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Effect of Educational Sessions about Coronavirus Disease 2019 (COVID-19) on Knowledge, Practice and Attitudes of Nurses in Zagazig Fever Hospital

Samia Farouk Mahmoud*, Mervat Elshahat Ibrahim

Community Health Nursing, Faculty of Nursing, Zagazig University, Egypt

Abstract: Background: The fast and global spread of the Coronavirus (COVID-19) pandemic has become a major cause of concern for the healthcare profession. The aim of this study is to assess the effect of educational sessions about coronavirus disease 2019 (COVID-19) on knowledge, practice and attitudes of nurses in Zagazig Fever Hospital. Subjects and Methods: Research design: A quasi experimental research design was used in carrying out the study with pre/posttest. Setting: the study was conducted at Zagazig Fever Hospital, Sharkia Governorate, Egypt. Tools of data collection: Three tools were used: Tool (I): A self-administered questionnaire; It consisted of two parts: Part one was used to collect data pertaining to personal characteristics of the nurses, while part two involved questions regarding nurses' knowledge about COVID-19. Tool (II): Nurse’s practice observation checklist to determine the hand washing practice during COVID-19. Tool (III): was intended to assess nurse’s attitudes toward COVID-19. Results: The comparison of pre, posttests knowledge, practice and attitudes on nurses revealed highly statistically significant improvement (p <0.001) that approved the research hypothesis of implementation, where the total mean of their knowledge increased from 23.915±9.539 in pre- intervention, to 43.366±0.914 at intervention and 42.746±1.509 at post intervention. All nurses (100%) were having satisfactory level of knowledge at intervention and post intervention. The total mean score of their attitudes increased from 16.929±2.344 in pre intervention to 19.098±1.415 at intervention and 18.873±1.482 at post intervention with (p < 0.001) for all changes. Conclusion: the posttest and follow-up knowledge, practice and attitudes’ score was higher than the pretest score of nurses. Recommendations: Continuous campaigns are required for nurses to prevent and control COVID-19 successfully with illustrated booklets for maintaining knowledge, emphasis should also be placed on training and retraining health professionals in the correct hand washing steps as well as media awareness campaigns on this disease.

Keywords: COVID-19, educational sessions, fever hospital, nurses

Received May 19, 2021; Revised June 23, 2021; Accepted July 04, 2021

Citation: Samia Farouk Mahmoud, Mervat Elshahat Ibrahim, Effect of Educational Sessions about Coronavirus Disease 2019 (COVID-19) on Knowledge, Practice and Attitudes of Nurses in Zagazig Fever Hospital. American Journal of Nursing Research, 9 (4). 133-142. January 2021. doi:10.12691/ajnr-9-4-5

1. Introduction

Coronaviruses have become the main pathogens of emerging respiratory disease outbreaks. They represent a large family of single-stranded RNA viruses, which can cause illnesses ranging from the common cold to severe symptoms [1]. Clinical symptoms of COVID-19 include fever, the most common symptoms of which are cough, fatigue, malaise and shortness of breath. Global concerns about the virus have increased due to its high transmissibility, which may be associated with illness and mortality [2]. Elderly people and patients with comorbidities are more susceptible, and more likely to develop serious complications, which may be associated with acute respiratory distress syndrome and cellular storm [3]. According to the World Health Organization (WHO), the outbreak of coronavirus disease 2019 (COVID-19) has become a pandemic. Globally, as of 5:06 p.m. CST, June 1, 2021, there were 170,426,245 confirmed cases of COVID-19, including 3,548,628 deaths, reported to the World Health Organization. As of May 31, 2021, a total of 1,579,416,705 doses of vaccine have been administered. Deaths of nurses and doctors due to COVID-19 have been reported from several countries [4]. In May 2021, they added that at least 260 nurses have died from COVID-19. In March 2020, at least 50 doctors were reported to have died in Italy due to COVID-19.

Egypt is one of the largest countries in the Arab region, Africa and the Middle East. With over 100 million citizens, Egypt is among the most populous countries in Africa [6] A large number of citizens can be associated with a higher risk of spread and death, especially among the elderly and those with chronic diseases. Global efforts have been made to prevent the spread of the virus. These efforts include political efforts by governments, along with personal attitudes and behaviors, which depend on the general public's awareness of the disease. In Egypt, from January 3, 2020 to June 1, 2021, there were 262,650 confirmed cases, with more than 15,096 deaths. On the same line, the International Council of Nurses (ICN) reported the percentage of HCW who tested positive for COVID-19 was 51.7%. The total prevalence of comorbidities in seven studies was 18.4% [7].

