https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article A Comparative Study of Nurses Knowledge, Attitudes, and Practices Concerning Fluid Therapy in Children in Public versus Private Hospitals in Erbil City ABSTRACT INTRODUCTION In fluid therapy, circulation is restored by increasing extracellular fluid. Proper func- tioning of cells depends greatly on water because it plays an essential role in chemi- cal and metabolic reactions inside cells, transports nutrients to cells, removes waste from cells, and regulates body tem- perature. The balance between the input and output of fluids in the body is called fluid balance which helps metabolic pro- cesses function correctly[1]. Acute diarrhea remains a leading cause of death among children in developing countries [2]. Glob- ally, in 2015, estimated that diarrhea was a leading cause of death among all ages (1·31 million deaths), and diarrhea was a common cause of death among children under 5 years old [3]. Nurses are in charge of initiating, monitoring, and terminating fluid therapy. They also need to know and prevent complications caused by catheter inserted through a vein or resulted from Background and objectives: Dehydration caused by diarrhea is considered as a significant cause of morbidity and mortality among children all over the world, fluid therapy remain the most effective methods to treat dehydration. Nurses are responsible for initiating, monitoring, terminating, knowing preventing and complications of intravenous fluid therapy. The main aim of the study was to compare nurses’ knowledge, attitude, and practice concerning fluid therapy in children in public versus private hospitals. Methods: A comparative study design was conducted in children hospitals in Erbil City. A randomized sampling technique was used for enrolling 98 nurses from three pediatric hospitals ; from three pediatric hospitals; 70 from Rapareen Public Hospital other 28 nurses from Lala and Consultant Medical City Private Hospitals. The data were collected through direct interview and analyzed through descriptive and inferential statistics (paired Samples t-test) using SPSS 22.0. Results: The results revealed that highest percentage of nurses age group were 22-28 years, 67.1% %were female in public hospital , about 34.3% and 64.3% graduated from institutes in both hospitals. there was no significant difference between the nurses socio- demographic characteristics from public hospital and private hospitals. There was a sig- nificant difference between the nurses from public hospital and private hospitals regard- ing their KAP. The nurses from private hospital have better KAP than public Hospital . Conclusion: Knowledge, attitude, and practice of fluid therapy among nurses of Rapareen Public Hospital were poor, while the nurses from private hospitals had an acceptable lev- el of knowledge, attitude, and practice of fluid therapy. Keywords: Nurses; KAP; Fluid; Public; Private; Hospital Nazar Ramadhan Othman; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. )Correspondence: nazar.ramathan@nur.hmu.edu.krd ) Abbas Abdulqader Ahmed; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 22 Erbil Journal of Nursing & Midwifery Received: 22/8/2019 Accepted: 13/11/2019 Published: 30/5/2020 mailto:%20nazar.ramathan@nur.hmu.edu.krd https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article intravenous fluid therapy[4.5.6].I Nurses are needed to increase their knowledge and performance regarding intravenous (IV) fluid therapy to manage its possible complications and improve patient safety [7]. In this regard, errors have been report- ed to be made by about 39% of nurses and 36% jointly by nurses and emergency phy- sicians. Incorrect medication dose (35%), incorrect medication (30%), and fluid over- load (35%) are among the most common errors[8].There has been a general tenden- cy in the last decade toward establishing private systems in the health service; how- ever, health services must be provided equally to all humans. Research has shown how patient satisfaction with health ser- vices can be affected by a tangible realm, and that this issue needs to be paid more attention to by the public sector [9]. It is argued that in low and middle income countries more efficient, accountable, and sustainable healthcare services are provid- ed by