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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONKyriacos et al. (2005) suggestedthat the curriculum content ofmicrobiology must equip nurses indeveloping countries, such as SouthAfrica, to meet their expanding rolesas leaders in health care clinics.In fact, doctors and service usersexpect of nurses a higher level ofknowledge of biosciences thanthey actually have (Davis, 2010).Staff nurses have been reportedto express lack of confidencein articulating their knowledgeto patients and other healthprofessionals (Courtenay, 1991;Clancy et al., 2000).As the knowledge of the variousareas of microbiology impactdifferently on clinical practice, itis of interest to evaluate students’performance in the various areas ofthe subject.AimThe aim of this study was to assessstudents’ knowledge of microbiologywith a view to improving the coursecontent for pre- registration nursingprograms.Definition of termsCourse content in this study refers tofour subject areas of microbiology,namely: infection control, immunity,epidemiology and pathogenicity.Study settingThe College of Nursing is the onlyinstitution, in Kuwait, admittinghigh school graduates for nursingtraining (Al-Kandari et al., 2009).Established by decree in November,2002, the College offers twoprograms: Bachelor of Science inNursing (BSN) which runs for fouryears and Associate Degree inNursing (ADN) that has five levelseach being one semester of fourmonths. Microbiology is compulsoryfor the nursing programs so, there isneed for enhancement of students’knowledge.Previous reports have focused onthe relevance of basic sciences tonursing practice, or as a predictor ofsuccess in nursing programs. Thereappears to be few studies on nursingstudents’ knowledge of microbiology as a basis for evaluation ofmicrobiology course content.The aim of this study was,therefore, to assess the knowledgeof microbiology among nursingstudents in the ADN and BSNprograms against a standard scoreby registered nurses who wereclinical teachers in the College ofNursing.MethodsEthical approvalApproval for this research projectwas given by the ResearchCommittees of the College ofNursing and the Public Authorityfor Applied Education andTraining (PAAET), Kuwait. Ethicalconsiderations were given in the useof human subjects and their informedconsent. The purpose of the studywas described in writing and alsoexplained to all the students beforedistribution of the questionnaire tothose willing to participate. Theirconsent was expressed by theirresponding to the questionnaire.QuestionnaireThe instrument for the researchstudy was an anonymousquestionnaire.The first section of the questionnairedealt with demographic informationon nationality, gender, collegeprogram, level of enrollment, and ifrespondent had previously studiedmicrobiology. The second sectioncomprised ten questions on each offour subject areas of microbiologynamely; infection control, immunity,epidemiology and pathogenicity.Answers were on a three -pointLikert scale of: I agree, I do notknow, and I disagree.ProcedureAn anonymous self-administeredquestionnaire was distributed tonursing students in a classroomsetting, under the supervision of afaculty member who explained theobjectives of the research study andthe anonymity of the questionnaire.Participation meant consent. Thesupervisor ensured that individualresponses were given to thequestionnaire.ValidityThe content validity of thequestionnaire was assessed by fourfaculty members - two registerednurses and two biomedicalscientists.Pilot studyTwenty-five students were giventhe questionnaire before the mainresearch study. Their responseswere used to test the suitability ofthe questions and feasibility of theresearch methods.ReliabilityTo test the reliability of theresponses, one week aftercompletion of the questionnaire,10 of the students were given newcopies of the questionnaire to repeat.The test retest responses given tothe questionnaire were compared,giving a result of 0.86.Statistical analysisDescriptive statistics were carriedout to determine the percentages,means, and standard deviations ofthe scores. T-test and ANOVA wereused to determine significance of thedifferences between mean scoresby different groups at 95 percentconfidence interval.Knowledge was assessed as thecorrect responses to the questions.ResultsDemographic dataThere were 330 students and 14teachers who responded to thequestionnaire. Of the students,97 percent were Arabs, and theremainder non-Arabs. Altogether,278 students (84 percent) were inthe Associate Degree in Nursing(ADN) program, while 52 students(16 percent) were in the Bachelor ofScience in Nursing (BSN) program.The number of students who hadnot studied microbiology previously,decreased as the level of enrollmentincreased. Only 10 percent ofstudents in BSN program had notstudied microbiology before theirenrollment.The response rate to thequestionnaire was 95.1 percent forOFGNURSINGM I D D L E E A S T J OMIDDLEU R N AEASTL O FJOURNALNURSIN D e c JANUARYe m b e r 22012009/ January2010

ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONTable 1. Mean scores (SD) for male and female students in 10 questions of each subject area according tolevels of enrollment (L) in ADNstudents, 93.3 percent for teachersand 95 percent overall.Mean scores by male and femalestudents at different levels ofenrollment (Table 1).Table 1 shows the mean scoresof male and female respondentsin each subject area according totheir level of enrollment. Generally,mean scores increased with level.However, in ADN at level 2, femaleshad lower mean scores than level1. Overall, female students hadhigher mean scores than their malecounterparts but the difference wasnot significant. Nevertheless, femalestudents (ADN) had significantlyhigher mean scores in pathogenicitythan male students in level 1(p 0.018) and level 4 (p 0.001).Mean scores by students in differentprograms as well as teachers (Table2 - next page)Results in Table 2 show thehighest mean scores in this order:teachers, BSN, ADN. Among theADN students, females had higherscores than males in each subjectarea. All groups of respondentshad the highest mean scores inMIDDLE EAST JOURNAL OF NURSING JANUARY 2012immunity followed by infectioncontrol. The area with lowest meanscores was pathogenicity followedby epidemiology. Teachers hadsignificantly higher scores thanADN male (p 0.004) and female(p 0.038) students, irrespective ofsubject area. Analysis of variance(ANOVA) showed that there was asignificant difference between thescores by teachers, when comparedto mean scores by ADN and BSNstudents, notably in epidemiology(p 0.001). Students in BSN obtainedsignificantly higher mean scoresin epidemiology than ADN malestudents (p 0.025).MIDDLE EAST JOURNAL OF NURSING JULY 2009

ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONTable 2: Mean scores (SD) for ADN (males & females), BSN and Teachers according to the Subject AreaFigure 1: Mean scores by different groups of respondents MIDDLEMIDDLE EAST JOU R N AEASTL O FJOURNALN U R S I OFN GNURSING D e c JANUARYe m b e r 22012009/ January2010

ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONError bar of mean scores by differentgroups of respondents (Figure 1).clinical practice (Davis et al., 2010).Using teachers’ mean scores as astandard, students’ knowledge indifferent areas of microbiology wasassessed. Thus, it was possible toidentify areas of the microbiologycourse that required modificationin order to improve the students’knowledge of the subject. Aspreviously reported (Al-Kandari etal., 2009), the number of teachersavailable to participate in the studywas much fewer than the numberof students. Similarly, more femalesthan males participated in the study(Al- Kandari & Vidal, 2007) possiblybecause nursing is not a preferredprofession among males. Besides,it is the policy of the nursing collegein Kuwait to admit only femalesto the BSN program (Al-Kandariet al., 2009). Although, students’scores generally increased withlevel of enrollment, ADN level 2female students consistently hadlower scores than those in level 1,irrespective of the subject area. Thismay be due to the fact that level2 female students were a weakerbatch.Male students had lower meanscores than females becausenursing is not popular with men andtherefore they show less interestin the nursing courses, includingmicrobiology. Oliveira et al. (2002)also observed that female dentalstudents had higher scores thanmales. Previous studies reportedthat male nursing students sufferedfrom heavy mental pressure andshowed low identity to the nursingspecialty (Lian-di & Ning, 2006;Ding et al., 2008). All groups ofrespondents had the highest meanscores in immunity and infectioncontrol which are the subject areasmost relevant to nursing practice.On the other hand, all groups hadlowest mean scores in pathogenicity,possibly because this subjectarea is sometimes viewed as lessrelevant to nursing practice. Davis(2010) reported that doctors andservice users expect nurses to beable to discuss pathogenesis ofdiseases. Therefore, there is a needto improve on the course contentand teaching of pathogenicity innursing programs so that nursesmay be able to explain diseaseprocesses to patients in the courseof their professional practice. Lowerknowledge in epidemiology amongrecipients may be attributed to thefact that epidemiology is taught inlectures but it is not reinforced bynursing practice.Microbiology is a compulsorycourse for pre-registration nursingeducation (Goetz et al. 1992; Choe& Shin, 1999; Jordan et al., 1999;Wong & Wong, 