KNOWLEDGE AND ATTITUDE OF NURSES TOWARDS THE PREVENTION OF DECUBITUS ULCER AND TREATMENT OF PRESSURE AREA IN IRRUA SPECIALIST TEACHING HOSPITAL

CHAPTER ONE

INTRODUCTION

• Background to the study

Pressure sores also known as bed, pressure ulcer or decubitus ulcers are skin lesion which can be caused by friction, humidity, temperature, older people, particularly those who have sustained a fractured hip or who are nursed in long term care facilities.

Pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure, shear, friction and or a combination of these conditions (Clark, Bours, Defloor, 2004). Pressure points in the body which are the bony prominence are the ones mostly affected.

An estimated 1.5 million patients develop pressure sore annually (Rochester 2009)

In Nigeria (south-south) patients develop nosocomial pressure ulcers, in patients with spinal cord injury (50%) orthopedics (38.6%) and head injury (11.4%) and other related diagnosis were the most prone to developing pressure ulcers (Onigbinde, Ayodele Teslim, June 2012, British journal Nursing, 2012). Skin problems varies from minor to catastrophic. Nurses require a wide range of skills to provide not only the necessary physical care to prevent complications but also the needed psychological support for example, prevention of pressure sore by encouraging patient to co-operate with the procedure involved in preventing the hazard. Prevention of pressure areas is a more desirable goal than successful treatment (which implies prevention is better than cure)

(Chima, 2005) states that adequate health education about pressure sore prevention can influence people’s attitudes on prevention of the development of pressure sore and it can reduce high incidence of pressure sore.Nowadays the public and the health care consumers increasingly expect to be involved in their own care they are also more conscious of the need for information related to health promotion, therefore the nurse play a major role in the prevention and management of pressure sores and in assisting individual and families to acquire the necessary knowledge and skills to promote, maintain and restore skin integrity.

The principal factor in pressure sore development is excessive tissue pressure between 20 and 33 mmHg. Therefore, pressure above this will renders death of the tissue (Burman 2007).

Critically ill patients have a lower capillary closure and are at greater risk of developing pressure ulcers when the closure pressure is increased, there is constriction of the blood vessels leading to necrosis of the affected part thereby predisposing the area to pressure sore development.

Another factor that many predispose the patient to the formation of pressure ulcer is the lack of education of the nurse. According to (Stanton 2001), In order for the nurse to be effective, they must have a sound knowledge base so that they can make an informed decision (Maylor 1997, European pressure ulcer advisory panel 1998 in Stanton 2001). Other factors contributing to tissue breakdown include friction and shearing, decreased tissue perfusion increased moisture e.t.c (Brenda, 2004).Other factors are age of the patient (66%) poor nutrition, loss of subcutaneous fat, incontinence, drug therapy and systemic illness such as diabetes mellitus (Reid and Morison 2006).The initial signs of pressure sore is erythema (redness of the skin) caused by reactive anoxia which is normally resolved in less than one (1) hour unrelieved pressure results in tissue ischemia or anoxia, the cutaneous tissue becomes broken or destroyed leading to progressive destruction and necrosis of underlying soft tissue and the pressure sore is painful and slow to heal, good understanding of these factors can help prevent and treat pressure sores early so that it does not pose problem to health.

The complications that arises include cellulitis, osteomyelitis or septicaemia, bone and joint infection, gangrene, limb amputation and death.

The researcher was opportune to work in the medical wards of Irrua Specialist Teaching HopsitalIrruaand observed that most of the very ill patients developed pressure sore. As a result of the above the researcher decided to find out about the nurse’s level of Knowledge and attitude of nurses towards the prevention of decubitus ulcer and treatment of pressure area in Irrua Specialist Teaching Hospital.

