CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter describes the background of the study, problem statement, research objectives, research questions, significant of study, justification, scope of study, and operational and conceptual definitions of terms.

1.1. Background of the Study

An open fracture is an injury in which the fracture site communicates with the external environment with an increased risk of wound infection (Chunteng et al, 2021). Open fractures are one of the most common forms of penetrating trauma, and is the leading cause of dead in low and middle income countries amongst ages of 18-35 years (Theopile et al., 2020). A survey sponsored by the World Health Organization (WHO) demonstrated a prevalence of open fractures ranging from 3-21%, with wound infections accounting for 5-34% of the total. (WHO.2019).

Open fractures can result from direct violence where the bone breaks at the site where the force was applied, or indirect violence where the fracture occurs some distance away from the site where the force was applied and or muscular violence due to a sudden forcible contraction of a muscle attached to a bone, causing it to break. Typically death from open fractures is due to organ failure and other complications (Riviello, 2010). Open fractures are associated with a high risk of infection.

The prevention of infection is a single most important goal, influencing peri-operative care of patients with open fractures (Paul et al,2016). Nurses have a role of establishing standards of care and a work setting that promotes safety, education of patients and quality care. Therefore the philosophy of Dr. Jean Watson on “Theory of Transpersonal Caring” was used in

This project.  (Alligood et al, 2010). Watson’s research on caring has been incorporated into education and the theory of human caring involves a more holistic treatment for patients. As opposed to just using science to care for and heal patients, the theory of human caring is the idea that being more attentive and conscious during patient interactions allow for more effective and continuous care with a deeper personal connection. (Watson, J.,1979). Surgical care carried out within the first six hours of injury reduces risk of disinfection rates. Early immobilization, wound debridement, antibiotic and anti -tetanus drug administration are important steps taken to prevent infections in patients with open fractures (Andrew, 2019).

In 2015 road traffic accidents resulted in 67 million injuries worldwide. This resulted in about 2.9 million hospitalizations and 238,000 dying from wound sepsis and other complications like hemorrhage shock. (Lozano R. et al, 2012). Open fracture injuries are serious types of traumas requiring care in specialized units. It is estimated that 2.5 million persons in the United States

Sustain fractures requiring medical attention each year. More than 100,000 of these patients     hospitalized, and there are 12,000 deaths per year due to wound sepsis. ( Deitch EA 2020)

In Canada in 2011, statistics reveals that 37% of all cases of open fractures were acquired from ghastly car crashes, with 25% rates of wound contamination and consequently sepsis. (Copper et al, 2013). There are so many controversies as to the management of open fractures in Canada. A research carried out in Alberta Edmonton hospital in Canada reveals an increasing incidence with open fracture infections.

In India, about 700,000 to 800,000 people per year sustain significant open fractures, though very few are looked after in specialist orthopedist units. This equally results to a high mortality rates due to the  poor  knowledge  on  the  immediate  action  to  be  taken  faced  with  the  management  of  open fractures. The highest rates occur in men 16–35 years of age. Part of this high rate is related to unsafe transportation measures. (Pećanac M. et al,2013).

In Nigeria, an epidemiological research carried out by (David et al,2015) in the sub-urban teaching hospital Oghara revealed that, 52 patients with open fractures were hospitalized (31males and 21 females) and after 32 days of hospitalisation,42.5% of the wounds were infected. He reported that management was challenging due to scarcity of resources, nursing mismanagement and delayance in antibiotic commencement In the English zones of Cameroon, crisis have let to the killing of approximately 4,000 people and more than half a million people injured. Approximately 300 have presented with open fractures from machete wounds and gunshots, with many deaths resulting from massive hemorrhage, poor fracture management and osteomyelitis from sepsis ( CHRDA,2019).

In  Cameroon,  study  carried  out  by  Nana  et  al,(2021),on  the  epidemiology  of  open  fractures infections and related complications in the South- West Region ,precisely in the Mutengene, Baptist Hospital, Buea and Limbe Regional hospitals revealed that open fractures affect mostly the active group of the population  with age ranges from 18-35years.

This study therefore seeks to assess the nurse‟s knowledge on the management of open fractures at the surgical unit of the Regional Hospital Buea.

1.2.  Statement Of The Problem

Management of open fractures still remains a challenge to the health team. Statistics reveal a global infection rate of 13.24% of all open fractures worldwide (WHO,2020). Its management has known a lot of irregularities especially from the manner in which the different health structures and health personnel manage it. Risks of wound infections related to open fractures are on the rise and therefore there is need to standardize its management.

During our academic internship at the Buea Regional hospital, it was realized that days of hospitalization days of some patients admitted with open fractures were prolonged due to wounds infection. This inflicted a lot of pain and financial burden on the patients and their families as well. I equally witnessed a case of a relative who was admitted in to the surgical unit.

A diagnosis of open fracture of the right arm was made. After interventions from the health team, the patient ended up with severe necrosis and sepsis. Findings revealed late commencement of antibiotherapy, nursing itervention after the  golden  period  (6hoursafter the fracture) and  poor wound dressing technique. Therefore, I was motivated to research on the proper role of nurses in the management of open fracture, despite the fact that most of the patients still undergo a surgical procedure with open or closed reduction and internal or external fixation of the  fractured bone

1.3 Research Objectives

1.3.1. General Research Objective

Assessment of nurses knowledge on the management of open fractures at the Buea Regional Hospital.

1.3.2. Specific Research Objectives

1. To assess the knowledge of nurses on open fractures.
2. To ascertain the methods used by nurses in the management of open fractures.
3. To assess the consequences and management of open fractures.

Check out: Nursing Project Topics with Materials