Knowledge and Practice Of Nurses Regarding Prevention Of Pressure Ulcer In Jinnah Hospital Lahore
Introduction:
A pressure ulcer is an area of localized damage to the skin, muscle and or underlying tissue, caused by shear, friction, or unrelieved pressure, usually over bony prominences.(Tolulope, Akinwande et al. 2018). An exchange in terminology from stress ulcer to pressure injury was announced (Kohta, Kameda et al. 2017) .
In 2017 by the remark of clinician the strain ulcer stills one of the essential causes of morbidity and mortality worldwide. About 60,000 human beings died because of problems of pressure ulcer worldwide.(Teague, Mahoney et al. 2011) Pressure ulcers have been labeled as one of the most costly and bodily debilitating issues in the 20th century. The ache and soreness of pressure delays rehabilitation, extend illness and timing of discharge and additionally make contributions to the disability and death. This increase the health care price and as a result of need for grant and nursing hours.
Pressure ulcers are common troubles in healthcare system and produce a massive burden on patients, relatives and caregivers. According to a cross-sectional study, approximately 1.7 million patients per year were reported to enhance pressure ulcers in the United States.(Pieper and Management 2000).
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The incidence of pressure ulcers varies between developed and developing countries. Estimated incidence rates of 8.3% to 25.1% were reported in developed countries and 2.1% to 31.3% in developing countries.(Hulsenboom, Bours et al. 2007) Pressure ulcers are recognized globally as one of the 5 most common causes of harm to patients.(Robinson 2005).
The prevalence of pressure ulcer is diverse in different areas of pakistan. According to a study conducted in 2017 in Pakistan KPK Overall correct answers from the knowledge section of the questionnaire were 58.2%. the practices of nurses regarding the “always” statements was 45.4% while of the “never” statement was 42.4%.(Muhammad, Ahmad et al.).
A study conduct in Jordanian, describe that the nurses have insufficient knowledge about pressure ulcer prevention as compared with national pressure ulcer advisory panel guidelines. Therefore it is important for all nurses to be aware of standards guidelines to prevent any com.plication associated with pressure ulcers to promote patient safety and better outcomes (Qaddumi and Khawaldeh 2014) . patient suffer with pain and discomfort because of pressure ulcer and also cause prolong illness, delay rehabilitation, increase patient’s hospital stay, and may lead to disability and even death (Nuru, Zewdu et al. 2015). World stop pressure ulcer day showed that nearly 700,000 patients were affected by pressure ulcers each year. Around 186,617 patients develop a new pressure ulcer in acute care settings each year. This has shown that in the year January 2012 to December 2013 between 4 and 6% of patients in acute care settings and more than 5–10% of patients in acute care had no pressure ulcers. Pressure ulcers are accountable for 2% of preventable deaths (Dilie and Mengistu 2015).
Nurse’s practices toward pressure ulcer prevention were not reliable because nurses prioritized it very low level that is because of their inadequate knowledge about the serious consequence of pressure ulcer complications. They had no access and up to date knowledge of evidence base practices (Mwebaza, Katende et al. 2014). Now days if a patient developed a pressure ulcer during his hospitalization it will indicate the poor quality of nursing care. Although to prevent a patient from a pressure ulcers are the responsibility of all health care professional but primarily are the responsibility of those who are involved in direct patient care and nurses are forefronts for providing pressure ulcer prevention care (Kaddourah, Abu-Shaheen et al. 2016). Nurses poor knowledge and skills in pressure ulcer prevention contributes significantly to the development or worsening of pressure ulcers and this is may be lead to more complications, Therefore, nurses require regular training and education in this area of practice (Lyder and Ayello 2008).
There is a gap between nurse’s knowledge of pressure ulcer prevention and the utilization of this knowledge according to proper standards in their practices. Nurses have good knowledge regarding pressure ulcers but they have poor practices regarding pressure ulcers prevention (Shrestha 2016). The code of conduct for nurses states that all nurses are obliged to maintain accurate and up to date patient records. According to study that nurses are unaware of current pressure ulcer prevention recommendation and practices they are follow traditional practices methods rather than on evidences base guidelines. Nurses did not implement their knowledge into their practices. The nurses are practicing wrong practices which are part of old methods and traditions, but it is not recommended from standards guidelines for pressure ulcer prevention (Tubaishat 2014). Furthermore nurses good knowledge regarding pressure ulcer prevention not only can improve the quality of nursing care but also within this reduce the patients duration of hospital stay and the number of patients suffering from this painful condition (Smith and Waugh 2009).
