| Research Article (Open access) |
|---|
SSR Inst. Int. J. Life Sci., 9(5): 3307-3314, September 2023
Evaluation of Knowledge and Practice on
Pressure Ulcer Prevention among Immobilized Clients at HSK Hospital
Siddartha
Gadagi1*, Shridhar Pujar2, Deelip S. Natekar3
1Student, Dept. of Nursing, BVVS Sajjalashree
Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India
2Associate Professor, Dept. of Nursing, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar,
Bagalkot, Karnataka, India
3Principal, Dept. of Nursing, BVVS Sajjalashree
Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India
*Address for Correspondence: Shridhar Gadagi, Student, Dept. of Nursing, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar,
Bagalkot, Karnataka, India
ABSTRACT Backgrounds: The skin is an active and largest organ in our body. The skin
protects the storage of food, regulates temperature and a sense organ.
The epidermis shields underlying tissue against water loss and injury and
prevents entry of micro-organisms. The dermis continues with nerve fibres,
sebaceous blood vessels, sweat glands, and hair follicle". The data
was analyzed by using descriptive study; the sample
includes 100 caregivers.
Methods: Simple random technique was used to select the hospitals, and a
convenient sampling technique was used to select the samples for the study.
Data was collected using a structured knowledge questionnaire and
self-constructed practice scale and analyzed using
descriptive and inferential statistics.
Results: The mean percentage of knowledge scores of pressure ulcers among
caregivers of immobilized clients was 16.91% score and SD (3.59). The mean
percentage of practice scores of pressure ulcers among caregivers of
immobilized clients was 15.33% score SD (4.98). The 'r' value is (-0.05); hence
it is clear that there is a statistically negative co-relation between knowledge and practice of pressure ulcers among caregivers of
immobilized clients.
Conclusion: The study concluded no significant difference was found between
the knowledge and practice scores of pressure ulcers among caregivers of immobilized clients. Negative correlation between knowledge and practice of pressure ulcers among caregivers of immobilized
clients.
INTRODUCTION- Healthy skin
indicates the health status of a person. It protects the person from infections
and injuries. It maintains the beauty of a person. "Without healthy skin
there is no essence" [1]. The skin protects food storage,
secretes, excretes, regulates temperature, and is a sense organ. Subcutaneous
tissue insulates and cushions the skin [2].
Here the signs and
symptoms of diseases exhibited through skin are temperature variations i.e. hot
& dry skin variations, skin texture, skin turgor and wrinkling, skin rash,
scars, ulcers, and dermatitis [3]. Health is a condition where all
body and mind functions are normally active. Health is a highly individual
perception. It is an ongoing process of life [4]. Pressure Ulcer is
a common health problem in hospitals, nursing homes, and home care settings.
The incidence of pressure ulcers is estimated at 11% in skilled care and
nursing homes, 10% in acute care and 4.4% in home care [5]. Pressure
ulcer prevention begins by identifying high-risk individuals, systematically
examining the skin, using bed and chair support surfaces, and changing posture,
mobility, and nutritional support [6].
A pressure ulcer is called a bed-sore, decubitus ulcer, pressure
sore, and sometimes pressure necrosis or ischemic ulcer [7]. He
noticed that patients who developed eschar of the buttocks and sacrum died
after some time. He named this lesion "decubitus ominous," meaning
death was inevitable after developing this lesion [8]. Pressure
injury (PI) is a painful, costly, but potentially preventable problem common in
older people and patients with limited mobility [9].
The reported burden of pressure ulcer in major
hospitals, long-term facilities and home care setting was 0.4-38%, 2.2-23.9%,
and 0-17%, respectively. Intensive care unit (3-23.9%), Neuro-trauma
(3.1-13.3%), and orthopedic (8.4-34.2%) patients are more prone to develop PUs
compared to other patients [10]. While
existing research provides some insight into current practice, no previous
studies have explored the collective knowledge and attitudes across the
interprofessional team in a community setting [11].
