Document Type : Research


Trauma in Police Operations Research Center, Department of Health, Rescue and Treatment of Police Force, Tehran, Iran.


Introduction: COVID- 19 outbreaks was a threat and opportunity for health care systems. Nurses play an important role in COVID-19 pandemic management. Inadequate knowledge, inappropriate attitude and, practice response among nurses might lead to delayed care, and result in the rapid spread of infection. Therefore, this study aims to determine the attitude, knowledge, and practice response among nurses towards the COVID-19 outbreak.
Methods: This cross- sectional, descriptive study was conducted at a military hospital (Seyed Alshohada Hospital), based a on census sampling method in Kerman, Iran. Data were collected from January to February, 2021, using a self- report questionnaire. The questionnaire was distributed among 122 nurses. Data were imported to SPSS v.17 for analysis.
Results: A total of 99 nurses participated in this study. Knowledge, attitude, and practice scores towards COVID- 19 were good. According to the data obtained, the majority had a bachelor, s degree, and most respondents were women (68%). The result of this study showed that 98% took practical infection prevention measures towards COVID-19. Also, our findings indicated that 91% of the study participants had favorable attitudes towards COVID-19.
Discussion: Results showed that participants were knowledgeable, held positive attitudes, and took effective measures for COVID-19. COVID-19 pandemic and other novel diseases are a challenge for all health systems; therefore, it is necessary to enhance knowledge and skills of nurses.



The recent outbreak of a severe respiratory syndrome, with unknown etiology, occurred in the city of Wuhan in eastern China, in December 2019 (1). Coronavirus is a large category of viruses that has been relatively widespread worldwide (2-4). This virus has low pathogenicity and high transmissibility capability (5). COVID-19, caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), continues to threaten public health (6). According to a report by the World Health Organization (WHO) On August 5, the cumulative number of COVID-19 cases, globally, surpassed 200 million, just six months after hitting 100 million. This week alone (August 5, 2021), over 4.2 million new cases and over 65 000 new deaths were reported, which was a slight increase as compared to the previous week. The largest increase in the number of new cases was reported by the Region of the Americas (14%) and Western Pacific Region (19%), with 1.3 million and over 375 000 new cases reported, respectively (7).

Transmission of virus among nurses depends on elements such as hand disinfection, mask wearing, overcrowding, lack of isolation rooms; it increase if nurses have inadequate awareness of infection control interventions (8).

Hospitals are at the front line of the healthcare system during a pandemic (9). Nurses have been the pioneers of medical care throughout the period from illness to wellness. Therefore, the roles and functions of nurses have become particularly important to prevent transmission of the COVID-19, and it is imperative that they become comprehensively familiar with preventive measures regarding the virus (10).

COVID-19 pandemic creates a situation in which nurses are at greater risk of viral exposure. Lack of knowledge, attitude and practice in nurses can lead to an unsatisfactory performance, regarding the care of epidemic patients. Thus, the gaps in knowledge, attitude, and practice must be identified and addressed to prepare nurses. The current study aims to determine attitude, knowledge, and practice response among nurses towards the COVID-19 outbreak (at a military hospital for the first time in Iran). This is a helpful approach to upgrade the prevention and control procedures in similar situations.

Materials and Methods

Study design

A cross-sectional study based on a census sampling method was used at military hospital in Kerman, Iran. The study period was from January to February, 2021. A total of 99 nurses participated in this study. The inclusion criterion was all nurses working in the hospitals, dedicated to the admission and hospitalization of patients. The exclusion criteria were nurses who were not present during the study and failed to complete the questionnaire (because of sick leave or annual leave). The purpose and procedures of this study were explained to the ward managers and all participants; then, questionnaires were distributed to nurses at their workplace. Nurses were informed that they were free to withdraw at any time, without giving a reason, and all information provided by them would be kept anonymous and confidential.

Data collection

A self- report questionnaire was used to collect attitude, knowledge, and practices towards COVID- 19 among nurses. This questionnaire was designed and developed using WHO course materials on emerging respiratory viruses, including COVID-19 in Ethiopia. Other published articles were also used (11, 12). The questionnaire's modification was carried out to fit the local context.

