CHAPTER ONE
INTRODUCTION
1.1Background
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
EFFECT OF A NURSE-LED TRAINING PROGRAMME ON PRESSURE ULCER PREVENTION AND TREATMENT AMONG NURSES IN TWO TEACHING HOSPITALS IN OGUN STATE