COVID-19 spreads through human-to-human transmission through droplets and direct contact and has an incubation period of 2-14 days [8]. To date, there is no proven treatment. Strong infection control measures are the primary intervention to reduce the spread of the virus in both health care settings and the community [9]. Nurses' awareness of dealing with highly contagious respiratory diseases plays a vital role in limiting the spread of infection, as health systems have, at best, a moderate capacity to respond to disease outbreaks.

Promoting hand hygiene has been a challenge for 150 years. Healthcare professionals should realize the importance of sanitation by washing hands in their work area. Healthcare professionals must take responsibility for their hand hygiene, and it is imperative that hospitals take measures to control the spread of disease within hospital environments [10].

Various factors are responsible for poor hand washing compliance among health care workers. These factors include lack of knowledge among health workers about the importance of hand hygiene in reducing the spread of infection and how hands become contaminated, lack of knowledge of correct hand hygiene technique, staff shortages and overcrowding, lack of hand washing facilities, and irritant contact. . Dermatitis associated with repeated exposure to soap and water, lack of adherence, and lack of institutional commitment to good hand hygiene [10].

The Community Health Nurse (CHN) in Egypt and especially in Sharkia Governorate, Zagazig University, is the forefront of health promotion and disease prevention including COVID-19. In line with the efforts made to increase community participation in the preservation of health. CHN implements COVID-19 prevention strategies in collaboration with various community groups, and the hospital's outpatient clinics provide care for infectious disease patients. Nurses play an important role in the healthcare system in both institutionalized settings and community care settings. In the hospital, nurses meet with different types of patients. Therefore, the nurse must have extensive knowledge of all diseases, especially infectious diseases such as COVID-19, one of the most important human diseases in the world [11].

1.1. Significance of the Study

There are many loopholes in COVID-19 research including; treatment and changing global standards [11]. The fact that nurses are at risk of developing outbreaks in the epidemic chain is critical because nurses help control outbreaks. Therefore, all possible measures must be taken to control the spread of infection to pathogens, first by identifying risk factors for infection and then taking appropriate measures to reduce these risks. It is well established that transmission of disease between nurses is associated with overcrowding, absence of isolation room facilities and environmental pollution. However, this is likely to be exacerbated by the fact that some nurses do not have sufficient awareness of infection prevention practices. Knowledge of illness may affect nurses' attitudes and practices, and attitudes and malpractices directly increase risk [12]. Therefore, there is an urgent need to develop tools to translate what is known about risk factors into risk mitigation practices within communities and in particular for nurses. Epidemiological data identifies nurse practitioners as a high risk for COVID-19 and mortality. Successful use of nursing intervention may be effective in improving knowledge, practices, and attitudes regarding COVID-19.

1.2. The Aim of the Current Study

The aim of this study is to assess the effect of educational sessions about coronavirus disease 2019 (COVID-19) on knowledge, practice and attitudes of nurses in Zagazig Fever Hospital. This could be accomplished through the specific objectives:

1. Assess nurses’ knowledge prior and after the nursing educational sessions during COVID-19 in Zagazig fever Hospital.

2. Determine the hand washing practices prior and after the nursing educational sessions during COVID-19 in Zagazig Fever Hospital.

3. Identify nurses’ attitudes prior and after the nursing educational sessions during COVID-19 in Zagazig Fever Hospital.

4. Plan, implement, and assess the effect of nursing educational sessions on knowledge, practice and attitudes for nurses regarding COVID-19.

1.3. Hypothesis

Nursing educational sessions will improve nurses’ knowledge, practice, and attitudes’ score in relation to COVID-19.

2. Subjects and Methods

2.1. Study Design

An interventional quasi-experimental design was used, with pre-post evaluation.

2.2. Study Setting

The current study was conducted at the outpatient clinic in Zagazig Fever Hospital. This Hospital provides care for patients who suffered from infectious diseases or communicable diseases like, COVID-19, dengue fever, Hepatitis A, B & C, influenza, salmonella, typhoid, brucellosis, AIDS and other food borne illnesses etc.