MATERIAL
AND METHODS
Study Design-
The research design adopted for this study was a descriptive correlational
study design, where the researcher describes the existing fact on the level of
knowledge and practice regarding preventing pressure ulcers among caregivers of
immobilized clients n=100. This test was conducted among caregivers,
who are physically disabled, caregivers who are not willing to participate in
the study, caregivers who are not able to cooperate throughout the period,
people in old age, co-morbidity, alcoholics and mentally challenged and
caregivers with age group of above 18 yrs. These caregivers can read and speak
Kannada or English who are willing to participate in the study.
Instruments- This study prepared the self-administered knowledge
questionnaire as multiple-choice questions.
It consists of 30 items regarding knowledge and information on the prevention
of pressure ulcers, and a self-constructed practice scale was prepared in the
form of practice scale. It consists of 15 items regarding the practice of
pressure ulcer prevention. A seeking system is developed for the item; each
correct answer is assigned a score of one, wrong answer score of zero.
Data collection
procedures- The main study was conducted from
10-07-2022 to 25-07-2022 at B.V.V.S, HSK Hospital & Research Center
Navanagar, Bagalkot, India.
Variables of the study: Dependent variable: In this study, it refers to the
knowledge regarding the prevention of pressure ulcer among caregivers.
Independent variable: Practice regarding prevention of pressure ulcer among
caregivers.
Statistical
Analysis- The data was
analyzed by using SPSS 18 statistical package. Statistical analysis in the
present study was done with the help of Descriptive statistics such as
frequency percentage distribution and mean and standard deviation. Inferential
statistics and chi-square tests were used to analyze the association of
knowledge and practice with sociodemographic variables.
Ethical clearance-
Ethical clearance certificate was obtained
from B.V.V.S Sajjalshree Institute of Nursing
Sciences, the institutional ethical committee. Written consent was obtained
from each participant.
RESULTS Sociodemographic characteristics- Percentage-wise
distribution of subjects according to age groups reveals out of 100 subjects, depicts the majority
(51%) were belonging to 25-30 yrs of age, reveals
that the majority (51%) of caregivers under this study belong to the age group
of 25 yrs to 30 yrs. Percentage-wise distribution of subjects according to gender reveals
that out of 100 subjects, most people, 56% were Male, and 44% were females in the study. The percentage-wise distribution of subjects according
to religion is that
the majority % of people 64% were Hindu, 23% were Muslims, 13% were Christian this study. The percentage-wise distribution
of subjects according to their educational status showed that the
majority of people 43% were graduates in this study. The percentage-wise distribution of subjects according to their
Family members in their health field 21% people were from the health field, and
79% were not from the health field under this study. The percentage-wise distribution of subjects according to their
relation to the client was that the majority of people 56% were children, 26%
were others, and 18% were spouses under this study.
Assessment
of knowledge regarding preventing pressure ulcers among caregivers of
immobilized clients. Knowledge reveals that
out of 100 caregivers, the majority (68%) of caregivers had average knowledge,
(24%) of them had good knowledge and (8%) of them had poor knowledge (Table 1).
Table 1: Assessment of knowledge
regarding preventing pressure ulcers among caregivers of immobilised clients
|
Level of knowledge |
Number (f) |
Percentage (%) |
|
Poor |
8 |
8% |
|
Average |
68 |
68% |
|
Good |
24 |
24% |
Table 2: Area-wise mean, standard
deviation & mean percentage of knowledge scores
|
Knowledge
area |
Max score |
Knowledge
scores |
|
|
Mean SD |
Mean (%) |
||
|
General Questionnaires on
pressure ulcer. |
13 |
7.7 1.7 |
7.76 |
|
Questionnaires on prevention and
management of pressure ulcer among immobilized clients. |
17 |
8.6 1.7 |
8.63 |
|
Total |
30 |
16.3 3.4 |
16.3 |
Assessment of
level practice scores regarding preventing pressure ulcers among caregivers of
immobilized clients. Practice reveals that
out of 100 caregivers, the highest percentage (63%) of caregivers had average
practice, (24%) of caregivers had good practice, and (16%) of caregivers had
poor practice. Hence it reveals that most (63%) caregivers have average practice
(Table 3).