The instrument consisted of four sections. The first part covered demographic data of the participants (sex, educational level, and work experience). The second part evaluated the nurses’ knowledge of participants about COVID-19. The third and last part evaluated attitude and practice response among nurses towards the COVID-19 outbreak. The coded data were analyzed using SPSS 17, and the descriptive statistics were used to describe the quantitative and categorical variables.

Knowledge of COVID-19

The total knowledge score of the nurses varied between 0 (no correct answer) and 18 (all answers correct); a cut-off level of _9 was evaluated as poor knowledge, and >9 indicated satisfactory level of knowledge (13-17).

Attitude towards COVID-19

There were 11 questions regarding attitude (with a minimum score of 11 and a maximum score of 55). The attitude score was based on a five-point Likert scale, in which a score of 1 to 5 was given from strongly disagree to strongly agree. A mean score of >33 (answering strongly agree or agree), was described as a favorable attitude, and a score of 11 to 33 indicated an unfavorable attitude (answering strongly disagree, disagree or neutral) (13, 15, 16-17).

Practices to Prevent COVID-19

There were 14 questions regarding practice (with minimum score of 14 and maximum score of 70). The score of the practice was based on a five-point scale, in which a score of 1 to 5 was given from never to always. A mean score of >42 (answering always or most of the time or sometimes) was carried out as performing good practices, and a score of _42 indicated poor practice (answering never or occasionally) (13, 15, 16).

The purpose and procedures of this study were explained to all participants. Then, the completed questionnaire returned to the researcher directly.


99 nurses responded to the questionnaire (81.14%). The majority had a bachelor, s degree. Most respondents were women (68%). Table 1 shows the demographic characteristics.

Nurses’ knowledge of COVID-19

Nurses’ knowledge of COVID-19 was measured using 18 questions, and a numerical value for each question was provided (1, Yes; 0, No) (Table 2).

Practices towards COVID-19

The infection prevention practices towards COVID-19 were measured by 14 questions using five criteria, and by proving numerical value (1, never; 2, occasionally; 3, sometimes; 4, most of the time; 5, always) (Table 3)

Nurses’ attitudes towards COVID-19

The nurses’ attitude towards COVID-19 was measured using 11 questions, each of which used five criteria. Numerical value was, then, provided. (1, strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree) (Table 4)

Table 1. Nurses Demographic Characteristics

Table 2. Knowledge of COVID-19

Table 3. Infection Prevention Practices of Nurses towards Coronavirus Disease 2019 (COVID-19)

Table 4. Nurses’ Attitude towards COVID-19


The present study was carried out to assess knowledge, attitude and practice response towards COVID- 19 among nurses, during COVID-19 outbreak, at a military hospital.

Knowledge about COVID-19 is essential to control and manage the disease. Based on this study, 100% of the participants had good knowledge regarding COVID-19 outbreak. This percentage is higher than other studies conducted in Iran and Ethiopia (11, 12). In another study in Nepal, the majority of healthcare workers had good to moderate knowledge (18). Similarly, Zhou et al. also reported that, the majority of healthcare workers in a study in China had sufficient knowledge and good practice towards COVID-19 (n = 89%, 89.7%, respectively) (13). Furthermore, Arslanca et al. concluded that the knowledge level of health care workers concerning COVID-19 was above 90% (19). These results were in line with a study that revealed good knowledge and positive attitude among healthcare workers towards MERS (20). They were also consistent with another study by Alqahtani (21) among 418 health college students in Najran, Saudi Arabia. Possible reasons for good knowledge may be that, the nurses were being prepared to deal with the epidemic.

The result of this study suggested that 98% of the participants showed satisfactory infection prevention practices towards COVID-19. Findings were consistent with the results of previous studies (15,22-23). In addition, Rani et al. explored the knowledge, attitude, and practices of health-care professionals regarding Coronavirus (COVID-19) pandemic infection, and found that the practice score was good (24).

Our findings showed that 91% of the study participants had favorable attitudes towards COVID-19. Also, similar results were obtained from other studies (14,22-24).


The relatively small sample size limited the general applicability of the results. The results presented in this study were self-reported, and partly dependent on the participants’ honesty and recall ability.


