ABSTRACT
Pressure ulcer refers to lesion on the skin
due to persistent pressure, friction or moisture leading to skin and tissue
destruction. It is associated with rise in treatment cost, lengthy hospital stay
andinadequate patients’ satisfaction. Despite
advancement in pressure ulcer prevention and treatment strategies, knowledge
and practice concerning pressure ulcer prevention and treatment among nurses
has been poor. This study aimed to evaluate the effect of a nurse-led training programmeon pressure ulcer prevention and treatment
among nurses.
Quasi-experimental
design was adopted. The population were 60 nurses working in medical and
surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu and 48
nurses working in the medical and surgical unit of Babcock University Teaching
Hospital, Ilishan remo. Sample size was determined using Leslie Kish formula
and convenient sampling was adoptedto select 20 nurses from Olabisi Onabanjo
University, Sagamu and 20 nurses from Babcock University Teaching Hospital,
Ilishan remo which formed the experimental and control group respectively. A
developed questionnaire and checklist was used to collect data on knowledge and
practice concerning pressure ulcer prevention and treatment among nurses pre
and post-intervention. Face and content validity of the instruments was
ascertained by presenting it to experts in the field. Reliability of the questionnaire was determined using
split-half method and Cronbach’s alpha reliability coefficient was 0.8. The
training modules and checklist were also pre-tested and found suitable for the
study. Data were processed using statistical package for social science version
21. Two research questions were answered using descriptive statistics of mean
and standard deviation. Two hypotheses were tested using inferential statistics
of student t-test at 0.05 level of significance.
(a) There is no
difference in pre-intervention mean knowledge score concerning pressure ulcer
prevention and treatment among nurses in the experimental (mean = 0.652) and
control group (mean = 0.621).
(b) There is no
difference in pre-intervention mean practice score concerning pressure ulcer
prevention and treatment among nurses in the experimental (mean = 0.407) and
control group (mean = 0.407).
(c) There is a
significant difference in effect of a nurse-led training programme on knowledge
concerning pressure ulcer prevention and treatment among nurses in the experimental
and control group (p = 0.000).
(d) There is a
significant difference in effect of a nurse-led training programme on practice
concerning pressure ulcer prevention and treatment among nurses in the experimental
and control group (p = 0.000).
The study concluded that nurses' knowledge and
practice concerning pressure ulcer can be improved as participants in the
experimental group showed improved knowledge and practice concerning pressure
ulcer prevention and treatment. The study recommended that hospitals should
regularly expose nurses to training programmes on pressure ulcer prevention and
treatment to improve the quality of nursing care.
CHAPTER ONE
INTRODUCTION
1.1 Background
to the Study
Pressure
ulcer refers to lesion on the skin which occurs as a result of persistent
pressure, friction or moisture leading to destruction of the skin and
underlying tissue. Over 95% of pressure ulcers develop over a bony prominence
and major risk factors for pressure ulcer development are immobility and
inactivity (El-Ata & Qalawa, 2016). Pressure ulcer is a common health problem in acute
and chronically ill patients and it negatively affects the patients, their
relatives and caregivers (Abumrad, Arbogast, Barbul, Fogerty, Nanney &
Poulose, 2012). Pressure ulcer development indicates poor nursing care and the negative effect on patient's health underscores the need to prevent the occurrence in hospitalized
patients (Chamanga, 2011).Adebule,
Gbadegesin, Idowu and Yinusa (2011) conducted a study on pressure ulcer among spinal cordinjury patients in Lagos University Teaching Hospital and result showed a 57.1% pressure ulcer
incidence rate.Ademola, Iyun,
Malomo, Oluwatosin and Shokumbi (2011) conducted a study on pressure
ulcer among patients with spinal
cordinjury in
University College Hospital, Ibadan and result showed that
87.5% developed pressure ulcer
after the first week of admission.
Obiano, Onche and Yiltock(2014) conducted a study on pressure ulcer prevalence among spinal cordinjury patients in Gombe State Hospital and the
resultshowed that 57% of patients developed
pressure ulcer on admission.These
studies show high incidence and prevalence of pressure ulcer which may be due to
low knowledge and practice concerning pressure ulcer prevention and treatment
among nurses. Pressure ulcer causes serious harm to patients, limit their
performance status, leads to severe infection and pain (Cooper, Courtney &
Ruppman, 2012). The burden of pressure ulcer is so serious that efforts have
been made in United States to reduce its occurrence through continuous nursing
education and in-service training of nurses (Gill, Reddy & Rochon, 2012).