Table 3: Assessment of practice
regarding preventing pressure ulcers among caregivers of immobilized clients
|
Level of practice
scores |
Number (f) |
Percentage (%) |
|
Poor |
16 |
16% |
|
Average
|
63 |
63%
|
|
Good
|
21 |
21% |
Table 4: Mean, standard deviation
& mean percentage of practice score
|
Level of
Practice |
Max. score |
Practice
scores |
|
|
Mean SD |
Mean (%) |
||
|
Practice
scores regarding prevention of pressure ulcer among caregivers of immobilized
clients. |
30 |
15.332 4.9 |
15.332% |
The findings regarding
the association between level of knowledge scores with their selected
sociodemographic variables show that there was no significant association found
between the level of knowledge scores with their selected sociodemographic
variables such as age (c2=0.036), Gender (c2=0.002), Religion (c2=2.543), Educational status (c2=0.333),
Family members in health field (c2=2.209),
relation to the client (c2=2.580), in this calculated
chi-square correction value is lesser than the table value for sociodemographic
variables (Table 5).
Table 5: Association between level of
knowledge scores regarding prevention of pressure ulcers among caregivers of
immobilized clients with their selected sociodemographic variables.
|
S. No |
Sociodemographic
variables |
Chi-square |
Table value |
|
1 |
Age |
0.036 |
3.84 |
|
2 |
Gender |
0.002 |
3.84 |
|
3 |
Religion |
2.543 |
3.84 |
|
4 |
Educational
status |
0.333 |
3.84 |
|
5 |
Family
members in health field |
2.209 |
3.84 |
|
6 |
Relation
to the client |
2.580 |
3.84 |
The findings regarding
association between level of practice scores with their selected
sociodemographic variables show that there was no significant association found
between the level of practice scores with their selected sociodemographic
variables such as age (c2=0.426),
Gender (c2=0.027),
Religion (c2=
0.732), Educational status (c2=0.542),
Family members in health field (c2=0.643),
relation to the client (c2=2.503),
in calculated Chi-square correction value is lesser than the table value for
sociodemographic variables
(Table 6).
Table 6: Association between level of practice scores regarding
prevention of pressure ulcers among caregivers of immobilized clients with
selected sociodemographic variables
|
S.No |
sociodemographic
variables |
Chi-square |
Table value |
|
1 |
Age |
0.426 |
3.84 |
|
2 |
Gender |
0.027 |
3.84 |
|
3 |
Religion |
0.732 |
3.84 |
|
4 |
Educational
status |
0.542 |
3.84 |
|
5 |
Family
members in health field |
0.643 |
3.84 |
|
6 |
Relation
to client |
2.503 |
3.84 |
DF= 1= Not significant
DISCUSSION- The present study was conducted to discover
caregivers' knowledge and practice of immobilized clients.
To achieve the study's objectives, the descriptive study design was adopted. A
sample of 100 caregivers was selected. The present
study shows that most caregiver's
knowledge reveals that out of 100 subjects, highest percentage (68%) of
caregivers had average knowledge, (24%) of caregivers had good knowledge, and
(8%) of caregivers had poor knowledge. Hence it reveals that most (68%)
caregivers have Average knowledge.
