained by harar health science college ethical committee.

Conflict of interest

  The authors declare that there is no conflict of interest regarding publication of this article.

Author contributions

Starting from title to data analysis and writing the manuscript was by AH