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 and inadequate 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 programme on 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 adopted to 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.
Keywords: Effect, Nurse-led training programme, Knowledge, Practice, Pressure ulcer.
Word Count: 445
TABLE OF CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables viii
List of Figures ix
Appendices x
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 4
1.4 Research Questions 4
1.5 Hypotheses 4
1.6 Scope of the Study 5
1.7 Significance of the Study 5
1.8 Operational Definition of Terms 6
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 7
2.1 Definition of pressure ulcer 7
2.2 Incidence and prevalence of pressure ulcer 7
2.3 Impact of pressure ulcer on patients 8
2.4 Prevention of pressure ulcer 9
2.4.1 Pressure ulcer risk assessment 10
2.4.2 Pressure ulcer identification 11
2.4.3 Pressure ulcer documentation 14
2.5 Treatment of pressure ulcer 14
2.6 Previous studies on pressure ulcer training programme 15
2.7 Conceptual Model 17
CHAPTER THREE: METHODOLOGY
Content Page
3.0 Introduction 20
3.1 Research Design 20
3.2 Population 20
3.3 Sample size and sampling Technique 21
3.4 Instrumentation 22
3.5 Validity and reliability of instruments 23
3.6 Data Collection Procedure 24
3.7 Method of Data Analysis 25
3.8 Ethical Consideration 25
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0 Introduction 26
4.1 Data analysis and results 27
4.2 Discussion of Findings 33
CHAPTER FIVE: SUMMARY, CONCLUSION
AND RECOMMENDATIONS
5.1 Summary 38
5.2 Conclusion 39
5.3 Recommendations 40
5.4 Limitation of the Study 40
5.5 Suggestion for Further Studies 41
REFERENCES 42
APPENDICES 49
LIST OF TABLES
Table Page
1: Frequency and percentage on demographic data of participants 27
2: Participants’ knowledge category regarding pressure ulcer prevention
and treatment 28
3: Descriptive statistics of nurses’ pre-intervention knowledge concerning
pressure ulcer prevention and treatment 29
4: Participants’practice category regarding pressure ulcer prevention and
treatment 30
5: Descriptive statistics of nurses’ pre-intervention practice concerning pressure
ulcer prevention and treatment 31
6: Descriptive and inferential statistics of nurses’ post-intervention
knowledge concerning pressure ulcer prevention and treatment 32
7: Descriptive and inferential statistics of nurses’ post-intervention practice
concerning pressure ulcer prevention and treatment 33
LIST OF FIGURES
Figure Page
1: Stages of pressure ulcer 13
2: Knowledge-to-action process conceptual model 18
APPENDICES
Appendix Page
A: Informed Consent form 49
B: Questionnaire 50
C: Checklist 54
D: Braden’s scale for pressure ulcer risk assessment 56
E: Training programme hand-out 57
F: Pictures from the field work 64
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 cord injury 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 cord injury 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 cord injury patients in Gombe State Hospital and the result showed 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 increased pressure ulcer incidence and prevalence. Litigation against nurses due to hospital acquired pressure ulcer has 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 programme on pressure ulcer prevention 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:
- Effect: outcome of a nurse-led training programme on pressure ulcer prevention and treatment measured by knowledge and practice score of nurses.
- Nurse-led training programme: guidelines and instructions on pressure ulcer prevention and treatment developed and implemented by a nurse.
- Nurse: an individual trained and registered to offer nursing care and working in the medical and surgical unit.
- Prevention: measures taken by a medical and surgical nurse to protect patients from pressure ulcer development.
- Treatment: measures taken by a medical and surgical nurse to stop the progression of pressure ulcer.
- Pressure ulcer: a skin or tissue damaged due to persistent pressure, friction or moisture.
- Teaching hospital: a hospital that offers tertiary healthcare services to people and clinical training to health professionals.
- Knowledge: nurses understanding regarding pressure ulcer prevention and treatment as measured by knowledge score.
- Practice: nurses activities regarding pressure ulcer prevention and treatment as measured by practice score.
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