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em
a
n
d
in
g
p
a
tien
ts
,
an
d
i
n
ab
ilit
y
to
p
r
o
v
id
e
a
d
eq
u
ate
p
ati
en
t
c
o
m
f
o
r
t
wh
ic
h
r
e
q
u
ir
es
s
y
m
p
t
o
m
ass
ess
m
en
t
an
d
im
p
r
o
v
ed
c
o
m
m
u
n
icatio
n
to
o
ls
[
1
7
]
.
Stu
d
ies
h
av
e
r
ep
o
r
ted
t
h
at
wh
en
p
atien
ts
ar
e
u
n
ab
le
to
r
esp
o
n
d
v
er
b
ally
,
n
u
r
s
es
o
f
ten
d
o
n
o
t
f
in
d
it
im
p
o
r
tan
t
to
talk
with
th
em
,
a
n
d
n
u
r
s
in
g
in
ter
v
en
tio
n
s
a
r
e
b
ased
o
n
th
e
n
u
r
s
es’
o
wn
id
ea
s
,
ass
u
m
p
tio
n
s
a
n
d
p
r
ev
io
u
s
ex
p
e
r
ien
ce
ab
o
u
t
p
a
tien
ts
’
n
o
n
-
v
er
b
al
co
m
m
u
n
icatio
n
s
,
wh
ich
m
ig
h
t
b
e
er
r
o
n
e
o
u
s
o
r
in
s
u
f
f
icien
t
[
1
8
]
.
Stu
d
ies
r
ef
lect
v
ar
ied
r
e
s
u
lts
o
n
attitu
d
e
to
war
d
s
co
m
m
u
n
icatio
n
b
y
n
u
r
s
es
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
an
d
u
n
an
im
o
u
s
ly
p
r
o
ject
d
if
f
icu
lties
f
ac
ed
b
y
n
u
r
s
es
d
u
r
in
g
co
m
m
u
n
icatio
n
.
T
h
u
s
,
u
n
d
er
s
tan
d
in
g
n
u
r
s
es’
attitu
d
e
o
n
co
m
m
u
n
icatio
n
with
in
tu
b
ated
p
atien
t
is
f
elt.
Un
d
er
s
tan
d
in
g
th
eir
attitu
d
e
will
h
elp
to
allev
iate
th
e
d
if
f
icu
lties
f
ac
ed
b
y
th
em
.
T
h
e
r
esear
ch
er
d
u
r
in
g
h
er
e
x
p
er
ien
ce
as
in
ch
a
r
g
e
n
u
r
s
e
to
o
f
o
u
n
d
th
at
t
h
e
n
u
r
s
es
r
esp
o
n
d
m
o
r
e
to
th
o
s
e
p
atien
ts
wh
o
tr
y
to
co
m
m
u
n
icate
an
d
n
e
g
lect
th
e
o
n
es
wh
o
d
o
n
’
t.
T
h
is
lead
s
to
less
co
m
m
u
n
icativ
e
p
atien
ts
’
n
ee
d
b
ein
g
u
n
a
d
d
r
ess
ed
.
L
iter
atu
r
es
r
ef
lecte
d
v
ar
io
u
s
r
ea
s
o
n
s
o
n
n
u
r
s
es’
p
ar
t
f
o
r
in
a
b
ilit
y
to
estab
lis
h
ef
f
ec
tiv
e
co
m
m
u
n
ic
atio
n
s
.
On
e
s
u
ch
s
tu
d
y
r
ev
ea
led
th
at
th
e
m
ajo
r
ity
o
f
th
e
n
u
r
s
es
h
ad
attitu
d
e
in
s
p
ea
k
in
g
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
b
u
t
also
co
n
clu
d
ed
th
at
it
is
v
ital
to
im
p
r
o
v
e
th
e
q
u
ality
an
d
q
u
an
tity
o
f
co
m
m
u
n
icatio
n
wi
th
p
atien
ts
with
s
p
ee
ch
p
r
o
b
le
m
s
b
y
im
p
lem
en
tin
g
m
an
a
g
e
m
en
t
s
tr
ateg
ies
[
1
8
]
.