By seeing the prevalence rates in different countries the knowledge and the practice of nurses is so important because the nurses are the frontline health care provider . In the 2011 cross-sectional learn about in a Belgian health center confirmed nurses had a terrible knowledge of pressure ulcer prevention. Similarly contradictory findings also have been pronounced in other cross-sectional research among nurses in developing countries, showing low/poor information levels amongst 91 nurses in Bangladesh and 111 nurses in Nigeria, moderate know-how among 248 nurses in Ethiopia, and high know-how among one zero five fitness care employees in Saudi Arabia. (Tolulope, Akinwande et al. 2018). Many studies have been conducted on this topic in many countries and very few studies have been done in Pakistan. Therefore, it is important to check the knowledge and the practice of nursing students in hospital settings of Pakistan. This is the main reason I select this topic( to explore the knowledge and practice of nurses in Jinnah hospital Lahore.).
Objectives
1. Assess the knowledge of the student nurses regarding pressure ulcer prevention.
2. Assess the practice of the student nurses regarding pressure ulcers prevention.
3. Assess the relationship between the knowledge and practice among student nurses regarding prevention ulcer.
Research questions
1. What is the knowledge of the student nurses regarding pressure ulcer prevention?
2. What is the practice of the student nurses regarding pressure ulcers prevention?
3. What is the relationship between the knowledge and practice among student nurses regarding prevention ulcer?
.
Literature Review
The time period pressure ulcer grew to be famous in the early 1970s.Previous phrases for skin and tissue lesions of this kind covered strain sores , bedsores or decubitus ulcer(Black, Baharestani et al. 2007) .It is a localized injury, that is generally restrained to the skin and underlying tissue over the hard bony prominence. Pressure ulcer develops when excessive pressure and stress is applied to the pores and skin of bony prominence or when the skin is entrapped between the difficult surface and the bone (Kohta, Kameda et al. 2017).
About 1.7 million patients suffers from pressure ulcer every year (Pieper, 2007).More than a million hospitalized patients developed one or more pressure ulcers each year in America (Young, Evans, ; Davis, 2003). The occurrence of pressure ulcer in patients that have spinal cord injury is 20% to 31% and 4% to 45% pressure ulcers develop in surgical patients (NPUAP, 2001). The Library of Medicine defines pressure ulcer as “an ulceration caused by prolonged pressure on the skin and tissues when one stays in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic under sustained and constant pressure.”(Black, Baharestani et al. 2007)
Different researches associated to nurses’ understanding and practice on the prevention of pressure ulcers have proven there are massive gaps. Panayiotopoulos and Kerr (2002) performed a find out about knowledge of pressure ulcer amongst nurses in a standard hospital in England to identify the nurses’ understanding and their exercise regarding stress ulcer prevention (Pieper et al., 1997).
It used to be determined that nurses had been educated in areas of risk factors, but they had a lack of knowledge related to preventive strategies of rub down and positioning of the bed ridden patients.. A study was once designed by means of Hays, Wolff, and McHugh (1995) to test the nurses’ understanding regarding stress ulcer chance factors. It was once revealed that most nurses had an inadequate knowledge of reducing pressure and friction. Another preceding find out confirmed that nurses’ practice concerning techniques and strategies for stopping pressure ulcers was once inadequate. Gunningberg et al. (2001) studied the understanding and practice concerning of workforce nurses in this field in Sweden. A majority of the nurses had inadequate practice to enforce and report stress ulcer prevention in sufferers at risk, such as these with hip fractures. Many preceding research have found level of the nurses’ knowledge and their relating practice to the prevention of strain ulcers. Some discovered an advantageous correlation between nurses’ information and practice (Maylor, 2001; Pancorbo-Hidalgo et al., 2007; Ulrika ; Bjorn-Ove, 2009).
Several factors affect the nurses’ information and practice concerning the prevention of stress ulcers. They are: 1) education and training , 2) period of experience, 3) lack of nursing leadership, 4) inadequate sources and equipment, 5) scarcity of nurses and work over-loads, and 6) nurses value and beliefs (Pancorbo-Hidalgo et al., 2007).
1.Education and trainingPieper and mott (1995) referred to that the nurses who attend classes have excessive stage of knowledge about pressure ulcers prevention then the nurses who exercise it.Researchers,concluded that understanding of nurses is higher than their medical practice.it is because of lack of interest, insufficient time, lack of cloth and sources and overburden of work.
2Period of experience is the 2nd factor that impact the nurse’s knowledge and practice concerning the prevention of stress ulcers. Nurses, having many years of scientific journey barring publicity to the cutting-edge knowledge, don’t know how to forestall the ulcers.
Skills in the areas of preventive exercise nurses who exercise to care for wound have higher exercise in prevention of strain ulcers then knowledge.