1999; Henderson,2000). Most students in the BSNprogram are registered nurses whohad obtained Associate Degreein Nursing (ADN). The higherscores by the BSN students inthe present study may be due tothe fact that they had previouslystudied microbiology in their preregistration training. Moreover,they had practiced nursing andtherefore realized the importanceof microbiology in their professionalpractice. This underscores thefact that students perform better inbiosciences when they appreciatethe importance of the subject inPrevious studies on teaching ofbioscience in nursing programshave dealt with performance in thesubject as a predictor of successin licensing examinations (Carpioet al., 1999; Wong & Wong, 1999;Reynolds, 2006) or the importanceof microbiology in clinical practice(Atulomah & Oladepo, 2002; DennySmith, 2006), whereas reportson microbiology course contentin nursing education (Reynolds,2006; Goetz et al., 1999; Choe &Shin, 1999) discussed relevanceof the different subject areas,the present study focuses onstudents’ knowledge of each areaof microbiology and the resultshave been used to identify aspectsof the course content that needimprovement. This approach mayMean scores at 95 percentconfidence intervals show that thehighest score was achieved by BSNstudents and the lowest by males inthe ADN program (Figure 1).DiscussionMIDDLE EAST JOURNAL OF NURSING JANUARY 2012be applicable in the improvement ofthe contents of other basic sciencecourses.ConclusionStudents were weak in areas ofpathogenicity and epidemiology.Therefore, the course content inthese areas of microbiology needs tobe improved.The nursing program in Kuwait hasgood microbiology course content,covering the subject areas mostrelevant to nursing practice being,infection control and immunity inwhich nursing students had thehighest knowledge. Students hadleast knowledge of pathogenicityconcerning pathogens and thedisease process that are moreacademic aspects of microbiology,not directly relevant to nursingpractice. Enhancement of nurses’knowledge in pathogenicity couldimprove their discussion with doctorsand service users. Improvementin epidemiology could reflect onnurses’ awareness of numbersin record keeping for statisticalpurposes.AcknowledgementsThe cooperation of the nursingfaculty in data collection was mostappreciated. The research studywas supported by Research GrantNo.CN-09-01 of the Public Authorityfor Applied Education and Training(PAAET), Kuwait. The statisticalanalysis was by Dr. P. N. Sharma,Health Sciences Center, Kuwait.ReferencesAl-Kandari F, Vidal VL, ThomasD. Assessing clinical learningoutcomes: A descriptive study ofnursing students in Kuwait. J Nursing& Health Sciences 2009; 11(3):252- 62. Al-Kandari F, Vidal VL.Correlation of the health-promotinglifestyle, enrollment level, andacademic performance of Collegeof Nursing students in Kuwait. JNursing & Health Sciences 2007;9(2): 112-19.Atulomah NO & Oladepo O.Knowledge, perception and practicewith regard to occupational risksMIDDLE EAST JOURNAL OF NURSING JULY 2009

ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONof HIV/AIDS among nursing andmidwifery students in Ibadan,Nigeria. Afr J Med Sci 2002;31(3):223- 27.Campbell AR, Dickson CJ.Predicting student success: a 10- year review using integrative reviewand meta- analysis. J ProfessionalNursing 1996;12: 47- 59.Carpio B, O’Mara L, HezekiahJ. Predictors of success on theCanadian Nurses AssociationTesting Service (CNATS)examination. Canadian J NursingResearch 1996; 28: 115-23.Choe M A, Shin GS. Objectives andContents of Basic Medical Sciencesin Nursing Education. J Korean AcadNurs 1999; 29 (6): 1455- 68.Clancy J, McVicar A, Bird D. Gettingit right? An exploration of issuesrelating to the biological sciencesin nurse education and nursingpractice. J Advanced Nursing 2000;32(6): 1522- 32.Courtenay M. A study of the teachingand learning of the biologicalsciences in nurse education. JAdvanced Nursing 1991; 16: 1110-16.Davis GM. What is provided andwhat the registered nurse needsbioscience learning through the preregistration curriculum. Nurse EducToday 2010; 30(8): 707-12.Denny-Smith T, Bairan A, PageMC. A survey of female nursingstudents’ knowledge, healthbeliefs, perceptions of risk, andrisk behaviors regarding humanpapillomavirus and cervical cancer.J Am Acad Nurse Prac 2006; 18(2):62- 9.Henderson L. Fitting in: craftingnursing program curricula. FocusMicrobiol Educ 2000; 7(1): 3- 5.Jordan S, Davies S, Green B. Thebiosciences in the pre- registrationnursing curriculum: staff andstudents’ perceptions of difficultiesand relevance. Nurse Educ Today1999; 19: 215- 26.Kyriacos U, Jordan S, van denHeever J. The biological sciencesin nursing: a developing countryperspective. J Advanced Nursing2005; 52(1): 91-103.Lian-di MA, Ning SHEN. The presentstatus and