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PROJECT TOPIC AND MATERIAL ON EFFECT OF A NURSE-LED TRAINING PROGRAMME ON PRESSURE ULCER PREVENTION AND TREATMENT AMONG NURSES IN TWO TEACHING HOSPITALS IN OGUN STATE

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  • Name: EFFECT OF A NURSE-LED TRAINING PROGRAMME ON PRESSURE ULCER PREVENTION AND TREATMENT AMONG NURSES IN TWO TEACHING HOSPITALS IN OGUN STATE
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ABSTRACT

Pressure ulcer refers to lesion on the skin due to persistent pressure, friction or moisture leading to skin and tissue destruction. It is associated with rise in treatment cost, lengthy hospital stay andinadequate patients’ satisfaction. Despite advancement in pressure ulcer prevention and treatment strategies, knowledge and practice concerning pressure ulcer prevention and treatment among nurses has been poor. This study aimed to evaluate the effect of a nurse-led training programme on pressure ulcer prevention and treatment among nurses.

Quasi-experimental design was adopted. The population were 60 nurses working in medical and surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu and 48 nurses working in the medical and surgical unit of Babcock University Teaching Hospital, Ilishan remo. Sample size was determined using Leslie Kish formula and convenient sampling was adoptedto select 20 nurses from Olabisi Onabanjo University, Sagamu and 20 nurses from Babcock University Teaching Hospital, Ilishan remo which formed the experimental and control group respectively. A developed questionnaire and checklist was used to collect data on knowledge and practice concerning pressure ulcer prevention and treatment among nurses pre and post-intervention. Face and content validity of the instruments was ascertained by presenting it to experts in the field. Reliability of the questionnaire was determined using split-half method and Cronbach’s alpha reliability coefficient was 0.8. The training modules and checklist were also pre-tested and found suitable for the study. Data were processed using statistical package for social science version 21. Two research questions were answered using descriptive statistics of mean and standard deviation. Two hypotheses were tested using inferential statistics of student t-test at 0.05 level of significance.

(a) There is no difference in pre-intervention mean knowledge score concerning pressure ulcer prevention and treatment among nurses in the experimental (mean = 0.652) and control group (mean = 0.621).

(b) There is no difference in pre-intervention mean practice score concerning pressure ulcer prevention and treatment among nurses in the experimental (mean = 0.407) and control group (mean = 0.407).

(c) There is a significant difference in effect of a nurse-led training programme on knowledge concerning pressure ulcer prevention and treatment among nurses in the experimental and control group (p = 0.000).

(d) There is a significant difference in effect of a nurse-led training programme on practice concerning pressure ulcer prevention and treatment among nurses in the experimental and control group (p = 0.000).

The study concluded that nurses’ knowledge and practice concerning pressure ulcer can be improved as participants in the experimental group showed improved knowledge and practice concerning pressure ulcer prevention and treatment. The study recommended that hospitals should regularly expose nurses to training programmes on pressure ulcer prevention and treatment to improve the quality of nursing care.

Keywords: Effect, Nurse-led training programme, Knowledge, Practice, Pressure ulcer.

Word Count: 445

TABLE OF CONTENTS

Title page                    i

Certification                            ii

Dedication                          iii

Acknowledgements          iv

Abstract                        v

Table of Contents              vi

List of Tables           viii

List of Figures        ix

Appendices                      x

CHAPTER ONE: INTRODUCTION

1.1 Background to the Study                1

1.2 Statement of the Problem                3

1.3 Objective of the Study                       4

1.4 Research Questions                             4

1.5 Hypotheses                                           4

1.6 Scope of the Study         5

1.7 Significance of the Study             5

1.8 Operational Definition of Terms    6

CHAPTER TWO: REVIEW OF LITERATURE

2.0 Introduction                                    7

2.1 Definition of pressure ulcer             7

2.2 Incidence and prevalence of pressure ulcer         7

2.3 Impact of pressure ulcer on patients                              8

2.4 Prevention of pressure ulcer                                   9

2.4.1 Pressure ulcer risk assessment                                                                10

2.4.2 Pressure ulcer identification                                                                               11

2.4.3 Pressure ulcer documentation                                                    14

2.5 Treatment of pressure ulcer                                            14

2.6 Previous studies on pressure ulcer training programme                              15

2.7 Conceptual Model 17

 