private sector than the public sector which tends to deliver more equitable and evidence-based care[10].According to the results of a review of 17 studies including over 5,500 hospitals across Europe, public hospitals are reported to have a better eco- nomic performance than private not-for- profit (PNFP) and private for-profit (PFP) hospitals. The results of that review also showed that PNFP hospitals are better than PFP hospitals regarding their economic performance[11].Research has shown that nurses in private hospitals have higher and better skills and competence than those working in public hospitals[12].The results of another study indicate that private healthcare centers deliver better care and pay more attention to patients[13].The present study was aimed at comparing knowledge, attitude, and practice needed for fluid therapy in children among nurses working in public and private hospitals in Erbil city. A comparative study was carried out from January to August 2018 order to investi- gate and compare knowledge, attitude, and practice (KAP) required for fluid thera- py in children among Public Hospital and Private Hospitals in Erbil, Kurdistan Region of Iraq. Researchers selected 98 nurses randomly to the study from selected hospi- tals with 70 nurses randomly chosen from Rapareen Public Hospital, 14 from Lala and other 14 from Consultant Medical City (CMC) Private Hospital. The study inclusion criteria were providing care to sick children admitted hospitals, both genders, having experience in caring for children of at least one year, and graduating from primary nursing schools, intermediate nursing schools, preparatory nursing schools, nurs- ing institutes, or nursing colleges. The study exclusion criteria included nurses working in operation room and who held MSc or PhD in nursing. The required data were collected through observation during practice by the researcher and direct (face- to-face) interview using a questionnaire which was designed and developed by the researcher according to the international guideline of pediatric fluid therapy. It con- sisted of two sections: (1) The sociodemo- graphic characteristics including personal data (age, sex, address, marital status, and years of experience) and socioeconomic data (occupation, education, and crowding index) and (2) The nurses knowledge (30 items), attitude (15 items), and practice (25 items). The content and structural va- lidity of the questionnaire was determined initially by a panel of 15 experts from different related specialties. And its relia- bility was examined through the Spearman -Brown Coefficient Reliability of 10 cases which was obtained as 83.9 which is statis- tically adequate. Moreover, a checklist for fluid therapy in children was prepared which included assessment of dehydration, 23 Erbil Journal of Nursing & Midwifery METHODS https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article working in private hospital have had poor knowledge. About 47.1% and 7.1% of nurs- es were poor attitude in public and private hospitals respectively, 51.4% and 57.1% were fair in practice in both hospital respectively. Table 3. According to the present study, there was a significant association between the nurs- es’ age, level of education and their knowledge on fluid therapy in both public and private hospitals 0.013, 0.041 and 0.022, 0.036 respectively. There was non significant association between nurses’ gender with their knowledge, attitude, and practice in public hospital and attitude and practice in private hospitals , Moreover, there was a highly significant association between the nurses’ years of experience toward fluid therapy and their Knowledge and practice and significant with their atti- tude in public and private hospitals. In ad- dition, a non significant association was observed between the nurses’ type of em- ployment and their KAP regarding fluid therapy (p>0.05). status of dehydration, oral rehydration therapy, intravenous solution, method of administration (bolus), deficit, mainte- nance, and ongoing loss. The nurses’ knowledge consisted of 30 multiple choice questions (MCQ) with 0 incorrect and 1 correct answer. The nurses’ attitude was scored using a 5-point Likert scale (Strongly Disagree=1,Disagree=2,Neutral=3,Agree=4, and Strongly Agree=5). Higher scores in this section