quantitative research study nursing

Nursing Research (NURS 3321/4325/5366)

• Introduction
• Understand What Quantitative Research Is
• Understand What Qualitative Research Is
• Sage Methods Map
• Step 1: Accessing CINAHL
• Step 2: Create a Keyword Search
• Step 3: Create a Subject Heading Search
• Step 4: Repeat Steps 1-3 for Second Concept
• Step 5: Repeat Steps 1-3 for Quantitative Terms
• Step 6: Combining All Searches
• Step 7: Adding Limiters
• Step 8: Save Your Search!
• What Kind of Article is This?
• PICO Keyword Search Strategy
• PICO Keyword Search
• PICO Subject Heading Search
• Combining Keyword and Subject Heading Searches
• Adding Filters/Limiters
• Finding Health Statistics
• Find Clinical Guidelines This link opens in a new window
• APA Format & Citations This link opens in a new window

What is Quantitative Research?

Quantitative methodology is the dominant research framework in the social sciences. it refers to a set of strategies, techniques and assumptions used to study psychological, social and economic processes through the exploration of numeric patterns . quantitative research gathers a range of numeric data. some of the numeric data is intrinsically quantitative (e.g. personal income), while in other cases the numeric structure is  imposed (e.g. ‘on a scale from 1 to 10, how depressed did you feel last week’). the collection of quantitative information allows researchers to conduct simple to extremely sophisticated statistical analyses that aggregate the data (e.g. averages, percentages), show relationships among the data (e.g. ‘students with lower grade point averages tend to score lower on a depression scale’) or compare across aggregated data (e.g. the usa has a higher gross domestic product than spain). quantitative research includes methodologies such as questionnaires, structured observations or experiments and stands in contrast to qualitative research. qualitative research involves the collection and analysis of narratives and/or open-ended observations through methodologies such as interviews, focus groups or ethnographies..

Coghlan, D., Brydon-Miller, M. (2014).  The SAGE encyclopedia of action research  (Vols. 1-2). London, : SAGE Publications Ltd doi: 10.4135/9781446294406

What is the purpose of quantitative research?

The purpose of quantitative research is to generate knowledge and create understanding about the social world. Quantitative research is used by social scientists, including communication researchers, to observe phenomena or occurrences affecting individuals. Social scientists are concerned with the study of people. Quantitative research is a way to learn about a particular group of people, known as a sample population. Using scientific inquiry, quantitative research relies on data that are observed or measured to examine questions about the sample population.

Allen, M. (2017).  The SAGE encyclopedia of communication research methods  (Vols. 1-4). Thousand Oaks, CA: SAGE Publications, Inc doi: 10.4135/9781483381411

How do I know if the study is a quantitative design?  What type of quantitative study is it?

Quantitative Research Designs: Descriptive non-experimental, Quasi-experimental or Experimental?

Studies do not always explicitly state what kind of research design is being used.  You will need to know how to decipher which design type is used.  The following video will help you determine the quantitative design type.

• << Previous: Introduction
• Next: Understand What Qualitative Research Is >>
• Last Updated: Apr 22, 2024 8:32 PM
• URL: https://libguides.uta.edu/nursingresearch

University of Texas Arlington Libraries 702 Planetarium Place · Arlington, TX 76019 · 817-272-3000

• Internet Privacy
• Accessibility
• Problems with a guide? Contact Us.

• Quantitative vs. Qualitative Research

You can find evidence for clinical decision making in quantitative and qualitative research studies .  Quantitative research  refers to any research based on something that can be accurately and precisely measured and will include studies that have numerical data . Quantitative data are expressed numerically and analyzed statistically. The data are collected from experiments and tests, metrics, databases, and surveys. In healthcare research they  often  include studies of intervention effectiveness, satisfaction with care, the incidence, prevalence, and etiology of diseases, and the properties of measurement tools (Kolaski, 2023).

Findings in qualitative studies are not based on measurable statistics. Qualitative data are descriptive rather than numerical. Qualitative research derives data from observation, interviews, verbal interactions, or textual analyses and focuses on the meanings and interpretations of the participants. Qualitative research studies in healthcare investigate the impact of illnesses and interventions. The research explores experiences, attitudes, beliefs, and perspectives of patients, caregivers, and clinicians (Kolaski, 2023). The analysis of qualitative research is interpretative, subjective, and impressionistic.  

Kolaski, K., Logan, L. R., & Ioannidis, J. P. A. (2023). Guidance to best tools and practices for systematic reviews. Systematic Reviews , 12 (1), 96. https://doi.org/10.1186/s13643-023-02255-9

For more information on qualitative research:

Curtis, A. & Keeler, C. (2022). An introduction to qualitative methods for the nurse researcher.  American Journal of Nursing, 122  (8), 52-56. https://doi: 10.1097/01.NAJ.0000854992.17329.51.

Noyes, J., Booth, A., Cargo, M., Flemming, K., Harden, A., Harris, J., Garside, R., Hannes, K., Pantoja, T., & Thomas, J. (2023). Chapter 21: Qualitative evidence.  In Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A. (Eds.).  Cochrane handbook for systematic reviews of interventions version 6.4.  Cochrane.  www.training.cochrane.org/handbook

Video:  UniversityNow: Quantitative vs. Qualitative Research

Appraising Quantitative and Qualitative Research

The articles below provide a step-by-step appraisal on how to critique quantitative and qualitative research articles:

Ryan, F., Coughlan, M. & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research.  British Journal of Nursing, 16 (11), 658-663 .

Ryan, F., Coughlan, M. & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 2: qualitative research.  British Journal of Nursing, 16 (2), 738-744 .

• << Previous: Study Types & Terminology
• Next: Critical Appraisal: Evaluating Studies >>
• Evidence-Based Medicine/Evidence-Based Practice
• Evidence-Based Practice in Nursing
• EBP in Nursing: More Resources
• Question Types
• Levels of Evidence
• Systematic Reviews and Meta Analyses
• Study Types & Terminology
• Critical Appraisal: Evaluating Studies
• Conducting a Systematic Review
• Research Study Design
• Selected Print and Electronic Reference Books for EBP
• Finding a Book on the Shelf by Call Number
• Finding EBP Articles in the Databases
• Selected Evidence Based Practice Journals
• Finding the Full Text of an Article from a Citation
• Intro to Nursing Databases
• Databases for EBP
• Intro to Nursing Resources
• Citation Management Programs
• Sample Annotated Bibliography
• Last Updated: Apr 16, 2024 6:07 PM
• URL: https://libguides.adelphi.edu/evidence-based-practice

A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation

Affiliation.

• 1 West Virginia University, Morgantown, WV, USA.
• PMID: 24606553
• DOI: 10.1111/jocn.12575

Aims and objectives: To quantify quantitative outcomes of a practice change to a blended form of bedside nursing report.

Background: The literature identifies several benefits of bedside nursing shift report. However, published studies have not adequately quantified outcomes related to this process change, having either small or unreported sample sizes or not testing for statistical significance.

Design: Quasi-experimental pre- and postimplementation design.

Methods: Seven medical-surgical units in a large university hospital implemented a blend of recorded and bedside nursing report. Outcomes monitored included patient and nursing satisfaction, patient falls, nursing overtime and medication errors.

Results: We found statistically significant improvements postimplementation in four patient survey items specifically impacted by the change to bedside report. Nursing perceptions of report were significantly improved in the areas of patient safety and involvement in care and nurse accountability postimplementation. However, there was a decline in nurse perception that report took a reasonable amount of time after bedside report implementation; contrary to these perceptions, there was no significant increase in nurse overtime. Patient falls at shift change decreased substantially after the implementation of bedside report. An intervening variable during the study period invalidated the comparison of medication errors pre- and postintervention. There was some indication from both patients and nurses that bedside report was not always consistently implemented.

Conclusions: Several positive outcomes were documented in relation to the implementation of a blended bedside shift report, with few drawbacks. Nurse attitudes about report at the final data collection were more positive than at the initial postimplementation data collection.

Relevance to clinical practice: If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes. However, managers should involve staff nurses in the implementation process and continue to monitor consistency in report format as well as satisfaction with the process.

Keywords: bedside shift report; nursing handover; nursing shift report; patient satisfaction; patient-centred care.

© 2014 John Wiley & Sons Ltd.

• Accidental Falls / prevention & control*
• Continuity of Patient Care*
• Mid-Atlantic Region
• Nursing Process*
• Patient Safety / standards*
• Point-of-Care Systems*
• Program Evaluation
• Surveys and Questionnaires
• Young Adult

NUR 39000: Nursing Research: Quantitative Study Searching

• Quantitative Study Searching
• Qualitative Study from a Specific Journal
• Inferential Statistics Tips
• Find Informative Articles
• Primary & Secondary Sources
• Nursing Databases
• Journal Types
• Accessing Full-Text
• Asking the PICO or PICo Question
• Acquiring Evidence
• Appraising the Evidence
• Research Designs
• Levels of Evidence
• Grey Literature Resources
• Writing & APA Citation Help
• How to Get Help
• COVID-19 Resources
• Video Tutorials

Identifying Research Articles

Identify research articles by reviewing the abstract and other bibliographic information. Many citations for research articles include the following headings:

• Participants
• Data Collection
• Data Analysis

Read the full text  of the article to learn more.

Identifying Peer Reviewed Sources

There are several ways that you can determine the peer reviewed status of a journal. Review the selections in the database advanced search page for a peer reviewed check box or menu limiter. You can also look at  title lists  which include  peer reviewed information. Click on the following database to see the title lists for  CINAHL Plus with Full Text ,  MEDLINE  or  Health Source: Nursing .

A basic Google search of "Is Journal Name peer reviewed" will often produce results that link you to a reliable source and answer.  The journal’s website will usually mention if it is peer reviewed in the description. 

Tips for Finding Nursing Journals

Tip: You may choose to use a journal-type limiter to narrow your search to nursing journals.

Here are nursing journals limits from CINAHL, MEDLINE (Ebsco), and PubMed:

In CINAHL you can target nursing journals by selecting Nursing from the Journal Subset menu options. This is not usually necessary, since CINAHL stands for Cumulative Index to Nursing and Allied Health Literature.  Nearly all publications in the CINAHL database are nursing journals.

In MEDLINE (Ebsco) you can target nursing journals by selecting Nursing from the Journal & Citation Subset menu options.

In PubMed, you can target nursing journals after you have performed your search.  On the results page, there will be a column on the left with filters including Article types, Text availability, Publication dates. Select Show additional filters , check the box next to Journal categories then the Show button. Click on Nursing journals to see results from nursing journals. 

Starting Your Assignment

This page offers tips on locating research articles from library databases for your NUR 390 assignment to find a primary quantitative research study.  Before you start your database search it is important to familiarize yourself with the requirements outlined on the assignment checklist.    

Please note that the help provided on this page is not exhaustive. The tips are intended to help generate potential relevant search results. Librarians will NOT be able to help you distinguish quantitative vs. qualitative research or determine whether or not a chosen article includes appropriate descriptive and inferential statistics.  Ultimately, you must read the full text of an article and use your textbook and other course materials to determine if it meets the assignment's criteria.

Video for Selecting a Quantitative Research Article

This link connects you to a demonstration video on how to locate articles for the assignment to find a primary quantitative research study.

PLEASE NOTE: The example demonstrates searching for research articles using search limiters in the CINAHL database.  However, the date range at the time of the recording will not necessarily match the range for your specific assignment.  

Please be sure to note the correct date range and other criteria from your instructor's checklist .

Tips for Finding Quantitative Research

The following are tips that can help you find quantitative research articles. These tips work best when your initial search produces a large amount of results. I do not recommend these methods if your initial search generates few results or if your required date range is less than one year.

Tip:  Although CINAHL does not have a checkbox to limit your search to either quantitative or qualitative research, it is sometimes helpful to add vocabulary that describes quantitative research tools, methodology or assessments. In the advanced search screen page, you can add a search box that will include words that describe quantitative research.

Tip: CINAHL allows you to filter by publication type.  If your initial search has returned lots of results, you might try using the Publication Type limiter to select only  Clinical Trial and/or  Randomized Controlled Trial.   These are types of  quantitative studies .  

Tips for Finding Nurse as Author

In CINHAL, you can find articles where a nurse is the first author by checking the First Author is Nurse checkbox in the advanced search page.

Although this limiter is useful for searches with a long date range (several years), it is not recommended for searches with a shorter date range, since the detailed index information in each record is not always up to date.  You may miss articles that were authored by a nurse but do not show up in your search results.

You may need to search the databases using other criteria, and then scan the resulting studies to see if the first author's credentials are listed on the page.

Library Liaison for Nursing Students & Faculty

About the Library

The library offers a wide range of online resources, including databases with various journals from which to choose articles and research studies.

To access your Library resources, please visit the homepage

Please consult your Library Liaison directly for research assistance.

If your Librarian is unavailable, please contact the Library's Reference desk at (219) 989-2676 or click on the CHAT WITH A LIBRARIAN  link below to submit a question or see answers to frequently asked questions.

Library Hours : 

Library staff members are available to assist you during library hours . 