2.3. Subjects

A convenience sample of 71 nurses comprise the nurses and staff working in the outpatient and emergency clinic The clinic works all days of the week from Saturday to Friday and the rate of cases per day ranges from 200 and 250 persons, while, the rate of cases per week ranges from 1400 and 1750 persons.

2.4. Data Collection Tools

Three tools were used to collect the necessary data to achieve the objectives of the study.

Tool I:

A self-administered questionnaire developed by researchers through a review of the relevant literature. It consists of two parts:

Part A:

It was used to collect data regarding the personal characteristics of the nurse. The researchers put them as follows: age, gender, residence, marital status, educational level, income, family members, crowding index, years of experience in fever hospital, total experience, and sources of information.

Part B:

Self-administered questionnaire, to assess nurses’ knowledge about COVID-19. The researcher developed it based on related literature [11,13,14]. The questionnaire comprised close ended questions in the following sections: definition, virus form, hotline telephone, COVID-19 virus belongs to virology, incubation period, the time the virus lives on the surface, and the carpets, as well as symptoms of COVID19, transmission, high-risk groups, diagnosis test, how to boost or strengthen the human immune system, steps of hand washing properly, suitable time of hand washing, complications. This part also includes, prevention methods of COVID-19, and treatment. Questionnaire reliability verified by Cronbach's Alpha; It was 0.755.

Total knowledge scoring system:

For knowledge items, one correct answer is scored and zero is incorrect. For each knowledge area, the item scores and their total were summarized divided by the number of items, giving the average score for the part. The total knowledge points reached (64) points.. These scores were converted to percent scores. Knowledge was considered satisfactory if the percentage was 60% or more and unsatisfactory if it was less than 60%.

Tool II:

Nurse's practice checklist. Adapted from Abdulsalam et al. [10], which included 5 steps, wet hands with clean running water, apply enough amount of soap to cover all surfaces of hands and wrists, rub hands and wrists for at least 20 seconds, rinse hands and wrists under clean water preferably running and dry hands and wrists with a clean towel.

Scoring system:

For each observed step “done” one point was scored and "not" zeroed. Practice was considered appropriate if the total was equal to 100%, and in adequate condition, if it was 100% based on statistical analysis. The reliability of the observation checklist has been verified by Cronbach's Alpha Test; it was 0.812.

Tool III:

Self-administered questionnaire. It was developed by researchers through a review of the relevant literature, and guided by Shigemura et al. [14]. It consists of two parts:

Part A:

This tool was intended to identify nurse attitudes toward COVID-19; it was developed by the researcher. Nurses were asked to respond by any of 3 options: “Agree,” “Disagree,” or “Not sure,” for each statement. Cronbach's alpha coefficient for the measured instrument was 0.69.

Scoring system:

The answers “Agree,” “Not Agree,” and “Not Sure” were scored, respectively 3, 2, and 1. The item scores were summarized and the total was divided by the number of items, giving the average score, which was converted into degrees of degrees. Take a positive if the percentage score is 75% or more, and negative if it is less than 75%.

Part B: Nursing educational sessions about COVID-19:

Each session was 15-20 minutes in the previous setting. The researchers developed an intervention module in the form of an educational illustrated booklet for responding to the needs of the nurses in the following the educational sessions and to serve as a reference at hospital. The intervention was implemented in 4 sessions at the mentioned settings. The researchers performed the fieldwork in three days weekly (Saturdays, Sundays and Thursdays).

Content validity:

The validity of the data collection tools was tested by five experts, two professors from Community Health Nursing, Faculty of Nursing, Zagazig University, and one professor from Community Health Nursing, Faculty of Nursing, Ain Shams University. Two professors from the Faculty of Medicine, Zagazig University, to assess the clarity, suitability, application and understanding of the tools. All recommended tool modifications have been made.

Field work:

Data collection took a period of 5 months; from January 2020 to the end of May 2020. The Researchers began collecting data 3 days a week from 10.00 a.m. to 12.00 p.m. during the three months. The study was implemented through four phases: evaluation, planning, implementation and evaluation.

Assessment phase:

This stage involved data collection prior to the intervention for baseline assessment. The researchers introduced themselves first and briefly explained the purpose of the research to the Director of Zagazig Fever Hospital and the Director of Nurses.