CHAPTER THREE: METHODOLOGY

Content                                                                                                      Page

3.0 Introduction                                                                                             20

3.1 Research Design  20

3.2 Population                                             20

3.3 Sample size and sampling Technique                     21

3.4 Instrumentation                                                    22

3.5 Validity and reliability of instruments        23

3.6 Data Collection Procedure                     24

3.7 Method of Data Analysis                   25

3.8 Ethical Consideration                    25

CHAPTER FOUR: DATA ANALYSIS, RESULTS AND

DISCUSSION OF FINDINGS

4.0 Introduction                                26

4.1 Data analysis and results       27

4.2 Discussion of Findings              33

CHAPTER FIVE: SUMMARY, CONCLUSION

AND RECOMMENDATIONS

5.1 Summary                                                             38

5.2 Conclusion                                                                39

5.3 Recommendations                                                    40

5.4 Limitation of the Study                                                          40

5.5 Suggestion for Further Studies                                           41

REFERENCES                                                                      42

APPENDICES                                                                        49

 

 

LIST OF TABLES

Table  Page

1: Frequency and percentage on demographic data of participants                           27

2: Participants’ knowledge category regarding pressure ulcer prevention

and treatment    28

3: Descriptive statistics of nurses’ pre-intervention knowledge concerning

pressure ulcer prevention and treatment      29

4: Participants’practice category regarding pressure ulcer prevention and

treatment              30

5: Descriptive statistics of nurses’ pre-intervention practice concerning pressure

ulcer prevention and treatment               31

6: Descriptive and inferential statistics of nurses’ post-intervention

knowledge concerning pressure ulcer prevention and treatment                32

7: Descriptive and inferential statistics of nurses’ post-intervention practice

concerning pressure ulcer prevention and treatment   33

 

 

LIST OF FIGURES

Figure Page

1: Stages of pressure ulcer                                                      13

2: Knowledge-to-action process conceptual model              18

 

 

APPENDICES

Appendix Page

A: Informed Consent form                                                                        49

B: Questionnaire                                                                                       50

C: Checklist                                                                                            54

D: Braden’s scale for pressure ulcer risk assessment      56

E: Training programme hand-out                                     57

F: Pictures from the field work                        64

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Pressure ulcer refers to lesion on the skin which occurs as a result of persistent pressure, friction or moisture leading to destruction of the skin and underlying tissue. Over 95% of pressure ulcers develop over a bony prominence and major risk factors for pressure ulcer development are immobility and inactivity (El-Ata & Qalawa, 2016). Pressure ulcer is a common health problem in acute and chronically ill patients and it negatively affects the patients, their relatives and caregivers (Abumrad, Arbogast, Barbul, Fogerty, Nanney & Poulose, 2012). Pressure ulcer development indicates poor nursing care and the negative effect on patient’s health underscores the need to prevent the occurrence in hospitalized patients (Chamanga, 2011).Adebule, Gbadegesin, Idowu and Yinusa (2011) conducted a study on pressure ulcer among spinal cordinjury patients in Lagos University Teaching Hospital and result showed a 57.1% pressure ulcer incidence rate.Ademola, Iyun, Malomo, Oluwatosin and Shokumbi (2011) conducted a study on pressure ulcer among patients with spinal cordinjury in University College Hospital, Ibadan and result showed that 87.5% developed pressure ulcer after the first week of admission.

Obiano, Onche and Yiltock(2014) conducted a study on pressure ulcer prevalence among spinal cordinjury patients in Gombe State Hospital and the resultshowed that 57% of patients developed pressure ulcer on admission.These studies show high incidence and prevalence of pressure ulcer which may be due to low knowledge and practice concerning pressure ulcer prevention and treatment among nurses. Pressure ulcer causes serious harm to patients, limit their performance status, leads to severe infection and pain (Cooper, Courtney & Ruppman, 2012). The burden of pressure ulcer is so serious that efforts have been made in United States to reduce its occurrence through continuous nursing education and in-service training of nurses (Gill, Reddy & Rochon, 2012). Pressure ulcer occurs in all admitted patients but it is frequently seen in patients with head and spinal cord injury, immobile patients, poorly nourished patients and patients in critical condition. Its development has been attributed to poor quality of nursing care across a wide range of healthcare settings despite exposure to continuous nursing education on pressure ulcer prevention and treatment (Cowman& O’Brian, 2011).