• << Previous: Home
• Next: Qualitative Study from a Specific Journal >>
• Last Updated: Apr 23, 2024 10:26 AM
• URL: https://guides.pnw.edu/NUR390

• For Students
• For Faculty
• Interlibrary Loan
• Request an Item from Everett Library
• Study Rooms & Labs
• Archives & Special Collections
• Accessibility Guide
• Citing Your Sources
• Off-Campus Access
• Online Tutorials
• Library 101
• Library Staff
• Library Hours
• Library Diversity Statement
• Friends of the Library
• History of Everett Library
• Give to the Library
• Library Mission & Vision
• Library Policies

Service Alert

• Nursing Databases
• APA Tutorial
• EBP - Evidence Based Practice and PICO
• Journal Search
• Nursing Websites
• Video Tutorials
• Digital Literacy Sites

Articles from Ovid Database

Abnf articles.

• Journal of Midwifery and Women's Health
• Link to Nursing Research (journal) This journal includes nursing research and has some quantitative studies.
• AJN, American Journal of Nursing
• Increasing Access to Diabetes Education in Rural Alabama Through Telehealth
• Evaluating the Impact of Smartphones on Nursing Workflow: Lessons Learned
• Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease
• Pharmacogenetics of Ketamine-Induced Emergence Phenomena
• Pressure Pain Phenotypes in Women Before Breast Cancer Treatmen
• Efficacy of a Breastfeeding Pain SelfManagement Intervention: A Pilot Randomized Controlled Tria
• Stress and Health in Nursing Students The Nurse Engagement and Wellness Study
• The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care
• Potassium Channel Candidate Genes Predict the Development of Secondary Lymphedema Following Breast Cancer Surgery
• Social Support Is Inversely Associated With Sleep Disturbance, Inflammation, and Pain Severity in Chronic Low Back Pain.
• Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults
• Poor Sleep Predicts Increased Pain Perception Among Adults With Mild Cognitive Impairment
• Feasibility, Acceptability, and Preliminary Effects of “Mindful Moms” A Mindful Physical Activity Intervention for Pregnant Women with Depression
• Associations Among Nitric Oxide and Enkephalinases With Fibromyalgia Symptoms
• Prescribed Walking for Glycemic Control and Symptom Management in Patients Without Diabetes Undergoing Chemotherapy
• Dysmenorrhea Symptom-Based Phenotypes A Replication and Extension Study
• Influence of Oxidative Stress-Related Genes on Susceptibility to Fibromyalgia
• ABNF journal link
• Cardiovascular Diseases in African-American Women: An Assessment of Awareness
• Document links
• << Previous: Digital Literacy Sites
• Last Updated: Feb 27, 2024 4:29 PM
• URL: https://library.queens.edu/nursing

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.10(1); 2023 Jan

Quantitative research on the impact of COVID ‐19 on frontline nursing staff at a military hospital in Saudi Arabia

Loujain sharif.

1 Faculty of Nursing, King Abdulaziz University, Jeddah Saudi Arabia

Khalid Almutairi

2 King Fahad Armed Forces Hospital (KFAFH), Jeddah Saudi Arabia

Khalid Sharif

Alaa mahsoon, maram banakhar, salwa albeladi, yaser alqahtani, zalikha attar, farida abdali, rebecca wright.

3 Johns Hopkins School of Nursing, Baltimore Maryland, USA

Associated Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

The aim of the study was to examine the relationship between stress, psychological symptoms and job satisfaction among frontline nursing staff at a military hospital in Saudi Arabia during the COVID‐19 pandemic.

Descriptive cross‐sectional study.

Data were collected using an online survey. All Registered Nurses ( N  = 1,225) working at a military hospital between February to April 2021 were contacted, 625 responded (51%). Data were analysed using descriptive and multivariate analysis, Student's t‐test for independent samples and one‐way analysis of variance followed by Tukey's multiple comparison tests.

Stress was experienced more significantly than depression or anxiety. Approximately 29% of the change in scores for psychological symptoms was explained by age group, being a Saudi national and working in emergency departments ( F [3,620]  = 19.063, p  < 0.0001). A 37% change in nursing stress scores was explained by nationality and work department. ( F [5,618]  = 19.754, p  < 0.0001). A 29% change in job satisfaction scores was explained by nationality and work department ( F [3,620]  = 19.063, p  < 0.0001).

1. INTRODUCTION

Saudi Arabia reported its first case of coronavirus disease 2019 (COVID‐19) on March 2, 2020 (Reuters Staff,  2020 ; Zu et al.,  2020 ). The World Health Organization has identified the COVID‐19 outbreak as a public health emergency and global pandemic (World Health Organization,  2020 ). The impact of COVID‐19 on those who have contracted it received rapid investigation and documentation (Harper et al.,  2020 ). However, healthcare workers were quickly recognized to be experiencing a secondary impact of COVID‐19, owing to vulnerability to stressors such as inadequate resources, long shifts, sleep problems, work−life imbalances and new occupational hazards (Sasangohar et al.,  2020 ). Notably, previous research on the impact of other coronavirus syndromes (severe acute respiratory syndrome, Middle East respiratory syndrome) found that approximately 62% of healthcare workers reported general health concerns, fear, insomnia, psychological distress, burnout, anxiety, depressive symptoms, posttraumatic stress disorder, psychosomatic symptoms and perceived stigma (Sasangohar et al.,  2020 ).

Compared with other healthcare professionals, nursing staff are particularly susceptible to the negative impact of a pandemic, with a higher vulnerability to negative outcomes associated with working in high‐risk departments (Shaukat et al.,  2020 ). Moreover, the impact is not limited to psychological effects. One systematic review on estimated COVID‐19 infections and deaths among healthcare workers reported 37.2 deaths per 100 infections in nursing staff aged at least 70 years (Bandyopadhyay et al.,  2020 ). Another study conducted in the UK found that out of 157 COVID‐19‐related deaths among medical health workers, 48 (30.6%) were nurses (Kursumovic et al.,  2020 ). This combination of physical (e.g. infection transmission and the underlying manifestations) and psychological effects (e.g. burnout, stress, anxiety and depression) caused by the pandemic (Hu et al.,  2020 ) has led to substantial concerns for nursing staff, with statistically significant bearing on job satisfaction (Del Carmen Giménez‐Espert et al.,  2020 ).

2. BACKGROUND

There has been a concerted effort in Saudi Arabia to understand and mitigate the impact of COVID‐19 on nursing staff, with studies investigating stress, fear of infection and resilience in relation to COVID‐19 (Tayyib & Alsolami,  2020 ); stress and coping strategies in dealing with COVID‐19 (Muharraq, 2021); and nursing knowledge and anxiety related to COVID‐19 (Alsharif,  2021 ). However, these studies give descriptive statistics with relatively small samples of less than 300 nurses, and, to the best of our knowledge, no study has yet focused on assessing multiple psychological symptoms (depression, anxiety, and stress) collectively in relation to job satisfaction. Furthermore, the effects of COVID‐19 among nursing staff in military hospitals have not yet been explored.

This is a key setting for investigation, as military hospitals in Saudi Arabia are considered highly specialized healthcare organizations, providing all forms of health care to an exclusive population of military personnel and their family members (Walston et al.,  2008 ). Healthcare providers recruited for military hospitals must meet high standards and requirements that differ from those in non‐military care settings (Olenick et al.,  2015 ). Because of higher standards and higher pay levels compared with other healthcare organizations in Saudi Arabia, military hospitals often employ healthcare providers, and nurses in particular, from different countries worldwide (Almalki et al.,  2011 ). Despite the higher salaries and expectations of care associated with urgent needs, military hospitals have had to adapt their policies and protocols in response to greater and new patient needs as a result of COVID‐19. Therefore, these hospitals have also been impacted by the brutal reality, thereby leading to an increase in resignations among nursing staff. Probable reasons for this increase include greater workloads, mandatory overtime, withholding of annual leave and switching of nurses from less demanding areas (e.g. outpatient clinics) to more demanding care areas (e.g. inpatient units), along with the risk of contracting COVID‐19 (King Fahad Armed Forces Hospital,  2020 ). These changes suggest that nursing staff at military hospitals have experienced many of the same mental and physical side effects as nurses in non‐military hospitals, with the same consequential burnout and resignations. However, it is also commonly reported that nurses avoid seeking psychological support and services (Knaak et al.,  2017 ). This may be due to a fear of stigma and discrimination in the workplace, where needing mental health help can be perceived as weakness (Jones et al.,  2020 ), which is a phenomenon that is particularly common among military personnel (Hernandez et al.,  2014 ).

Despite investigations into the types of symptoms experienced by nursing staff as outlined above, few studies have explored the relationship between psychological impact and nurses' job satisfaction within the context of military hospitals in the Middle East. Therefore, the present study aimed to examine the relationships within and between stress, psychological symptoms (including depression and anxiety) and job satisfaction among frontline nursing staff at a military hospital in Saudi Arabia during the COVID‐19 pandemic. The purpose of this study was to identify key components that may benefit not only the study site in improving nursing staff retention but also the wider healthcare field, as nursing retention is an increasingly documented challenge. We hypothesized that the abovementioned challenges encountered by nurses, as a secondary impact of COVID‐19, are likely to be linked to low job satisfaction among frontline nurses.

3.1. Design

We used a descriptive cross‐sectional design with a quantitative questionnaire. Convenience sampling was used to recruit Registered Nurses (RNs) working in all hospital units. Overall, 1,125 RNs worked at the study site. The hospital only has full‐time RNs and does not employ part‐time or agency RNs. As such there was no criteria excluding any RN employed at the hospital from participation in this study. Five hundred seventy‐six participants were required for a 50% response rate (Sataloff & Vontela,  2021 ). Data were collected from one military healthcare organization in the western region of Saudi Arabia. The hospital provides all medical services with a 420‐bed capacity, serving members of the Saudi Arabian Armed Forces and their families. The hospital is accredited by the Central Board for Accreditation of Healthcare Institutions, Joint Commission International and International Organization for Standardization, and it is the only adult cardiac surgical facility in the western region.

3.2. Method

The questionnaire comprised four sections and was in English language, with 122 items, in total and took approximately 35 minutes to complete.

Section 1 – Demographic information : We collected data on eight items: age, gender, marital status, nationality, education level, experience and department.

Section 2 – Expanded Nursing Stress Scale (ENSS; French et al.,  2000 ): The ENSS (Cronbach's alpha = 0.96) identifies the sources and frequency of stress among hospital nurses. The scale comprises a total of 57 items on the following stressful situations: death and dying patients (7 items), conflict with physicians (5 items), inadequate emotional preparation (3 items), problems related to peers (6 items), problems related to supervisors (7 items), workload (9 items), uncertainty concerning treatment (9 items), patients and their families (8 items) and discrimination (3 items). The ENSS was also used in the present study to assess the frequency in which nurses experienced work stressors, rated within a range between 0–4, on a scale modified from the original as follows: I have not encountered it (0), never stressful (1), occasionally stressful (2), frequently stressful (3) and always stressful (4). In a pilot test of the modified ENSS, conducted by the authors of this study, the Cronbach's alpha was 0.98.

Section 3 – Depression , Anxiety and Stress Scales (DASS; Lovibond & Lovibond,  1995 ): The DASS (Cronbach's alpha = 0.89) focuses on assessing depression, anxiety and stress among hospital nurses. Each of the three scales contains seven items. The depression scale assesses dysphoria, hopelessness, devaluation of life, self‐deprecation, lack of interest/involvement, anhedonia and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety and subjective experience of anxious affect. The stress scale assesses difficulty relaxing, nervous arousal and being easily upset/agitated, irritable/over‐reactive and impatient. The DASS is rated on a scale ranging between 0–3: (0) does apply to me at all , (1) applies to me to some degree or some of the time , (2) applies to me to a considerable degree or a good part of time and (3) applies to me very much or most of the time . Cronbach's alpha for the DASS in the current study was calculated as 0.969, indicating excellent reliability.

Section 4 – Job Satisfaction Survey (JSS; Spector,  1985 ): The JSS (Cronbach's alpha 0.91) assesses job satisfaction among hospital nurses. It includes 36 items with nine facets as follows: pay (4 items), promotion, supervision (4 items), fringe benefits (4 items), contingent rewards (4 items), operating procedures (4 items), co‐workers (4 items), nature of work (4 items) and communication (4 items). Items are rated on a six‐point Likert scale with responses ranging from 1 ( disagree very much ) to 6 ( agree very much ). The JSS demonstrated acceptable reliability in the current study, with a Cronbach's alpha of 0.798. Regarding the scoring system, scores for each four‐item subscale ranged from 4 to 24 and were scored as follows: dissatisfied (4–12 points), ambivalent (12–16) and satisfied (16–24). For the total 36‐item JSS, scores ranged from 36 to 216 and were scored as follows: dissatisfied (36–108 points), ambivalent (108–144) and satisfied (144–216; Spector,  1994 ).

