Knowledge, attitude, and practice of operating room nurses regarding equipment management and multi-stakeholder needs for an information system: a cross-sectional survey

Imagine the hospital operating room as the most high-tech cockpit in the world. It's not just a place for surgery; it's a bustling hub filled with expensive, complex machines that are constantly being moved, plugged in, and unplugged. Managing all this gear is like trying to run a massive orchestra where the instruments keep hiding themselves, the sheet music is outdated, and the conductor is constantly asking, "Where is the violin?" If the right tool isn't found instantly, the music stops, the show is delayed, and the safety of the patient in the spotlight is at risk.

To understand how to fix this chaos, scientists often look at something called "KAP," which stands for Knowledge, Attitude, and Practice. Think of it as a three-part checklist for how people handle a job. Knowledge is knowing the rules and having the manual in your head. Attitude is how much you care about following those rules and whether you think the system is worth your time. Practice is what you actually do when the pressure is on. While we know that having a good attitude and knowing the rules is great, this study asks a tricky question: Does being a "good student" with a perfect manual actually stop the chaos when the equipment is missing? And more importantly, what kind of digital tool would actually help everyone—from the nurses on the floor to the managers in the office—get their instruments back on track?

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The Great Equipment Hunt: A Survey of the Operating Room

This paper is like a massive, real-time detective story set in the operating rooms of hospitals in Hunan Province, China. The authors, a team of researchers from Xiangya Hospital, decided to stop guessing and start asking the people who actually live in the chaos: the nurses, the head nurses (the team leaders), and the equipment administrators (the gear managers). They wanted to build a better digital system to manage all the medical equipment, but first, they needed to understand the current mess.

The Detective Work: Building the Questionnaire
Before they could ask questions, they had to build a reliable "lie detector" test, or in this case, a questionnaire. They created a special survey for the nurses to measure their KAP levels regarding equipment. They tested it rigorously to make sure it was accurate, checking that the questions made sense and that the answers were consistent. They found that their test was solid, with a reliability score of 0.899, which is like saying the test is a very trustworthy ruler.

The Findings: Good Students, Broken Systems
When they surveyed 309 people (211 nurses, 81 head nurses, and 17 equipment managers), they found a fascinating contradiction.

• The Nurses are Smart and Willing: The nurses scored very high on Knowledge (4.06 out of 5), Attitude (4.33 out of 5), and Practice (4.25 out of 5). In plain English, they know the rules, they care about doing their job, and they generally try to follow the procedures. They are the "good students" of the operating room.
• But the System is Failing Them: Despite being so knowledgeable and willing, the reality on the ground was messy. More than half of the nurses (51.2%) said they had trouble finding equipment in the past week. Even worse, 64.0% of them said surgeries were delayed because of equipment problems. Some of these delays were short, but others stretched over 6 minutes.

It's like having a chef who knows every recipe by heart and loves cooking, but the kitchen is so disorganized that they can't find the pots and pans, causing the dinner service to stall. The problem isn't the chef; it's the kitchen.

The "Knowing-Doing" Glitch
The researchers discovered something interesting about how the nurses' brains work in this environment. Usually, we think of Knowledge, Attitude, and Practice as three separate steps. But in the operating room, the data showed that Knowledge and Practice were fused together. If a nurse knew how to use a machine, they were likely using it correctly. However, Attitude was a separate thing. A nurse could have a great attitude and want to use the system perfectly, but if the system was clunky or the equipment was missing, they couldn't "practice" effectively.

This means that just giving nurses more training or telling them to "try harder" won't fix the delays. The barrier isn't their willingness; it's the environment.

The Manager vs. Staff Gap
One of the most surprising discoveries was a huge gap in perception between the bosses and the workers.

• The Head Nurses (the bosses) thought training was going great. About 90.1% of them rated the training as "satisfactory."
• The Staff Nurses (the workers) had a very different story. Only 39.8% of them felt the training was actually adequate.

It's like a teacher giving an "A" to a class because everyone showed up to the lecture, while the students are sitting there thinking, "But I still don't know how to solve the problem!" This gap suggests that the managers are looking at the wrong metrics. They see attendance; the nurses see a lack of practical, usable skills.

What Everyone Wants: The "Magic Tool"
The researchers asked everyone what they needed to fix these problems. Surprisingly, the nurses, the head nurses, and the equipment managers all agreed on the same three things. They didn't want more paperwork or more meetings. They wanted a digital system that could:

1. Automatically generate reports (so no one has to manually count or write down data).
2. Talk to other hospital systems (like the main hospital computer system, so data isn't stuck in "silos").
3. Send automatic alerts for maintenance (so equipment gets fixed before it breaks, rather than waiting for a nurse to notice it's broken).

The satisfaction with current technology was the lowest of all the stages, with an overall score of just 38.5%. The head nurses were especially unhappy, with only 11.1% satisfied with the current IT support. This is a loud signal that the current tools are failing everyone.

The Conclusion: A Call for a New System
The study concludes that while the nurses are ready and willing, the current system is holding them back. The delays and the difficulty in finding equipment aren't because the nurses are bad at their jobs; it's because the "kitchen" is disorganized.

The authors suggest that the solution is a new, full-lifecycle Internet of Things (IoT) system. This would be a smart network that tracks every piece of equipment from the moment it's bought, through its training and use, all the way to when it's thrown away. It would automatically tell you where a machine is, remind you when it needs fixing, and sync with the hospital's main computer.

The paper doesn't claim this is a magic wand that will solve everything overnight. It admits that their study was a snapshot in time (a cross-sectional survey) and that they need more data to be 100% sure about the equipment managers' views since there were so few of them. However, the evidence is strong: the staff is ready, the need is urgent, and the path forward is clear. It's time to stop relying on paper and memory and start building a digital safety net that actually works for the people keeping the operating room running.