An
o
th
er
s
tu
d
y
f
o
u
n
d
u
n
s
atis
f
ac
to
r
y
lev
el
o
f
s
atis
f
ac
tio
n
with
co
m
m
u
n
icatio
n
am
o
n
g
n
u
r
s
es,
an
d
co
n
clu
d
e
d
th
at
ef
f
ec
tiv
e
u
s
e
o
f
co
m
m
u
n
i
ca
tio
n
aid
ca
n
lea
d
to
u
n
d
er
s
t
an
d
in
g
a
n
d
s
atis
f
y
in
g
th
e
n
ee
d
s
o
f
p
atien
ts
[
1
9
]
.
Attitu
d
e
to
war
d
lear
n
in
g
co
m
m
u
n
icatio
n
s
k
ills
is
a
co
m
p
licated
p
r
o
ce
s
s
th
at
in
clu
d
e
s
b
o
th
in
ter
n
al
(
e.
g
.
,
p
er
s
o
n
ality
tr
aits
,
em
p
ath
ic
te
n
d
en
cies)
an
d
ex
ter
n
al
ele
m
en
ts
(
e.
g
.
,
en
v
i
r
o
n
m
e
n
tal,
s
u
ch
a
s
s
en
io
r
ity
)
[
1
0
]
.
Stu
d
ies
r
ef
lect
th
at
s
in
ce
th
e
p
h
y
s
io
lo
g
ical
p
ar
a
m
eter
s
f
o
r
life
s
av
in
g
tr
ea
tm
en
t
an
d
ca
r
e
tak
es
p
r
ec
ed
en
ce
o
v
e
r
co
m
m
u
n
ica
tio
n
n
ee
d
,
d
iv
e
r
g
en
t
v
iews
ex
is
t
am
o
n
g
n
u
r
s
es
r
eg
ar
d
i
n
g
th
e
u
tili
ty
an
d
p
r
ef
er
en
ce
s
o
f
th
e
c
o
m
m
u
n
icatio
n
ai
ds
[
1
4
]
,
[
1
5
]
.
T
h
u
s
,
m
i
x
ed
attitu
d
e
is
d
o
c
u
m
en
ted
till
d
ate
o
n
c
o
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
an
d
n
u
r
s
es’
co
m
m
u
n
icatio
n
in
ter
m
s
o
f
co
m
m
u
n
icatio
n
n
ee
d
,
u
s
e
o
f
co
m
m
u
n
icatio
n
aid
an
d
attitu
d
e
to
war
d
s
lear
n
in
g
co
m
m
u
n
icatio
n
tech
n
iq
u
es
is
av
ailab
le.
So
,
t
h
e
p
r
es
en
t
s
tu
d
y
tak
es
in
itiativ
e
to
d
escr
ib
e
f
u
r
th
e
r
th
e
n
u
r
s
es’
attitu
d
e
to
co
m
m
u
n
icate
with
c
o
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
,
th
eir
d
if
f
icu
lties
an
d
th
e
m
eth
o
d
s
th
ey
ad
o
p
t
to
d
o
s
o
.
T
h
e
s
tu
d
y
r
esu
lt
m
ay
h
elp
to
d
ev
elo
p
p
r
o
p
e
r
co
m
m
u
n
i
ca
tio
n
s
tr
ateg
ies
to
ea
s
e
th
e
c
o
m
m
u
n
icatio
n
d
if
f
i
cu
lties
f
ac
ed
b
y
n
u
r
s
es
an
d
th
e
p
atien
ts
b
o
th
.
T
h
e
s
tu
d
y
'
s
f
in
d
in
g
s
m
ig
h
t
aid
d
ec
is
io
n
-
m
ak
er
s
b
y
s
h
ed
d
in
g
l
ig
h
t
o
n
th
e
p
r
o
b
lem
o
f
c
o
m
m
u
n
icatio
n
an
d
ass
is
tin
g
th
em
in
p
u
ttin
g
p
o
licies
in
p
lace
to
h
elp
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
wh
o
ar
e
h
av
i
n
g
co
m
m
u
n
icatio
n
is
s
u
es.
Nu
r
s
es
wil
l
b
e
ab
le
to
co
m
m
u
n
icate
with
c
o
n
s
cio
u
s
i
n
tu
b
ated
p
atien
ts
m
o
r
e
ef
f
ec
tiv
ely
.
