ASSESSING THE NURSES PRACTICE IN THE PREVENTION AND MANAGEMENT OF PRESSURE ULCER AT THE BUEA REGIONAL HOSPITAL

Abstract

Pressure ulcers have been identified as a major problem of hospitalization worldwide. Nurses are at the forefront of preventing and managing pressure ulcers. The aim of this study was to assess the nurses practice in the prevention and management of bedsores in the Regional Hospital Buea.

The specific objectives of this research project was To asses the prevention practice of pressure ulcer by nurses at the Regional hospital buea, To asss the management practice of pressure ulcer by nurses at the regional hospital buea and To assess the challenges faced by nurses at the regional hospital buea.

This study made use of a cross-sectional descriptive design and a sample size of 30 respondents were conveniently selected. Data was collected using a structured questionnaire and an observational checklist. Data was analyzed using Microsoft Excel 2013. The results are presented on frequency distribution tables and bar charts. Results showed that majority of respondents tried to carry out the preventive practices in the prevention and managing of bedsores as 24 (80%) repositioned bed ridden clients, 28 (93.3) inspected patients body for risk of bedsores which were moderate practices. Though some did not carry out the practices frequently, as 3(12.5%) repositioned patients on a four hourly basis.

The major challenges mentioned included uncooperative patients which were reported by 29.90%, heavy workload 37.3%, limited resources 6% and 26.90 lack of guidelines. Thus the government should recruit more nurses so as to reduce the workload of the nurses and provide resources/equipment’s so that the preventive practices can be improved.

The specific objectives of this research project was To asses the prevention practice of pressure ulcer by nurses at the Regional hospital buea, To asss the management practice of pressure ulcer by nurses at the regional hospital buea and To assess the challenges faced by nurses at the regional hospital buea.

This study showed that Most of the nurses carried out the preventive and management measures of bedsores. Even though some did not carry out the practices frequently, Some carried out effective prevention measures such as repositioning of bed ridden clients28 (93.3%), massage of pressure ulcers 27 (90%) and all made wrinkled free beds 30 (100%). Some of the nurses were lacking in some aspects such as 20% who did not repositioned bed ridden patients, and some even repositioned them for a very long period of time 3 (12.5%) for more than four hours. As regarding management, 28(93.3) did appropriate wound dressing. Some of the major challenges reported by nurses were heavy workload 37.30%, uncooperative patients 29.90%, and limited resource/equipment 6%.

CHAPTER ONE
INTRODUCTION

Constant pressure on an area of the skin stops blood flowing normally, so the cells die and the skin breaks down. Hence pressure sore. Other names for pressure sores are bedsores, pressure ulcers and decubitus. Pressure sores are wounds that develop when constant pressure or friction on one area of the body ulcers.

Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and pose a significant burden on patients, their relatives and caregivers Pressure ulcers have been described as one of the costliest and physically debilitating complications since the 20th century. The pain and discomfort of pressure ulcer delays rehabilitation, prolongs illness and timing of discharge, and also contribute to disability and death. These dramatically raise health care costs as a result of the need for supplies and nursing hours. It has been estimated that the cost of treating a pressure ulcer is 2 times higher than the cost of preventing it. The objective of this work is to assess the nurse’s practice in the prevention and management of pressure sore or bed sore at the Buea Regional Hospital.

1.1 Background

Pressure ulcers, also known as bedsores or pressure sores, are localized areas of tissue damage arising due to excess pressure and shearing forces.(Melese.et al2018).

Pressure ulcer is a preventable medical complication of immobility. It has psychological, economic and social impact on individual and family. Its cost of treatment is more than twice the cost of prevention. It is primarily the nurses’ responsibility to pressure ulcer. Pressure ulcers (PUs) prevention remains a significant challenge for nurses, and its incidence is considered an indicator of poor quality of care.

Patients and families know that pressure ulcers are painful and slow to heal. Some risk factors for the development of pressure ulcers/injuries include advanced age, immobility, incontinence, inadequate nutrition and hydration, neuro-sensory deficiency, device-related skin pressure. A person who holds a positive attitude toward an issue will have a greater possibility of performing a supportive behavior related to that issue. For example, the more positive attitude of nurses to PU prevention, the better practice of PU prevention care demonstrated (Nuru et al; 2015).

Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose a significant burden on patients, their relatives and caregivers. Nowadays, pressure ulcers are recognized worldwide as one of the five most common causes of harm to patients and preventable patient safety problems. In the USA, pressure ulcers remain a major health problem affecting approximately 3 million adults. A systematic review of 31 studies found that pressure ulcers significantly limit many aspects of an individual’s wellbeing, including general health and physical, social, financial and psychological quality of life. According to an international literature, it has been identified that nurses’ knowledge of the prevention of pressure ulcers is poor, which is reflected in their practices as they do not comply with best practice guidelines.

Study conducted in Sweden on nurses’ knowledge and practice of existing guidelines on prevention of pressure ulcer found that, majority of them had inadequate knowledge and practice to implement guidelines. Similarly, a study in Belgian Hospital found that knowledge of nurses about the prevention of pressure ulcers was inadequate. Poor knowledge and practice of nurses have its own significant contribution for higher prevalence of pressure ulcers. Moreover, a study in Bahir Dar, Ethiopia found that a total of 71 pressure ulcers were detected in 422 patients, with the prevalence rate of 16.8 %.

In Cameroon, the prevalence of pressure ulcer was detected in 946 patients which fell between the ages of 50 to 70 years. in the study, 53% were males while 47% were females .385 patients were found to be at risk of pressure ulcer with the prevalence rate of 50% in the population at risk .(Marc Leory ;2016)

A systematic review of 31 studies found that pressure ulcers significantly limit many aspects of an individual’s wellbeing, including general health and physical, social, financial and psychological quality of life. According to an international literature, it has been identified that nurses’ knowledge of the prevention of pressure ulcers is poor, which is reflected in their practices as they do not comply with best practice guidelines Study conducted in Sweden on nurses’ knowledge and practice of existing guidelines on prevention of pressure ulcer found that, majority of them had inadequate knowledge and practice to implement guidelines Moreover, a study in Bahir Dar, Ethiopia found that a total of 71 pressure ulcers were detected in 422 patients, with the prevalence rate of 16.8 Thus preventing ulcer should be the goal of all nurses but it is rarely researched in low income countries like Ethiopia and Sweden. (Nuru et al. 2015)

Also there are some knowledge gaps that exist in the prevention of bed sores which include heavy workload/staff shortage, lack of universal guideline for prevention of bed sores lack of trained personnel in the prevention of bed sores, uncooperative patient/client, other priorities other pressure ulcers, shortage of pressure relieving devices, inadequate knowledge of nurse about the prevention of pressure ulcers.

1.2 Statement of the problem
Pressure ulcers have been described as one of the costliest and physically debilitating complications in the 21st centuries. Despite all the guidelines put in place, such as frequent changing of position, using of support surfaces, education on self-care and nutrition, wound care to manage patients with bed sore and facilitate healing, bedsores still stand as a major care concern affecting tens of thousands of patients and costing billions each year, there by becoming a major concern in nursing. An average of 60.000 people dies worldwide due to pressure ulcer related causes. The exact incidence and prevalence of pressure ulcer remains unclear.

Data from national pressure ulcer advisory panel (NPUAP) indicate that, the incidence varies widely from 0.4% to 38% in acute care, 2.2% to 23.9 % in long term care and 0% to 17% in 3 home care. Prevalence rate show the same variability. 10 % to 18% in acute care, 2.3 % to 28 % in long term care and 0% in home care.

Resent large national surveys suggest that the prevalence range is 10.1 % with surprisingly consistent rate found in studies of 3 multisite acute care setting 14.8%,15%. (NPUAP 2015). There for, the purpose of this sturdy is to assess the nurses practice in the prevention and management of bedsores

1.3 Objective
1.3.1 General Objectives:
The purpose of this study is to assess the nurses’ practice in the prevention and management of bedsores at the Buea Regional Hospital.

1.3.2 Specific Objectives
To assess the prevention of bedsores by the nurses at the Regional Hospital Buea.
To assess the management of bed sores at the Regional hospital Buea.
To determine the challenges faced by nurses in the prevention and management of bedsores at the Buea Regional Hospital.