Abstract

Pressure ulcers (PUs) are a significant health concern, particularly among bedridden patients, leading to prolonged hospital stays, increased healthcare costs, and reduced quality of life. This study assessed nurses’ knowledge and practices regarding the prevention and management of pressure ulcers at Efoulan District Hospital, Yaounde.

A cross-sectional descriptive design was employed, with data collected from 30 nurses using questionnaires and observational guides. Findings revealed that while 80% of nurses practiced repositioning, only 28.5% adhered to the recommended 2-hourly frequency. Skin inspections focused primarily on ankles and buttocks (34% each), neglecting other high-risk areas.

Management practices showed gaps in wound debridement (43.5%) and inconsistent dressing frequencies. Key challenges included staff shortages (35%), lack of equipment (25%), and heavy workload (20%). The study concludes that systemic barriers hinder optimal PU care despite nurses’ theoretical knowledge.

Recommendations include government funding for resources, hospital training programs, and curriculum enhancements for nursing schools to improve adherence to evidence-based practices.

CHAPTER ONE

INTRODUCTION

Constant pressure on an area of the skin stops blood flowing normally, so the cells die and the skin breaks down. Hence pressure sore. Other names for pressure sores are bedsores, pressure ulcers and decubitus. Pressure sores are wounds that develop when constant pressure or friction on one area of the body ulcers.

Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and pose a significant burden on patients, their relatives and caregivers Pressure ulcers have been described as one of the costliest and physically debilitating complications since the 20th century. The pain and discomfort of pressure ulcer delays rehabilitation, prolongs illness and timing of discharge, and also contribute to disability and death.

These dramatically raise health care costs as a result of the need for supplies and nursing hours. It has been estimated that the cost of treating a pressure ulcer is 2 times higher than the cost of preventing it. The objective of this work is to assess the nurse’s practice in the prevention and management of pressure sore or bed sore at the Efoulan District Hospital Yaounde.

1.1 Background of the Study                      

Pressure ulcers, “also known as bedsores or pressure sores, are localized areas of tissue damage arising due to excess pressure and shearing forces”.(Melese.et al2018).

Pressure ulcer is a preventable medical complication of immobility. It has psychological, economic and social impact on individual and family. Its cost of treatment is more than twice the cost of prevention. It is primarily the nurses’ responsibility to pressure ulcer. Pressure ulcers (PUs) prevention remains a significant challenge for nurses, and its incidence is considered an indicator of poor quality of care.

Patients and families know that pressure ulcers are painful and slow to heal. Some risk factors for the development of pressure ulcers/injuries include advanced age, immobility, incontinence, inadequate nutrition and hydration, neuro-sensory deficiency, device-related skin pressure. A person who holds a positive attitude toward an issue will have a greater possibility of performing a supportive behavior related to that issue. For example, “the more positive attitude of nurses to PU prevention, the better practice of PU prevention care demonstrated “(Nuru et al; 2015).

Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose a significant burden on patients, their relatives and caregivers. Nowadays, pressure ulcers are recognized worldwide as one of the five most common causes of harm to patients and preventable patient safety problems. In the USA, pressure ulcers remain a major health problem affecting approximately 3 million adults.

A systematic review of 31 studies found that pressure ulcers significantly limit many aspects of an individual’s wellbeing, including general health and physical, social, financial and psychological quality of life. According to an international literature, it has been identified that nurses’ knowledge of the prevention of pressure ulcers is poor, which is reflected in their practices as they do not comply with best practice guidelines. Study conducted in Sweden on nurses’ knowledge and practice of existing guidelines on prevention of pressure ulcer found that, majority of them had inadequate knowledge and practice to implement guidelines.

Similarly, a study in Belgian Hospital found that knowledge of nurses about the prevention of pressure ulcers was inadequate. Poor knowledge and practice of nurses have its own significant contribution for higher prevalence of pressure ulcers. Moreover, a study in Bahir Dar, Ethiopia found that a total of 71 pressure ulcers were detected in 422 patients, with the prevalence rate of 16.8 %.

In Cameroon, the prevalence of pressure ulcer was detected in 946 patients which fell between the ages of 50 to 70 years. in the study, 53% were males while 47% were females .385 patients were found to be at risk of pressure ulcer with the prevalence rate of 50% in the population at risk .(Marc Leory ;2016)

A systematic review of 31 studies found that pressure ulcers significantly limit many aspects of an individual’s wellbeing, including general health and physical, social, financial and psychological quality of life.

According to an international literature, it has been identified that nurses’ knowledge of the prevention of pressure ulcers is poor, which is reflected in their practices as they do not comply with best practice guidelines Study conducted in Sweden on nurses’ knowledge and practice of existing guidelines on prevention of pressure ulcer found that, majority of them had inadequate knowledge and practice to implement guidelines Moreover, a study in Bahir Dar, Ethiopia found that a total of 71 pressure ulcers were detected in 422 patients, with the prevalence rate of 16.8 Thus preventing ulcer should be the goal of all nurses but it is rarely researched in low income countries like” Ethiopia and Sweden”. (Nuru et al. 2015)

In Cameroon”,the prevalence of pressure ulcers was detected in 946 patients which fell between the ages of 50 to 70 years. In the study,53% were males while 47% were females.385 patients were found to be at risk of pressure ulcers with the prevalence rate of 50% in the population at risk”.(Marc Leory;2016).

Also there are some knowledge gaps that exist in the prevention of bed sores which include heavy workload/staff shortage, lack of universal guideline for prevention of bed sores lack of trained personnel in the prevention of bed sores, uncooperative patient/client, other priorities other pressure ulcers, shortage of pressure relieving devices, inadequate knowledge of nurse about the prevention of pressure ulcers.

1.2 Statement of the problem

Pressure ulcers have been described as one of the costliest and physically debilitating complications in the 21st centuries. Despite all the guidelines put in place, such as frequent changing of position, using of support surfaces, education on self-care and nutrition, wound care to manage patients with bed sore and facilitate healing, bedsores still stand as a major care concern affecting tens of thousands of patients and costing billions each year, there by becoming a major concern in nursing. An average of 60.000 people dies worldwide due to pressure ulcer related causes.

The exact incidence and prevalence of pressure ulcer remains unclear. Data from national pressure ulcer advisory panel (NPUAP) indicate that, the incidence varies widely from 0.4% to 38% in acute care, 2.2% to 23.9 % in long term care and 0% to 17% in 3 home care. Prevalence rate show the same variability. 10 % to 18% in acute care, 2.3 % to 28 % in long term care and 0% in home care.

Resent large national surveys suggest that the prevalence range is 10.1 % with surprisingly consistent rate found in studies of 3 multisite acute care setting 14.8%,15%. (NPUAP 2015). There for, the purpose of this sturdy is to assess the nurses practice in the prevention and management of bedsores

1.3 Objective of the study

1.3.1 General Objectives:

The purpose of this study is to assess the nurses’ practice in the prevention and management of bedsores at the Efoulan District hospital.

1.3.2 Specific Objectives

1. To assess the prevention of bedsores by the nurses at the Efoulan District Hospital Yaounde.
2. To assess the management of bed sore at the Efoulan District hospital Yaounde.
3. To determine the challenges faced by nurses in the prevention and management of bedsores at the Efoulan District hospital.

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