All nurses working in the outpatient and emergency clinic were interviewed and their verbal consents were obtained to participate. Knowledge, practices and attitudes were distributed before the test, then the same questionnaire was used after the sessions were carried out for the post-evaluation (post-test). The time it took to complete the study questionnaire ranged from 15 to 20 minutes. The data was analyzed primarily to provide a basis for designing the intervention sessions.

Planning phase:

Based on the literature review, sample characteristics, and results obtained from the assessment phase, the researchers designed the content of the intervention sessions. The learning booklet was prepared by researchers and its content was validated and then distributed to the nurses for use as a self-learning guide.

Goal:

The overall goal of the nurses' sessions was to raise their level of knowledge, practice and positive attitude about COVID-19.

Specific objectives:

By the end of the sessions, the nurses should be able to:

1. Define the meaning of COVID-19.

2. Describe the virus form; COVID-19 virus belongs to virology and its incubation period.

3. Recognize the time the virus lives on the surface and on the carpets

4. List the signs and symptoms of COVID-19.

5. Discuss the mode of transmission of COVID-19.

6. Identify the high risk of COVID-19.

7. Describe the diagnosis of COVID-19.

8. Discuss how to boost or strengthen the human immune system to compact COVID-19.

9. Explain the prevention methods of COVID-19.

10. Understand the steps of hand washing properly and suitable time of hand washing.

11. Explain the role of the nurse of COVID-19.

12. Discuss the treatment of COVID-19.

13. Apply hand washing practice properly.

Implementation phase:

The intervention was conducted in the form of sessions; It was performed in the hospital's outpatient room. educational training methods were lectures, group discussions and brainstorming. The sessions were supported by video, images, and posters by displaying labtop data to facilitate and clarify teaching. To ensure nurses understood the content, each session began with a summary of what was presented from the previous session, followed by the objectives of the new session. The intervention was conducted in 4 sessions; each session lasted 15-20 minutes. The number of nurses in each session was 4-7 nurses. The objectives of the sessions were as follows

At the beginning of the first session, the orientation to the session is explained, such as: purpose, importance, contents, time and place of the topic all in order to establish good communication. Researchers have provided basic knowledge related to COVID-19 as the meaning of COVID-19. Today, COVID-19 is one of the most important arthropod-borne viral diseases in humans in terms of morbidity and mortality, it follows the virus form and the COVID-19 virus belongs to virology and incubation period. Coronaviruses are small viruses (65-125 nm in diameter) encased in a crown-like appearance under an electron microscope, due to the presence of elevated glycoproteins on the coat. Coronaviruses contain large genomes (26-32 kbs) of positive-sense single-stranded RNA. The average incubation period (the time between infection and the onset of symptoms) is about 4-6 days with about 95% of individuals developing symptoms within 14 days of infection [16].

The aim of the second session was to explain the signs and symptoms of Covid-19 disease. In the same session, the researchers discussed the mode of transmission of COVID-19. Evidence suggests that COVID-19 is transmitted from human to human via infectious droplets [16], followed by a high risk of COVID-19 and COVID-19 diagnosis. The majority of molecular diagnostics developed for detection of COVID-19 include detection of nucleic acid from COVID-19 on upper respiratory tract samples (for example, nasopharyngeal and oropharyngeal samples) and lower respiratory tract samples. It follows how the immune system is boosted during the COVID-19 pandemic, like physical activity, eating right, getting enough sleep, a practice good hygiene and follow city and state quarantine protocols. Wear personal protective equipment, stay active, read books, learn a new language, and spend at least 30 minutes a day on. Stay in touch during social distancing, contact with friends, family and colleagues may have lost contact via a phone call, email, or Skype / Face time. This can help fight feelings of depression, helplessness, reduce stress levels [17].

The third session, researchers demonstrate prevention of COVID-19 through hand washing and social distancing measures are recommended to protect oneself. Maintaining a distance of at least 1 meter (World Health Organization, 2020). In addition, researchers discuss the role of the nurse. The fourth session, the main objectives were to equip the nurses with skills in hand washing practice. Researchers demonstrate and re-demonstrate hand washing practices and techniques among nurses. Finally, a global summary and review of program objective and termination module sessions.

Evaluation phase:

The nursing educational intervention was evaluated immediately and three months after its implementation of the sessions; By applying the same pretest tools in order to compare changes in nurses' knowledge, practices, and attitudes towards COVID 19 after the educational sessions.

