European Journal of Cardiovascular Medicine

Urinalysis remains one of the most commonly requested laboratory investigations, offering vital information in the diagnosis and monitoring of renal, metabolic, and infectious diseases. The reliability of test results is highly dependent on preanalytical quality, which encompasses the correct collection, preservation, and transport of urine specimens. Errors in this stage may lead to contamination, chemical alteration, or bacterial overgrowth, ultimately compromising diagnostic accuracy and patient safety [1].

Preanalytical variability has been recognized as a major contributor to laboratory errors, and strict adherence to standardized guidelines is essential for ensuring the validity of results [2]. Improvements in urine specimen workflow, such as appropriate timing of collection, use of sterile containers, and adherence to storage and transport recommendations, have been shown to significantly enhance diagnostic reliability [3]. Despite these guidelines, challenges persist in many healthcare settings, where sample nonconformities remain a frequent cause of error, especially in resource-constrained environments [4].

Systematic reviews have further highlighted that optimal preanalytic practices such as immediate transport, refrigeration, and the use of preservatives when necessary are critical to reducing contamination rates and enhancing diagnostic yield in urine cultures [5]. These findings underline the importance of continuous training and monitoring of healthcare personnel, including nursing students, who play a frontline role in guiding patients and handling specimens.

Against this background, the present study was undertaken to assess the knowledge, attitude, and practice related to the collection, preservation, and transport of urine samples among B.Sc. Nursing students at Government College of Nursing, Eluru. The findings aim to identify existing gaps and suggest areas for targeted educational interventions.

Study Design and Setting:
A descriptive cross-sectional study was conducted at Government College of Nursing, Eluru, Andhra Pradesh, from November 2023 to March 2024. The study focused on assessing knowledge, attitude, and practice (KAP) regarding collection, preservation, and transport of urine samples among undergraduate nursing students.

Study Population and Sample Size:
The study population comprised B.Sc. Nursing students enrolled in the 2nd, 3rd, and 4th years of the course. A total of 80 students were included using purposive sampling. Students who were present during the data collection period and consented to participate were considered eligible, while those absent or unwilling were excluded.

Study Tool:
Data were collected using a pretested, structured, self-administered questionnaire developed after literature review and expert validation. The tool consisted of four sections:

Demographic profile (age, gender, year of study).

Knowledge items related to urine sample collection, preservation, and transport.

Attitude scale measured using Likert-type responses (agree, neutral, disagree).

Practice items assessing routine handling procedures during clinical postings.

Data Collection Procedure:
The questionnaire was administered in classroom settings after obtaining informed consent. Adequate instructions were provided, and confidentiality of responses was maintained.

Data Analysis:
Collected data were coded and entered into Microsoft Excel. Descriptive statistics such as frequency and percentage were used to summarize demographic variables and KAP scores. Associations between knowledge and practice were tested using correlation analysis. Results were presented in tabular form.

A total of 80 B.Sc. Nursing students from Government College of Nursing, Eluru, participated in the study conducted between November 2023 and March 2024. The majority of the participants (65.0%) were in the age group of 20–22 years, followed by 23–25 years (30.0%), and only 5.0% were above 25 years. All participants were female, reflecting the study population of a nursing college. With respect to academic year, 45.0% were in 2nd year, 35.0% in 3rd year, and 20.0% in 4th year (Table 1).

Table 1: Demographic Characteristics of Participants (N = 80)

Regarding knowledge on collection, preservation, and transport of urine samples, more than half of the students (57.5%) demonstrated adequate knowledge, while 27.5% had moderate and 15.0% had inadequate knowledge levels (Table 2).

Table 2: Knowledge Regarding Collection, Preservation and Transport of Urine Samples

Figure 1. Knowledge Regarding Collection, Preservation and Transport of Urine Samples

Attitude assessment revealed that a large majority (76.2%) of the students expressed a positive attitude towards proper handling of urine samples, while 15.0% remained neutral and 8.8% showed a negative attitude (Table 3).

Table 3: Attitude of Students towards Urine Sample Handling

Figure 2. Attitude of Students towards Urine Sample Handling

In terms of practice, 60.0% of the students reported following correct practices such as use of sterile containers, proper labeling, and timely transport of specimens. However, 25.0% had inconsistent practices, and 15.0% admitted to poor practices including delayed transport or improper handling (Table 4).

Table 4: Practice of Students on Urine Sample Handling

Figure 3. Practice of Students on Urine Sample Handling

The present study assessed the knowledge, attitude, and practice regarding urine sample handling among B.Sc. Nursing students of Government College of Nursing, Eluru. While 57.5% demonstrated adequate knowledge and 76.2% reported positive attitudes, only 60% consistently adhered to correct practices. This discrepancy underscores the persistent challenge of translating knowledge into routine practice, which has been widely reported in literature on preanalytical errors [6].

Our findings on inadequate awareness of preservation time and transport guidelines are comparable to a two-year analysis by Alcantara et al., who highlighted transport delays and improper storage as major contributors to preanalytical errors in laboratory medicine [6]. Similarly, Giménez-Marín et al. reported that continuous monitoring and structured error management strategies are crucial to reduce such lapses [7].

Encouragingly, the majority of participants in our study expressed positive attitudes towards the importance of proper sample handling. Wu emphasized that accurate urinalysis is critically dependent on the preanalytical phase, with mishandling directly impacting diagnostic accuracy [8]. A systematic review by Llor et al. also highlighted that improper collection techniques significantly compromise diagnostic yield, particularly in urinary tract infection cases [9].

However, the 40% of students with inconsistent or poor practices reflects earlier findings where nurses reported variability in the timing and method of urine collection, particularly in catheterized patients [10]. Coppens et al. further noted that routine urinalysis continues to face challenges due to preanalytical variability, reinforcing the need for clear protocols and supervision [11].

The value of structured educational interventions is evident, as Chen et al. demonstrated through the development of a KAP questionnaire that targeted training can improve knowledge and practices related to urinary procedures [12]. Likewise, Yüksel et al. found notable gaps in awareness among nurses regarding both blood and urine sample collection, suggesting that reinforcement and competency-based learning are essential for sustained improvements [13].

Limitations: Being a single-center study with a modest sample size, the results may not be generalizable to all nursing institutions. Self-reported practices may also be subject to recall or reporting bias.

Implications: Despite these limitations, the findings highlight critical areas for educational intervention. Continuous training sessions, workshops, and inclusion of case-based discussions could enhance adherence to standard operating procedures for urine sample handling.

This study conducted among B.Sc. Nursing students demonstrated that while most participants possessed adequate knowledge and a positive attitude regarding collection, preservation, and transport of urine samples, gaps in actual practice were evident. Only 60% consistently adhered to correct practices, indicating a need to strengthen the translation of knowledge into routine clinical skills. Regular training sessions, skill-based demonstrations, and supervision during clinical postings are essential to ensure accuracy in laboratory reporting and enhance patient safety. Incorporating structured modules on pre-analytical procedures into the nursing curriculum will help bridge the gap between knowledge and practice.

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