This descriptive, cross-sectional study was conducted at Federal Teaching Hospital Ido-Ekiti (FETHI) in Ido-Ekiti, a suburban area located in Ido-Osi Local Government Area, Ekiti State, Nigeria. FETHI is a 280-bed tertiary institution formerly known as Federal Medical Centre, Ido-Ekiti. The target population of this study consists of all nurses working in the medical, gynecology, pediatrics, accidents and emergency, surgical, and orthopedic wards of FETHI. A purposive sampling method was adopted in selecting nurses from the research population. Nurses on duty at the time of visit for the survey were approached and recruited for the study. The study questionnaire was developed by the researchers and pretested among 10 nurses in the department of Nursing at Afe Babalola University (Ado Ekiti, Nigeria) to ascertain the clarity and validity of the questionnaire and to measure the dependent variables (pressure ulcer knowledge and pressure ulcer prevention attitude). The questionnaire was checked for face and content validity before and after the pretest, respectively, by 2 clinicians in the field of nursing, and 2 epidemiologists/ biostatisticians. The constructs were reviewed by checking the internal consistency to establish the content validity of the questionnaire after the pretest. The sample size was calculated using a proportion of 0.32621 and desired precision of 0.1 at 95% confidence interval. After necessary adjustments, it was determined a total of 93 respondents was needed for the study.
Questionnaire instrument. The structured questionnaire consisted of 3 sections (A, B, and C). Section A (6 items) assessed sociodemographic variables such as gender, age, marital status, educational level, years of experience, and acknowledgment of special training on pressure ulcer prevention after obtaining their nursing qualification/license to practice. Section B comprised 11 items that assessed nurse knowledge of pressure ulcers. The questions tested nurses’ knowledge on pressure ulcer etiology, prevention, care, legal implication, staff influence, and recent practice of pressure ulcer prevention; 8 items were single-choice questions and 3 items were multiple-choice questions. Each correct response was worth 1 point (maximum score was 11). Scores equal to or higher than the median were categorized as high/adequate knowledge and scores equal to or below the median were categorized as low/inadequate knowledge. Total minimum and maximum scores for section B were 5 and 11, respectively.
Section C comprised 8 items on attitude and included statements answered using a Likert scale with 5 options ranging from strongly agree to strongly disagree; responses reflected participant reaction to the statements. Positive responses were worth 1 point and negative responses received no points. Scores equal to or higher than the median were categorized as positive attitude and scores equal to or below the median were categorized as negative attitude. Total minimum and maximum scores for section C were 3 and 8, respectively.
Questionnaire completion. The questionnaires were printed on paper and administered to nurses in the medical, gynecology, pediatrics, accidents and emergency, surgical, and orthopedic wards. The nurses were informed about the purpose of the research and that participation was voluntary. After obtaining participant verbal consent, the questionnaires were administered in January and February 2017. The questionnaires were administered individually to the nurses while at work. Participants were able to fill in the questionnaires within 5 to 10 minutes, and the questionnaires were retrieved immediately. The questionnaires ensured the anonymity of the respondents; each questionnaire was assigned a serial number. The researchers ensured that the nurses completed the questionnaires in their presence to avoid respondent bias. Clearance to conduct the study was obtained from the university and the hospital before the respondents were approached. This is akin to an Institutional Review Board (IRB) approval.
Data collection. All the variables were coded before they were entered into the statistical software. For example, male gender was coded 1 and female gender was 2. Summary statistics were calculated for the sociodemographic characteristics. Pressure ulcer knowledge questions and attitude toward pressure ulcer prevention statements were summed to generate scores. The scores then were recoded into groups.
Data analysis. Data were entered manually and were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corporation, Armonk, NY). Data were presented using descriptive statistics (frequencies and percentages).