indicated higher attitude. The prac- tice checklist was obtained from the Col- lege of Nursing, Hawler Medical University. To score the checklist, each achieved step was given 1 and each non-achieved step 0. The Nurses’ KAP was rated as Poor ≤50%, Fair=50-75 %, Good≥75%. Data analysis was carried out through frequency and percentage and inferential statistics (chi square and Paired Samples t-test) using SPSS 22.0. Formal permission was take from an Ethical Committee of the College of Nursing, Hawler Medical University, Par- ticipants and hospitals(No.86in 26/1/2017). Table 1. The present study reveal 54.3% of nurses from public and 60.7% from private hospital aged 22 to 28 years old. It was ob- served that most of them 67.1% from pub- lic and 60.7% from private hospital were female. As for their education, 41.4% from colleges from public, while 64.3% of them graduated from institutes in private hospi- tals. 54.3% of the nurses had 1 to 5 years of experience in public and 67.9% of nurses from private hospital. In respect of their socioeconomic status (SES), the highest percentage 53% of nurses were from low socioeconomic class. there was non signifi- cant association between nurses socio de- mographical characteristics in both hospital p-value ≥0.05. Table 2. this table clarifies that majority 87.1 % of nurse in public hospital have had poor knowledge while 67.9% of nurses 24 Erbil Journal of Nursing & Midwifery RESULTS https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 25 Erbil Journal of Nursing & Midwifery Table 1: Sociodemographic characteristics of the nurses Sociodemographic characteristics Category Public hospital n=70 Private hospitals n=28 P-value F (%) F (%) Age group/Years 22-28 38 (54.3) 17 (60.7) 0.643 NS 29-35 8 (11.4) 4 (14.3) 36-42 10 (14.3) 2 (7.1) 43-49 14 (20) 5 (17.9) Gender Male 23 (32.9) 11 (39.3) 0.225 NS Female 47 (67.1) 17 (60.7) Level of Education Intermediate 6 (8.6) 0 (0) 0.827 NS Secondary 11 (15.7) 1 (3.6) Institute 24 (34.3) 18 (64.3) College 29 (41.4) 9 (32.1) Marital Status Married 41 (58.6) 16 (57.1) 0.702 NS Single 27 (38.6) 12 (42.9) Widow 2 (2.9) 0 (0) Type of Employments Formal 55 (78.6) 0 (0) 0.080 NS Contract 3 (4.3) 28 (100) Volunteer 12 (17.1) 0 (0) Years of Experience 1-5 38 (54.3) 19 (67.9) 0.918 NS 6-10 11 (15.7) 2 (7.1) 11-15 9 (12.9) 2 (7.1) >15 12 (17.1) 5 (17.9) Unit of Work Medical 17 (24.3) 13 (46.4) 0.078 NS Surgical 18 (25.7) 0 (0) NICU 22 (31.4) 7 (25) Emergency 13 (18.6) 8 (28.6) Training Course Yes 0 (0) 0 (0) a* No 70 (100) 28 (100) Residency Urban 46 (65.7 20 (71.4) 0.901 NS Sub Urban 10 (14.3 6 (21.4) Rural 14 (20) 2 (7.1) Socio-Economical status High 10 (14.3) 3 (10.7) 0.881 NS Middle 32 (45.7) 10 (35.7) Low 28 (40) 15 (53.6) *No statics because the participation was constant https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 26 Erbil Journal of Nursing & Midwifery Table 2: Nurse KAP in public and private Hospitals. KAP Category Public Hospital (n=70) Private Hospitals (n=28) F (%) F (%) Knowledge Poor 61 (87.1) 19 (67.9) Fair 5 (7.1) 2 (7.1) Good 4 (5.7) 7 (25) Attitude Poor 33 (47.1) 2 (7.1) Fair 33 (47.1) 19 (67.9) Good 4 (5.7) 7 (25) Practice Poor 32 (45.7) 11 (39.3) Fair 36 (51.4) 16 (57.1) Good 2 (2.9) 1 (3.6) Table 3: The association between the nurses’ KAP and their socio demographic character- istics Sociodemographic characteristics Public hospital Private Hospital Knowledge Attitude Practice Knowledge Attitude Practice Age 0.013 0.216 0.016 0.041 0.494 0.218 Gender 0.261 0.666 0.132 0.049 0.416 0.963 Level of Education 0.022 0.098 0.003 0.036 0.278 0.117 Type of Employments 0.678 0.068 0.976 0.515 0.396 0.788 Years of Experience 0.004 0.047 0.002 0.008 0.016 0.006 Socio-Economical status 0.045 0.177 0.035 0.539 0.411 0.956 https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 27 Erbil Journal of Nursing & Midwifery The current study revealed that that most of the nurses from public and private hos- pitals were aged between 22 and 28 years. This finding agrees with findings from Elshamy et al (2015) who reported that 60% of the nurses aged from 21 to 32 years[14]. Similarly, Mohammed (2015) showed that most of the nurses aged un- der 30 years[15]. It was also concluded that about most of nurse from public and private hospital were female, which is in line with Deshmukh and Shind (2012) whose study consisted of 83.3% women [16]. Regarding the nurses’ level of educa- tion, the current study revealed that more than half of the nurses public and private hospital graduated from institutes, which is in line with the studies carried out by Elshamy et al (2015) and Deshmukh and Shind (2012) who reported that most of the nurses held diploma[14, 16] .On con- trary, the majority of the nurses (76.4%) in the study of Shaymaa et al (2013) graduat- ed from nursing schools[17]. Concerning the nurses’ clinical experience, most from public and private hospitals had 1 to 5 years of experience. This finding is in high agreement with the results reported by Deshmukh and Shind (2012) who reported that 71.67% of the nurses had worked 0 to 5 years in clinics[16]. Similarly, Ahmed (2007) concluded that 70.3% of the nurses had less than 5 years of experience[18]. Concerning the nurses’ SES, about 40.0% and 53.6% of the participants were from both hospitals respectively belonged to the low socioeconomic class, which can be attributed to the current financial prob- lems in the Kurdistan Region since 2014. There was no significant association be- tween nurses socio-demographical charac- teristics in both hospital p-value ≥0.05.this finding is strongly with Ghorbani et al (2014) also demonstrated that in their there was no significant association between nurses gender and educational level between public and private hospi- tal while a significant association was seen with nurses age group and years of experience p-value <0.05[19] . Our re- sults agree with Javadi et al (2011), which found no significant association between nurses view point score of re- sponse based on gender and educational level and type of hospital p-value <0.05 [20]. similarly founded by Haukedal et al (2018) found there was no significant association between nurses age group, gender, and experience in health care in both control and intervention group p- value ≥0.05[21]. Likewise Keleekai et al (2016) reported no significant associa- tion between nurses socio demograph- ical characteristics in both control and intervention group p-value ≥0.05[22]. With respect to knowledge about fluid therapy, results showed that the nurses from both hospitals had poor knowledge, nurses in the private hospi- tal had better knowledge than public hospital. This finding aligns with Deshmukh and Shind (2012) and Mo- hammed and Taha (2016), which showed that nurses had poor knowledge [16,23]. Higher level of knowledge in the private hospitals could be due to atten- tion to educational program and finan- cial support than private one, while disa- gree with Alrubaee et al (2017) who found that most nurses (87%) had a fair level of knowledge[24]. Concerning nurse attitudes, our study revealed that 47.1% of nurses had a fair attitude about public hospitals while 67.9% had fair atti- tudes about private hospitals. this find- ing is completely agree with the study done by Kwateng et al (2017) in their study that indicate there was a higher level of care and attention at private healthcare facilities than the public[25]. but disagree with Moonaghi et al; (2012) DISCUSSION https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 28 Erbil Journal of Nursing & Midwifery and Feng et al ;(2014) they concluded that the nurses’ poor perception regarding toward fluid administration [26,27]. Unfortunately, regarding nurse practice, 51.4% of nurse demonstrated only fair practice in public hospital while 57.1% demonstrate fair practice in private hospi- tals. Camilleri et al (1998) also found that private hospitals are expected to offer a higher quality service[28] . the higher level of practice in the private hospitals of the present study can be due to greater finan- cial support and adequate equipment sup- ply in the private hospitals, and lower level of practice in Rapareen Hospital was be- cause there is no infusion pump and they do not use flow meter despite its availabil- ity. The present study revealed a signifi- cant association between nurse age , level of education, and their knowledge about fluid therapy in children . This is agree- ment with Feng etal (2014) and Mo- gileeswari and Ruth Grace (2016), which demonstrated a significant association be- tween the nurse knowledge about fluid and electrolyte replacement therapy and age and