Pilot study:

Before conducting the main study, a pilot study was conducted on 7 nurses in Zagazig Fever Hospital to ensure the reliability of the tool and the feasibility of the study.

Administrative and ethical considerations:

Prior to data collection, formal permission was obtained from the appropriate authority of the selected hospital and informed consent from the participants. They were also assured of the confidentiality of the information. Permission to conduct the study was granted by submitting official letters from the College of Nursing to the authorities responsible for study preparations to obtain their permission to collect data. Approval of the local ethics committee was taken prior to the start of the study. Informed consent was taken from each participant while participating in the study.

2.5. Statistical Analysis

Descriptive statistics were used to summarize the demographic characteristics of the nurses. Data were revised, coded, analyzed and tabulated using number and percentage distribution and carried out using the Statistical Package for Social Sciences (SPSS) version 20. Appropriate statistical methods were applied (percentage, mean and standard deviation, chi square, repeated measure ANOVA test, Sperman and Pearson correlations). Regarding P- value, was considered Non-significant (NS) if P> 0.05, Significant (S) if P< 0.05, Highly Significant (HS) if P< 0.001.

3. Results

The mean age of the nurses in the study sample was 35.81±8.38, while 97.2% of nurses were female, and 93% were married. Furthermore, 45.1% in the study sample were faculty of nursing qualification. Additionally, 69.0% of them had sufficient income. As for crowding index Table 1: indicates that for only 16.9% of them it was not crowded, and 57.7% resided in urban area. The same table also demonstrates that 45.1% of the study nurses reported previous experience in fever hospital for 10 to 20 years. Moreover, the total mean of experience for the study sample was 13.38±8.17 compared to 11.66±8.24 in fever hospital.

Figure 1: Illustrates that the primary sources of information for nurses’ knowledge about COVID19 were from TV/Radio (33.8%), followed by friends (26.8%) and colleagues in hospital, internet and lecture in hospital (14.1%).

Table 2: indicates that, only 26.8% of the study sample identified the meaning of Covid-19 at preprogram compared to 100% at posttest and 94.4% after three months. A considerable change was noticed between studied sample pre, and post program implementation related to how to strengthen the human immune system during the COVID-19 among males and females X² = 72.511 at p= 0.001. Additionally, all of them were identifying methods of hand washing properly that may be arisen from COVID-19 diseases in post intervention. As well, 97.2% were identifying prevention methods that may be arisen from COVID-19 diseases in post intervention.

Figure 2 illustrates that the total knowledge increased from 50.7% in pre-sessions, to 100% after implementation of nursing intervention.

Table 3: Describes that, there were statistically significant differences between nurses in relation to their practice toward COVID-19 diseases throughout intervention phases pre and post (P<0.001). A considerable change was noticed between studied sample pre, and post program implementation related to scrub the hands and wrists for at least 20 seconds among males and females (X²= 44.70. p= 0.001). The total score of their practices adequately increased from 35.2% in pre-sessions to 100% in post and follow up sessions (X²= 68.04 at p= 0.001).

Table 1. Frequency Distribution of Studied Sample Regarding Their Personal Characteristics (N= 71)

Figure 1. Percentages of Sources of Information about COVID 19 (N= 71)

Table 2. COVID19 Knowledge Difference of Studied Sample Pre, Post and Follow up Intervention (N= 71)

Figure 2. Total scores of COVID19 Knowledge Difference of Studied Sample Pre, Post and Follow up Intervention

Table 3. Hand Washing Practice Difference of Studied Sample Pre, Post and Follow up Intervention (N= 71)

Figure 3: illustrates that the total hand washing practice improved from 35.2% in pre-intervention, to 100% after intervention.

Table 4: Clarifies that, there were highly statistically significant differences between nurses in relation to their attitudes toward COVID 19 throughout intervention phases pre and post ((P<0.001).

Figure 3. Total scores of Hand Washing Practice Difference of Studied Sample Pre, Post and Follow up Intervention

Table 4. Attitude toward COVID 19 Difference of Studied Sample Pre And Post Intervention (N= 71)

Table 5 describes that, there were highly statistically significant differences between nurses in relation to their attitudes toward COVID 19 throughout intervention phases pre and follow up (P<0.001).