Nurses showed almost good attitude, knowledge, and practices concerning COVID-19. Emergence and spread of Coronavirus as an international threat, has disrupted all global equations. COVID-19 pandemic has impacted normal life in most countries. Despite problems, a unique opportunity has been created to recognize true values and status of nursing. However, nurses must be equipped with more information to prevent and control infectious disease.

Conflict of interest

Authors declared no conflict of interest.


Not applicable

Authors, contributions

All authors equally contributed to preparing this article.


The authors like to extend their gratitude and thanks to nurses who participated in the study.

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020; 20;382(8):727–33.
  2. Schoeman D, Fielding BC. Coronavirus envelope protein: current knowledge. Virol J 2019; 16:69.
  3. Sohrabi C, Alsafi Z, O'neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International journal of surgery. 2020; 76: 71-6.
  4. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance. 2020; 25(10): 2000180.
  5. Jiang S, Shi Z, Shu Y, et al. A distinct name is needed for the new coronavirus. The Lancet. 2020; 395(10228): 949.
  6. Jones DS. History in a crisis—lessons for Covid-19. New England Journal of Medicine. 2020 Mar 12.
  7. WHO. Weekly epidemiological update on COVID-19 – 10. 2021.
  8. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. jama. 2020; 323(13): 1239-42.
  9. Leiba A, Goldberg A, Hourvitz A, Amsalem Y, Aran A, Weiss G, et al. Lessons learned from clinical anthrax drills: evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments. Annals of emergency medicine. 2006; 48(2): 194-9.
  10. Abdollahimohammad A, Firouzkouhi M. Future perspectives of nurses with COVID 19. Journal of Patient Experience. 2020; 7(5): 640-1.
  11. Tadesse DB, Gebrewahd GT, Demoz GT. Knowledge, attitude, practice and psychological response toward COVID-19 among nurses during the COVID-19 outbreak in northern Ethiopia, 2020. New microbes and new infections. 2020; 38: 100787.
  12. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin Infect Dis. 2020; 15(COVID-19): e102848.
  13. Zhou M, et al. Knowledge, attitude and practice regarding COVID-19 among health care workers in Henan, China. J Hosp Infect 2020.
  14. Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Novel Coronavirus (COVID-19) knowledge and perceptions: a survey of healthcare workers. MedRxiv. 2020.
  15. Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. International journal of biological sciences. 2020; 16(10): 1745.
  16. COVID-19 Basic information survey and psychological response analysis(Ethiopia). Available at: forms/ d/e/ 1FAIpQLSescY0MQWQqT- 5vnMgmh4 UnAbgRGbQcALn52YTQbeqyyorIQA/. Accessed 12 April 2020.
  17. Giao H, et al. Knowledge and attitude towards COVID-19 among healthcare workers at district 2 hospital, Ho chi minh city. Asian Pac J Trop Med. 2020; 13.
  18. Nepal R, Sapkota K, Adhikari K, et al. Knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, Nepal. 2020.
  19. Arslanca T, Fidan C, Daggez M, Dursun P. Knowledge, preventive behaviors and risk perception of the COVID-19 pandemic: A cross-sectional study in Turkish health care workers. PloS one. 2021; 16(4): e0250017.
  20. Khan MU, Shah S, Ahmad A, et al. Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC public health. 2014; 14(1): 1-7.
  21. Alqahtani AS. Knowledge and attitude toward Middle East respiratory syndrome coronavirus among heath colleges’ students in Najran, Saudi Arabia. Int J Community Med Public Health. 2017; 4(8): 2641-7.
  22. Huynh G, Nguyen TNH, Vo KN, Pham LA. Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific Journal of Tropical Medicine. 2020; 13(6): 260.
  23. Asaad AM, et al. Knowledge and attitudes towardss Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia. East Mediterr Health J. 2019; 25.
  24. Rani M, Sharma I, Sharma S, Sharma L, Kumar S. Exploring the knowledge, attitude, and practice of health-care professionals on coronavirus (COVID-19) pandemic infection. Journal of Education and Health Promotion. 2021; 10.