countermeasures ofmale nurse’s education. Journalof Nursing Administration DOI:CNK1:1SSN:1671-315X.O.2006-07005.Oliveira ER, Narendran S, Falcao A.Brazilian dental students’ knowledgeand attitudes towards HIV infection.AIDS Care 2002; 14(4): 569-76.Reynolds J. The importance ofMicrobiology to Nursing Students.Focus Microbiol Educ 2006; 2(2):7- 9.Trnobranski PH. Biological sciencesand the nursing curriculum: achallenge for educationists. JAdvanced Nursing 1993; 18: 49399.Wong J, Wong S. Contribution ofbasic sciences to academic successin nursing education. International JNursing Studies 1999; 36(4): 34554.DING Ding, SONG Xiao-ping,WANG Hong-jie. Investigation andanalysis on the attitude towardsnursing specialty in male nursingstudents. J Nursing Administration .DOI: CNK1:SUN:HLGL.0.2008-01009.Goetz A, Yu CM, Muder RR.Microbiology, infection control,immunizations, and infectiousdisease exposure: Education andpractices in United States nursingschools. Am J Infect Control 1992;20(3): 115-21. OFGNURSINGM I D D L E E A S T J OMIDDLEU R N AEASTL O FJOURNALNURSIN D e c JANUARYe m b e r 22012009/ January2010

ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONDeterminants of Fertility Behaviour among Adolescent ReproductiveWomen in BangladeshRashed AlamAbstractAdolescent’s reproductivehealth and fertility behaviourin Bangladesh is in the worstcondition. Fertility behaviouramong adolescent reproductivewomen in Bangladesh, usingnational representative data fromthe Bangladesh Demographic andHealth Survey (BDHS), 20032004, allowing for the existenceof observed characteristics thataffect both adolescent reproductivewomen and fertility was studied.The study pertains to 1,703 evermarried adolescent women inthe reproductive age group (1019). The challenges and risksthe young people face duringthis period impact directly ontheir physical and emotionalmental wellbeing. The reductionof fertility is one of the majorproblems of developing countriesin the world and Bangladesh isone of them. The purpose of thisstudy is to identify the effectsof various socio-economic anddemographic variables on fertilityin six divisions of Bangladesh.Multivariate analysis, such asmultiple classification analysis, hasbeen used to identify the importantdeterminants of children ever born.The study result shows that varioussocio-economic and demographicvariables affect on adolescentsfertility. These are adolescent’seducation, place of residence,religion, working status, breastfeeding etc. An inverse relation isfound between age at marriage,and fertility. Results show thatfertility is highest in rural areasthan that of urban areas. Divisionaldifference reveals that fertility ishighest in Chittagong division andlowest in Khulna division amongthe adolescent mothers. This alsoindicated that the total fertilityrate decreased about 10% from1999/00 to 2003/04 respectively.Keywords: Fertility behaviour,Adolescent reproductive women,Multiple Classification Analysisand Bangladesh.Correspondence:Md. Rashed Alam, Assistant Professor, Department of Population Scienceand human Resource Development, University of Rajshahi,Rajshahi-6205, BangladeshEmail:mrasps 29us@yahoo.comIntroductionYoung people do not live inisolation. Much of what they dois determined by what others doincluding the leading adults in theirfamilies, in their communities andin health and education programsin the workplace and in policy andlawmaking positions Nurul M. I.(1995). One third of the world’spopulation is between the age of 10to 24 and four out of five of theseyoung people live in the developingcountries. They form a great poolof resources for humanity withtheir energy, idealism and freshviews. But at the same time, theycan be quite vulnerable to the fastchanges taking place around them.The tremendous flow of populationtowards the cities, the spread oftelecommunications across culturaland geographic boundaries,increased traveling, a generallyearlier beginning of puberty and alater age at marriage, a decreasein the influence and strength of thefamily as an institution, the adventof AIDS, increase in violenceand easier access to potentiallyharmful tobacco, alcohol and otherdrugs, have significant impactson the behaviour and health ofyoung people. The InternationalConference on Population andDevelopment (ICPD) held in Cairo in1994 also emphasized the specialneeds of adolescents and youth.Since, then government and nongovernment organizations carriedout some activities that are relatedto certain aspects of adolescents’health. The

microbiology must equip nurses in developing countries, such as South Africa, to meet their expanding roles as leaders in health care clinics. In fact, doctors and service users expect of nurses a higher level of knowledge of biosciences than they actually have (Davis, 2010). Staff nurses