Fahd et al. [12] supported to
perform the quasi-experimental study on the effect of the designed pressure
ulcer prevention program on caregivers knowledge of immobilized patients in
King Fahd Hospital; 64 male and female caregivers were selected randomly,
structured questionnaire was used to collect data, 96.9% of the sample had poor
knowledge with mean score of (7+3.8)
regarding pressure sore in the pre-test, but in the post-test, 93.8% of them
had good knowledge with mean score of (19.2+3.1), there was a highly
statistical difference between the 'p-value 0.001, the study concluded that
implementation of the educational programmed for caregivers showed remarkable
improvement of the caregiver's knowledge in preventive of pressure sore [12].
A quantitative cross-sectional study was conducted among
caregivers of home-based palliative care patients residing in Olavanna Panchayath, Kozhikode. Caregivers of home-based
palliative care patients at risk of developing bedsores. Samples Using the
purposive sampling technique, the need assessment was conducted among 20
caregivers of home-based palliative care patients. The obtained data were
analyzed using descriptive statistics. The results showed that the Knowledge
assessment among care providers reveals that 10% had good knowledge, 40% had
average knowledge, 50% had poor knowledge, and none had very good or very poor
knowledge. The study concluded that evidence-based clinical practice guidelines
and structured teaching programs can improve caregivers' knowledge [13].
Assessment of
level practice scores regarding preventing pressure ulcers among caregivers of
immobilized clients. Practice reveals that out of 100 caregivers, the highest
percentage (63%) of caregivers had average practice, (24%) of caregivers had
good practice, and (16%) of caregivers had poor practice. Hence it reveals that
most (63%) caregivers have average practice. Nuru
et al. [14] show that nearly half (54.4 %) of the
nurses had good knowledge; 48.4 % had good practice on the prevention of
pressure ulcer. Educational status [Adjusted Odds Ratio (AOR)=2.4,95% CI
(1.39-4.15)], work experience [AOR= 4.8,95%CI (1.31-10.62)] and having
formal training [AOR=4.1, 95%, staff shortage [AOR=0.07, 95 % CI (0.03-0.13)]
and inadequate facilities and equipment [AOR=0.4, 95 % CI (0.19-0.83)] were
found to be significantly associated with the practice on prevention of
pressure ulcer, the study concluded that knowledge and practice of the nurses
regarding prevention of pressure ulcer was found to be inadequate.
A quantitative cross-sectional study with a descriptive
correlation design implemented a modified semi-structured questionnaire using a
convenient sampling method. McDonald's standard of learning outcome measurement
criteria was used to categorize caregivers' KAP. A Pearson product-moment
correlation coefficient (r) was utilized to assess the relationships
between caregivers' KAP, with a value of 0.05 or less considered statistically
significant. The study findings indicate that caregivers had a moderate level
of knowledge (M=73.68%, SD=6.43), a neutral attitude (M=70.32%, SD=6.89), and a
moderate level of practice (M=74.77%, SD=9.08). A positive correlation existed
between caregivers' knowledge and attitude (r=0.30) and between
knowledge and practice (r=0.37). Nevertheless,
there was no correlation between attitude and practice (r=0.12,). The
study concluded that caregivers must develop a positive attitude and expand
their knowledge to improve their practice [15].
A study was conducted on a systematic review to
assess the effectiveness of static air
mattress overlays in preventing pressure ulcers. The study was focused on the
incidence of pressure ulcers, costs, and patient comfort. The methodological
quality assessment was evaluated using the Critical Appraisal Skills Program
Tool. Results were reported in a descriptive way to reflect the exploratory
nature of the review. The searches included 13 randomized controlled trials
(n=11) and cohort studies (n=2). The mean pressure ulcer incidence figures
found in the different settings were, respectively, 7.8% pressure ulcers of
categories II to IV in nursing homes, 9.06% pressure ulcers of categories I to
IV in intensive care settings, and 12% pressure ulcers of categories I to IV in
orthopedic wards. This study concluded that interpretation of the evidence
should be performed cautiously due to the wide variety of methodological and
reporting quality levels of the included studies [16].
