1 BACKGROUND

Medical adhesive related skin injury (MARSI) is the symptom that after the removal of medical adhesive, the skin appears erythema lasting for 30 min or even longer, with or without blisters, erosion or tears and other skin abnormalities (de Oliveira Marcatto et al., 2022). In recent years, with the wide application of medical adhesive in medical care environment, the skin damage caused by it has become increasingly prominent. Previous studies (Mishra et al., 2021; Wang et al., 2019) show that MARSI is the primary factor of skin damage in neonates, and its incidence is 8.04%–17.68%. Therefore, it is the focus of neonatal skin care to identify high-risk neonates with MARSI and provide timely nursing care.

At present, the researches in the field of neonatal MARSI are insufficient. Most of the existing research covers newborns in a larger paediatric field to discuss the prevalence of MARSI. Many studies (Jiaobo et al., 2017; Ying et al., 2017) have showed that nurses' awareness of MARSI is at a low level. There is a lack of guidelines and preventive measures to guide nurses how to correctly select and use medical adhesives to reduce MARSI, and nurses are the key to avoid the occurrence or continuous development of MARSI. Therefore, this study investigated the status quo of knowledge, attitude and behaviour of neonatal nurses on MARSI, analysed its influencing factors, and put forward feasible suggestions and countermeasures on prevention and nursing of MARSI, providing reference for the management and nursing of neonatal MARSI.

2 METHODS

This study was a cross sectional survey design. Our study had obtained the ethical approval from hospital (approval number: 20220056), and written informed consents had been obtained from all the included nurses.

3 RESULTS

A total of 121 questionnaires were issued and recovered, with a recovery rate of 100%. After removing 5 invalid questionnaires, 116 valid questionnaires were obtained, with an effective recovery rate of 95. 87%. Of the included 116 neonatal nurses, there were 111 female nurses. The age of most nurses were 31–40 years old. Most nurses had the bachelor degree and worked for 6–10 years. Most nurses (67.24%) did not accept the MARSI training in clinical nursing care. The characteristics of nurses are presented in Table 1.

The average knowledge score for nurses was 22.65 ± 6.13, the average attitude score was 24.44 ± 5.06, the average behaviour score was 48.16 ± 9.94, and the total score was 95.08 ± 16.15 (Table 2).

Correlation analysis (Table 3) showed that there was positive correlation between the nurses' knowledge and attitude, and behaviour scores (all p < 0.05).

Univariate analysis on the knowledge, attitude and behaviour scores of nurses are showed in Table 4. There were significant differences on the knowledge score in nurses with different age, education level, year of work experience, professional ranks and titles, had accepted MARSI training and wound specialist nurse (all p < 0.05). There were significant differences on the attitude score in nurses with different professional ranks and titles, had accepted MARSI training (all p < 0.05). There were significant differences on the behaviour score in nurses with MARSI training or wound specialist nurse (all p < 0.05).

Multivariate regression analysis on influencing factors of nurses' MARSI knowledge, attitude and behaviour scores are presented in Table 5. Multivariate regression analysis indicated that had accepted MARSI training, education level, year of work experience are the influencing factors of nurses' MARSI knowledge score (all p < 0.05). Had accepted MARSI training, year of work experience are the influencing factors of nurses' MARSI attitude score (all p < 0.05). Had accepted MARSI training, year of work experience are the influencing factors of nurses' MARSI behaviour score (p = 0.015).

Table 5 Multivariate regression analysis on influencing factors of nurses' MARSI knowledge, attitude and behaviour scores.

4 DISCUSSION

NICU nurses scored higher in the attitude part, behaviour part and total score part of MARSI, and lower in the knowledge part. They were ranked as the attitude part, behaviour part, overall part and knowledge part according to the score rate from high to low, indicating that NICU nurses could pay attention to MARSI in consciousness, but their mastery of MARSI knowledge was relatively low (average score < 60), and their protection measures for MARSI were not standardized. So it was necessary to improve the knowledge level of nurses' MARSI, strengthen the standardization of MARSI protection behaviour. In the survey, the score of nurses' attitude was high, but the score of MARSI prevention behaviour was medium. It can be seen that some medical staff were aware of the necessity of learning, and their behaviour may be affected by other factors. Nursing managers should pay attention to the training and effect of nurses' MARSI knowledge, and then guide them to change their attitudes, so as to improve the compliance of preventing MARSI behaviour (Swanson et al., 2022; Yuanyuan & Xuejiao, 2021).

In the questionnaire survey, it was found that most nurses did not know what products, ingredients and functions of skin protectants were. The liquid dressing has been used in clinical practice. The liquid skin dressing is a polymer solution. It can form a colourless and waterproof protective film when sprayed on the skin, which can isolate sweat, oil, etc (Crespo et al., 2022). Before using the adhesive, the liquid dressing can form a protective layer between the adhesive and the skin after drying. When removing the adhesive product, the protective layer is removed instead of the skin keratinocytes, thus reducing the damage to the skin cuticle (Bernatchez & Bichel, 2022). The low score of this item may be due to the latest clinical use of this product, and the medical staff are not familiar with the use method and mechanism (Belfield-Cockings, 2022; Yan, 2019).