3.3. Data collection process

After obtaining ethical approval, potential study participants who were recruited to participate through unit meetings by the head nurses of the units, who acted as gatekeepers. All relevant information on the study, including its research topic, aim, sample and significance were explained to all RNs in each unit. Within Saudi culture, in addition to communication modalities such as email, social media platforms are a common and effective method of communicating with groups within different organizations. Therefore, the head nurse in each unit sent the survey using google form as an electronic link via the social media application “WhatsApp” to all RNs who agreed to participate in the study. The survey was sent out in February 2021 and remained available until April 2021.

3.4. Analysis

Data were analysed using SPSS 26.0 Windows version statistical software (IBM, Armonk, NY, USA). Descriptive statistics (means, standard deviations, frequencies and percentages) were used to describe the quantitative and categorical variables. Student's t‐test for independent samples was used to compare the mean values of quantitative outcome variables in relation to the categorical study variable with two categories. One‐way analysis of variance, followed by Tukey's multiple comparison tests (Tukey,  1953 ), was used to compare the mean values of quantitative outcome variables in relation to the categorical study variables with more than two categories. A p ‐value of ≤0.05 was used to report the statistical significance of the results.

For the multivariate analysis, a stepwise Multiple linear regression was carried out to observe the independent relationship of variables of categorical study variables with the three quantitative variables (DASS, ENSS and JSS scores). As the study variables were categorical, dummy variables were created to include them in the model. The proportion of variability R 2 was used to observe the change in the outcome variable explained by the significant independent variables in the model. Regression coefficients were used to observe changes in the outcome variables. A p ‐value ≤0.05, was used to report the statistical significance of the estimates.

3.5. Ethics

Ethical approval was obtained from the King Fahd Armed Forces Hospital‐ Jeddah, Research and Ethics Committee (Ref. number: REC 398), confirming no risk to study participants via the application of an anonymous online survey. The cover page of the survey provided key information, including the importance and purpose, expected time necessary to complete the survey, and why survey recipients were asked to participate. A statement regarding confidentiality and anonymity was included within the online link to the survey. No financial incentives were offered.

Of the 624 nurses who completed the survey (response rate: 51%), 91.3% were women, approximately two‐thirds (66.8%) were aged between 25–35 years, and more than 50% were unmarried. The majority were Filipino (75.8%), and only 5.6% were Saudi. Approximately 90% of the sample had a bachelor's degree, and 48.4% had 1–5 years of experience; 6.3% had more than 15 years of experience. The sample was distributed among the following departments and units: emergency departments (14.6%), intensive care units (22.6%), inpatient units (39.1%) and outpatient units (9.6%); the remaining 14.1% were from other departments. A quarter of the sample (n = 156) had tested positive for COVID‐19 (Table  1 ).

Socio‐demographic and professional characteristics of participants ( N  = 624)

Table  2 shows the mean values of the three DASS subscales (depression, anxiety and stress). The mean stress score was higher than the mean scores for either depression or anxiety. Table  3 shows the ENSS scores and mean values of its nine domains, in which the mean score of the “workload” domain was highest (2.39), followed by mean scores of “patients and their families” (2.30) and “problems relating to supervisors” (2.14); the mean scores of the remaining six domains were less than 2.0 The mean value for the nine domains of the JSS was 121.07 (22.1), which indicated ambivalence (Table  4 ). The only mean score that indicted satisfaction was in the “nature of work” domain (17.04), followed by “co‐workers” (15.88) and “supervision” (15.16). The mean scores of the remaining six domains were less than 15.0, ranging from ambivalent to dissatisfied.

Comparison of mean scores of DASS sub scales and total score in relation to socio‐demographic and professional characteristics of study subjects ( n  = 624)

Note : Bolded text denotes p value of <0.05.

Comparison of mean values of nine domains and total score of ENSS scale in relation to socio‐demographic and professional characteristics of study subjects ( n  = 624)

Comparison of mean values of nine domains and total score of job satisfaction scale in relation to socio‐demographic and professional characteristics of study subjects ( n  = 624)

4.1. Bivariate and multivariate analyses

For mean DASS scores, bivariate analysis showed statistically significant differences in relation to age group, nationality and work department with further statistically significant differences found in mean anxiety scores among nurses who had tested positive for COVID‐19 ( p  = 0.030; Table  2 ). Multivariate analysis revealed that the overall regression model was statistically significant ( F [3,620]  = 19.063, p  < 0.0001), with an R 2 of 29.1 (Table  S1 ). The R 2 is the proportion of variability, which means approximately 29% of the change in DASS scores was explained by age group (25–30 years), being a Saudi national and working in emergency or “other” departments. The corresponding regression coefficients of these variables indicated that the DASS scores increased on average (i) by 6.334 units in nurses aged 20–30 years when compared to those aged 46–50 years, (ii) by 17.725 units in Saudi nationals when compared to South African nationals and (iii) by 11.699 units in nurses who worked in emergency departments when compared to those who worked in outpatient departments (Table  S1 ).

For ENSS scores, bivariate analysis showed statistically significant differences related to nationality, place of work and experience (Table  3 ). Multivariate analysis showed that the overall regression model was statistically significant ( F [5,618]  = 19.754, p  < 0.0001) with an R 2 of 37.1 (Table  S2 ). A 37% change in ENSS score was explained by nationality and place of work. The corresponding regression coefficients of these variables indicated that ENSS scores increased, on average, (i) by 5.619 units in Filipino nationals when compared to Indian nationals, (ii) by 7.987 units in Malaysian nationals when compared to Indian nationals, (iii) by 4.976 units in Saudi nationals when compared to Indian nationals and (iv) by 4.996 units in nurses who worked in emergency departments when compared to those who worked in inpatient departments (Table  S2 ).

For JSS scores, bivariate analysis showed that the mean values had statistically significant differences in relation to nationality, place of work and education level (Table  4 ). Multivariate analysis showed that the overall regression model was statistically significant ( F [3,620]  = 19.063, p  < 0.0001), with an R 2 of 29 (Table  S3 ). A 29% change in JSS score was explained by nationality and place of work. The corresponding regression coefficients of these variables indicated that JSS scores increased, on average, (i) by 13.022 units in Indian nationals when compared with Filipino nationals, (ii) by 10.017 units in Saudi nationals when compared to Filipino nationals and (iii) by 9.992 units in nurses who worked in inpatient departments when compared to those who worked in outpatient departments (Table  S3 ).

5. DISCUSSION

The present study explored the impact of COVID‐19 on nurses working in a military hospital in Saudi Arabia and identified correlations between psychological symptoms and job satisfaction. The data give a detailed understanding of specific challenges to enable the study site to give additional support where needed, as well as give the wider field with new insights that can be built upon in future research. We found that the COVID‐19 pandemic is driving frontline nursing staff in the Jeddah region of Saudi Arabia to experience severe psychological strain.

Based on mean DASS scores, stress was the highest, when compared to depression and anxiety. This result is consistent with a meta‐analysis of 93 studies in which stress was found to be the most severe psychological symptom among nurses working during the COVID‐19 pandemic (Al Maqbali et al.,  2021 ). This result itself is unsurprising, as stress is considered a normal reaction to circumstances related to the pandemic, whereas depression and anxiety are considered psychiatric disorders that should meet certain symptom criteria for a specific duration (Regier et al.,  2013 ). However, nurses in the present study, who tested positive for COVID‐19 showed symptoms of anxiety. A previous qualitative exploration with nurses who had contracted COVID‐19 revealed similar results, while also providing further context regarding the depth of anxiety, fear and psychological shock they experienced (He et al.,  2021 ). However, as that was the only qualitative study, we were able to identify on this topic to date, we highlight this as an area that would benefit from further qualitative research not only to determine lived experiences but also to identify mitigating and supporting factors.

Data collected using the ENSS and JSS indicated that the most significant sources of stress for nursing staff in the present study were those associated with their work environment, such as workload, working under pressure, short time allotted to complete tasks, unsuitable rest/work regimens, frequent night shifts and overtime work. Pre‐pandemic, unusually high workloads were countered by reductions in outpatient appointments and treatments. However, the uniquely intense and demanding nature of COVID‐19 has made that an impossibility for isolation and triage hospitals. Similar findings have been reported elsewhere, as continuous emergency COVID‐19 cases, along with sustained increases in the number of suspected and confirmed cases, are placing frontline nursing staff under intense pressure (Brahmi et al.,  2020 ; Kakar et al.,  2021 ). Moreover, the extreme nature of COVID‐19 cases and high mortality rates have also changed the challenges nurses face in their work environment. New infection control safety policies have physically separated patients and families to reduce the risk of cross‐infection (Hsu et al.,  2020 ; Jaswaney et al.,  2022 ). Nurses implementing these policies have at times faced unreasonable demands and even abuse from distressed families, which exacerbates stressors and increases the pressure on them (Abu‐Snieneh,  2021 ). We found this to be the case among our nursing participants, who reported distress at the manner and frequency of patients deteriorating and dying, regardless of all medical and nursing efforts and care. These encounters led to a sense that the pandemic cannot be overcome, causing some nurses to experience guilt and self‐blame. This phenomenon has been noted elsewhere, as nurses have responded to blaming themselves, distressed, or angry relatives and patients and cited as one of the main stressors among frontline nurses (Byrne et al.,  2021 ; Liu et al.,  2020 ). We suggest that training in end‐of‐life care processes and approaches may be beneficial to give nurses with the skills to care for patients and families and to equip them with resiliency skills for this type of care (Peters et al.,  2013 ).

Frontline nurses were further impacted by the department in which they worked. We found nurses who worked in emergency departments scored the highest on the DASS, and ENSS, which is consistent with another study showing that nurses working in high‐exposure units with suspected COVID‐19 patients had higher levels of depression than nurses working in other units (Doo et al.,  2021 ). There could be several reasons for this finding, such as an unsafe work environment, insufficient personal protective equipment and unknown patient conditions. In addition, emergency departments are known to be unpredictable work environments, which not only means nurses must be ready to respond to any potential patient need but also increases their vulnerability to unexpected events, such as workplace violence and crises (Cui et al.,  2021 ).

There were other multiple domains on the ENSS and JSS that contributed to frontline nurses experiencing occupational stress and lacking job satisfaction, respectively. Interestingly, one correlation that was found was between the level of satisfaction and the level of education. Other researchers have found that the higher the level of education, the higher the level of satisfaction (Coomber & Barriball,  2007 ). Conversely in the present study, we found that the higher the level of education, the lower the level of satisfaction. One possible explanation for this could be that during the COVID‐19 pandemic, nurses with higher levels of education are more prepared and equipped to understand evidence‐based practice and policies and guidelines, and the absence of such may have contributed towards feelings of distress and lower satisfaction than nurses who are less highly trained and may not be as aware of the lack of research underpinning rapidly developed new policies and guidelines. This finding is at odds with other studies exploring this relationship (Lorber & Skela Savič,  2012 ). Another possible reason is that “job satisfaction” has not been consistently defined across studies (Coomber & Barriball,  2007 ), and those previous studies were performed in other counties where the term's meaning may have different cultural nuances.

Another area of note was as a perceived lack of support from supervisors. Although they are generally more experienced than their subordinates, nursing supervisors have been asked to serve in their roles with greater demands on them to manage an unfamiliar scenario (Alnazly et al.,  2021 ). As such, previously developed regulations, protocols and processes have not been effective or appropriate for responding to changing patient needs or care practices for infection control management; thus, supervisors have simply not had the information needed to guide practice and support junior staff, patients and families (Buheji & Buhaid,  2020 ). We found the nature of relationships to be a consistent source of stress for nurses, with conflicts between co‐workers (nurse to nurse) and with physicians, and a sense of continuous blame directed at nurses being particularly challenging. This is not an unsubstantiated perception, as Wang et al. ( 2020 ) found that other medical professionals often treat nurses as scapegoats.

Age was of particular significance in the present study, as depression, anxiety and stress were significantly higher in nurses aged 25–30 years. This is in line with the results of other studies with nurses in Saudi Arabia (Abu‐Snieneh,  2021 ; Ghawadra et al.,  2019 ) and internationally. For example, in China, Portugal and Turkey, younger frontline nurses were found to be more likely to experience depression and worry about personal or family health during the COVID‐19 pandemic (Murat et al.,  2021 ; Sampaio et al.,  2021 ; Zheng et al.,  2021 ). Potential explanations include a lack of preparedness for the occupational role in a pandemic and less experience responding to crisis situations among younger nurses, compared with older nurses (Shahrour & Dardas,  2020 ). Within our setting, another possible explanation connects to a prevailing cultural expectation. In Arab cultures it is expected that by age 25, most people will have settled down and established a family. Thus, attempts to meet expectations, such as finding the right partner, during the pandemic while experiencing mental and physical distress is likely to increase the negative psychological impact on individuals in this age group.

