Cath Lab Digest

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Index: Ostomy Wound Manage. 2012;58(2):24–32.

Abstract

  Pressure ulcer (PU) development remains a significant complication among at-risk patients. Optimal prevention strategies start with knowledge about current evidence-based prevention interventions. A pilot study was conducted to describe nurses’ level of knowledge of PU preventive interventions and to test the reliability of the Pressure Ulcer Knowledge Test (PUKT) among Nigerian nurses. One hundred, eleven (111) nurses were purposively selected from specific wards of a state teaching hospital in South West Nigeria. While 106 nurses (95.5%) correctly identified patients at risk for PU development, 78 participants (70.3%) had low (<59% correct) prevention intervention knowledge scores. No significant differences in PU prevention intervention knowledge scores were observed between nurses with different educational backgrounds (P = 0.317) or years of working experience (P >0.005). The Cronbach’s alpha coefficient for reliability was 0.861. The results of this study confirm that many PU prevention interventions in Nigeria are based on tradition and that a structured educational approach is needed to enable Nigerian nurses to provide evidence-based PU prevention interventions.

Keywords: pressure ulcer, prevention, evidence-based, knowledge, nursing

Potential Conflicts of Interest: none disclosed

Introduction

  Pressure ulcer (PU) development is a nursing-sensitive quality indicator. The negative impact of PUs on patients’ quality of life underscores the need to prevent their occurrence in hospitalized patients. The literature suggests that PUs can be prevented or their incidence reduced when appropriate interventions are in place,¹ although the Wound Ostomy and Continence Nurses Society (WOCN)² warns that some ulcers maybe unavoidable — ie, they can develop despite early and accurate risk assessment and provision of appropriate preventive interventions. Despite this position by organizations concerned with PU prevention, nurses are still stigmatized and blamed for poor quality care when PUs occur.³

  The facility for this study is a state-funded teaching hospital in South West Nigeria. It was established in 1986 and provides tertiary healthcare services for people in Ogun State and its environs. The hospital operates 28 specialty and subspecialty disciplines with 240 beds distributed among various specialties. Researchers observed that most nursing interventions to prevent and manage PUs could be considered obsolete and based on tradition rather than empirical evidence. The hospital does not have a dedicated wound clinic. A recent descriptive study⁴ among Nigerian nurses (N = 95) that examined the perception of activities to prevent PUs reported that 32.6% of nurses were massaging bony prominences for 10 to 30 minutes, a practice not supported by evidenced-based recommedations^5,6 and indicative of a gap in the practitioners’ knowledge. The same study also noted that although nurses use turning schedules, consistency in turning frequency was lacking.

  Currently, no national guidelines for PU risk assessment, prevention, and treatment exist in Nigeria; recommendations for care are based on international guidelines and caregiver experience. However, despite the lack of a national guideline, PUs are an important concern to care providers, as evidenced by the fact that some hospitals in Nigeria report facility-acquired ulcers.