The systematic literature review assessed the cost of pressure
ulcer prevention and treatment in adults to conform to the Cochrane
Collaboration guidelines. After assessing eligibility, 17 articles were
included. Five articles reported on the cost of prevention and treatment, three
reported on cost of prevention, and nine reported on the cost of pressure ulcer
treatment. The cost of pressure ulcer prevention per patient per day varied
between 2.65 to 87.57 across all settings. The cost of pressure ulcer
treatment per patient per day ranged from 1.71 to 470.49 across different
settings. The study concluded that the cost of pressure ulcer prevention and
treatment differed considerably between studies. The studies identified the
need to use available and study design-specific methodological guidelines to
conduct health economic studies and the need for additional pressure
ulcer-specific recommendations [17].
A qualitative study design based on
Grounded Theory was conducted on homecare support workers for people with
dependency. The research was conducted on a theoretical sample of 10 people
currently suffering from a pressure ulcer or who had experienced one in the
past, and 15 caregivers of patients who had suffered from this pathology, all
of whom came from the four health districts of Puertollano (Ciudad Real, Spain)
with in-depth interviews, the study was concluded that the specific problems
surrounding home care for pressure ulcers, including the perceptions of both
patients and their caregivers [18].
The study design was descriptive, cross-sectional, and 133
caregivers were interviewed using a semi-structured interview schedule. The
study findings revealed that 45.9% of respondents were from adjacent districts
of Chitwan, 45.9% were between the age group 16-30 yrs,
56.4% were female, 84.2% were married and 70.7% were literate. The level of
knowledge is statistically significant with area of residence (p=0.03), marital
status (p=0.02) and educational status (p=0.001) of respondents. The study
concluded that caregivers had poor knowledge regarding preventive measures.
Awareness programs need to be planned and implemented [19].
A descriptive cross-sectional study was
conducted to assess the pressure ulcer knowledge. The majority of the 90
caregivers' participants were female (60, 66.7%), 45(50%) were married, and
75(83.3%) had 1 to 10 yrs' experience in nursing
practice; 69(76.7%) had received special training on pressure ulcer prevention.
Overall, 58(64.4%) caregivers had corrected pressure ulcer knowledge and
67(74.4%) had a positive attitude toward preventing pressure ulcers. Thus, the
study concluded that nurses need to be orientated to the fact that pressure
ulcer risk screening of all patients with limited mobility is an integral part
of their job and that nurses must enlighten patients and their relatives on how
to prevent pressure ulcers [20].
CONCLUSIONS- The
mean percentage of knowledge scores of pressure ulcers among caregivers of
immobilized clients was 16.91% score and SD (3.59). The mean percentage of
practice scores of pressure ulcers among caregivers of immobilized clients was
15.33% score SD (4.98). The r-value is (-0.05); hence
it is clear that there is a statistically negative correlation
between knowledge and practice of pressure ulcers among caregivers of
immobilized clients. A finding reveals no significant association between knowledge
scores of the family members of pressure
ulcers among caregivers of immobilized client's sociodemographic variables.
A similar study can be undertaken on a large scale to
make a more valid generalization, a similar study can be undertaken in other
hospitals of Bagalkot, and a similar study can be conducted with other groups
to improve knowledge and practice
CONTRIBUTION
OF AUTHORS
Research
concept- Siddartha Gadagi, Dr.
Shridhar C. Pujari
Research
design- Siddartha Gadagi, Dr.
Shridhar C. Pujari
Supervision- Siddartha Gadagi, Dr.
Deelip S Nateker
Data
collection- Siddartha Gadagi
Data
analysis and Interpretation- Siddartha Gadagi
Literature
search- Siddartha Gadagi
Writing
article- Siddartha Gadagi
Critical
review- Dr. Shridhar C. Pujari, Dr. Deelip S Nateker
Article editing- Siddartha Gadagi, Dr. Shridhar C. Pujari, Dr. Deelip S Nateker
Final approval- Dr.
Shridhar C. Pujari, Dr. Deelip S Nateker
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