Nationality was of particular interest, as although the five nationalities of nurses captured in the questionnaire (Filipino, Indian, Malaysian, Saudi and South African) were not normally distributed, Saudi nurses showed higher levels of depression, anxiety and stress than nurses of other nationalities. Similar findings were reported by Al‐Dossary et al. ( 2020 ), whose study on the effect of COVID‐19 in 500 nurses found that non‐Saudi nurses had higher self‐reported awareness, positive attitudes, optimal prevention and positive perceptions compared with Saudi nurses. A possible explanation is that many non‐Saudi nurses working in the region are away from their families, while Saudi nurses are in their usual living arrangements. Therefore, during the pandemic, Saudi nurses have an additional concern of transmitting the virus to their families, while non‐Saudi nationals may be concerned about their loved ones, but do not experience the distress of their job leading to direct risk or harm to them (Abu‐Snieneh,  2021 ). Other studies have also shown family safety to be a significant concern among frontline nursing staff during the COVID‐19 pandemic (Labrague,  2021 ).

5.1. Limitations

The present study has some limitations that should be noted. Although this study provides insights into the main psychological stressors that are impacting the nursing workforce and to what degree, it would have been strengthened by including a qualitative arm to provide context and depth to our findings. This research is planned as our next phase. Survey tools were delivered in their original English language as our hospital nursing staff includes a wide range of nationalities and English is the official language of Saudi healthcare organizations. However, it may be beneficial in future research to develop alternative translations and variables that would more directly capture cultural context.

6. CONCLUSION

The present findings demonstrated a relationship between stress, psychological symptoms and job satisfaction. The main concerns were workload, work department, supervision, collegial relationships and high mortality rates in patients. More research is needed to identify what types of support are required, along with mechanisms to tailor such support to the different variables identified by the nursing participants. Based on the findings of this study, we recommend focusing efforts on raising awareness among hospital managers regarding nurses' psychological symptoms and possible support measures, which may include flexible working hours, clear communication and training in palliative and end‐of‐life care. Finally, qualitative investigation is highly recommended to explore in‐depth further context for the identified sources of stress, and psychological and emotional experiences among nurses as frontline workers facing COVID‐19. A co‐design approach may be particularly beneficial, as this will not only lead to strategies that draw from the knowledge and experience of the nursing staff but also potentially offer these nurses the opportunity to take back some control in a time of immense instability.

AUTHOR CONTRIBUTIONS

All authors listed have met all four of the following criteria: Have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; Been involved in drafting the manuscript or revising it critically for important intellectual content; Given final approval of the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

FUNDING INFORMATION

This research received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

ETHICS STATEMENT

Ethical approval was obtained from the King Fahd Armed Forces Hospital—Jeddah Research and Ethics Committee (Ref. number: REC 398), confirming no risk to study participants via the application of an anonymous online survey. This study conforms to the recognized standards listed by the Declaration of Helsinki.

Supporting information

Sharif, L. , Almutairi, K. , Sharif, K. , Mahsoon, A. , Banakhar, M. , Albeladi, S. , Alqahtani, Y. , Attar, Z. , Abdali, F. , & Wright, R. (2023). Quantitative research on the impact of COVID‐19 on frontline nursing staff at a military hospital in Saudi Arabia . Nursing Open , 10 , 217–229. 10.1002/nop2.1297 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

• Abu‐Snieneh, H. M. (2021). Psychological factors associated with the spread of coronavirus disease 2019 (COVID‐19) among nurses working in health sectors in Saudi Arabia . Perspectives in Psychiatric Care , 57 ( 3 ), 1399–1408. 10.1111/ppc.12705 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Al Maqbali, M. , Al Sinani, M. , & Al‐Lenjawi, B. (2021). Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID‐19 pandemic: A systematic review and meta‐analysis . Journal of Psychosomatic Research , 141 , 110343. 10.1016/j.jpsychores.2020.110343 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Al‐Dossary, R. , Alamri, M. , Albaqawi, H. , Al Hosis, K. , Aljeldah, M. , Aljohan, M. , Aljohani, K. , Almadani, N. , Alrasheadi, B. , Falatah, R. , & Almazan, J. (2020). Awareness, attitudes, prevention, and perceptions of COVID‐19 outbreak among nurses in Saudi Arabia . International Journal of Environmental Research and Public Health , 17 ( 21 ), 8269. 10.3390/ijerph17218269 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Almalki, M. , Fitzgerald, G. , & Clark, M. (2011). The nursing profession in Saudi Arabia: An overview . International Nursing Review , 58 , 304–311. [ PubMed ] [ Google Scholar ]
• Alnazly, E. , Khraisat, O. M. , Al‐Bashaireh, A. M. , & Bryant, C. L. (2021). Anxiety, depression, stress, fear and social support during COVID‐19 pandemic among Jordanian healthcare workers . PLoS One , 16 ( 3 ), e0247679. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Alsharif, F. (2021). Nurses' Knowledge and Anxiety Levels toward COVID‐19 in Saudi Arabia . Nursing Reports , 11 ( 2 ), 356–363. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bandyopadhyay, S. , Baticulon, R. E. , Kadhum, M. , Alser, M. , Ojuka, D. K. , Badereddin, Y. , Kamath, A. , Parepalli, S. A. , Brown, G. , Iharchane, S. , & Gandino, S. (2020). Infection and mortality of healthcare workers worldwide from COVID‐19: A systematic review . BMJ Global Health , 5 ( 12 ), e003097. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Brahmi, N. , Singh, P. , Sohal, M. , & Sawhney, R. S. (2020). Psychological trauma among the healthcare professionals dealing with COVID‐19 . Asian Journal of Psychiatry , 54 , 102241. 10.1016/j.ajp.2020.102241 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Buheji, M. , & Buhaid, N. (2020). Nursing human factor during COVID‐19 pandemic . International Journal of Nursing Science , 10 ( 1 ), 12–24. 10.5923/j.nursing.20201001.02 [ CrossRef ] [ Google Scholar ]
• Byrne, A. , Barber, R. , & Lim, C. H. (2021). Impact of the COVID‐19 pandemic–a mental health service perspective . Progress in Neurology and Psychiatry , 25 ( 2 ), 27–33b. [ Google Scholar ]
• Coomber, B. , & Barriball, K. L. (2007). Impact of job satisfaction components on intent to leave and turnover for hospital‐based nurses: A review of the research literature . International Journal of Nursing Studies , 44 ( 2 ), 297–314. 10.1016/j.ijnurstu.2006.02.004 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cui, S. , Jiang, Y. , Shi, Q. , Zhang, L. , Kong, D. , Qian, M. , & Chu, J. (2021). Impact of COVID‐19 on anxiety, stress, and coping styles in nurses in emergency departments and fever clinics: A cross‐sectional survey . Risk Management and Healthcare Policy , 14 , 585–594. 10.2147/RMHP.S289782 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Del Carmen Giménez‐Espert, M. , Prado‐Gascó, V. , & Soto‐Rubio, A. (2020). Psychosocial risks, work engagement, and job satisfaction of nurses during COVID‐19 pandemic . Frontiers in Public Health , 8 , 566896. 10.3389/fpubh.2020.566896 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Doo, E. Y. , Kim, M. , Lee, S. , Lee, S. Y. , & Lee, K. Y. (2021). Influence of anxiety and resilience on depression among hospital nurses: A comparison of nurses working with confirmed and suspected patients in the COVID‐19 and non‐COVID‐19 units . Journal of Clinical Nursing , 30 ( 13–14 ), 1990–2000. 10.1111/jocn.15752 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• French, S. E. , Lenton, R. , Walters, V. , & Eyles, J. (2000). An empirical evaluation of an expanded Nursing Stress Scale . Journal of Nursing Measurement , 8 ( 2 ), 161–178. [ PubMed ] [ Google Scholar ]
• Ghawadra, S. F. , Abdullah, K. L. , Choo, W. Y. , & Phang, C. K. (2019). Psychological distress and its association with job satisfaction among nurses in a teaching hospital . Journal of Clinical Nursing , 28 ( 21–22 ), 4087–4097. 10.1111/jocn.14993 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Harper, L. , Kalfa, N. , Beckers, G. M. A. , Kaefer, M. , Nieuwhof‐Leppink, A. J. , Fossum, M. , Herbst, K. W. , Bagli, D. , & ESPU Research Committee . (2020). The impact of COVID‐19 on research . Journal of Pediatric Urology , 16 ( 5 ), 715–716. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• He, J. , Liu, L. , Chen, X. , Qi, B. , Liu, Y. , Zhang, Y. , & Bai, J. (2021). The experiences of nurses infected with COVID‐19 in Wuhan, China: A qualitative study . Journal of Nursing Management , 29 ( 5 ), 1180–1188. 10.1111/jonm.13256 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hernandez, S. H. A. , Bedrick, E. J. , & Parshall, M. B. (2014). Stigma and barriers to accessing mental health services perceived by Air Force nursing personnel . Military Medicine , 179 ( 11 ), 1354–1360. 10.7205/MILMED-D-14-00114 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hsu, S. T. , Chou, L. S. , Chou, F. H. C. , Hsieh, K. Y. , Chen, C. L. , Lu, W. C. , Kao, W. T. , Li, D. J. , Huang, J. J. , Chen, W. J. , & Tsai, K. Y. (2020). Challenge and strategies of infection control in psychiatric hospitals during biological disasters—From SARS to COVID‐19 in Taiwan . Asian Journal of Psychiatry , 54 , 102270. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hu, D. , Kong, Y. , Li, W. , Han, Q. , Zhang, X. , Zhu, L. X. , Wan, S. W. , Liu, Z. , Shen, Q. , Yang, J. , & He, H. G. (2020). Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID‐19 outbreak in Wuhan, China: A big‐scale cross‐sectional study . EClinical Medicine , 24 ( 2 ), 100424. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Jaswaney, R. , Davis, A. , Cadigan, R. J. , Waltz, M. , Brassfield, E. R. , Forcier, B. , & Joyner, B. L., Jr. (2022). Hospital policies during COVID‐19: An analysis of visitor restrictions . Journal of Public Health Management and Practice , 28 ( 1 ), E299–E306. [ PubMed ] [ Google Scholar ]
• Jones, S. , Agud, K. , & McSweeney, J. (2020). Barriers and facilitators to seeking mental health care among first responders: “Removing the darkness” . Journal of the American Psychiatric Nurses Association , 26 ( 1 ), 43–54. 10.1177/1078390319871997 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kakar, M. S. , Rauf, S. , Jalal, U. , Khan, W. A. , & Gul, I. (2021). The emotional burden of COVID 19 in frontline health care workers at a tertiary care hospital in Pakistan . Journal of Bahria University Medical and Dental College , 11 ( 2 ), 60–64. [ Google Scholar ]
• King Fahad Armed Forces Hospital . (2020). Nurse‐driven quality improvement intervention to reduce the hospital acquired community infection rate among health care workers . Internal report: Unpublished.
• Knaak, S. , Mantler, E. , & Szeto, A. (2017). Mental illness‐related stigma in healthcare: Barriers to access and care and evidence‐based solutions . Healthcare Management Forum , 30 ( 2 ), 111–116. 10.1177/0840470416679413 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kursumovic, E. , Lennane, S. , & Cook, T. M. (2020). Deaths in healthcare workers due to COVID‐19: The need for robust data and analysis . Anesthesia , 1 ( 1 ), 1–10. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Labrague, L. J. (2021). Psychological resilience, coping behaviours and social support among health care workers during the COVID‐19 pandemic: A systematic review of quantitative studies . Journal of Nursing Management , 29 ( 7 ), 1893–1905. 10.1111/jonm.13336 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Liu, M. , He, P. , Liu, H. G. , Wang, X. J. , Li, F. J. , Chen, S. , Lin, J. , Chen, P. , Liu, J. H. , & Li, C. H. (2020). Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia . Chinese Journal of Tuberculosis and Respiratory Diseases , 43 ( 3 ), 209–214. [ PubMed ] [ Google Scholar ]
• Lorber, M. , & Skela Savič, B. (2012). Job satisfaction of nurses and identifying factors of job satisfaction in Slovenian hospitals . Croatian Medical Journal , 53 ( 3 ), 263–270. 10.3325/cmj.2012.53.263 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lovibond, P. F. , & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories . Behaviour Research and Therapy , 33 ( 3 ), 335–343. [ PubMed ] [ Google Scholar ]
• Murat, M. , Köse, S. , & Savaşer, S. (2021). Determination of stress, depression and burnout levels of front‐line nurses during the COVID‐19 pandemic . International Journal of Mental Health Nursing , 30 ( 2 ), 533–543. 10.1111/inm.12818 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Olenick, M. , Flowers, M. , & Diaz, V. J. (2015). US veterans and their unique issues: enhancing health care professional awareness . Advances in Medical Education and Practice , 6 , 635–639. 10.2147/AMEP.S89479 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Peters, L. , Cant, R. , Payne, S. , O'Connor, M. , McDermott, F. , Hood, K. , Morphet, J. , & Shimoinaba, K. (2013). How death anxiety impacts nurses' caring for patients at the end of life: A review of literature . The Open Nursing Journal , 7 , 14–21. 10.2174/1874434601307010014 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Regier, D. A. , Kuhl, E. A. , & Kupfer, D. J. (2013). The DSM‐5: Classification and criteria changes . World Psychiatry , 12 ( 2 ), 92–98. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Reuters Staff . (2020). Saudi Arabia announces first case of coronavirus . Reuters. https://www.reuters.com/article/us‐health‐coronavirus‐saudi/saudi‐arabia‐announces‐first‐case‐of‐coronavirus‐idUSKBN20P2FK Accessed 5 April 2021. [ Google Scholar ]
• Sampaio, F. , Sequeira, C. , & Teixeira, L. (2021). Impact of COVID‐19 outbreak on nurses' mental health: A prospective cohort study . Environmental Research , 194 , 110620. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sasangohar, F. , Jones, S. L. , Masud, F. N. , Vahidy, F. S. , & Kash, B. A. (2020). Provider burnout and fatigue during the COVID‐19 pandemic: Lessons learned from a high‐volume intensive care unit . Anesthesia and Analgesia , 131 , 106–111. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sataloff, R. T. , & Vontela, S. (2021). Response rates in survey research . Journal of Voice , 35 ( 3 ), 683–684. 10.1016/j.jvoice.2020.12.043 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shahrour, G. , & Dardas, L. (2020). Acute stress disorder, coping self‐efficacy and subsequent psychological distress among nurses amid COVID‐19 . Journal of Nursing Management , 28 ( 7 ), 1686–1695. 10.1111/jonm.13124 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shaukat, N. , Ali, D. M. , & Razzak, J. (2020). Physical and mental health impacts of COVID‐19 on healthcare workers: A scoping review . International Journal of Emergency Medicine , 13 ( 1 ), 1–8. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Spector, P. (1985). Measurement of human service staff satisfaction: Development of the Job Satisfaction Survey . American Journal of Community Psychology , 13 ( 6 ), 693–713. [ PubMed ] [ Google Scholar ]
• Spector, P. (1994). Job satisfaction survey , copyright Paul E . Spector . http://shell.cas.usf.edu/~pspector/scales/jssinterpretation.html
• Tayyib, N. A. , & Alsolami, F. J. (2020). Measuring the extent of stress and fear among Registered Nurses in KSA during the COVID‐19 Outbreak . Journal of Taibah University Medical Sciences , 15 ( 5 ), 410–416. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tukey, J. (1953). Multiple comparisons . Journal of the American Statistical Association , 48 ( 263 ), 624–625. [ Google Scholar ]
• Walston, S. , Al‐Harbi, Y. , & Al‐Omar, B. (2008). The changing face of healthcare in Saudi Arabia . Annals of Saudi Medicine , 28 ( 4 ), 243–250. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wang, W. , Song, W. , Xia, Z. , He, Y. , Tang, L. , Hou, J. , & Lei, S. (2020). Sleep disturbance and psychological profiles of medical staff and non‐medical staff during the early outbreak of COVID‐19 in Hubei Province, China . Frontiers in Psychiatry , 11 , 733. 10.3389/fpsyt.2020.00733 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• World Health Organization . (2020). Rolling updates on coronavirus disease . (COVID‐19 ) . https://www.who.int/emergencies/diseases/novel‐coronavirus‐2019/events‐as‐they‐happen . Accessed 5 April 2021.
• Zheng, R. , Zhou, Y. , Fu, Y. , Xiang, Q. , Cheng, F. , Chen, H. , Xu, H. , Fu, L. , Wu, X. , Feng, M. , Ye, L. , Tian, Y. , Deng, R. , Liu, S. , Jiang, Y. , Yu, C. , & Li, J. (2021). Prevalence and associated factors of depression and anxiety among nurses during the outbreak of COVID‐19 in China: A cross‐sectional study . International Journal of Nursing Studies , 114 , 103809. 10.1016/j.ijnurstu.2020.103809 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Zu, Z. Y. , Jiang, M. D. , Xu, P. P. , Chen, W. , Ni, Q. Q. , Lu, G. M. , & Zhang, L. J. (2020). Coronavirus disease 2019 (COVID‐19): A perspective from China . Radiology , 296 ( 2 ), E15–E25. [ PMC free article ] [ PubMed ] [ Google Scholar ]

