1.1Background 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.
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