T
h
e
o
b
jectiv
e
o
f
th
is
s
tu
d
y
is
t
o
f
in
d
th
e
attitu
d
e
o
f
n
u
r
s
es o
n
n
ee
d
o
f
co
m
m
u
n
icatio
n
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
.
C
o
m
m
u
n
ic
atio
n
is
es
s
en
tial
f
o
r
estab
lis
h
i
n
g
a
tr
u
s
two
r
th
y
,
th
er
a
p
eu
tic
c
o
n
n
ec
tio
n
b
etwe
en
n
u
r
s
es
an
d
p
atien
ts
.
Fo
r
p
atie
n
ts
ad
m
itted
in
an
in
te
n
s
iv
e
c
ar
e
u
n
it
(
I
C
U
)
,
in
esp
ec
ially
,
t
h
e
q
u
ality
o
f
p
atien
t
co
m
m
u
n
icatio
n
with
h
ea
lth
ca
r
e
s
taf
f
is
lin
k
ed
with
th
eir
p
r
o
g
n
o
s
is
.
T
h
is
s
tu
d
y
's
th
eo
r
etica
l
ap
p
r
o
ac
h
is
g
u
id
ed
b
y
class
ic
n
u
r
s
in
g
c
o
m
m
u
n
icatio
n
th
eo
r
ies
[
2
0
]
a
n
d
in
c
o
r
p
o
r
ates
asp
ec
ts
f
r
o
m
th
e
co
llab
o
r
ativ
e
in
ter
p
er
s
o
n
al
c
o
m
m
u
n
icatio
n
m
o
d
el
[
2
1
]
,
wh
ic
h
r
ec
o
g
n
iz
es
n
u
r
s
e
f
ee
d
b
ac
k
as
a
v
ital
co
m
p
o
n
en
t
f
o
r
th
e
co
r
r
ec
tn
ess
o
f
v
e
r
b
al
an
d
n
o
n
v
er
b
al
co
m
m
u
n
icatio
n
.
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h a
pp
ro
a
ch
I
n
th
is
s
tu
d
y
,
a
q
u
a
n
titativ
e
r
e
s
ea
r
ch
ap
p
r
o
ac
h
was
ch
o
s
en
a
n
d
u
tili
ze
d
.
T
h
e
s
tu
d
y
h
ad
a
d
escr
ip
tiv
e
d
esig
n
ap
p
ly
i
n
g
r
eliab
le
a
n
d
v
alid
ated
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
a
ir
e
u
s
in
g
a
s
u
r
v
e
y
m
eth
o
d
to
c
o
llect
d
ata
th
r
o
u
g
h
o
n
lin
e
m
o
d
e
.
A
s
u
r
v
ey
was
c
h
o
s
en
b
ec
au
s
e
th
e
tar
g
et
s
tu
d
y
p
o
p
u
latio
n
s
wer
e
s
tu
d
y
in
g
in
t
h
e
in
s
titu
tio
n
.
T
h
e
s
u
r
v
ey
was
u
n
d
e
r
tak
en
in
Ma
y
2
0
2
1
,
am
o
n
g
1
2
5
r
esp
o
n
d
e
n
ts
f
r
o
m
Peer
less
I
n
s
titu
te
o
f
Nu
r
s
in
g
,
Ko
lk
ata
,
W
est
B
en
g
al,
I
n
d
ia.
Pre
v
io
u
s
s
tu
d
ies
to
f
in
d
th
e
attitu
d
e
o
f
n
u
r
s
es
h
av
e
b
ee
n
c
o
n
d
u
cted
u
s
in
g
f
ewe
r
s
am
p
le
s
ize
o
f
as lo
w
1
2
1
[
2
2
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N:
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8
8
0
6
N
u
r
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a
ttit
u
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w
a
r
d
s
co
mmu
n
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tio
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w
ith
in
tu
b
a
ted
co
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s
cio
u
s
p
a
tien
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… (
Ma
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K
a
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ka
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79
2
.
2
.