• Statement of problem

Pressure ulcer increases the risk of complication such as bacteremia, necrosis of underlying soft tissue, deformity and gangrene. It also leads to extensive rehabilitation and prolong hospitalization. In spite of these complications associated with pressure ulcer, it has been observed that most nurses are involved in negligent behaviour such as lying of patient on bare mackintosh for a long period of time when there is no bed sheet, non turning of very ill patients, improper bed making, leaving patient to lie down on sweat and urine for a long period of time. Why are some nurses careless about the patients entrusted to their care? Could it be that they do not know about the health hazard of neglecting pressure area care? Hence the topic; Knowledge and attitude of nurses towards prevention of decubitus ulcer and treatment of pressure areas among very ill patients in Irrua Specialist Teaching Hospital Irrua.

• Research questions

1. What is the level of knowledge of the respondents about prevention of pressure sore?
2. What type of attitude is developed by nurses towards prevention and treatment of pressure areas?
3. What are the factors militating against effective practice of treatment of pressure areas?
4. To what extent are they aware of patient susceptibility to pressure sore?
   • Objectives of the study

General objective

To assess the level of Knowledge and attitude of nurses towards the prevention of decubitus ulcer and treatment of pressure area in Irrua Specialist Teaching Hospital.

Specific objectives of the study

1. To ascertain the attitude of nurses towards prevention and treatment of pressure sore.
2. To determine the level of knowledge in prevention of bed sore among the nurses.
3. To ascertain the factors influencing the prevention of pressure sore.
4. To determine the level of awareness of patient susceptibility to pressure ulcer.

• Significance of the study

Pressure ulcer appear to be a significant problem amongst critically ill patients and older people; especially those who have sustained a fractured hip or who are nursed in long term care facilities. Pressure ulcer can cause physical, social and psychological suffering. Therefore, the significant of this study is that adequate knowledge, right attitude and high level of awareness among nurses of the hazardous effect of development of pressure sore will significantly aid prevention of decubitus ulcer (pressure sore) in very ill patient in Irrua Specialist Teaching Hospital Irrua.

It is hoped that this study when completed will:

1. Encourage nurses about their role in the prevention of pressure sore in very ill patient/helpless patients
2. Help the hospital management to provide articles necessary for prevention and treatment of pressure areas such as bed sheets, air rings, lion creams etc.
   • Scope of the study

The scope is focused on all trained nurses working in the medical areas of Irrua Specialist Teaching Hospital Irrua, Edo State.Irrua Specialist Teaching Hospital (formerly OtibhorOkhae Teaching Hospital), Irrua was Established by Decree 92 of 1993 to provide tertiary Health Care Delivery Services to the people of Edo State and beyond. The hospital is located in Irrua, Edo Central Senatorial District, along the Benin-Abuja highway at about 87 kilometers north of Benin City, the Edo State Capital.

• Operational definition of terms

• Knowledge: information or awareness gained through experience or education
• Attitude: A way of thinking.
• Prevention:to stop something from happening.
• Treatment: care by procedures or applications that intended to relieve illness or injury.
• Nurse: one skilled in caring for the sick. A person who is qualified in the act and science of nursing and where job is to take care of the sick or injured people.
• Nursing: The skill of caring for sick and injured people.
• Pressure area: These are areas in the body where a bony prominence lies just beneath the skin and is subjected to pressure or anywhere the moist surfaces are in continual contact e.g. Hip or buttocks, shoulder etc.
• Pressure sore: it is an ulcer which if formed at any point where pressure friction or a moist condition is prolong as a result of constraining a patient or person to bed.
• Ischaemia: This is when there is insufficient supply of blood to a specific organ e.g. the buttocks.
• Very ill patient: This is a patient that is restless in bed and whose recovering is beyond reasonable expectations.
• Pressure point: A point at which an artery lies over a bone on which it may be compressed by finger pressure.
• Practice: A way of doing something that is the usual or expected way.
• Incontinence: The in appropriate involuntary passage of urine.
• Hyperemia: The presence of excess blood in the vessels supplying a part of the body.
• Anoxia: A condition in which the tissues of the body receive inadequate amounts of oxygen.

Erythema: flushing of the skin due to dilatation of the blood capillaries in the dermis.

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