3 Inadequate sources and equipments. Facilities for dealing with pressure ulcers, such as associated mastering substances and relevant equipment, are essential elements for nurses to prevent stress ulcers. Lack of sources to get right of entry to literature, lack of possibilities to make use of lookup findings, and lack of equipment are contributing factors for nurses to enforce fine care for pressure ulcer prevention. Previous research have observed a range of boundaries for nurses to boost to practice in this field. These include: lack of access to literature; lack of resources and equipment’s; lack of sanatorium insurance policies for using chance evaluation tools; an absence of evidence-base guidelines; and inadequate utilization of lookup findings in medical
areas (Moore ; Price, 2004; Panayiotopoulos ; Kerr, 2002.)
4.scarcity of nurses and work over-loads,
The low wide variety of nursing staff is one of the factors for providing inappropriate nursing care to prevent pressure ulcer formation. Previous research show that lack of time and shortages of nursing group of workers prevented nurses implementing their fantastic. attitudes into right exercise (Moore ; Price, 2004; Panagiotopoulou ; Kerr, 2002). There is a huge scarcity of nursing staff in Pakistan.
6) nurses value and beliefs
It was once suggested that the contemporary ratio of nurses to sufferers in only Bangladesh was once 1: 15, as in opposition to an international ratio of 1:4 (Arju, 2008)to Individual beliefs. A nice mind-set is a necessary element for an individual to seriously change conduct into practice. Previous research have proven that nurses had poor attitudes concerning pressure ulcer prevention due to the fact they believed that pressure ulcer prevention things to do have low precedence in nursing care (Bus, Halfens, Abu-Saad, ; Kok, 2004). Moore and Price (2004) cited that nurses demonstrated a superb mindset toward the attention of strain ulcer prevention care. Another study indicated that nurses validated bad attitudes by their preferring their personal clinical judgment as an alternative than the use of a chance assessment scale to assess sufferers at risk from stress ulcers (Ulrika ; Bjorn-Ove, 2009).
Many previous studies have determined inconsistent findings in terms of the
relationship between nurses’ knowledge, and their practice concerning to the
prevention of stress ulcers. Some found a advantageous correlation between nurses’
knowledge and practice (Maylor, 2001; Pancorbo-Hidalgo et al., 2007; Ulrika ;
Bjorn-Ove, 2009). Maylor located that greater degree of orthopedic nurses’ understanding was negatively correlated with the occurrence of pressure ulcers. Therefore, it could be hypothesized that nurses’ greater stages of knowledge have an effect on nurses’ exercise for reducing the occurrence of stress ulcers. Some preceding studies located a bad correlation between information and practice. Halfens and Eggink (1995) studied Dutch nurses’ knowledge and practice. The effects showed that nurses’ knowledge level was once appreciably higher than that their exercise level.
Ulrika and Bjorn (2009) additionally determined that Swedish nurses’ knowledge was not related to their practice. The authors regarded that there may be other elements related to nurses’ tiers of practice. These included: lack of strain relieving equipment, lack of preventive policies; absence of excellent crew work; lack of time; and the stipulations of patients. Another find out about also discovered that Spanish nurses had higher levels of know-how than levels of exercise (Pancorbo-Hidalgo et al., 2007).
Therefore, the stage of understanding is not in accord with the stage practice in terms of pressure ulcer prevention.
These authors put forward the idea that other factors, such as an insufficient range of nurses and heavy working loads, are related to nurses’ levels of practice. two It has been shown that nurses’ exercise was once now not associated to both their knowledge or attitudes. Ulrika and Bjorn-Ove (2009) discovered that Swedishnurses had better knowledge and wonderful attitudes, however showed insufficient exercise in stress ulcer prevention. Another find out aboutdetermined that inadequate practice was once related to inadequate information (Halfens & Eggink, 1995). They determined that nurses still massaged over bony prominences, used topical cream, and applied donut rings to
reduce pressure. These have now not been advocated to forestall stress ulcers
(Pancorbo-Hidalgo et al., 2007).
It is very noticeable from the above discussion that relationships between
nurses’ knowledge and practices regarding pressure ulcer prevention were
uneven. High levels of knowledge is not always reflected in
good practice because there may be other factors related to good practice, such as hospital policy, organizational barriers, and social values and beliefs.
Summary
In summary, three major areas of the literature have been reviewed. These
are the concept of pressure ulcer development, pressure ulcer prevention practices,and nurses’ current knowledge, and practices towards pressure ulcer
prevention.
There are some factors affecting the knowledge and practice of nurses regarding prevention of pressure ulcer including education and training , period of experience, lack of nursing leadership, inadequate sources and equipment, scarcity of nurses and work over-loads, and nurses value and beliefs. Many previous researches proved that nurses knowledge and practice of pressure ulcer prevention is not sufficient. Moreover, the relationship between knowledge and practice is uneven.
References.
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