Figure 4 illustrates that the total scores of studied sample of their attitudes increased from 70.4% pre intervention to 98.6% at post and follow up interventions.

Table 5. Attitude Toward COVID 19 Difference of Studied Sample Pre And Follow up Intervention (N= 71)

Figure 4. Total scores of COVID 19 Attitude Difference of Studied Sample Pre, Post And Follow up Intervention (N= 71)

As displayed in Table 6 correlations among personal characteristics of studied sample and their knowledge, practice and attitudes. There was a statistically significant strong negative correlation with their residence (r=-.236).

Table 7 clarifies that statistically significant improvements in the nurses’ knowledge, practices and attitudes from pre-intervention to post intervention and follow up intervention, where the total mean score of their knowledge increased from 23.915±9.539 in pre- intervention, to 43.366±0.914 post intervention and 42.746±1.509 at follow up intervention. The total mean score of their practice increased from 2.971±1.723 pre- intervention to 5.000 at post and follow up intervention. The total mean score of their attitudes increased from 16.929±2.344 in pre- intervention; to 19.098±1.415 at post intervention and 18.873±1.482 at follow up intervention.

Table 6. Correlation among Personal Characteristics of Studied Sample, Knowledge, Practice And Attitude

Table 7. Difference mean of Knowledge, practice and Attitude about COVID19 Pre, Post and Follow up Intervention

4. Discussion

Nowadays, COVID-19 is a global topic of discussion in the media and among the public, especially among health care workers (HCWs) and patients. As transmission of the novel coronavirus increases, it is raising tensions for everyone, including health officials and health systems, and raises an important question about how information is managed to help health care workers on the front lines in times of public health crises.

The targeted populations in the current study were nurses. This target is selected because the nurses are first-line health care providers of COVID-19 infection diagnosis while providing nursing care. Nurses can help the society by giving awareness related to the COVID-19 and its prevention and control measures mainly focused towards protection from COVID-19 and its breeding. Nurses play a very important role both locally and globally. Many of the similar studies involved nurses in the same target such as the study of Shigemura et al. [14], in Japan, Cascella et al. [1], in Treasure Island, [13] in China, and Abdelhafz et al. [18] in Egypt.

The current study revealed that the primary sources of information about COVID-19 were television/radio followed by friends and colleagues in the hospital, the Internet, and lectures at the hospital. This may be because the media plays a prominent role in spreading information among people. It is the most powerful tool for creating awareness in society. Additionally, friends play a vital information role among the nurses as they stayed most of the time in the hospital. The results of this study were in agreement with those of Bhagavathula et al. [19] In the United Arab Emirates, which found that the primary sources were official government websites and media. Nearly 30% of nurses using media (TV / video, magazines, newspapers, and radio) and 40% of nurses occasionally discussed COVID-19-related topics with family and friends. The results also consistent with a study conducted in Malaysia [20], which revealed that the most of nurses (95.6%) cited TV as the main source of information. This underlines the fact that media like TV are a very important source of information and can be used further to spread more awareness about COVID-19.

Concerning knowledge related to methods of hand washing properly in the present study, less than tenth and less than half of nurses listed the suitable time of hand wash, and the correct steps of hand washing respectively. This finding is supported by that of the research conducted in Uganda by Olum et al. [21], twhich showed that only 25.7% of health professionals were able to list the correct steps of hand washing.

The mean of age of the nurses in the study sample was 35.81±8.38. This finding is appropriate with that of Ahamed et al. [22], who mentioned that the mean age of nurses was 30.1±5.4 years. Most of the studied nurses were married and nearly all of them were female this might be due to that nursing faculties were initially limited to the females, and this results was consistent with the known of women nature. As well, most of Egyptian women marry; in early age, especially nurses who have a stable income. Additionally, the current study showed that more than two fifths of the studied nurses had bachelor in nursing, which may be due to the new trend of the Ministry of Health to place highly qualified nurses in critical settings in hospitals especially in the outpatient clinics. These findings are in agreement with those Aghdam et al. [23], in Iran, which found that the highest proportion of nurses was female (78%) and married (70%). Similarly, Olum et al. [21] in Uganda reported similar results.