Sa
m
ple
T
h
e
r
esp
o
n
d
e
n
ts
wer
e
in
-
s
er
v
ice
s
taf
f
n
u
r
s
es
en
r
o
lled
f
o
r
p
o
s
t
b
asic
b
ac
h
elo
r
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s
d
e
g
r
ee
af
te
r
co
m
p
letio
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o
f
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ip
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m
a
in
n
u
r
s
in
g
with
th
e
wo
r
k
ex
p
er
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ce
in
cr
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ca
r
e
u
n
its
o
n
c
o
n
s
cio
u
s
in
tu
b
ate
d
p
atien
ts
.
T
h
e
r
esp
o
n
d
en
ts
we
r
e
s
tr
atif
ied
ac
r
o
s
s
ag
e
an
d
y
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s
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f
wo
r
k
ex
p
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ce
with
ed
u
ca
tio
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lev
el
o
f
d
ip
lo
m
a
i
n
Nu
r
s
in
g
.
All
n
u
r
s
es
wh
o
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o
n
ac
tiv
e
d
u
ty
i
n
cr
itical
ca
r
e
ar
ea
d
u
r
in
g
th
e
d
ata
co
llectio
n
we
r
e
en
r
o
lled
f
o
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th
e
s
u
r
v
ey
.
T
h
e
r
e
s
p
o
n
d
en
ts
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e
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n
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er
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ip
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ce
in
c
r
itical
ca
r
e
u
n
its
o
n
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
.
T
h
e
s
am
p
le
s
ize
wa
s
ca
lcu
lated
at
9
5
%
C
I
,
w
h
e
r
e
m
ar
g
i
n
o
f
er
r
o
r
o
r
p
r
ec
is
io
n
r
ate
d
ec
id
ed
b
y
r
esear
ch
er
is
5
%
f
o
r
f
in
ite
s
am
p
le
o
f
1
6
0
s
taf
f
n
u
r
s
es
s
tu
d
y
in
g
f
o
r
i
n
-
s
er
v
ice
e
d
u
ca
tio
n
at
th
e
in
s
titu
te
also
co
n
s
id
er
in
g
1
0
%
d
r
o
p
o
u
t
o
f
s
tu
d
y
p
ar
ticip
a
n
ts
.
A
s
u
r
v
ey
with
s
am
p
le
s
ize
o
n
1
1
6
n
u
r
s
es
to
f
in
d
th
e
attitu
d
e
o
n
s
k
in
in
ju
r
y
co
u
ld
y
iel
d
s
u
c
ce
s
s
f
u
l r
esu
lt a
n
aly
s
is
p
r
ev
io
u
s
ly
[
2
3
]
.
T
h
e
f
o
r
m
u
la
u
s
ed
f
o
r
ca
lcu
lat
io
n
o
f
s
am
p
le
s
ize
was
n
=N
/1
+(
Nx
d
2
)
.
T
h
e
f
o
r
m
u
la
is
b
ase
d
o
n
f
in
ite
s
am
p
le
o
f
s
tu
d
y
as
th
e
to
tal
n
u
m
b
er
o
f
en
r
o
lled
wo
r
k
in
g
s
taf
f
n
u
r
s
es
f
o
r
Po
s
t
B
asic
d
ip
lo
m
a
ed
u
ca
tio
n
c
o
u
r
s
e
is
1
6
0
with
wo
r
k
e
x
p
er
ien
ce
i
n
cr
itical
ca
r
e
u
n
its
o
n
co
n
s
ci
o
u
s
in
tu
b
ated
p
atien
ts
[
2
4
]
.
W
h
er
e
n
is
r
eq
u
ir
e
d
s
am
p
le
s
ize.
N
i
s
f
in
ite
p
o
p
u
latio
n
=1
6
0
,
d
is
m
ar
g
in
o
f
er
r
o
r
5
%
,
n
=1
6
0
/1
+
(
1
6
0
*
0
.
0
5
*
0
.
0
5
)
=1
1
4
,
w
ith
1
0
%
attr
itio
n
s
am
p
le
s
ize
was ta
k
en
as 1
2
5
.
2
.
3
.
