Introduction

The COVID-19 pandemic has greatly affected all aspects of life, including social, economic, and especially the health sector. Nurses are the largest number of professionals and play an important role in coordinating health services in hospitals [1]. New data obtained by the International Council of Nurses (ICN) indicates that COVID-19 is causing the nurses across the world to experience mass trauma. The number of reported nurse deaths now exceeds 2,200, and with high levels of infections continuing in the nursing workforce, in the face of ever-growing workloads, continued violence and demonstrations by anti-vaccinators, overstretched workers are experiencing increasing psychological distress. In the COVID-19 pandemic, nurses play an important role in identifying, isolating, and caring for COVID-19 patients, as well as providing support to people having close contact with the patients [2]. It is obvious that nurses always play a role in infection prevention and control and caring for patients during a health crisis in a region [3].

Research shows that from March to November 2020, at least 282 health workers, including doctors and nurses in Indonesia, died due to COVID-19 [4]. The National Hospital Infection Management and Quality Control Centre reports that the incidence of infection in health workers in the Hubei province of China is mainly due to errors in the use of personal protective equipment [5]. Health workers in workplaces with limited resources, need to have the ability to properly use personal protective equipment (PPE), including the selection, installation, removal, decontamination, and disposal of PPE. This ability must also be supported by theoretical knowledge about the indications and procedures for its use to provide effective protection in the clinical area [6]. Health workers, in this case nurses, should have the proper attitudes towards the use of PPE to succeed and win the battle against COVID-19 [6].

COVID-19 is a new disease, which has never been encountered before. Therefore, nurses need assurance that they have sufficient knowledge to provide services since the information circulating regarding COVID-19 standards and protocols is changing rapidly [7]. Knowledge can guide nurses in dealing with this pandemic and mitigate health crises that may be faced in the future [2]. Telecommunication technology is an effective way to get around the distance and learning barriers caused by pandemic [8].

Tele-education is a teaching and learning process that uses a combination of telecommunications and computer devices for educational purposes [9,10]. There are two forms of tele-education [11]: (1) asynchronized — the internet is used to publish digital media which is used, then participants are encouraged to study independently; and (2) synchronized — the main form is real-time interactive virtual classrooms that are supported by applications developed to meet the needs of participants. A teleconference is a part of distance learning or tele-education, which serves as a medium to provide direct education; this method has been used in the area of health education. Nurses need to receive accurate information regarding the use of PPE. In this study, the researchers tried to apply synchronized teleconferences to increase nurses’ knowledge about PPE and foster adaptive attitudes to pandemic conditions.

Material and methods

The present study used a pre-post quasi-experimental design [12] without a control group. Approval to conduct this study was obtained from the Research Ethics Committee of Sultan Agung Islamic Hospital (No. 03/EC/KEPK/2020). The samples were 60 nurses from three hospitals in Semarang city, Indonesia. Non-probability sampling with a consecutive sampling technique was employed to recruit the samples. The inclusion criteria were nurses who worked in the emergency units, COVID-19 isolation units, ICU, and nurses who were off duties during this research. Meanwhile, the exclusion criteria were nurses who had less than two-year work experience and apprentice nurses. This study was conducted from May to June 2020.

The data in this study were collected using the knowledge and attitude questionnaire. Three microbiologists were invited to provide expert judgment on the questionnaire. In addition, this questionnaire was also tested for its validity and reliability; the result showed the Guttman split-half coefficient of 0.66. Teleconferences were conducted as the study’s interventions. The speakers were a virologist and the head of the infection prevention and control committee in a hospital in Semarang. The video conferences were conducted simultaneously with the participants synchronously for an hour and a half. The subject materials were the prevention and control of COVID-19 infection in the hospitals, including the infection transmission measures, models for suspected COVID-19 patients, caution with PPE, and procedure illustrations for wearing and removing PPE as indicated by its level. The questionnaire was administered to all participants before and after the intervention using the Google form on the first and fourth weeks of the study. Figure 1 shows the research procedures in one month during the study.

Figure 1: Research procedure with a teleconference intervention

The collected data were tested for homogeneity using the Kolmogorov-Smirnov test. The result showed an alpha value of >0.05, indicating the data were normally distributed. Therefore, the paired t-test was used for data analysis. The paired t-test with a p-value of t-table was performed to determine significance. The characteristics of participants were presented with percentage and frequency.

Result and Dissection

Characteristics of participants

The participants in this study were 60 nurses. Data on the participants’ characteristics and levels of knowledge and attitudes are presented in Table 1. The majority of the participants were aged 26-35 (40%), who showed moderate knowledge (40%) and attitudes (45%), and males (35%), who showed moderate knowledge (35%) and attitude (45%) as well. Furthermore, the majority of the participants had work experience of more than five years with moderate knowledge (50%) and attitudes (58.33%), and attended the infection prevention and control training with moderate knowledge (51.67%) and attitudes (56.67%) as well.

Table 1: Characteristics of participants by percentage and frequency (n = 60)

The level of nurses’ knowledge and attitude after receiving the teleconference for infection control

The level of nurses’ knowledge before the intervention was generally moderate (68%) to high (7%). After the intervention, there was an increased level of knowledge: high (20%) and moderate (63%). The nurses’ attitudes in this study were generally at moderate (70%) and poor (13%) levels. However, after the intervention, the participants with a moderate level increased to 77%, while those with a poor level decreased to 7%.

Table 2: Knowledge and attitudes before and after the teleconference for infection control (n = 60)

Analysis of differences before and after the teleconference intervention for infection control

The analysis of the differences before and after the intervention is presented in Table 3. It is shown that after the intervention, the p-values for nurses’ knowledge and attitudes were 0.000 and 0.005, respectively. This indicates that the intervention of teleconference for infection control was effective in increasing nurses’ knowledge and attitudes towards infection prevention and control.

Table 3: Analysis of differences before and after the teleconference for infection control (n = 60)