PRESSURE ULCER PREVENTION PRACTICES AND IT'S INFLUENCING FACTORS AMONG NURSES

1.1 Introduction

Pressure Ulcer occur where there is pressure on the skin from a bed, wheelchair, cast, splint, poorly fitting artificial (prosthetic) device, or other object. The most common places Pressure Ulcer occur are where bone is close to the skin, such as over the hip bones, tailbone, heels, ankles, and elbows, but they can occur anywhere (Msdmanuals, 2021). The prevention and management of pressure injuries continues to be a concern in the Canadian health-care system. An integrated approach focused on prevention is required across all areas of the health-care system to make a significant difference in incidence rates. For optimal effectiveness, interdisciplinary teams need to be integrated to include the person at risk of or with a pressure injury along with their families and departments such as purchasing and housekeeping (Black et al., 2011).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Pressure Ulcer is a worldwide health concern that contributes to mortality among bedridden patients, when present, can cause chronic, infected and hard to treat wounds. Patients with Pressure Ulcer have a greater mortality risk and complications such as pain, delayed healing, septicemia and longer hospital stay. Pressure Ulcer occur most frequently in older people because their skin may be thinner and may heal more slowly. The sores often develop in people after they have been hospitalized for a different medical problem that limits their ability to move or shift around. Pressure Ulcer can occur in people of any age who are confined to bed or a chair, or who are unable to reposition themselves. People who have nerve damage or paralysis have a higher risk of developing Pressure Ulcer. They can also develop in children who have severe neurologic impairments that make them less able to move such as spina bifida, cerebral palsy, and spinal cord injury (Msdmanuals, 2021).

Prevention of Pressure Ulcer in hospitalized patients is the responsibility of nurses. Pressure Ulcer as worldwide health problem contribute to morbidity and mortality rate among all age group, especially patients at high risk such as elderly, physically impaired, bedridden and those with neurological deficits (Bauer et al., 2008). Recent studies confirm that patients with have mortality risk up to six folds greater than patient without. Also, between 6 - 8.6% of all injured patients die as a result of its complication such as septicemia, pain, and delayed healing (Dilie et al., 2015 and Uba et al., 2015).

Patients requiring long-term hospitalization and in rehabilitation facilities have a high potential for the development of Pressure Ulcer. Universally, maintaining skin integrity and preventing bed sores have traditionally been a nursing responsibility (Barker et al., 2013). The presence of in hospitalized patients has been identified as a measure of quality in healthcare (Beeckman et al., 2011 and Kaddourah et al., 2016). However, if unrecognized and left untreated, can deteriorate into deep, hard-to-treat, chronic wounds that undermine the patient's health and quality of life (Barker et al., 2013). Even when healed, ulcers will attain only 80 present of the skin’s original strength making the area vulnerable to re-injury (Grey et al., 2006). Extensive or slow-to-heal are also prone to infection as they develop (Sving et al., 2012). In addition to the physical complications of , there are substantial economic burdens as well (Demarré et al., 2015 and Nguyen et al., 2015). Similarly, occurrence of in hospitalized patients has been linked with the length of stay, which indicates higher costs for management (Joseph et al., 2013).

Therefore, in Enugu State where the research was carried out, the activities that was conducted is to know the Pressure Ulcer Prevention Practices and it’s Influencing Factors among Nurses.

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1.3 Statement of Problems

Investigation revealed inadequate nutrition increases the risk of developing Pressure Ulcer and slows the healing process of sores that do develop. Undernourished people may not have enough body fat to cushion the tissue. Also, the skin heals poorly if people are undernourished, particularly if they are deficient in protein, vitamin C, or zinc.

Pressure Ulcer are areas of localized injury to the skin, underlying tissue or both, usually over a bony prominence, as a result of pressure or in combination with shear. They are common problem in health care and represent a significant burden on patients, their relatives and caregivers. Pressure Ulcer as worldwide health problem contribute to morbidity and mortality rate among all age group, especially patients at high risk such as elderly, physically impaired, bedridden and those with neurological deficits (Bauer et al., 2008).

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Pressure Ulcer Prevention Practices and it’s Influencing Factors among Nurses. In achieving this aim, the following specific objectives were laid out as follows:

1. To investigate the factors affecting the pressure ulcer prevention practice among Nurses in the area under study;
2. To measure the public knowledge and identify their attitudes and practices on medication use and safety towards the treatment of Pressure Ulcer;
3. To identify the difference in demographic characteristics between participants interviewed manually and electronically about the Prevention and Treatment of Pressure Ulcer in Hospitalized Patients;
4. To assess nurses’ knowledge, attitudes and beliefs towards Pressure Ulcer prevention; and
5. To find out the difference in their level of knowledge and attitudes towards to medication use and safety precautionary measure on the treatment of Pressure Ulcer in Hospitalized Patients.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are nurses aware of Pressure Ulcer prevention among Hospitalized Patients?
• Is there any significant difference in demographic characteristics between participants interviewed manually and electronically about the Prevention and Treatment of Pressure Ulcer in Hospitalized Patients?
• What is the safety measures applied in the treatment of Pressure Ulcer?
• What is the difference in their level of knowledge and attitudes towards to medication use and safety precautionary measure on the treatment of Pressure Ulcer in Hospitalized Patients?
• What are the factors affecting the pressure ulcer prevention practice among Nurses in the area under study?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant difference in demographic characteristics between participants interviewed manually and electronically about the Prevention and Treatment of Pressure Ulcer in Hospitalized Patients
• H1: There is a significant difference in demographic characteristics between participants interviewed manually and electronically about the Prevention and Treatment of Pressure Ulcer in Hospitalized Patients

Hypothesis Two

• H0: Nurses have no significant knowledge of Pressure Ulcer prevention among Hospitalized Patients in Enugu State Primary Health Care Facility
• H1: Nurses has significant knowledge of Pressure Ulcer prevention among Hospitalized Patients in Enugu State Primary Health Care Facility

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1.7 Significance of Study

The study will be of great importance to researchers in the field of medical research on the use of medical prescription to reduce the prevalence of certain chronic diseases like Pressure Ulcer and other bacterial infections. The result will also help in building up knowledge base on the care of the patients. Improving data base on patients’ health nutrition and standard of living which will help for further research, advocacy, policy dialogue and programming.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of Study

The study focuses on the Pressure Ulcer Prevention Practices and it’s Influencing Factors among Nurses in Enugu State Primary Health Care Facility.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Research material: availability of research material is a major setback to the scope of the study.
4. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
5. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Operational Definition of Terms

These are precise descriptions of how to derive a value for characteristics the researcher is measuring. It also entails how specific these characteristics are;

Knowledge: To have information in one's mind as a result of experience or because you have learned or been told (Oxford Advanced Learner's Dictionary, 2005).

Attitude: The way one thinks feels or behaves about somebody or something (Oxford Advanced Learner's Dictionary, 2005).