Assessment Of Knowledge On Prevention And Management Of Pressure Ulcer Among Nurses In A Hospital

Project and Seminar Material for Nursing (Science)

Assessment Of Knowledge On Prevention And Management Of Pressure Ulcer Among Nurses In A Hospital


Abstract


This descriptive survey focused on the assessment of knowledge on prevention and management of pressure ulcer among nurses in a hospital. It assessed knowledge and practice regarding prevention of pressure ulcer among nurses in selected private hospitals in Calabar Metropolis. A validated questionnaire was used to collect data from eighty nine (89) registered nurses working in 22 purposely selected private hospitals. Data were analyzed using descriptive statistical method such as frequencies and percentages. Results revealed that: Majority (84.3%) of the nurses working at private hospitals in Calabar Metropolis have good knowledge of prevention of pressure ulcers. The level of practice of pressure ulcer prevention among nurses in the private hospitals was also good, Factors such as shortage of nurses, lack of utilization of research findings, poor work attitude of nurses, lack of nurses’ exposure to continuous education on current pressure ulcer preventive strategies, and lack of pressure prevention materials and equipments were found to be major factors affecting the practice of pressure ulcer prevention in private hospitals in Calabar Metropolis. Recommendations: more nurses should be recruited in private hospital so as to reduce work load. Nurses in private hospitals should be exposed to continuous education, research and be provided with pressure Ulcer prevention materials and equipments. This will help them to practice pressure ulcer prevention effectively.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses
  • 4.5 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

Pressure ulcers (PUs) pose a serious health problem in all health care settings and resident homes across the globe, especially in developing and third world countries (The United Kingdom Care and Support Alliance, 2017). Early recognition of patients that are at risk of developing pressure ulcers by nurses is an essential part of preventive care. In developing Countries, pressure ulcer constitute a remarkable challenge in modern medical and nursing practice (Kruger, Pires, Ngann, Sterling & Rubayi, 2013). In Africa, as well as other developing countries in the world, pressure ulcers develop in 8 out of every 10 confined and immobile patients both in hospital and home settings, most often as a result of poor assessment and management of the patients by nurses (Ostadabbas, Yousefi, Faezipour & Nourani, 2011, The United Kingdom Care and Support Alliance, 2017). No national surveys have been conducted in Nigeria, therefore information concerning prevalence and incidence are not currently available. However, Onigbinde, Olafimihan, Ojoawo, Mothabeng, Ogundiran (2011) noted that PUs are very common in Nigerian hospitals, particularly among mobility- compromised patients, and affect approximately 9% of hospitalized patients within the first 2 weeks of admission. Furthermore Onche, Yiltock, Obiano (2004) confirmed high incidence of PUs in Gombe state, Nigeria. A pressure ulcer, sometimes called a bedsore, is a localized injury to the skin or underlying tissue caused by pressure mostly over a bony prominence, friction and moisture. Ulcers often occur when patients have limited mobility and can’t change positions in bed on their own. Having adequate knowledge of risk assessment to identify at risk patients, risk factors and vulnerable patients is an important strategy in preventing pressure ulcer. Such factors may include extremes of age, patients with chronic illnesses such as cardiovascular diseases, diabetes mellitus, anemia, Alzheimer’s disease, obesity, congestive cardiac failure (CCF), cardiovascular accident (CVA) and malignancy, imbalanced nutrition especially lack of protein calories and vitamin C for long periods causing progressive weight loss, decrease soft tissue mass and subcutaneous fat padding (Neloska, Damevska, Nikolchev, Pavleska, Petreska- Zovic& Kostov, 2016, the consortium of Spinal Cord Medicine 2010) For risk areas high frequency sites include the sacrum (38.3%), the ischium (25.5%) and the heel (23.4%), other sites include occipital bone, temporal bone, scapular, spinous processes, elbow, iliac crest, coccyx, Achilles tendons, ear lobe, shoulder anterior iliac crest, trochanter, thigh, medial, lateral knee, lower leg and malleoli (Consortium for Spinal Cord Medicine, 2010).