• Open access
• Published: 25 April 2024

Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study

• Aslı Emine Büyükkasap 1 &
• Gülay Yazıcı 2  

BMC Nursing volume  23 , Article number:  277 ( 2024 ) Cite this article

Metrics details

The use of nutrients and food supplements is increasing worldwide. Nutrients and food supplements frequently used in the surgical period may cause complications and side effects. This study was conducted to determine the level of knowledge about sixty-one nutrients and food supplements among doctors and nurses working in surgical clinics.

A multicentre descriptive, quantitative, cross-sectional study.

The study was conducted between 15 February and 31 May 2022 with a total of 410 participants, including 143 doctors and 267 nurses, working in the surgical clinics of 8 hospitals, including public, university and private hospitals, within the borders of one province in Turkey. Data were collected face-to-face using a questionnaire developed by the researchers, which included descriptive characteristics of the doctors and nurses and questions about sixty-one nutrients and food supplements.

The median overall success score of the doctors and nurses participating in the study regarding the use of nutrients and food supplements was 3.20 out of 100 points, the median success score of complications and side effects of nutrients and food supplements in the surgical period was 7.06 out of 33 points, the median success score for discontinuation of nutrients and food supplements prior to surgery was 0.21 out of 16 points, and the median success score for drug interactions of nutrients and food supplements was 1.70 out of 51 points. In addition, it was found that the overall success scores of doctors and nurses regarding nutrients and food supplements increased statistically significantly with increasing age and working years. The total success score of doctors and nurses who received training in nutrients and food supplements was statistically significantly higher than that of doctors and nurses who did not receive training.

In conclusion, it was found that the level of knowledge of nutrients and food supplements among doctors and nurses working in surgical clinics was less than half or even close to zero. Therefore, it is recommended that training on nutrients and food supplements should be included in the undergraduate and postgraduate education of doctors and nurses in order to prevent complications, side effects, drug interactions and patient safety related to the use of nutrients and food supplements in the surgical period.

Peer Review reports

Introduction

Plants, medicinal herbs, foods, and their derivatives have been used for centuries to prevent, treat, and maintain physical and mental health [ 1 , 2 ]. With the advancement of the modern pharmaceutical industry, these natural remedies have been transformed into nutrients and food supplements through physical and biological processes [ 3 ]. These products comprise of a variety of vitamins, minerals, amino acids, probiotics, or herbal components [ 4 , 5 ]. Nutrients and food supplements that are used to support daily nutrition are extensively used globally [ 2 , 6 , 7 ]. As per the World Health Organisation, around 80% of individuals in developing countries use nutrients and food supplements [ 8 ]. In developed countries, the use of nutrients and food supplements varies widely, with Spain at 41%, Canada at 70%, Australia at 82%, the United States of America at 35%, and Turkey at 53% [ 9 , 10 , 11 ].

The promotion of these products in mass media [ 12 , 13 , 14 , 15 ] and recommendations from friends and family [ 1 , 12 , 14 , 15 , 16 , 17 ], combined with their availability without prescription and affordability [ 16 , 18 , 19 ], contribute to their increased use [ 14 , 16 , 20 ]. Nutrients and food supplements are often preferred for improving health and well-being, alleviating symptoms associated with chronic diseases [ 10 ], cancer treatment [ 10 , 21 ], pregnancy [ 22 ], and the surgical period [ 23 , 24 , 25 ].

Nevertheless, their use can cause drug interactions and serious complications during surgery [ 24 , 26 , 27 ]. Nutrients and food supplements alter the efficacy of anticoagulants and antiplatelets [ 28 ], increase the efficacy of antihypertensive and antidiabetic drugs [ 29 ], interact with corticosteroids, central nervous system depressants, opioid analgesics [ 30 ] and anaesthetics [ 31 , 32 ] and increase the efficacy of sedatives and tranquillisers [ 13 ]. These supplements may also cause prolonged sedation [ 31 , 33 , 34 ], delayed recovery from anaesthesia [ 15 , 29 ], bleeding [ 15 , 31 , 33 , 34 , 35 ], coagulation disorders [ 34 , 35 ], cardiac problems [ 29 , 34 ], fluid-electrolyte imbalances [ 34 , 36 ], hypoglycaemia [ 15 , 34 ], affecting the need for analgesics after surgery [ 31 ], transplant rejection, irreversible side effects such as kidney [ 29 ] and liver toxicity [ 29 , 37 ] and even death. To prevent complications, side effects, and drug interactions, it is recommended to stop taking nutrients and food supplements two weeks prior to surgery [ 31 , 32 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Awareness and knowledge level of doctors and nurses are very important in order to prevent, recognise and treat complications related to nutrients and food supplements [ 25 , 26 , 27 , 46 ]. Upon examination of the literature, it was found that there is a lack of studies on doctors' knowledge of nutrients and food supplements, and the existing studies indicate that their knowledge on the subject is inadequate [ 47 , 48 ]. Similarly, no studies were found regarding the knowledge level of nurses on nutrients and food supplements.

Doctors and nurses working in surgical clinics should have the necessary awareness and knowledge to prevent, recognise, and treat complications related to nutrients and food supplements [ 25 , 26 , 27 , 46 ]. This study aimed to determine the level of knowledge of doctors and nurses working in surgical clinics regarding complications and side effects of sixty-one nutrients and food supplements, withdrawal periods, and drug interactions.

Type of research

The study was conducted in a descriptive, quantitative, cross-sectional manner to determine the level of knowledge about sixty-one nutrients and food supplements among doctors and nurses working in surgical clinics.

Research population and sample

The population of the research consists of a total of 1,537 people, including 700 doctors and 837 nurses, working in the surgical clinics of 8 hospitals (6 public, 1 university and 1 private hospital) within the borders of a province in Turkey that approved the study. The sample calculation of the study was made with 50% unknown frequency and 95% confidence interval with type 1 error 0.05, and it was calculated that at least 307 participants should be reached. When the sample size was stratified separately for doctors and nurses, it was found that 140 doctors and 167 nurses needed to be reached. Criteria for inclusion in the study; working as a staff doctor or nurse in surgical clinics, volunteering to participate in the research, working in adult surgical clinics. Exclusion criteria from the study were as follows; not volunteering to participate in the research, not answering the entire questionnaire, working in surgical intensive care units, working in a pediatric surgery clinic, not being a permanent employee of the clinic where the research is conducted, being in the clinic due to rotation, working in the clinic on a temporary basis due to day or night shifts. The study was completed with a total of 410 people, including 143 doctors (6 from private hospitals, 30 from university hospitals, 107 from public hospitals) and 267 nurses (25 from private hospitals, 45 from university hospitals, 197 from public hospitals), who agreed to participate in the study, gave written consent, and completed the entire questionnaire. Doctors and nurses working in hospitals do not receive training in nutrients and food supplements.

Data collection tools

The research used a questionnaire-interview method to collect data. This questionnaire-interview was designed for this study by the researchers utilizing the literature ( Supplementary Material ). The questionnaire used for data collection consists of four parts. The first part includes the descriptive characteristics of the doctors and nurses, the second part includes the complications and side effects seen during the surgical period due to the use of nutrients and food supplements, the third part includes the duration of discontinuation of nutrients and food supplements before the surgical period, and the fourth part includes questions about drug interactions of nutrients and food supplements.

Section 1: descriptive characteristics of doctors and nurses

This section was developed by the researcher based on the literature [ 1 , 10 , 11 , 14 , 16 , 20 , 49 , 50 ]. This section consists of a total of 14 questions about doctors and nurses, including age, sex, education level, marital status, occupation, total years of professional experience, clinic where they work, total years of experience in the department where they work, status of training in nutrients and food supplements, status of questioning patients about the use of nutrients and dietary supplements, status of postponement of surgery due to the use of nutrients and dietary supplements, and number of patients for whom surgery was postponed.

Section 2: questions related to complications and side effects during the surgical period due to the use of nutrients and food supplements

This section was developed by the researcher based on the literature [ 4 , 13 , 24 , 28 , 29 , 32 , 35 , 42 , 44 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ].

This section consists of questions about complications and side effects caused by 61 foods and nutrients and food supplements (garlic, onion, lemon, nettle, parsley, red pepper (capsicum), chia seed, celery, rosemary, sage, thyme, St. John's wort, turmeric, ginger, hawthorn, aloe vera, black tea, green tea, linden, lavender, chamomile, echinacea, calendula, clove, dandelion, ginseng, ginkgo biloba, cherry, blueberry, horse chestnut, liquorice, valerian, red clover, anise seed, ephedra, kava, fenugreek, black cohosh, burdock, cat's claw, mistletoe, hops, passionflower, bitter melon, devil's claw, coenzyme Q10, vitamin E, vitamin C, vitamin B12, vitamin D, fish oil, calcium, magnesium, iron, zinc, folic acid, alpha-lipoic acid, L-arginine, sports supplements, probiotics, weight-loss products).

These questions consist of a total of four questions: bleeding, fluid-electrolyte imbalance, hepatotoxic effects and effects on blood glucose levels. Each box in which the answers to the questions are scored corresponds to a response option. The answer options for the questions assessing bleeding are "increases", "decreases", "has no effect" and "don't know"; the answer options for the question assessing fluid-electrolyte imbalance are "does", "has no effect" and "don't know", the answer choices for the hepatotoxic effect question are 'does', 'has no effect' and 'don't know', and the answer choices for the blood glucose effect question are 'increases', 'decreases', 'has no effect' and 'don't know'.

