Introduction

Nursing is a unique profession because it addresses humanistically and holistically, the response of clients and families to actual and potential health problems [1]. A pressure ulcers is a localized area of tissue necrosis that tends to develop when soft tissue is compressed (for a prolonged period of time) between a bony prominence and an external surface. Early action to prevent pressure ulcers such as increasing patient mobility can cut down hospital stay and reduce demands on nursing time. The frequency of pressure ulcers ranges from3% -14% globally. The incidence of pressure ulcer in hospital has been reported to be 23% to 27.5 % [2].

Prevention of pressure ulcers is a significant nursing concern. Nurses' ability to identify the patient at risk for the formation of the pressure ulcer would help to reduce the costs of treatment. A major aspect of nursing care is the maintenance of skin integrity to ensure quality of care. Pressure ulcers not only cause suffering to the patients but also increases the economical burden [3,4].

The prevalence of pressure ulcers has been reported in various studies ranging 4.7 % to 18.6 % [5-7].The occurrence of pressure ulcer among clients admitted to nursing home is between 12%.and 25% [8].  As highlighted 58% of clients with Pressure sores were above 65 years.   Therefore, prevention of pressure ulcers is major nursing priorities. The ability to find or identify clients at risk will help to maintain the health care in preventing pressure ulcers [9]. This study was conducted to assess the knowledge and practices of bed sore prevention among staff nurses working in a selected hospital of India.

Materials and Methods

A hospital based exploratory study was conducted among the staff nurses’ working in general and special wards of Christian Medical College and Hospital, Ludhiana, Punjab, India. Purposive sampling technique was used for selecting 60 respondents; thirty respondents working in general wards (Male Medical, Orthopedic and Neurology Department) and thirty from special units (Intensive Care Unit, Intensive Coronary Care Unit and Intensive Neurosurgery Unit) were included. Eligibility was based on attained a Diploma in nursing; registered nurse with atleast 6 month professional experience in respective unit.  Anonymity of the subject was maintained to protect their privacy. A semi-structured, self administered questionnaire was developed by investigator based on extensive literature reviewed and pretested with 10% of sample size (n=6) in a similar setting which was excluded from main study. Minor changes were made in response to the pilot study. International reliability was tested using Cronbach's alpha (0.7) which is considered as a reliable instrument.

In the data collection period, firstly, written informed consent was obtained from each respondent and confidentiality assurances made. A semi structured questionnaire was administered to the subjects for assessing knowledge score. They were allotted 20-30 minutes to complete after their duty hours. Secondly, participatory observation was undertaken based on checklist to assess practice of those nurses who took part in the questionnaire. Observations were undertaken across the nurses shift patterns to cover morning, evening and night. Moreover the selected time was appropriate to provide back care before signing off their shift duty.

Data was analyzed using SPSS version 17.0. Categorical variables were described as frequency and percentage while continuous variables were presented as mean, standard deviation and degree of freedom. Correlation coefficient test was used to findout if relationship existed between knowledge and practice score of bed sore prevention among staff nurses working at general and specialized unit. Association was calculated by using independent sample t test and ANOVA test for findout influencing variables of knowledge and practice of bed sore prevention among nurses.

Results

A sample of 60 staff nurses drawn purposively showed that the majority of the respondents were aged between 21-25 years of age (45%) and resided in Punjab (83.0 %). The majority were trained from private institutes (95%), held a proficiency certificate level qualification (90%) and had between 3-5 years of professional nursing experience (36%) (Table 1). 

Higher level of knowledge regarding bed sore prevention among nurses working in general ward was good (36.67%) whereas nurses working in specialized areas (53.33%) and  overall (40.0%) had excellent (figure 1).

Level of practice regarding bed sore prevention was lower (<85%) than standard skill level among nurses working in general (46.67%) as well as special unit (60.29%) and overall was (53.48). Although staff nurses working in special units had better practice percentage  score than those working in general ward , yet all of them needed improvement to come up to excellence level (figure 2).

The relationships between mean percentage score of knowledge the staff nurses was higher (67.70) as compared to their practices (53.5) with a low positive correlation (r - 0.087) (table 2). Staff nurses in general wards had (r=0.125) and nurses in special units had (r=0.005) relationship between knowledge and practice. 

According to the clinical areas of staff nurses, overall knowledge areas regarding preventing bed sore was found to be the highest (98.50%) in definition and lowest (52.50%) in clinical manifestation by semi structured self administered questionnaire (Table 3).

Finding showed that practices areas regarding preventing bed sore was found to be too low (53.48%). It showed highest mean score in planning (86.50%) and lowest in evaluation (38.83%) among staff nurses working in special units by participatory observation using checklist (Table 4).

There is no significant difference in knowledge and practice score of the staff nurses with selected variables such as age, state of domicile , training institute and professional experience and duty shift (p=>0.10)  except in professional qualification (p=<0.05) for knowledge score (table 5).

Discussion

The present study aimed to assess the level of knowledge and practice regarding bed sore prevention among staff nurses working in general and special units of selected hospital in India.

In this study, findings showed that a difference between the knowledge and practice scores between specialist and generalist based registered nurses. Such findings confirm previous research by Anju Bala et al, (2003) which found that staff nurses of special unit have higher percentage related to knowledge as well as in practice than those working in general unit [10]. This might be the reason for critical patient are more prone to get bed sore and nurses are aware of it.

Finding showed that practices areas regarding preventing bed sore was too low than standard skill level (>85%) suggesting a real need for immediate nursing intervention to upgrade their quality nursing care for high risk patients. 

Overall deficit mean score of knowledge and practice was 7.29% and 31.51% respectively (see table no 3 &4).

Finding showed that mean score of knowledge of staff nurses is 67.71% and in practice 53.49%.This finding was consistent with a similar study conducted in Spain reported that the level of knowledge of prevention intervention was 79.1%, while the level of  practice were notably lower 68.1% for preventive measures of bed sore among nurses [11]. While in a study conducted in Sweden by Kallman and Suserud reported that all respondents displayed good knowledge on prevention and treatment of pressure ulcers [12].

Professional qualification is significant influencing variable for knowledge mean percentage score of bed sore prevention among nurses (p=<0.05) but in practice non significant (p=0.10).  However, a study done by Anju Bala et al, (2003) reported that staff nurses with B.Sc degree were having significantly more skill (p=0.03) than the nurses with diploma degree (GNM).

Conclusion

Study findings concluded that SIM on bed sore prevention would help to bring awareness   among nursing personnel clinically which helps to identify high risk patients to prevent pressure sore preventing devastating effects on the prognosis of the patient. Only knowledge would not be enough for preventing bed sore but also utilizing developed protocol is equally important.  Regular assessment of skin integrity and documentation, reporting any alteration for timely initiating nursing intervention would improve the quality care to the patient resulting reduced hospital stay.

Acknowledgement

It is my great privilege to express a profound sense of gratitude and sincere thanks to Prof. Renuka Chauhan and Prof Triveni Rajappa, Christian Medical College, Ludhiana, Punjab, India for their continuous valuable guidance and support throughout the period of this study. I also gratefully acknowledge the contribution of all the nurses working at Christian Medical College, Ludhiana, India for their willingly giving their time and information for this study.

Figure1: Level of  Knowledge Regarding Bed Sore Prevention  Among Staff Nurse

Figure 2: Level of Practice Regarding Bed Sore Prevention Among Staff Nurse

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