Da
t
a
c
o
llect
io
n t
o
o
l
I
n
th
is
s
tu
d
y
,
t
h
e
in
s
tr
u
m
e
n
t
was
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
o
n
attitu
d
e
r
eg
a
r
d
in
g
co
m
m
u
n
icatio
n
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
t
s
co
n
tain
in
g
1
0
clo
s
e
-
en
d
ed
q
u
esti
o
n
s
.
A
s
im
ilar
s
tu
d
y
h
as
em
p
lo
y
ed
1
0
q
u
esti
o
n
n
air
es
to
ass
ess
th
e
at
titu
d
e
o
f
n
u
r
s
es
o
n
co
m
m
u
n
ic
atio
n
with
d
ec
r
ea
s
ed
lev
el
o
f
co
n
s
cio
u
s
n
ess
[
2
5
]
.
T
h
e
p
r
esen
t
s
tu
d
y
h
ad
two
s
ec
tio
n
s
in
th
e
in
s
tr
u
m
en
t o
f
th
e
s
tu
d
y
n
am
el
y
Par
t
A
an
d
p
ar
t B.
Par
t
A
co
n
tain
ed
d
em
o
g
r
a
p
h
ic
in
f
o
r
m
ati
o
n
o
f
t
h
e
r
esp
o
n
d
en
ts
lik
e
g
en
d
e
r
,
a
g
e,
m
ar
ital
s
tatu
s
,
to
tal
y
ea
r
s
o
f
n
u
r
s
in
g
s
er
v
ice
an
d
y
ea
r
s
o
f
ex
p
er
ien
ce
in
c
r
itical
ca
r
e
n
u
r
s
in
g
.
Par
t
B
co
n
t
ain
ed
th
e
item
s
to
ass
ess
th
e
attitu
d
e
o
n
n
ee
d
o
f
co
m
m
u
n
icatio
n
with
co
n
s
cio
u
s
in
-
tu
b
ated
p
atien
ts
.
I
t e
m
p
lo
y
ed
a
3
-
p
o
in
t L
ik
er
t scale
with
r
esp
o
n
s
es r
an
g
in
g
f
r
o
m
1
(
n
e
v
er
)
,
2
(
s
o
m
e
tim
es),
an
d
3
(
alwa
y
s
)
.
2
.
4
.
Va
lid
it
y
a
nd
re
lia
bil
it
y
T
h
e
to
o
l
was
v
alid
ated
b
y
5
e
x
p
er
ts
f
r
o
m
n
u
r
s
in
g
f
r
ater
n
ity
an
d
co
n
ten
t
v
alid
ity
in
d
ex
wa
s
f
o
u
n
d
to
b
e
0
.
9
with
1
0
0
p
er
ce
n
t
ag
r
ee
m
en
t
in
all
ar
ea
s
ex
ce
p
t
m
in
o
r
lan
g
u
a
g
e
m
o
d
if
icatio
n
s
s
u
g
g
ested
b
y
th
e
v
alid
ato
r
s
o
n
two
item
s
.
Nec
e
s
s
ar
y
m
o
d
if
icatio
n
s
wer
e
m
a
d
e
as
p
er
v
alid
ato
r
s
'
s
u
g
g
esti
o
n
s
.
R
eliab
ilit
y
was
o
b
tain
ed
b
y
C
r
o
n
b
ac
h
’
s
alp
h
a
an
d
was
f
o
u
n
d
to
b
e
0
.
8
wh
i
ch
s
h
o
ws
th
e
in
ter
n
al
c
o
n
s
is
ten
cy
o
f
th
e
to
o
l
was
r
eliab
le.
Pre
test
in
g
o
f
th
e
to
o
l
was d
o
n
e
o
n
2
0
s
am
p
les wh
o
wer
e
n
o
t in
clu
d
ed
in
t
h
e
f
in
al
d
ata
co
llectio
n
.
2
.
5
.
E
t
hica
l c
o
ns
idera
t
io
n
Vo
lu
n
tar
y
p
a
r
ticip
atio
n
f
r
o
m
th
e
p
ar
ticip
an
ts
wer
e
o
b
tain
ed
with
o
u
t
an
y
co
er
ci
o
n
.
I
n
f
o
r
m
e
d
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
all
th
e
r
esp
o
n
d
en
ts
.
Fo
r
m
al
in
s
titu
tio
n
al
e
th
ics
co
m
m
ittee
p
er
m
is
s
io
n
was
s
o
u
g
h
t.