For example, question 1 consists of four questions about the effects of garlic on bleeding, fluid-electrolyte imbalance, hepatotoxic effects, and blood glucose levels. When the literature was reviewed, it was found that garlic affects bleeding [ 44 ] and blood sugar [ 50 , 53 ]. However, no information was found in the literature on fluid-electrolyte imbalance and hepatotoxic effects. For this reason, the questions related to fluid-electrolyte imbalance and hepatotoxic effects were excluded from the evaluation and the effects on bleeding and blood glucose levels were evaluated. In this context, questions on 61 nutrients and food supplements that could not be found in the literature were excluded. Table 1 below shows the nutrients and food supplements that were excluded in this section. As a result, a total of 244 questions were asked in this section and 131 questions were evaluated in line with the literature (Table 1 ).

Section 3: questions related to the duration of discontinuation of nutrients and food supplements before the surgical period

This section was developed by the researcher based on the literature [ 31 , 32 , 35 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 50 , 52 , 75 ]. This section consists of a total of 61 questions about when to discontinue nutrients and food supplements (garlic, onion, lemon, nettle, parsley, red pepper (capsicum), chia seed, celery, rosemary, sage, thyme, St. John's wort, turmeric, ginger, hawthorn, aloe vera, black tea, green tea, linden, lavender, chamomile, echinacea, calendula, clove, dandelion, ginseng, ginkgo biloba, cherry, blueberry, horse chestnut, liquorice, valerian, red clover, anise seed, ephedra, kava, fenugreek, black cohosh, burdock, cat's claw, mistletoe, hops, passionflower, bitter melon, devil's claw, coenzyme Q10, vitamin E, vitamin C, vitamin B12, vitamin D, fish oil, calcium, magnesium, iron, zinc, folic acid, alpha-lipoic acid, L-arginine, sports supplements, probiotics, weight-loss products) in the preoperative period. Answers to these questions are sought as ".... should be discontinued weeks ago", ".... should be discontinued days ago (the period less than seven days will be written)", ".... should be discontinued hours ago (the period less than twenty-four hours will be written)", "I do not know the answer". The answer of the participants who answered "there is no need to cut" was noted as "0 hours".

Section 4: Drug interaction questionnaire for nutrients and food supplements

This section was developed by the researcher based on the literature [ 13 , 26 , 29 , 31 , 42 , 43 , 44 , 50 , 51 , 53 , 56 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ]. It consists of questions on the interaction of nutrients and food supplements (garlic, onion, lemon, nettle, parsley, red pepper (capsicum), chia seed, celery, rosemary, sage, thyme, St. John's wort, turmeric, ginger, hawthorn, aloe vera, black tea, green tea, linden, lavender, chamomile, echinacea, calendula, clove, dandelion, ginseng, ginkgo biloba, cherry, blueberry, horse chestnut, liquorice, valerian, red clover, anise seed, ephedra, kava, fenugreek, black cohosh, burdock, cat's claw, mistletoe, hops, passionflower, bitter melon, devil's claw, coenzyme Q10, vitamin E, vitamin C, vitamin B12, vitamin D, fish oil, calcium, magnesium, iron, zinc, folic acid, alpha-lipoic acid, L-arginine, sports supplements, probiotics, weight-loss products) with the drug groups antihypertensive, anticoagulant, anaesthetic, analgesic, corticosteroid, antidiabetic, antidepressant. Each box corresponds to a response option and the options are 'increases', 'decreases', 'has no effect' and 'don't know'.

For example, there are 7 questions assessing the interaction of garlic with the following drug classes: antihypertensive, anticoagulant, anaesthetic, analgesic, corticosteroid, antidiabetic, antidepressant. There is information in the literature that garlic interacts with antihypertensive [ 44 ], anticoagulant [ 13 ], anaesthetic [ 31 ], analgesic [ 13 , 76 ], antidiabetic and antidepressant [ 50 ] drug groups. However, this question was excluded from the analysis as there was no information on the interaction with the corticosteroid group. Therefore, questions about 6 groups of drugs with which garlic interacts were analysed. In this context, questions about 61 nutrients and food supplements that could not be found in the literature were excluded. Table 2 shows the nutrients and food supplements that were excluded from the assessment in this section. As a result, a total of 427 questions were asked in this section and 201 questions were evaluated in accordance with the literature (Table 2 ).

A total of 393 questions were evaluated, including 131 questions to assess the level of knowledge about complications and side effects in the surgical period due to the use of nutrients and food supplements, 61 questions to assess the level of knowledge about the duration of cessation of nutrients and food supplements before the surgical period, 201 questions to assess the level of knowledge about nutrients and food supplements and drug interactions. The success score was calculated over 0-100 points based on the number of correct answers of doctors and nurses. Points were calculated for each correct answer. The score for one correct answer (100 points/393 questions ≌ 0.25) was calculated as approximately 0.25 points. Accordingly, the success score for complications and side effects of nutrients and food supplements in the surgical period was 33 points (131*0.25 ≌ 33.33), the success score for discontinuation periods before the surgical period was 16 points (61*0.25 ≌ 15.52), and the success score for nutrients and food supplements and drug interactions was 51 points (201*0.25 ≌ 51.15).

The questions in the questionnaire form were analysed by 5 faculty members who are experts in their fields are to evaluate them in terms of formality, scientific content and comprehensibility criteria. The questionnaire form was finalised in accordance with the form containing the expert opinions.

Use of data collection tools

Written permission was obtained from the ethics committee of Yıldırım Beyazıt University (06.01.22/36) and the institutions where the research was conducted. Written informed consent was obtained from the doctors and nurses who participated in the research. The study was conducted between 15 February and 31 May 2022, after obtaining ethics committee approval and institutional permission. Nursing directors/health services directors and chief doctors of hospitals with institutional approval were interviewed. The nurse in charge of the surgical clinics and the doctors' clinic chiefs were then interviewed and informed about the study. Information on the working hours, shift patterns and working practices of the doctors and nurses was obtained. To reach more participants, clinic visits were made between 08:00-16:00 and 16:00-20:00. Doctors and nurses were informed about the ethics committee and administrative permissions obtained, the content of the study and the method of implementation. Questions raised by the doctors and nurses were answered. Written informed consent was obtained from doctors and nurses who agreed to participate in the study. The doctors and nurses were interviewed alone in a quiet environment in the doctors' and nurses' room in the clinic. The interview was concluded once the questions had been answered. It took approximately 15-20 minutes for doctors and nurses to complete the questionnaire. The study was completed with 143 doctors and 267 nurses who agreed to participate in the study, a total of 410 participants.

Analysis of the data

The data obtained by the questionnaire collection method were transferred to the computer environment. The mean, standard deviation, minimum, maximum, median, frequency and percentage were used in the descriptive statistics of the characteristics of the doctors and nurses in the study. Before comparing the knowledge levels of doctors and nurses in groups, the normal distribution status, which is the assumption of parametric analyses, was tested using the Kolmogrow-Smirnow test [ 85 , 86 ].

Since the groups in the study did not meet the assumption of normal distribution, the Mann-Whitney U test in independent groups was used for pairwise group comparisons, the Kruskal-Wallis H test for three or more group comparisons, and the Mann-Whitney U analysis with Bonferroni correction for post hoc analysis [ 87 , 88 , 89 , 90 ]. SPSS 26 software was used for statistical analyses [ 91 ]. p <0.05 was considered statistically significant.

Table 3 shows that the mean age of the doctors and nurses participating in the study was 33.26 (±7.90) years, 43.2% ( n =177) were between 22-29 years old, 72% ( n =295) were female, 46.6% ( n =191) were graduates, 65. 1% ( n =267) were nurses, 37.8% ( n =155) had worked for 10 years or more, 39.3% ( n =161) worked in general surgery and 39.8% ( n =163) had worked in their department for 1-4 years. It was found that 88.8% ( n =364) of doctors and nurses had not received any training on nutrients and food supplements, and 50% of those who had received training on nutrients and food supplements had received it during their professional training.

Doctors and nurses believed that 87.40% ( n =340) of patients used nutrients and food supplements because they found them beneficial to their health (Fig.  1 ). It was found that 64.6% ( n =265) of doctors and nurses did not question the use of nutrients and food supplements and 89.8% ( n =368) did not postpone surgery due to the use of nutrients and food supplements (Fig.  2 ).

Reasons for patients' preference for nutrients and food supplements according to doctors and nurses

Doctors' and Nurses' Questioning of Patients' Use of Nutrients and Food Supplements and Postponement of Surgery Due to the Use of Nutrients and Food Supplements

The median overall success score of doctors and nurses in the use of nutrients and food supplements was calculated as 3.20. Doctors and nurses received the highest score of 7.06 for complications and side effects of nutrients and food supplements in the surgical period and the lowest score of 0.21 for the duration of discontinuation of nutrients and food supplements prior to the surgical period (Table 4 ).

A statistically significant difference was found in the success scores of doctors and nurses regarding complications and side effects of nutrients and food supplements in the surgical period in terms of age groups ( p =0.002), years of employment ( p =0.025), and receiving training on nutrients and food supplements ( p <0.05) (Table 5 ). The knowledge level of the participants in the 22-30 age group was found to be statistically significantly lower than the 31-40 and 41 and over age groups ( p <0.05). The knowledge level of the participants working for 6-10 years was found to be statistically significantly higher than the participants working for 5 years ( p <0.05). In addition, the knowledge level of the participants who received training on nutrients and food supplements about the complications and side effects of nutrients and food supplements in the perioperative period was found to be statistically significantly higher than those who did not receive training ( p <0.05).

Success scores related to the duration of discontinuing of nutrients and food supplements in the preoperative period were statistically significantly higher in those who received training on nutrients and food supplements ( p <0.001) (Table 5 ).

The success scores of drug interactions of nutrients and food supplements were found to be statistically significantly higher in female participants than in males ( p =0.001), in nurses than in doctors ( p =0.007), according to educational status ( p =0.008), according to years of working experience ( p =0.010), in those who received training on nutrients and food supplements than in those who did not ( p <0.05), and in women statistically significantly higher than in men ( p =0.001) (Table 5 ). The knowledge level of high school graduates was found to be statistically significantly higher than that of postgraduate participants ( p <0.05). The knowledge level of the participants working for 11 years or more was found to be statistically significantly higher than the participants working for less than 5 years ( p <0.05).

The general success scores of doctors and nurses on nutrients and food supplements were found to be statistically significantly higher in older age groups ( p =0.003), in those who had worked for more years ( p =0.015) and in those who had received training on nutrients and food supplements ( p <0.001) (Table 5 ). The knowledge level of the participants in the 31-40 age group was found to be statistically significantly higher than the participants in the 41 and over age group ( p <0.01). The knowledge level of the participants who have been working for 6-10 years is statistically significantly higher than the participants who have been working for less than 5 years ( p <0,05).

Nutrients and food supplements are widely used worldwide [ 2 , 6 , 7 ] for health protection and treatment of chronic diseases [ 10 ]. For the same reasons, patients often prefer to use nutrients and food supplements during their surgical period [ 23 , 92 ]. However, because nutrients and food supplements may contain complex active ingredients with side effects [ 93 , 94 ], they may cause unexpected complications and side effects [ 40 ] or drug interactions in the surgical period [ 51 , 95 ]. To prevent these complications, side effects and drug interactions, the use of nutrients and food supplements should be stopped two weeks before surgery [ 39 , 44 ].

Doctors and nurses should ask patients directly about their use of nutrients and food supplements [ 42 ] and take a detailed medical history before surgery to prevent potential complications and adverse effects related to nutrients and food supplements during surgery [ 96 ]. According to a study conducted by Gamsız et al. (2011), 28.2% of doctors ask patients about their use of nutrients and food supplements during their treatment or before prescribing [ 97 ]. Shorofi et al. (2017) found that 15.8% of nurses questioned patients about nutrients and food supplements while taking their medical history [ 98 ]. In our study, only 35.4% of doctors and nurses questioned the use of nutrients and food supplements in the preoperative period, and 10.2% reported postponing surgery due to the use of nutrients and food supplements. The average number of operations postponed was 3.72±2.83. The rate of use of nutrients and food supplements during the surgical period in Turkey is 32.5-54.2% [ 17 , 23 , 99 , 100 ]. Considering the size of the population in which our study was conducted and the average annual number of operations, the rates of questioning the use of nutrients and food supplements and the number of operations postponed due to the use of nutrients and food supplements were found to be low. This result in our study, which is consistent with the literature, suggests that 11.2% of doctors and nurses have received training in nutrients and food supplements, and the more knowledge doctors and nurses have on this subject, the more they can implement practices aimed at questioning and preventing potential problems.

Doctors and nurses should have a high level of knowledge and awareness of the complications and side effects of nutrients and food supplements in the surgical period, drug interactions [ 101 ] and the duration of discontinuation in the preoperative period [ 35 , 39 , 44 ]. However, studies conducted with doctors in the literature emphasise that doctors do not have a sufficient level of knowledge [ 47 , 48 ]. No studies were found that assessed nurses' knowledge of nutrients and food supplements.