Pressure ulcer occurs in all admitted patients but it is frequently seen in
patients with head and spinal cord injury, immobile patients, poorly nourished
patients and patients in critical condition. Its development has been
attributed to poor quality of nursing care across a wide range of healthcare
settings despite exposure to continuous nursing education on pressure ulcer
prevention and treatment (Cowman& O'Brian, 2011).
Pressure ulcer development has been attributed to poor quality of nursing care and
inadequate preventive practice by nurses especially when preventive measures
are not implemented early during the period of hospitalization (Chamanga, 2011).Pressure
ulcer prevention involves risk assessment, identification, staging,
documentation and implementation of pressure ulcer preventive measures. Treatment
of pressure ulcer is more expensive than prevention so efforts have been
directed towards aquisition of skills in preventive care of pressure ulcer
rather than treatment (Alhosis,El-Moneem&
Qalawa, 2012).Pressure ulcer preventive measures are implemented
on all patients especially those in critical condition because the tendency of
pressure ulcer development in such patients is high (Estocado, Landers, Shen
& Young, 2012). Pressure ulcer prevention and treatment is often
wrongly done by nurses and its development negatively affects the patients’ quality
of life (Bergquist-Beringer, Dunton, Gajewski & Klaus, 2011).Estocado,
Landers, Shen and Young (2012) stated that increased incidence and prevalence
of pressure ulcer has been attributed to low knowledge and practice concerning
pressure ulcer prevention and treatment among nurses.
Cherry, Maloney, Midyette and Moss (2012) opined
that the prevention of hospital acquired pressure ulcer remains a top priority
worldwide with key areas addressed including; training for nurses on pressure
ulcer prevention and treatment, nurses training on utilization of standardized
risk assessment scale and continuous nursing education on pressure ulcer
prevention and treatment. Low knowledge and practice concerning pressure ulcer prevention and
treatment among nurses has persisted despite exposure to continuous nursing
education and in-service training (Aydin & Karadag, 2010). Tweed and Tweed
(2008) stated that despite nurses’ exposure to in-service training programmes
and continuing nursing education on pressure ulcer, knowledge and practice
concerning pressure ulcer prevention and treatment among nurses has been low.
Altun and Zencirci (2011) opined that knowledge and practice concerning
pressure ulcer among nurses is low despite exposure to training programmes on
pressure ulcer prevention and treatment. According to Beeckman,
Boucque, Defloor, Maele and Schoonhoven (2008) knowledge and practice concerning pressure ulcer
prevention and treatment among nurses is low despite exposure to training
programmes on pressure ulcer prevention and treatment.
Hsu, Sung and Tsao (2013) stated that despite nurses’
exposure to in-service training programmes and continuous nursing education on pressure
ulcer prevention and treatment, knowledge and practice concerning pressure
ulcer prevention and treatment has been low. Despite initiation of continuous
nursing education and training programmes on pressure ulcer prevention and
treatment, problems associated with it seem to persist suggesting a fundamental
problem. These prompted the researcher to study the effect of a nurse-led
training programme on pressure ulcer prevention and treatment among nurses in
Olabisi Onabanjo University Teaching Hospital, Sagamu and Babcock University
Teaching Hospital, Ilishan remo, Ogun State.
1.2 Statement of the Problem
Despite
advancement in pressure ulcer prevention and treatment through discovery of
latest preventive measures and treatment approaches, knowledge and practice
concerning pressure ulcer prevention and treatment among nurses has been low (Adejumo
& Ingwu, 2010).Smith
& Waugh (2014) opined that the adverse effect of pressure ulcer
has significantly increased leading to worsening wound, increased cost of care, increased period of
hospitalization and increasedpressure ulcer incidence and prevalence. Litigation against
nurses due to
hospital acquired pressure
ulcerhas also been on the increase. In Nigeria, 50% incidence of pressure ulcer was found
among spinal cord injury patients, 38.6% incidence was found among orthopedic
patients and 11.4% incidence was found among head injury patients which has resulted in great burden and negative effect
on patients such as poor patients' care outcome, poor patient care
satisfaction, increased cost of hospital care and lenghty hospital stay (Ogunsanya,
Onigbinde & Oniyangi, 2013).