An
o
n
y
m
ity
o
f
th
e
p
ar
ticip
an
ts
an
d
co
n
f
id
en
tiality
o
f
th
e
d
at
a
wer
e
m
ain
tain
ed
.
T
h
e
s
tu
d
y
p
o
s
ed
n
o
h
ar
m
to
th
e
p
ar
ticip
an
ts
.
As
p
er
in
ter
n
atio
n
al
s
tan
d
ar
d
o
r
u
n
iv
er
s
ity
s
tan
d
ar
d
eth
ical
a
p
p
r
o
v
al
h
as
b
ee
n
co
llected
an
d
p
r
eser
v
ed
b
y
th
e
a
u
th
o
r
.
I
n
s
titu
tio
n
al
eth
ics
co
m
m
ittee
ap
p
r
o
v
al
was
o
b
tain
ed
f
r
o
m
Peer
less
Ho
s
p
itex
Ho
s
p
ital a
n
d
R
esear
ch
C
en
ter
lim
ited
o
n
1
st
J
u
ly
2
0
2
1
with
R
ef
n
o
.
PHH
&
R
C
L
C
R
E
C
/3
3
7
0
/2
0
2
1
2
.
6
.
Da
t
a
a
na
ly
s
is
Descr
ip
tiv
e
s
tati
s
tics
wer
e
u
s
ed
to
an
aly
ze
th
e
d
ata.
T
h
e
d
ata
wer
e
en
ter
ed
in
to
Mic
r
o
s
o
f
t
Of
f
ice
E
x
ce
l
2
0
0
7
s
p
r
ea
d
s
h
ee
ts
an
d
cr
o
s
s
-
ch
ec
k
ed
f
o
r
ac
cu
r
ac
y
b
ef
o
r
e
d
ata
an
aly
s
is
.
Fo
r
d
escr
ip
tiv
e
an
aly
s
is
,
f
r
eq
u
e
n
cy
an
d
p
r
o
p
o
r
tio
n
w
er
e
u
s
ed
to
p
r
esen
t
th
e
d
is
tr
ib
u
tio
n
ca
teg
o
r
ical
v
ar
iab
le
s
.
All
q
u
an
tita
tiv
e
v
ar
iab
les we
r
e
ex
am
in
e
d
f
o
r
n
o
r
m
al
p
r
o
b
ab
ilit
y
d
is
tr
ib
u
tio
n
b
y
s
k
ewn
ess
an
d
k
u
r
to
s
is
test
b
ef
o
r
e
a
n
aly
s
is
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
T
he
a
g
e
info
r
m
a
t
io
n o
f
t
he
re
s
po
nd
ent
s
A
to
tal
o
f
1
2
5
p
ar
ticip
an
ts
in
c
lu
d
in
g
i
n
-
s
er
v
ice
ed
u
ca
tio
n
n
u
r
s
es
r
esp
o
n
d
ed
to
o
n
lin
e
s
u
r
v
e
y
.
Am
o
n
g
th
em
7
1
%
wer
e
f
r
o
m
t
h
e
ag
e
g
r
o
u
p
1
9
-
2
5
wh
ile
2
9
%
wer
e
f
r
o
m
t
h
e
ag
e
g
r
o
u
p
2
6
-
3
2
a
n
d
1
0
%
wer
e
f
r
o
m
ab
o
v
e
3
2
y
ea
r
s
.
T
h
u
s
,
th
e
m
aj
o
r
ity
o
f
th
e
s
u
r
v
e
y
r
esp
o
n
d
en
t
s
wer
e
f
r
o
m
th
e
ag
e
g
r
o
u
p
1
9
-
2
5
y
ea
r
s
.
3
.
2
.
At
t
it
ud
e
o
f
nu
rses
o
n c
o
m
m
un
ica
t
io
n nee
ds
wit
h c
o
ns
cio
us
intu
ba
t
ed
pa
t
ient
s
Attitu
d
e
o
f
n
u
r
s
es
o
n
co
m
m
u
n
icatio
n
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
ar
e
r
e
f
lecte
d
th
r
o
u
g
h
q
u
esti
o
n
n
air
es
with
r
esp
o
n
s
es
in
L
ik
er
t
s
ca
le
ar
e
d
escr
ib
e
d
i
n
tab
le
an
d
f
i
g
u
r
es.