Heller et al (2006) found that 54% of plastic surgeons asked about nutrients and food supplements in the study knew the name and 90% did not know the side effects [ 102 ]. Taşpınar et al. (2014) found that 8.6% of doctors correctly answered the duration of stopping nutrients and food supplements in the preoperative period in their study with doctors [ 103 ]. Soltanipour et al (2022) found that the mean success score of doctors' ( n =142) knowledge of nutrients and food supplements was 6.47 ± 6.17 out of 25 points [ 48 ]. In this study, the success scores of doctors and nurses related to complications and side effects of nutrients and food supplements were 7.06 out of 33 points, the success scores related to discontinuation periods before the surgical period were 0.21 out of 16 points, the success scores related to drug interactions were 1.70 out of 51 points, and the total success scores were 3.20 out of 100 points. Although our study is consistent with the literature, 88.8% of doctors and nurses did not receive any training on nutrients and food supplements. This situation suggests that nutrients and food supplements are not included in continuing education during professional training or during working period.

Educating doctors and nurses about nutrients and food supplements in both professional and in-service training programmes will increase the knowledge of doctors and nurses [ 57 , 104 ]. Mikail et al (2003), in their study evaluating doctors' knowledge of nutrients and food supplements, found that the mean pre-test pass rate for doctors was 34% and the mean post-test pass rate after training was 61% [ 47 ]. In our study, the overall success score of doctors and nurses who received training on nutrients and food supplements was found to be higher than that of doctors and nurses who did not receive training. In addition, the success scores of doctors and nurses who received training on complications and side effects, discontinuation periods and drug interactions of nutrients and food supplements were also found to be higher. Our results show that education about nutrients and food supplements is effective in improving the level of knowledge.

In addition to education, age and years of experience also influence the level of knowledge of nutrients and food supplements among doctors and nurses [ 46 ]. Hasen et al found that doctors, nurses, and pharmacists aged 36-40 years were four times more knowledgeable about nutrients and food supplements than those aged 25-30 years [ 46 ]. Nurses' clinical experience and previous patient experience increase the level of knowledge in nursing practice [ 105 ].

In this study, it was found that the overall success scores of doctors and nurses in relation to nutrients and food supplements and the success scores in relation to complications and side effects increased statistically significantly with increasing age. In addition, total success scores, success scores related to complications and side effects, and success scores related to drug interactions of nutrients and food supplements increased statistically significantly with increasing years of employment. The results of our study suggest that the experience of doctors and nurses with increasing age and years of employment may contribute positively to the level of knowledge about nutrients and food supplements.

The success score for drug interactions of nurses with a high school degree was found to be statistically significantly higher than that of doctors and nurses with a university degree. This situation suggests that this is due to the statistically significant experience gained from the statistically significantly greater number of years of work of the high school graduate nurses.

Nurses were found to have higher success rates in drug interactions than doctors. This is due to the fact that nurses administer medications, observe side effects, and have experience in this area [ 106 ].

In our study, female doctors and nurses were found to have a statistically significant higher success rate with regard to drug interactions with nutrients and food supplements than male doctors and nurses. Koyu et al (2020) evaluated the use of nutrients and food supplements by healthcare professionals throughout the hospital and found that female healthcare professionals used nutrients and food supplements at a higher rate than male healthcare professionals [ 107 ]. Taşpınar et al. found that 33.9% of female doctors and 27.5% of male doctors used nutrients and food supplements [ 103 ]. It has been reported in the literature that female doctors and nurses prefer nutrients and food supplements more often than male doctors and nurses [ 103 , 107 ]. The fact that female doctors and nurses had higher achievement scores related to drug interactions of nutrients and food supplements may be related to the higher frequency of use in female doctors and nurses.

In our study, knowledge scores were evaluated in three groups (complications and side effects, drug interactions, discontinuation periods) and as a total score. It was found that the only common and most important factor affecting all three groups and the overall knowledge score was the status of training received on the subject. On the other hand, no positive effect of the level of education (high school, associate degree, undergraduate, postgraduate) on the knowledge level success score was found in any of the knowledge level success score groups. We believe that this situation is due to the lack of training on nutrients and food supplements in current medical and nursing education curricula.

Although nutrients and food supplements are widely used, in practice they may cause complications and side effects in the surgical period. Therefore, training doctors and nurses on the complications and side effects of nutrients and food supplements in the surgical period, discontinuation periods and drug interactions are necessary to prevent and resolve problems that may occur due to nutrients and food supplements used by the patient. In order to prevent potential complications and side effects in the surgical period due to misuse of nutrients and food supplements, it is essential that doctors and nurses are educated and have a high awareness of the use of nutrients and food supplements. In this study, it was found that the level of knowledge of nutrients and food supplements among doctors and nurses working in surgical clinics was less than half or even close to zero. This study revealed significant gaps in physicians' and nurses' knowledge of nutrients and food supplements and highlighted the need for comprehensive education to prevent potential risks associated with the use of nutrients and food supplements during the surgical period.

Availability of data and materials

The datasets generated during and/or analysed during the current study are available in the Zonedo repository, https://doi.org/10.5281/zenodo.10738144 [ 108 ].

Büyükkasap AE, Yazıcı G. Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study, dataset. Zenodo. 2024. https://doi.org/10.5281/zenodo.10738144

The research used a questionnaire-interview method to collect data. This questionnaire-interview was designed for this study by the researchers utilizing the literature (Supplementary Material 1 ).

Alqathama A, Alluhiabi G, Baghdadi H, Aljahani L, Khan O, Jabal S, et al. Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship? BMC Complement Med Ther. 2020;20(1):65.

Article   PubMed   PubMed Central   Google Scholar  

El Khoury G, Ramadan W, Zeeni N. Herbal products and dietary supplements: a cross-sectional survey of use, attitudes, and knowledge among the lebanese population. J Community Health. 2016;41(3):566–73.

Article   PubMed   Google Scholar  

WHO. General guidelines for methodologies on research and evaluation of traditional medicine Geneva: World Health Organization; 2000. Available from: http://whqlibdoc.who.int/hq/2000/WHO_EDM_TRM_2000.1.pdf .

Atalay D, Erge HS. Gıda Takviyeleri ve Sağlık Üzerine Etkileri. Food Health. 2018;4(2):98–111.

Article   Google Scholar  

Rautiainen S, Manson JE, Lichtenstein AH, Sesso HD. Dietary supplements and disease prevention - a global overview. Nat Rev Endocrinol. 2016;12(7):407–20.

Article   CAS   PubMed   Google Scholar  

Jordan SA, Cunningham DG, Marles RJ. Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment. Toxicol Appl Pharmacol. 2010;243(2):198–216.

Kohn OF, Lew SQ, Wong SS, Sam R, Chen HC, Raimann JG, et al. Using herbs medically without knowing their composition: are we playing Russian roulette? Curr Med Res Opin. 2022;38(5):847–52.

WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization; 2019.

WHO Traditional Medicine Strategy 2014-2023. Geneva: World Health Organization; 2013.

Rashrash M, Schommer JC, Brown LM. Prevalence and predictors of herbal medicine use among adults in the United States. J Patient Exp. 2017;4(3):108–13.

GTBD. Gıda Takviyesi ve Beslenme Araştırması Gıda Takviyesi ve Beslenme Derneği2021 [Available from: https://gtbd.org.tr/5-gida-takviyesi-ve-beslenme-arastirmasi-basinda-genis-yanki-buldu/ .

Özçelik G, Toprak D. Bitkisel tedavi neden tercih ediliyor? Ankara Med J. 2015;15(2):48–58.

Franco Ruiz S, González Maldonado P. Dietary supplements and the anesthesiologist: Research results and state of the art. Rev Colomb Anestesiol. 2014;42(2):90–9.

Oral B, Öztürk A, Balcı E, Sevinç N. Aile sağlığı merkezine başvuranların geleneksel/alternatif tıpla ilgili görüşleri ve kullanım durumu. TAF Prev Med Bull. 2016;15(2):75.

Guilmetdinov EF, Al-Khalaf M, Bhatt J, Parsons R, Sim TF. Complementary medicines use amongst elective surgery patients at a public tertiary hospital: a prospective observational cohort study in Australia. Complement Ther Clin Pract. 2019;35:284–9.

Judith O, Ijeoma O, Ekere K, Isaac A, Christianah I, Olubunmi O, et al. Popularity and customer preferences for herbal medicines in Nigeria: a questionnaire based survey. Humanit Soc Sci Lett. 2016;4(3):69–76.

Google Scholar  

Uysal Aİ, Altıparmak B, Toker MK, Gümüş Demirbilek S. Ameliyat planlanan hastalar arasında bitkisel ürün kullanımı ve bitkisel ürünlerin nötrofil lenfosit oranına etkisi: Kesitsel araştırma. JARSS. 2020;28:158–62.

Bulut S, Karakaş N, Orhan DD. Pediatri Hastalarında Bitki ve Bitkisel İçerikli Ürün Kullanım Alışkanlıklarının Değerlendirilmesi. Sağlık ve Toplum. 2021;31(2):172–80.

Kocabaş D, Erdal E, Demir M. Sağlık Hizmeti Kullanımında Bireylerin Geleneksel ve Alternatif Yöntemlere İlişkin Tutumlarının Değerlendirilmesi. BAİBÜ Sosyal Bilimler Enstitüsü Dergisi. 2019;19(1):63–80.

Çolak B, Özcan S, Akkız H. Kilo vermede kullanılan bitkisel ürünlerin ve diyet takviyelerinin hepatotoksik etkileri. Çukurova Tıp Öğrenci Derg. 2021;1(1):19–27.

Karakoç MD. Onkoloji hastalarının tamamlayıcı ve alternatif tedavi yöntemlerini kullanma durumları. Pam Med J. 2020;13(1):69–80.

McLay JS, Pallivalappila AR, Shetty A, Pande B, Al Hail M, Stewart D. “Asking the right question”. A comparison of two approaches to gathering data on “herbals” use in survey based studies. PLoS One. 2016;11(2):e0150140.

Yazici G, Erdogan Z, Bulut H, Ay A, Kalkan N, Atasayar S, et al. The use of complementary and alternative medicines among surgical patients: a survey study. J Perianesth Nurs. 2019;34(2):322–9.

Kitaguch K, Sasaoka N, Soeda T, Egawa J. The implication of dietary supplements and herbal medicines in perioperative period. Masui. 2016;65(11):1152–9.

PubMed   Google Scholar  

Lederer AK, Samstag Y, Simmet T, Syrovets T, Huber R. Complementary medicine usage in surgery: a cross-sectional survey in Germany. BMC Complement Med Ther. 2022;22(1):263.

Bajwa SJ, Panda A. Alternative medicine and anesthesia: Implications and considerations in daily practice. Ayu. 2012;33(4):475–80.

Donoghue TJ. Herbal medications and anesthesia case management. Aana J. 2018;86(3):242–8.

Leite PM, Martins MAP, das Graças Carvalho M, Castilho RO. Mechanisms and interactions in concomitant use of herbs and warfarin therapy: an updated review. Biomed Pharmacother. 2021;143:112103.

Posadzki P, Watson L, Ernst E. Herb–drug interactions: an overview of systematic reviews. Br J Clin Pharmacol. 2013;75(3):603–18.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kumar NB, Allen K, Bell H. Perioperative herbal supplement use in cancer patients: potential implications and recommendations for presurgical screening. Cancer Control. 2005;12(3):149–57.

Abe A, Kaye AD, Gritsenko K, Urman RD, Kaye AM. Perioperative analgesia and the effects of dietary supplements. Best Pract Res Clin Anaesthesiol. 2014;28(2):183–9.

De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2018;35(6):407–65.

Levy I, Attias S, Ben-Arye E, Goldstein L, Matter I, Somri M, et al. Perioperative risks of dietary and herbal supplements. World J Surg. 2017;41(4):927–34.

King AR, Russett FS, Generali JA, Grauer DW. Evaluation and implications of natural product use in preoperative patients: a retrospective review. BMC Complement Altern Med. 2009;9:38.

Hatfield J, Saad S, Housewright C. Dietary supplements and bleeding. Proc (Bayl Univ Med Cent). 2022;35(6):802–7.

Shibata T, Yoshinuma H, Sugiyama D, Kobayashi O. Severe hypokalemia and metabolic alkalosis caused by licorice discovered during the treatment of intraoperative hypoxemia. Cureus. 2022;14(5):e25432.

PubMed   PubMed Central   Google Scholar  

Lin HC, Yen CM, Chen KF, Kung YY, Hsieh YH, Chang CM. The banned herbal medicine induced liver injury in Taiwan. Hepatol Int. 2022;16(3):730–1.

Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208–16.

ASA. Herbal and Dietary Supplements and Anesthesia 2015. Available from: https://www.asahq.org/madeforthismoment/wp-content/uploads/2017/10/asa_supplements-anesthesia_final.pdf .

Chadha RM, Egan BJ. Perioperative considerations of herbal medications. Curr Clin Pharmacol. 2017;12(3):194–200.