Pressure ulcer development has been attributed to poor quality of nursing care and inadequate preventive practice by nurses especially when preventive measures are not implemented early during the period of hospitalization (Chamanga, 2011).Pressure ulcer prevention involves risk assessment, identification, staging, documentation and implementation of pressure ulcer preventive measures. Treatment of pressure ulcer is more expensive than prevention so efforts have been directed towards aquisition of skills in preventive care of pressure ulcer rather than treatment (Alhosis,El-Moneem& Qalawa, 2012).Pressure ulcer preventive measures are implemented on all patients especially those in critical condition because the tendency of pressure ulcer development in such patients is high (Estocado, Landers, Shen & Young, 2012). Pressure ulcer prevention and treatment is often wrongly done by nurses and its development negatively affects the patients’ quality of life (Bergquist-Beringer, Dunton, Gajewski & Klaus, 2011).Estocado, Landers, Shen and Young (2012) stated that increased incidence and prevalence of pressure ulcer has been attributed to low knowledge and practice concerning pressure ulcer prevention and treatment among nurses.

Cherry, Maloney, Midyette and Moss (2012) opined that the prevention of hospital acquired pressure ulcer remains a top priority worldwide with key areas addressed including; training for nurses on pressure ulcer prevention and treatment, nurses training on utilization of standardized risk assessment scale and continuous nursing education on pressure ulcer prevention and treatment. Low knowledge and practice concerning pressure ulcer prevention and treatment among nurses has persisted despite exposure to continuous nursing education and in-service training (Aydin & Karadag, 2010). Tweed and Tweed (2008) stated that despite nurses’ exposure to in-service training programmes and continuing nursing education on pressure ulcer, knowledge and practice concerning pressure ulcer prevention and treatment among nurses has been low. Altun and Zencirci (2011) opined that knowledge and practice concerning pressure ulcer among nurses is low despite exposure to training programmes on pressure ulcer prevention and treatment. According to Beeckman, Boucque, Defloor, Maele and Schoonhoven (2008) knowledge and practice concerning pressure ulcer prevention and treatment among nurses is low despite exposure to training programmes on pressure ulcer prevention and treatment.

 

Hsu, Sung and Tsao (2013) stated that despite nurses’ exposure to in-service training programmes and continuous nursing education on pressure ulcer prevention and treatment, knowledge and practice concerning pressure ulcer prevention and treatment has been low. Despite initiation of continuous nursing education and training programmes on pressure ulcer prevention and treatment, problems associated with it seem to persist suggesting a fundamental problem. These prompted the researcher to study the effect of a nurse-led training programme on pressure ulcer prevention and treatment among nurses in Olabisi Onabanjo University Teaching Hospital, Sagamu and Babcock University Teaching Hospital, Ilishan remo, Ogun State.

1.2 Statement of the Problem

Despite advancement in pressure ulcer prevention and treatment through discovery of latest preventive measures and treatment approaches, knowledge and practice concerning pressure ulcer prevention and treatment among nurses has been low (Adejumo & Ingwu, 2010).Smith & Waugh (2014) opined that the adverse effect of pressure ulcer has significantly increased leading to worsening wound, increased cost of care, increased period of hospitalization and increasedpressure ulcer incidence and prevalence. Litigation against nurses due to hospital acquired pressure ulcerhas also been on the increase. In Nigeria, 50% incidence of pressure ulcer was found among spinal cord injury patients, 38.6% incidence was found among orthopedic patients and 11.4% incidence was found among head injury patients which has resulted in great burden and negative effect on patients such as poor patients’ care outcome, poor patient care satisfaction, increased cost of hospital care and lenghty hospital stay (Ogunsanya, Onigbinde & Oniyangi, 2013).