level of education[27,29]. Howev- er, this finding not in line with Deshmukh and Shind (2012) and Vijayan (2011) they concluded that there was no significant association between the nurse age and their knowledge[16, 30]. The present study also showed that there was a highly significant association between nurse years of experience and knowledge and practice in public and private hospitals p value 0.004, 0.008 and 0.002, 0.006 re- spectively . This finding is in strong agree- ment with the studies by Mohammed and Taha (2016) and Mogileeswari and Ruth Grace (2016) they reported in theirs stud- ies a highly significant association be- tween the nurses’ knowledge and experi- ence[23,29]. The results demonstrated a significant association between nurses so- cioeconomic status knowledge nurses’ and practice in public hospitals, p value 0.046 ,0.035 respectively, while non- sig- nificant association in private hospitals. This finding is in agreement with Mo- gileeswari and Ruth Grace (2016), which reported a significant correlation be- tween the nurses’ income and their knowledge and practice[29]. Regarding the nurses’ attitude, there was a signifi- cant association between the type of hos- pital and the attitude in public hospital p.value 0.011, which may be due to greater accountability and administrating supervisor and better finance support in private hospitals. The majority of nurses were between 22 and 28 years old, female, married, gradu- ates of institutes, and formally em- ployed. Nurses had less than five years of experience, and had low socioeconomic status , Nurse knowledge, attitudes, and practices were better in the private hos- pitals than public hospital. Researchers recommended supporting public hospi- tals financially and ,administratively to improve services at public hospitals. [1] Welch, K. “Fluid balance”. Learning Disabil- ity Practice.2010; 13: 6, 33-38. [2] Walker CL, Aryee MJ, Boschi-Pinto C, Black RE.Estimating diarrhea mortality among young children in low and middle income countries.PLoS One.2012; 7(1):e29151 [3] Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Reiner RC Jr, Fullman N etal; Global Burden of Diseases, .Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study. Lancet Infectious Disease. 2017;17(9):909-948 [4] Ulusoy, MF. and Görgülü, RS.. Principles of Nursing Basic Theory, Concept Principles and Methods: (3rd ed). TDFO Ltd. Şti: An- kara, Turkey, 1996; 233-276. [5] Karadağ, A. Intravenous Fluid Therapy: CONCLUSION REFERENCES https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 29 Erbil Journal of Nursing & Midwifery Complications and Nursing Care. CU Journal of School of Nursing, 1999;3: 39-47. [6] Karadeniz, G., Baykal, D. and Özbakkaloğlu, B. Nurses' Knowledge about the Develop- ment of Phlebitis in a Patient with Intrave- nous Catheter Applications to patients with phlebitis. Ege Journal of School of Nursing,. 1999; 15: 103-113.. [7] NICE ,National Institute of Health and Care Excellence guidance on giving intravenous fluids, Nursing Times, 2014;110 (6), 12-13. [8] Selbst, M., Fein, A.Medication and intrave- nous fluid errors in a paediatric emergency Department; Pediatric Emergency Care Jour- nal;1999;15(1); 1-4. [9] Mehran A., Seyed, M., Roya, R,, Seyed, M., Fard, A., Mahnaz, J, etal; Comparison Quali- ty of Health Services between Public and Private Providers: The Iranian People’s Per- spective. Electron Physician. 2016; 8(9): 2935–2941. [01] Sanjay, B., Andrews, J., Kishore, S., Panjabi, R., and Stuckler, D.Comparative perfor- mance of private and public healthcare sys- tems in low- and middle-income countries: a systematic review. PLoS Medicine.2012; 9 (6): e1001244. doi: 10.1371 [00] Liina-K, T. and Karsten ,V. Comparing public and private providers: a scoping review of hospital services in Europe. BMC Health Services Research. 2018;18;141 [01] Mehdi, R., Mohammad, K. Bahadori, R., Ramin, R. and Seyed, M. Comparing the quality of nursing services between two public and private hospitals. International Journal of Healthcare Management. 2017; 10(4):252-258. [01] Kwame, R, and Florence, A. Service quality in public and private hospitals: A compara- tive study on patient satisfaction. Interna- tional Journal of Healthcare Management. 2017; 12(4). 