Cordier W, Steenkamp V. Herbal remedies affecting coagulation: a review. Pharm Biol. 2012;50(4):443–52.

Cummings KC, Keshock M, Ganesh R, Sigmund A, Kashiwagi D, Devarajan J, et al. Preoperative management of surgical patients using dietary supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc. 2021;96(5):1342–55.

Flanagan K. Preoperative assessment: safety considerations for patients taking herbal products. J Perianesth Nurs. 2001;16(1):19–26.

NHS. Herbal Medicines with potential peri-operative complications 2018. Available from: https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Anaesthetics/PreAssessmentClinicalGuidelines.pdf .

Tinker JH, Miles RR, Newland MC, Hurlbert BJ, Sink BJ, Healey KM, et al. Recommendations and Guidelines For Preoperative Evaluation Of the Surgical Patient With Emphasis on the Cardiac Patient For Non-cardiac Surgery. Nebras: University of Nebraska Medical Center; 2006.

Hasen G, Hashim R. Current awareness of health professionals on the safety of herbal medicine and associated factors in the South West of Ethiopia. J Multidiscip Healthc. 2021;14:2001–8.

Mikail CN, Hearney E, Nemesure B. Increasing physician awareness of the common uses and contraindications of herbal medicines: utility of a case-based tutorial for residents. J Altern Complement Med. 2003;9(4):571–6.

Soltanipour S, Keihanian F, Saeidinia A. Knowledge, attitude and practice of physicians towards herbal remedies in Rasht, north of Iran. Medicine (Baltimore). 2022;101(47): e31762.

Blendon RJ, Benson JM, Botta MD, Weldon KJ. Users’ views of dietary supplements. JAMA Intern Med. 2013;173(1):74–6.

Broughton GI, Crosby MA, Coleman J, Rohrich RJ. Use of herbal supplements and vitamins in plastic surgery: a practical review. Plast Reconstr Surg. 2007;119(3):48e–66e.

Asher GN, Corbett AH, Hawke RL. Common herbal dietary supplement-drug interactions. Am Fam Phys. 2017;96(2):101–7.

Kritzinger S, Smith R. Pre-Operative Assessment Guidelines for Adults Undergoing Surgery Under General or Regional Anaesthesia Bradford, England: NHS; 2018. Available from: https://www.bradfordhospitals.nhs.uk/wp-content/uploads/2019/05/Pre-op-Guidelines.pdf .

Leite PM, Martins MAP, Castilho RO. Review on mechanisms and interactions in concomitant use of herbs and warfarin therapy. Biomed Pharmacother. 2016;83:14–21.

Mehmood Z, Khan MS, Qais FA, Ahmad I. Herb and modern drug interactions: efficacy, quality, and safety aspects. New look to phytomedicine: Elsevier; 2019. p. 503–20.

Pruitt R, Lemanski A, Carroll A. Herbal supplements: research findings and safety. Nurse Pract. 2018;43(5):32–7.

Sugumaran M, Cohen JC, Kacker A. Prevalence of over-the-counter and complementary medication use in the otolaryngology preoperative patient: a patient safety initiative. Laryngoscope. 2012;122(7):1489–92.

Williams CT. Herbal supplements: precautions and safe use. Nurs Clin North Am. 2021;56(1):1–21.

Bunchorntavakul C, Reddy K. Herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther. 2013;37(1):3–17.

Abebe W. Review of herbal medications with the potential to cause bleeding: dental implications, and risk prediction and prevention avenues. EPMA J. 2019;10(1):51–64.

Adusumilli PS, Ben-Porat L, Pereira M, Roesler D, Leitman IM. The prevalence and predictors of herbal medicine use in surgical patients. J Am Coll Surg. 2004;198(4):583–90.

Arora G, Arora A, Chaudary V, Kamlija M, Kamlija H. Possible Herbal-Drug Interactions An Evidenced Base Review. Altern Ther Health Med. 2022;28(2):70–7.

Butacnum A, Chongsuwat R, Bumrungpert A. Black tea consumption improves postprandial glycemic control in normal and pre-diabetic subjects: a randomized, double-blind, placebo-controlled crossover study. Asia Pac J Clin Nutr. 2017;26(1):59–64.

CAS   PubMed   Google Scholar  

Liu K, Zhou R, Wang B, Chen K, Shi LY, Zhu JD, et al. Effect of green tea on glucose control and insulin sensitivity: a meta-analysis of 17 randomized controlled trials. Am J Clin Nutr. 2013;98(2):340–8.

Hooman N, Mojab F, Nickavar B, Pouryousefi-Kermani P. Diuretic effect of powdered Cerasus avium (cherry) tails on healthy volunteers. Pak J Pharm Sci. 2009;22(4):381–3.

Masuda T, Ino Y, Hirai A, Okamura A, Ishikawa H, Yokoyama SI, et al. Effects of isoflavone-rich red clover extract on blood glucose level: a randomized, double-blind, placebo-controlled trial. J Food Sci. 2021;86(4):1393–9.

Richardson WN, Henderson L. The safety of kava: a regulatory perspective. Br J Clin Pharmacol. 2007;64(4):418–20.

Skinner C, Rangasami J. Preoperative use of herbal medicines: a patient survey. Br J Anaesth. 2002;89(5):792–5.

Jalili J, Askeroglu U, Alleyne B, Guyuron B. Herbal products that may contribute to hypertension. Plast Reconstr Surg. 2013;131(1):168–73.

Wang CZ, Moss J, Yuan CS. Commonly Used Dietary Supplements on Coagulation Function during Surgery. Medicines (Basel). 2015;2(3):157–85.

Pittas AG, Harris SS, Stark PC, Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. 2007;30(4):980–6.

Vu TT, Fredenburgh JC, Weitz JI. Zinc: an important cofactor in haemostasis and thrombosis. Thromb Haemost. 2013;109(3):421–30.

Patel KR, Sobczyńska-Malefora A. The adverse effects of an excessive folic acid intake. Eur J Clin Nutr. 2017;71(2):159–63.

Knackstedt R, Oliver J, Gatherwright J. Evidence-based perioperative nutrition recommendations: optimizing results and minimizing risks. Plast Reconstr Surg. 2020;146(2):423–35.

Holeček M. Side effects of amino acid supplements. Physiol Res. 2022;71(1):29–45.

Huntley A. Drug-herb interactions with herbal medicines for menopause. Br Menopause Soc J. 2004;10(4):162–5.

Skalli S, Zaid A, Soulaymani R. Drug interactions with herbal medicines. Ther Drug Monit. 2007;29(6):679–86.

Parvez MK, Rishi V. Herb-drug interactions and hepatotoxicity. Curr Drug Metab. 2019;20(4):275–82.

Chen X-W, S Serag E, B Sneed K, Liang J, Chew H, Pan S-Y, et al. Clinical herbal interactions with conventional drugs: from molecules to maladies. Curr Med Chem. 2011;18(31):4836-50.

Brumley C. Herbs and the perioperative patient. AORN J. 2000;72(5):783–96.

Cásedas G, Les F, Gómez-Serranillos MP, Smith C, López V. Bioactive and functional properties of sour cherry juice (Prunus cerasus). Food Funct. 2016;7(11):4675–82.

Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009;76(4):S126.

Asadujjaman M, Mishuk AU, Hossain MA, Karmakar UK. Medicinal potential of Passiflora foetida L. plant extracts: biological and pharmacological activities. J Integr Med. 2014;12(2):121–6.

Issa MM, Nejem RM, Shanab AA. Effects of iron on the pharmacokinetics of paracetamol in saliva. Pak J Biol Sci. 2013;16(24):2050–3.

Jordan MA. Interactions with drugs and dietary supplements used for weight loss. Drug Discovery: IntechOpen; 2013.

Karagöz Y. SPSS 23 ve AMOS 23 uygulamalı istatistiksel analizler: Nobel Akademik Yayıncılık Ankara, Turkey; 2016.

Erdoğan S, Nahcivan N, Esin MN. Hemşirelikte araştırma: süreç, ugulama ve kritik: Nobel Tıp Kitabevi; 2015.

Cronk BC. A Step-by-Step Guide to Analysis and Interpretotion. Pyrczak Publisher; 2008.

Denis DJ. SPSS data analysis for univariate, bivariate, and multivariate statistics: John Wiley & Sons; 2018.

Finch H, French BF, Immekus JC. Applied psychometrics using SPSS and AMOS: IAP; 2016.

Alpar C. Spor Sağlık Ve Eğitim Bilimlerinden Örneklerle UYGULAMALI İSTATİSTİK VE GEÇERLİK GÜVENİRLİK. 2016.

George D, Mallery P. IBM SPSS statistics 26 step by step: A simple guide and reference: Routledge; 2019.

Soós S, Palásti AF, Darvas K, Harsányi L. [The use of herbal remedies prior to elective surgical procedures at an urban hospital and a university clinic in Hungary. Descriptive study]. Orv Hetil. 2020;161(1):17-25.

Yang B, Xie Y, Guo M, Rosner MH, Yang H, Ronco C. Nephrotoxicity and Chinese Herbal Medicine. Clin J Am Soc Nephrol. 2018;13(10):1605–11.

Alkhamaiseh SI, Aljofan M. Prevalence of use and reported side effects of herbal medicine among adults in Saudi Arabia. Complement Ther Med. 2020;48:102255.

Yeung KS, Gubili J, Mao JJ. Herb-drug interactions in cancer care. Oncology (Williston Park). 2018;32(10):516–20.

Lucenteforte E, Gallo E, Pugi A, Giommoni F, Paoletti A, Vietri M, et al. Complementary and Alternative Drugs Use among Preoperative Patients: A Cross-Sectional Study in Italy. Evid Based Complement Alternat Med. 2012;2012:527238.

Gamsızlar Z, Kurt AE, Yücel A, Kartal M. Hekimlerin fitoterapi ürünlerine bakış açısı. J Clin Anal Med. 2011;2(2):1–3.

Shorofi SA, Arbon P. Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users. Complement Ther Clin Pract. 2017;27:37–45.

Bayraktar S, Yavaşcaoğlu B, Özyurt G. Opere edilecek olgularda bitkisel ürün kullanımının değerlendirilmesi. Uludağ Tıp Dergisi. 2014;40(1):137–41.

Demircan Z. Cerrahi geçiren ve kemoterapi tedavisi alan onkoloji hastalarının bitkisel ürün kullanımı ve etkileyen faktörlerin değerlendirilmesi: Sağlık Bilimleri Enstitüsü; 2016.

Bellikci Koyu E, Yürekli BPŞ, Özdemir N, Büyüktuncer Z. Tip 2 Diabetes Mellituslu Hastaların Bitkisel Destek Kullanım Durumları. Akd Tıp D. 2021;7(3):377–84.

Heller J, Gabbay JS, Ghadjar K, Jourabchi M, O'Hara C, Heller M, et al. Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know. Plast Reconstr Surg. 2006;117(2):436-45; discussion 46-7.

Taşpinar V, Gökbulut Özaslan N, Özkaya G, Karakelle N, Türkaslan D, Yavuz N, et al. Health professionals’ approach to patients using herbal medicine Saǧlik profesyonelleri̇ni̇n bi̇tki̇sel i̇laç kullanan hastalara yaklaşimi. Anestezi Dergisi. 2014;22(3):164–8.

Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;4:177.

Nibbelink CW, Brewer BB. Decision-making in nursing practice: an integrative literature review. J Clin Nurs. 2018;27(5–6):917–28.

Yöntem S, Güntürkün F, Tokem Y, Kaplan YC. İlaç hatalarına yönelik hemşirelerin bilgi ve tutumlarının incelenmesi. İKÇÜSBFD. 2019;4(2):51–9.

Koyu EB, Çalık G, Tohtak GK, Yıldırım GG. Sağlık çalışanlarının besin desteği kullanma durumları ve ilişkili etmenler. DEÜ Tıp Fakültesi Dergisi. 2020;34(2):141–51.

Büyükkasap A, Yazıcı G. Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study, dataset. 2024.

Download references

Acknowledgements

There is no acknowledgement.

Conflict of interest

There is no conflict of interest.

No funding was obtained for this study.

Author information

Authors and affiliations.

Gazi University Health Research and Application Center, Ankara, Turkey

Aslı Emine Büyükkasap

Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey

Gülay Yazıcı

You can also search for this author in PubMed   Google Scholar

Contributions

AEB interviewed the participants, collected data and wrote the original text. GY did editing and supervision.

Corresponding author

Correspondence to Aslı Emine Büyükkasap .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval was obtained from the ethics committee of Yıldırım Beyazıt University (06.01.22/36) and the institutions where the research was conducted. Written informed consent was obtained from the doctors and nurses who participated in the research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary material 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Büyükkasap, A.E., Yazıcı, G. Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study. BMC Nurs 23 , 277 (2024). https://doi.org/10.1186/s12912-024-01968-z

Download citation

Received : 19 February 2024

Accepted : 22 April 2024

Published : 25 April 2024

DOI : https://doi.org/10.1186/s12912-024-01968-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Nutrients and food supplements
• Level of knowledge

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]