The total score of nurses' attitude was high, which showed that they were highly motivated to prevent MARSI, but the medical staff did not pay enough attention to the details of preventing MARSI. They did not realize the harm of MARSI to patients, and felt that it was unnecessary to educate the families and patients of high-risk groups about MARSI. Therefore, it is suggested that managers should strengthen the attitude of learning the importance of MARSI in the future and guide medical staff to put positive attitude into healthy behaviour. It has been reported that viscose can also promote the overgrowth of yeast and saprophytic fungi (Rehan et al., 2018). If the skin under medical adhesive is not properly treated, it is very easy to cause infiltration, erosion and damage, which will lead to skin infection (Zhao et al., 2022). There are also studies (Hitchcock et al., 2021; Kaur et al., 2022) show that the pollution of adhesive products is a related factor in the occurrence of contact dermatitis. It can be seen that adhesive is the vector of infection transmission, which has not attracted the attention of medical staff. In actual work, clinical medical staff rarely use lotion, vaseline, and mineral oil to assist in removal, which may be due to the busy clinical work (Barton, 2021; Kim & Shin, 2021; Pires-Junior et al., 2021). In order to improve work efficiency, medical staff did not take standardized protective measures, and secondly, the department may not provide such items for use. Most nurses have indicated that they only use the adhesive tape according to what the department has prepared. It can be seen that the nurses lack the knowledge about the characteristics of adhesive products and clinical application. Therefore, the managers should purchase adhesive products with different characteristics according to the types of fixed catheters in the department to meet the actual clinical needs as much as possible (Collier, 2019; McNichol et al., 2013; Yates et al., 2017).

There is a positive correlation between the scores of nurses' knowledge, attitude and behaviour about MARSI. The higher the score of MARSI related knowledge, the more positive the attitude of preventing MARSI, and the higher the score of preventing MARSI behaviour practice. Therefore, in order to achieve the goal of behaviour change, nurses must base themselves on correct knowledge and take correct beliefs as motivation (Alcantara et al., 2021; Fumarola et al., 2020; Lin et al., 2021). After fully understanding MARSI and its hazards, and mastering the correct methods of preventing MARSI, the nurses can put the specific MARSI prevention strategies into practice under the drive of the correct attitude to ensure the integrity of the skin of the adhesive site (Huahua et al., 2020; Qingqing et al., 2020; Yanqiong et al., 2016). Age is an important factor affecting MARSI cognition. The older the nurse is, the higher the score of MARSI knowledge, attitude and behaviour is. With the increase of age, the clinical work experience is more and more rich, and the understanding of MARSI is more profound, so the score is higher. The scores of knowledge, attitude and behaviour of nurses who have accepted MARSI training are higher than those of nurses who have not received MARSI related knowledge learning (Hitchcock & Savine, 2015; Kim et al., 2019; Yu et al., 2017). It is necessary for medical staff to participate in MARSI related knowledge learning and training to improve their understanding of MARSI (Alavi et al., 2016; Zhang et al., 2020). Hospital managers should strengthen the learning and training of medical staff on MARSI related knowledge, improve their awareness of skin protection, standardize their protective behaviours, and achieve a harmonious unity of knowledge, attitude and behaviour (de Faria et al., 2019; McNichol et al., 2013; Yates et al., 2017).

This study has some limitations that must be considered. First of all, even though this study used a self-developed questionnaire. Due to the requirements of the number of items in the questionnaire, there may be some other influencing factors that do not include for analysis. Secondly, this study is a single center survey, with a small sample size and no medical staff from other different hospitals involved. The results of this study cannot represent the universality of the event. Therefore, in order to make the evaluation results more accurate, in the future research, further investigations on the the medical staff in multiple cities and hospitals of different levels to fully understand the overall situation of medical staff's knowledge, attitude and behaviour in preventing MARSI.

5 CONCLUSIONS

In summary, this survey has found that neonatal nurses do pay enough attention to the prevention of MARSI, but their mastery of MARSI knowledge is not ideal. The standardization of MARSI protection behaviour needs to be strengthened. The knowledge, belief and practice of neonatal nurses on MARSI are influenced by many factors, especially whether they have received MARSI related training. Medical staff should strengthen their learning and training of MARSI related knowledge, to improve nurses' awareness of protection and standardize their protective behaviours, to reduce the occurrence of neonatal MARSI.

AUTHOR CONTRIBUTIONS

LW, SD, HR designed research; LW, SD, LY, HR conducted research; LW, HR analysed data; LW, HR wrote the first draft of manuscript; H R had primary responsibility for final content. All authors read and approved the final manuscript.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests.

RESEARCH ETHICS COMMITTEE APPROVAL

In this study, all methods were performed in accordance with the relevant guidelines and regulations. Our study had obtained the ethical approval from Children's hospital of Nanjing medical university (approval number: 20220056), and written informed consents had been obtained from all the included nurses.