Prevention requires that knowledgeable assessment be carried through History taking, observations, physical examination which involves palpation and inspection. Palpation will reveal thinness of the skin, warmth, numbness or loss of motor function, all of which place a patient at high risk for pressure sore (Mann, 2012). It also requires use of pressure ulcer Risk assessment tools such as Braden scale, Norton’s Pressure Area Risk Assessment form scale, by nurses in identifying clients at high risk for pressure ulcer development (Fosco 2012, Moore and Cowman 2014). Studies around the world have revealed that knowledge of pressure ulcer assessment and prevention among nurses in hospital setting is poor (Nurhusien, Fisseha, Senafikish & Yohannes, 2015; Ilesanmi & Olabisi, 2014; Uba, Alih, Kever & Lola, 2015). Some studies have been carried out in many public hospitals concerning nurses’ assessment and prevention of pressure ulcer in Nigeria by Ilesami, Ofi and Adejumo 2012, Onche, Yiltock, Obiano (2004) Onigbinde, Olafimihan, Ojoawo, Mothabeng, Ogundiran (2011) and a few in Cross River state in particular, but none have been undertaken in private hospitals in Cross River State. It is for this reason that this study was conducted to assess knowledge and practice regarding prevention of pressure ulcer among nurses in selected private hospitals in Calabar Metropolis.


1.2 Statement of the Problem

Pressure ulcer prevention guideline is one of the core components of the national healthcare strategic planning services. Guidelines are the instructions for nurses to provide up-to-date scientific clinical evidence on specific areas to ensure consistent and appropriate clinical practice (Langemo et al., 2008). A guideline is a systematically developed statement for practitioners that help to take decision about appropriate nursing practice for defined areas (Langemo et al.). Previous studies showed that in order to deliver high quality of care, it was essential for nurses to provide evidence-based nursing practice. In this regards, nurses must have knowledge of risk factors and preventive strategies of pressure ulcer development (Panagiotopoulou & Kerr, 2002). Various preventive measures were being used in nursing practice following a set of national guideline. Not only the nurses’ knowledge, but also attitude towards pressure ulcer prevention is important. If an individual had a very negative attitude towards a given topic, then it is unlikely that the individual would perform positive or supportive behaviors in relation to that topic (Maylor, 2001). For example, the more pressure ulcer prevention was valued by nurses, the greater the likelihood of prevention practice being carried out by them (Maylor & Torrance, 1999).

Factors that enhance nurses’ knowledge, attitude, and practice regarding pressure ulcer prevention were effective education, willingness to change clinical practice, availability of resources, sufficient equipment supplies, administrative support, and increased multidisciplinary team collaboration (Clarke et al., 2005). One study found that lack of updating in nurses’ education decreased the level of knowledge among nurses with many years experience (Pancorbo-Hidalgo, Garcia- Fernandez, Lopez-Medina, & Lopez-Ortega, 2007). It was stated that nurses who were not being trained in pressure ulcer prevention possessed lower level of knowledge and practice as compared to those being trained in pressure ulcer prevention program (Pancorbo-Hidalgo et al.) Other social and organizational factors that affect nurses to incorporate knowledge into practice included: 1) inadequate leadership, 2) lack of education and training program, 3) lack of evidence-base practice guideline, 4) patients over load, 5) shortage of staff, 6) insufficient time and cooperation from other professionals, and 7) lack of equipment and facilities, and inadequate pain management (Moore & Price, 2004).

In Nigeria, there is very limited information available about pressure ulcer prevention strategies used by the nurses. Currently, there is no evidence on nurses’ knowledge, attitude, and practice regarding pressure ulcer prevention and this study was the first of its kind. Therefore, it was important to explore and investigate the knowledge on prevention and management of pressure ulcer among nurses in a hospital, using a selected private hospitals in Calabar Metropolis.


1.3 Objective of the Study

The study was designed for an assessment of knowledge on prevention and management of pressure ulcer among nurses in a hospital using selected private hospitals in Calabar Metropolis. Specific objectives were:

  1. To assess knowledge of prevention of pressure ulcer among nurses in selected private hospitals in Calabar Metropolis.
  2. To determine the level of practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis.
  3. To examine the factors affecting the practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis.

1.4 Research Questions

The study aims to provide answers to the following research questions;

  1. What is the level of knowledge of prevention of pressure ulcer among nurses in selected private hospitals in Calabar Metropolis?
  2. What is the level of practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis?
  3. What are the factors affecting the practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis?

1.5 Hypothesis of the Study

  • H0: There are no positive relationships between nurses’ knowledge and attitude, attitude and practice, and knowledge and practice regarding pressure ulcer prevention.
  • H1: There are positive relationships between nurses’ knowledge and attitude, attitude and practice, and knowledge and practice regarding pressure ulcer prevention.

1.6 Significance of the Study

The findings will identify gaps (that needs improvements) in knowledge and practice of pressure ulcer prevention among nurses in private hospitals in Calabar. This study will contribute to existing knowledge on prevention of pressure ulcer as well as serve as a resource material to future researchers into pressure ulcer assessment and prevention. It will serve as a database for quality care on pressure sores.