251-258 [01] Elshamy, F ,Mohammed, A., and Moham- med, A. Effect of Implementing Intravenous Infusion Therapy Protocol on Nurses’ Knowledge and Performance at Specialized Medical Hospital. Journal of American Sci- ence.2015;11(11) [01] MohamedA. Salwa and Weheida M Soheir .Effects of implementing educational program about pressure ulcer control suc- cessfully complete a test of basic knowledge on nurses’ knowledge and safety of immobi- lized and performance before assuming independent patients, Journal of Nursing Education and Practice. 2015;5 (3). 1-10. [16] Deshmukh, M. and Shind, M. Impact of Structured Education on Knowledge and Practice Regarding Venous Access Device Care among Nurses”. International Journal of Science and Research (IJSR).2012; 3.358 1 2 [07] Shaymaa s. Khalil, zienab a. Mohammad, manal e. Ez el-deen, nagwa m. Ahmed, Impact of Implementing A Designed Nurs- ing Intervention Protocol on Nurses' Knowledge and Practice Regarding Patients Undergoing Blood Transfusion. Medical. Journal of Cairo university . 2013;81(2), 163-171 [08] Ahmed Abd.Sherein. Study of nurse’s per- formance regarding infection control for patients with central venous catheter. Mas- ter Thesis. Faculty of Nursing, Zagazig Uni- versity,2007 p. 95.publications.zu.edu.eg. [09] Ghorbani A.Ali , Hesamzadeh A , Khadem- loo M, Khalili S, Hesamzadeh Sh and Berger V.Public and Private Hospital Nurses’ Per- ceptions of the Ethical Climate in Their Work Settings, Sari City, Nursing Midwifery Study. 2014; 3(1): e12867. [11] Haukedal A.Thor,Reierson A. Inger, Hede- man H and Bjørk T. Ida. The Impact of a New Pedagogical Intervention on Nursing Students’ Knowledge Acquisition in Simula- tion-Based Learning: A Quasi-Experimental Study. Hindawi. Nursing Research and Prac- tice. 2018; ID 7437386, 10 pag- es.doi.org/10.1155/2018/7437386 [10] Keleekai L. Nowai, Schuster L. Cathe- rine, Murray L. Connie , King A. Mary, Stahl R. Brian, Labrozzi J. Laura , et al. Improving Nurses' Peripheral Intrave- nous Catheter Insertion Knowledge,Confidence, and Skills Using a Simulation-Based Blended Learning Pro- gram A Randomized Trial. Simulation Healthcare 2016; 11(6): 376–384. [11] Javadi M.,KarimiS.,RaiesiA.,YaghoubiM., Kaveh K.Comparison of patients’ and nurs- es’viewpoints about responsiveness among a sample from public and private hospitals of Isfahan. Iranian Journal of Nursing and Midwifery research. 2011; 16(4): 273–277. [11] Mohammed, K., and Taha, S., Critical Care Nurses’ Knowledge and Practice Regarding Administration of Total Parenteral Nutrition at Critical Care Areas in Egypt. Journal of Biology, Agriculture and Healthcare. 2014;4 (13):10-22 https://doi.org/10.15218/ejnm.2020.03 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 30 Erbil Journal of Nursing & Midwifery [24] Alrubaiee, G., Baharom, A., Shahar, K., Daud, M. and Basaleem, O. Knowledge and practices of nurses regarding nosocomial infection control measures in private hospi- tals in Sana’a City, Yemen. Safety in Health. 2017; 3(16):2-6 [25] Kwateng O. Kwame, Lumor R. and Acheam- pong o. Florence. Service quality in public and private hospitals: A comparative study on patient satisfaction. International Journal of Healthcare Management 2017;12(4). 251 -258 [26] Moonaghi K., Hasanzadeh F,, Shamsoddini S,., Emamimoghadam, Z. and Ebrahimza- deh, S. A comparison of face to face and video-based education on attitude related to diet and fluids: Adherence in hemodialy- sis patientsiran. Journal of Nursing and Mid- wifery Reseach. 2012;17(5): 360–364. [27] Feng X. Li., Liu, A. and Qin, Y. Nurses' per- ception of risk factors for infusion phlebitis: A cross-sectional survey. Chinese Nursing Research .2016;3(1). pp37-40 [28] Camilleri D, Mark O’Callaghan . Comparing public and private hospital care service quality. International Journal of Health Care Quality Assurance. 1998;11(4-5)127-33 [29] Mogileeswari P, Ruth M., Knowledge and practice regarding fluid and electrolyte re- placement therapy for patient with burns. International Journal of Multidisciplinary Research and Development. 2016; 3( 4).217- 220. [30] Vijayan, A. “A study to assess the knowledge and practices of staff nurses regarding fluid and electrolyte administration in post- operative cardiac surgical patients admitted in cardiac surgical ICU and cardiac surgical ward, free chitra tirunal institute for medi- cal sciences and technology. 2011;P1-27.