T
a
b
le
1
s
h
o
ws
th
e
f
r
e
q
u
en
c
y
an
d
p
e
r
ce
n
tag
e
o
n
s
tatem
en
t
o
f
attitu
d
e
o
f
n
u
r
s
es
o
n
co
m
m
u
n
icatio
n
n
ee
d
s
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
77
-
84
80
Sev
en
ty
f
iv
e
p
er
ce
n
t
r
esp
o
n
d
en
ts
h
av
e
tr
ied
to
co
m
m
u
n
ic
ate
with
co
n
s
cio
u
s
in
tu
b
ated
p
atien
ts
alth
o
u
g
h
alm
o
s
t 7
0
% h
av
e
f
ac
e
d
ch
alle
n
g
es to
co
m
m
u
n
icate
with
th
e
m
.
T
h
is
r
esu
lt
is
s
u
p
p
o
r
ted
b
y
a
s
tu
d
y
th
at
in
s
p
ite
o
f
n
u
r
s
es’
h
ig
h
le
v
els
o
f
k
n
o
wled
g
e,
attitu
d
e
an
d
s
k
ills
[
2
6
]
; th
ey
o
f
ten
f
ac
e
d
if
f
icu
lty
in
co
m
m
u
n
icatin
g
with
in
tu
b
ated
p
atien
ts
in
cr
itical
c
ar
e
ar
ea
s
.
A
s
im
i
lar
s
tu
d
y
h
as
also
s
t
ated
th
at
n
u
r
s
es
ca
r
in
g
f
o
r
p
atien
ts
wh
o
ar
e
lig
h
tly
s
ed
ated
d
u
r
in
g
m
ec
h
a
n
ical
v
en
tilatio
n
is
q
u
ite
ch
allen
g
in
g
in
ter
m
s
o
f
co
m
m
u
n
icatio
n
[
9
]
.
Data
in
T
ab
le
1
also
r
ev
ea
led
th
at
o
n
l
y
th
ir
ty
s
ev
en
p
er
ce
n
t
o
f
th
e
r
esp
o
n
d
en
ts
h
av
e
b
ee
n
tau
g
h
t
h
o
w
to
co
m
m
u
n
ica
te
with
th
e
in
tu
b
ated
co
n
s
cio
u
s
p
atien
ts
an
d
alm
o
s
t
f
o
r
ty
s
ix
p
er
ce
n
t
h
av
e
u
s
ed
c
o
m
m
u
n
icatio
n
to
o
ls
f
o
r
th
e
s
am
e.
A
s
tu
d
y
s
h
o
wed
m
o
d
e
r
a
te
p
er
f
o
r
m
an
ce
an
d
s
h
o
r
t
-
ter
m
ed
u
ca
tio
n
ca
n
im
p
r
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Nu
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4.
CO
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[
1
]
S
.
P
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a
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l
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,
“
A
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me
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[
2
]
X
.
C
h
e
n
e
t
a
l
.
,
“
A
ssess
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.
[
3
]
A
.
H
o
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m,
V
.
K
a
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,
L.
N
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k
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,
a
n
d
P
.
D
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mm
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[
4
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M
.
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.
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mp
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N
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:
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.
[
5
]
A
.
H
o
l
m,
A
.
V
i
f
t
r
u
p
,
V
.
K
a
r
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sso
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N
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k
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se
n
,
a
n
d
P
.
D
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,
“
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mm
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1
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1
4
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4
.
[
6
]
A
.
H
o
l
m,
V
.
K
a
r
l
ss
o
n
,
a
n
d
P
.
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f
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c
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We
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[
7
]
I
.
I
t
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B
e
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d
a
v
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d
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t
a
l
.
,
“
T
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C
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M
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[
20
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1]
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[
22
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E.
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M
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[
23
]
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[
24
]
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9
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[
25
]
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[
26
]
X.
-
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.
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,
J
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.
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u
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[
27
]
K
.
G
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.
[
28
]
M
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me
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[
2
9
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[
3
1
]
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.
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