The study was expected to describe the nurses’ knowledge, attitude, and practice regarding pressure ulcer prevention. The outcomes of this study contribute to nursing education, nursing practice, and future research in Nigeria. It will provide baseline data for higher authority to plan for an initiation for staff development in order to improve quality of care. The study findings will also provide a unique exploration of level of nurses’ knowledge, attitude, and practice regarding pressure ulcer prevention; thereby, contributing to body of knowledge on this subject. In- service training and educational program can be designed for nurses to enhance their knowledge, attitude, and practice.

Recommendations if fully implemented will greatly reduce the morbidity and mortality associated with pressure ulcers.


1.7 Scope of the Study

The study focused on the assessment of knowledge on prevention and management of pressure ulcer among nurses in a hospital. the study will utilize Responses from nurses in private hospitals in Calabar, Cross River state.


1.8 Limitations of the Study

This study was constrained by a number of factors which are as follows:

Financial constraint is inevitable considering the present economic situations. Due to lack of finance at the researchers disposal to get materials and in printing of questionnaires. it was not possible to visit some of the police stations and some of the victims of corruption.

In developing countries like Nigeria, there is the problem of insufficient data.

Time Factor: Time factor pose another constraint since having to shuttle between writing of the research and also engaging in other academic work making it uneasy for the researcher.


1.9 Definition of Terms

Nurses’ knowledge of pressure ulcer prevention refers to the level of nurses’ remembering, understanding, and applying of pressure ulcer prevention in the following contents: factors related to pressure ulcer development, risk assessment, skin care, nutrition to maintain healthy skin, management of mechanical loads, and educational program for patient, family, and staff. Nurses’ knowledge was assessed by self-report questionnaire developed by the researcher. The higher scores indicate higher level of knowledge.

Nurses’ attitude of pressure ulcer prevention refers to the level of nurses’ receiving, responding, and valuing of pressure ulcer prevention in the following areas:

Factors related to pressure ulcer development, risk assessment, skin care, nutrition to maintain healthy skin, management of mechanical loads, and educational program for patient, family, and staff. Nurse’s attitude was assessed by self-report questionnaire developed by the researcher. The higher scores indicate positive attitude.
Nurses’ practice of pressure ulcer prevention refers to the level of nurses’ imitation, manipulation, and precision of pressure ulcer prevention in the following areas: factors related to pressure ulcer development, risk assessment, skin care, nutrition to maintain healthy skin, management of mechanical loads and educational program for patient, family, and staff. Nurses’ practice was assessed by self-report questionnaire developed by the researcher. The higher scores indicate higher level of practice.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusion and Recommendation

5.1 Introduction

This chapter summarizes the findings on the assessment of knowledge on prevention and management of pressure ulcer among nurses in a hospital using seleceted private hospital in calabar as case study. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was on the assessment of knowledge on prevention and management of pressure ulcer among nurses in a hospital using selected private hospital in calabar as case study. The study is was specifically focused on assessing the knowledge of prevention of pressure ulcer among nurses in selected private hospitals in Calabar Metropolis, determine the level of practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis and examine the factors affecting the practice of pressure ulcer prevention among nurses in selected private hospitals in Calabar Metropolis..

The study adopted the survey research design and randomly enrolled participants in the study. A total of 89 responses were validated from the enrolled participants where all respondent are nurses in selected private hospitals in Calabar Metropolis.


5.3 Conclusion

Knowledge of assessment, prevention and the practice of pressure ulcer prevention is very crucial to quality nursing care of critically ill patients towards the prevention of pressure ulcers. This study had revealed that majority of the nurses working in private hospital in Calabar Metropolis have good knowledge of assessment of pressure ulcer risk factors towards pressure ulcer prevention. Also, the level of practice of pressure ulcer prevention among the nurses was good. However, factors affecting the practice of pressure ulcer prevention included shortage of nurses, lack of utilization of research findings, and poor work attitude of nurses. Based on the findings,


5.4 Recommendations

  1. Medical Directors/Owners of private should always employ qualified nurses in their clinics.
  2. Staff of private clinics especially nurses should periodically be sent for continuous education programmes ( Seminars and workshops )
  3. Proprietors should encourage research and application of research findings by staff.
  4. Government especially Ministry of Health should ensure that basic criteria for establishing private clinics (e.g. qualified number of staff and necessary equipment) are met by each clinic before giving approval.

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