Likewise, the researcher through clinical experience has observed high incidence and prevalence of pressure ulcer. These may be attributed to low knowledge and practice concerning pressure ulcer prevention and treatment among nurses. These may also be attributed to a gap in the type of training programmes offered to nurses on pressure ulcer prevention and treatment. Hence, the need for a study on the effect of a nurse-led training programme on pressure ulcer prevention and treatment among nurses in Olabisi Onabanjo University Teaching Hospital, Sagamu and Babcock University Teaching Hospital, Ilishan remo, Ogun State.

 

1.3 Objective of the Study

The main objective of the study is to evaluate the effect of a nurse-led training programme on pressure ulcer prevention and treatment among nurses. The specific objectives are to

  1. determine pre-intervention knowledge concerning pressure ulcer prevention and treatment among nurses in the experimental and control group;
  2. ascertain pre-intervention practice concerning pressure ulcer prevention and treatment among nurses in the experimental and control group;
  3. implement a nurse-led training progamme on pressure ulcer prevention and treatment;
  4. determine the effect of a nurse-led training programme on knowledge concerning pressure ulcer prevention and treatment among nurses in the experimental and control group and
  5. identify the effect of a nurse-led training programme on practice concerning pressure ulcer prevention and treatment among nurses in the experimental and control group.

1.4 Research Questions

The following research questions were answered:

  1. What is pre-intervention knowledge concerning pressure ulcer prevention and treatment among nurses in the experimental and control group?
  2. What is pre-intervention practice concerning pressure ulcer prevention and treatment among nurses in the experimental and control group?

1.5 Hypotheses

The following hypotheses were tested at 0.05 level of significance.

HO1. There is a significant difference in effect of a nurse-led training programme on

knowledge concerning pressure ulcer prevention and treatment among nurses in the

experimental and control group.

HO2. There is a significant difference in effect of a nurse-led training programme on practice

concerning pressure ulcer prevention and treatment among nurses in the experimental

and control group.

1.6 Scope of the Study

The researcher studied the effect of a nurse-led training programme on knowledge and practice concerning pressure ulcer prevention and treatment among nurses in Olabisi Onabanjo University Teaching Hospital, Sagamu and Babcock University Teaching Hospital, Ilishan remo, Ogun State.The study was limited by closeness in the distance between the experimental and control group settings.

1.7 Significance of the Study

Nurses would benefit from the study as the outcome would further assist them to improve their clinical performance and decision making. Nurses would also benefit from the study because the training programme would improve their knowledge and practice concerning pressure ulcer prevention and treatment. This study would be beneficial to nurses because the training programme would help translate available knowledge into clinical decision making during practice. The study would be of great benefit to nurses as the outcome would increased time required for nurses’ to give quality nursing care to patient.

The training programmes would transform information on pressure ulcer prevention and treatment into a more usable process that would assist nurses with the transfer of evidence based findings into clinical practice and aid optimal clinical decision making, thus enhancing patients care and outcome. Patients would benefit from the study as the outcome would positively influence patients’ satisfaction about care, cost of care, length of hospital stay, pressure ulcer incidence and prevalence, pressure ulcer morbidity and mortality rate. The hospital management would benefit from the study as it would positively influence the utilization of hospital resources for better purposes.

  

 

1.8 Operational Definition of Terms

Operational definition was utilized to define the following terms in the study:

  • Effect: outcome ofa nurse-led training programme on pressure ulcer prevention and treatment measured by knowledge and practice score of nurses.
  • Nurse-led training programme: guidelines and instructions on pressure ulcer prevention                                                          and treatment developed and implemented by a nurse.
  • Nurse: an individual trained and registered to offer nursing care and working in the medical and surgical unit.
  • Prevention:measures taken by a medical and surgical nurse to protect patients from pressure ulcer development.
  • Treatment: measures taken by a medical and surgical nurse to stop the progression of pressure ulcer.
  • Pressure ulcer: a skin or tissue damaged due to persistent pressure, friction or moisture.
  • Teaching hospital: a hospital that offers tertiary healthcare services to people and clinical training to health professionals.
  • Knowledge: nurses understanding regarding pressure ulcer prevention and treatment as measured by knowledge score.
  • Practice: nurses activities regarding pressure ulcer prevention and treatment as measured by practice score.

 

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