One of the main objectives of this study was to assess the improvement of nurses' knowledge regarding implementation of COVID-19 after nursing education sessions. The general knowledge score before intervention of nurses concerning COVID-19 was low, in particular, to hand washing time, strengthening of the human immune system, and complications. These study findings highlight the urgent need to implement the COVID-19 intervention as knowledge often comes from educational programs. These results were consistent with those of a study by Mohiuddin et al. [20]. A study in the United Arab Emirates, aimed at assessing knowledge and perceptions of COVID-19 among health care workers, found that nurses and other health professionals typically possessed low knowledge and that a large proportion of healthcare workers had poor knowledge of its transmission (61.0%) and the onset of symptoms (63.6%). Similarly, a study by Moody et al. [24] In the Mumbai metropolitan area, they found that only 22.6% of respondents were aware that the virus causing COVID-19 was initially called COVID-19, the main mode of transmission Virus by respiratory droplet (62%).

After implementing the nursing education sessions on COVID-19, the results indicated overall high levels of knowledge about COVID-19. These improvements may be due to the fact that they were interested and eager to participate in the program. Therefore, this program has succeeded in improving nurses' knowledge of COVID-19. In addition, the government has taken major steps to educate nurses and reduce the spread of the disease. This study result was in the same line with the results of a study conducted with Bhagavathula et al. [19] in Egypt, who found that most of the participants had good knowledge of COVID-19. Overall, a correct 90% rate was detected in a knowledge questionnaire, indicating that most of the respondents are aware of COVID-19. In the same line with Zhong et al. [13] in China, they reported that 90% of respondents had a good knowledge of the causes, signs, symptoms, mode of transmission, and preventive measures about it. These results support the results of research conducted by Ahamed et al. in Egypt [22], which reported a knowledge score of 82.4%, indicating good knowledge among healthcare workers.

In this study, the results revealed that only approximately one-third of nurses in the pre-intervention could practice proper hand washing. This may be because nurses routinely forget to wash their hands before touching patients. Health care-associated transmission is most often caused by contaminated health-care workers' hands. Training and retraining health professionals in the correct hand washing steps will encourage and remind them of the importance of hand washing to reduce the risk of infection and transmission.

A consistent explanation by Abdulsalam et al. [10] in Kano, which found only 17% of health professionals could mention the five moments of hand washing. After implementing the nursing education sessions on COVID-19, the overall score for their practices increased from nearly a third in the previous sessions to 100% in the subsequent sessions. The training and retraining of health professionals in the correct steps for hand washing will encourage and remind them of the importance of washing hands before wearing gloves and before touching patients to reduce the risk of infection and transmission. Moreover, simple hand washing has been shown to reduce the risk of contracting a hospital infection, especially with the current concern of COVID-19. Hospital-acquired infections have contributed significantly to total mortality, morbidity, and healthcare costs. Likewise, Zhong et al. [13], in China, 89.7% of respondents were found to follow correct practices regarding COVID-19. This finding is supported by research conducted in Egypt by Ahamed et al. [22], who mentioned that nurses had good hand-washing practices during COVID-19.

Regarding the attitude, the finding of the current study reported that there were statistically significant improvements in positive attitudes during the intervention phases between the pretest, the post test, and the follow-up intervention. In addition, their overall position scores rose from less than three quarters of the pre-program to the vast majority immediately after the program. These results provided evidence that the health education program played an important role in improving attitudinal scores among nurses. Moreover, the higher position scores among nurses at higher levels of education are attributed to the maturity of the nurses as they gain more knowledge and practice. Similar positive situations were reported by Zhong et al. [13] in China and Ahamed et al. [22], in Egypt.

5. Conclusion and Recommendations

In light of the results of the current study, it can be concluded that the study showed nursing sessions were effective in increasing the level of knowledge and practice of the nurses in addition to their positive attitudes towards COVID-19. Moreover, the results showed that post-test scores were higher than pre-test scores in both knowledge, practice and attitudes of the nurses.

Based on the present study findings, the following recommendations were suggested: Primary prevention of infectious diseases like, COVID-19 should be given priority and education about it should be applied in fever hospitals, through in-service health educational training sessions to be provided to all nurses in the fever hospitals especially the newly appointed ones before starting their work. Furthermore, continuous campaigns are required for nurses to prevent and control COVID-19 successfully, with illustrated booklets for maintaining knowledge, training and retraining of health professionals on correct steps of hand washing and as well as media awareness campaigns on this disease.

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