Likewise,
the researcher through clinical experience has observed high incidence and
prevalence of pressure ulcer. These may be attributed to low knowledge and
practice concerning pressure ulcer prevention and treatment among nurses. These
may also be attributed to a gap in the type of training programmes offered to
nurses on pressure ulcer prevention and treatment. Hence, the need for a study on the effect of a nurse-led training
programme on pressure ulcer prevention and treatment among nurses in Olabisi
Onabanjo University Teaching Hospital, Sagamu and Babcock University Teaching
Hospital, Ilishan remo, Ogun State.
1.3 Objective of the Study
The main objective of the study is to evaluate the effect of a nurse-led
training programmeon
pressure ulcerprevention and treatment among nurses. The specific objectives are to
- determine pre-intervention knowledge concerning pressure ulcer
prevention and treatment among nurses in the experimental and control
group;
- ascertain pre-intervention practice concerning pressure ulcer
prevention and treatment among nurses in the experimental and control
group;
- implement a nurse-led training progamme on pressure ulcer
prevention and treatment;
- determine the effect of a nurse-led
training programme on knowledge concerning pressure ulcer prevention and
treatment among nurses in the experimental and control group and
- identify the effect of a nurse-led
training programme on practice concerning pressure ulcer prevention and
treatment among nurses in the experimental and control group.
1.4 Research Questions
The
following research questions were answered:
- What is pre-intervention knowledge concerning pressure ulcer
prevention and treatment among nurses in the experimental and control
group?
- What is pre-intervention practice concerning pressure ulcer
prevention and treatment among nurses in the experimental and control
group?
1.5 Hypotheses
The following hypotheses were tested at 0.05
level of significance.
HO1. There is a significant difference
in effect of a nurse-led training programme on
knowledge concerning pressure
ulcer prevention and treatment among nurses in the
experimental
and control group.
HO2. There is a significant
difference in effect of a nurse-led training programme on practice
concerning
pressure ulcer prevention and treatment among nurses in the experimental
and control group.
1.6 Scope of the Study
The
researcher studied the effect of a
nurse-led training programme on knowledge and practice concerning pressure
ulcer prevention and treatment among nurses in Olabisi Onabanjo University Teaching Hospital,
Sagamu and Babcock University Teaching Hospital, Ilishan remo, Ogun State.The study was limited by closeness in the distance
between the experimental and control group settings.
1.7 Significance of the Study
Nurses
would benefit from the study as the outcome would further assist them to
improve their clinical performance and decision making. Nurses would also
benefit from the study because the training programme would improve their
knowledge and practice concerning pressure ulcer prevention and treatment. This
study would be beneficial to nurses because the training programme would help
translate available knowledge into clinical decision making during practice.
The study would be of great benefit to nurses as the outcome would increased time required for nurses' to give
quality nursing care to patient.
The
training programmes would transform information on pressure ulcer prevention
and treatment into a more usable process that would assist nurses with the
transfer of evidence based findings into clinical practice and aid optimal
clinical decision making, thus enhancing patients care and outcome. Patients would benefit from
the study as the outcome would positively influence patients' satisfaction about care, cost of care, length of hospital
stay, pressure ulcer incidence and prevalence, pressure ulcer morbidity and
mortality rate. The hospital management would benefit from the study as it
would positively influence the utilization of hospital resources for better
purposes.
1.8
Operational Definition of Terms
Operational definition was utilized to define the following terms in the study:
1
Effect: outcome ofa nurse-led training programme on pressure
ulcer prevention
and treatment measured
byknowledge and practice score of nurses.
2
Nurse-led
training programme: guidelines and instructions on
pressure ulcer prevention and
treatment developed and implemented by a nurse.
3
Nurse: an individual trainedand registered to offer nursing care and working in the medical and surgical unit.
4
Prevention:measures takenby a medical and surgical nurse to protect patients from pressure
ulcer development.
5
Treatment: measures taken by a medical and
surgical nurse to stop the progression of pressure ulcer.
6
Pressure
ulcer: a skin or tissue damaged due to persistent pressure, friction
or moisture.
7
Teaching
hospital: a hospital that offers tertiary healthcare services to
people and clinical training to health professionals.
8
Knowledge:
nurses understanding regarding pressure ulcer prevention and treatment as
measured by knowledge score.
9
Practice:
nurses activities regarding pressure ulcer prevention
and treatment as measured by practice score.
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