Abstract

Background: Pressure ulcers have been identified as a major burden of hospitalization worldwide, and nurses are at the forefront of prevention.

Objective: The aim of this study was to investigate the challenges faced by patients in the prevention of pressure ulcers.

Materials and methods: the instrument for data collection was a semi-structured questionnaire divided in 5 sections patterning to the various specific objectives. For validity, a pilot study was conducted to pre-test the instrument and corrections made before the final study. The populations under study were patients at the Cite des Palmiers district hospital. A sample size calculation was made using the Lorenz formula and the sample population was gotten by convenient sampling technique. A cross sectional study design was used where data was collected face to face. Data was analysed using a Microsoft Excel and results presented on graphs and charts.

Results: 50 participants were recruited in this study, majority of 26(52%) were males, as concerning, all 50(100%) of the participants had heard of pressure ulcers or bed sores, when asked the definition of pressure ulcers, the majority of 23(46%) said it is a burn. Majority of 20(40%) gave the sign of pressure ulcer to be open wound, 40(80%) said yes when asked if they always feel tired to make up your bed, when asked if they always forget to turn in bed, majority of 36(72%) said yes, majority of 80%) of the participants faced the challenge of lack of financial means to afford skin care products, on observation, majority of 29(58%) were limited by physical immobility. Majority of 39(78%) reported that they were unable to afford and maintain recommended nutrition guidelines.

Conclusions: There was a high level of knowledge on pressure ulcers among the participants on aspects such as its definition, cause and manifestations as well as recommendations for its prevention. The participants faced problems in the prevention of pressure ulcers such as forgetfulness to implement preventive measures. They also faced challenges such as physical immobility, lack of assistance; lack of motivation etc. there is therefore the need for strategies to be employed to improve the preventive practices of patients towards bedsore occurrence.

CHAPTER ONE

INTRODUCTION

Pressure ulcers (PU) are lesions or injury to the skin or underlying tissues resulting from prolong pressure over a bony prominence that may result in tissue death. It resulted from tissue compression between a bony prominence and an external surface for a prolonged period of time [1].

The consequences of pressure-induced skin injury range from non blanchable erythema of intact skin to deep bone [2]. The ulcer imposes a significant burden not only on the patient, but the entire health care system [3]. Pressure ulcers occur across all health care settings, with the highest incidence in the hospital. More recent data, however, recognized that the incidence of PU differs by care area, with patients in intensive care units, medical and surgical wards are at high risk of development of pressure ulcer [4, 10].

Globally, nurses are known to care for hospitalized patients and the presence or absence of pressure ulcers is being regarded as a performance of quality nursing care [15].

People with medical conditions that limit their ability to change positions or those who spend most of their time in bed or chair are mostly at risk of pressure ulcers. The elderly, patients with spinal cord injury and persons who are sedated from trauma or surgery are mainly at risk of developing pressure ulcers [6]. But, any person at any age could potentially develop a pressure ulcer if they were exposed to sustained unrelieved pressure, friction and shear forces for prolonged period of time [6, 7].

The incidence of pressure ulcers in adults varies from 0 to 12% in acute care setting, 24.3 to 53.4% in critical care setting and 1.9% to 59% in elderly care setting. In Ethiopia, it was reported 16.8% and 14.9% overall prevalence rate of pressure ulcer [18]. Globally, pressure ulcers accounted for 0.85 million prevalent cases, 3.17 million YLDs in 2019 [17]. In Africa, point prevalence varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11% for grades II-IV 5 [20]. In Cameroon, the cumulative incidence of PU was 20% in general and 50% in the population at risk. Prevalent PU stages were stage 2 (57.4%), stage one (30.9%), and stage 3 and 4 (10%) [21]

1.1 Background of the Study

Pressure ulcers are often considered to be largely preventable and while this may be true, health care professionals still seem to be struggling to reduce their occurrence. For example, the USA has the longest record of large‐scale pressure ulcer prevalence surveys undertaken over many years and found the rates to range between 9•2% and 15% in surveys undertaken between 1990 and 2001 [11]. Van Gilder found a slight reduction in prevalence from 13•5% to 12•3% in their surveys from 2006 to 2009 [12].The situation is similar elsewhere in the world where studies have shown some reduction, but not large reductions. For example, in Germany, there was a reduction in prevalence from 13•9% in 2001 to 7•3% in 2007 [13]. Over the same time frame, one of the states in Canada observed reduction in their prevalence rate from 18% to 14% [14]. It is not possible to prevent all pressure ulcers, and it would appear that despite provision of education and considerable resources, time and effort, the numbers of patients with pressure ulcers have not really reduced as much as it has been hoped. To try and understand this situation better, it may be helpful to review current understanding of pressure ulcers, their ethology and appropriate prevention strategies.

Pressure ulcers are defined as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure.PUs significantly limits many aspects of an individual’s well-being, including general health and physical, social, financial, and psychological quality of life [8]. In the United States, nearly 1 million people develop pressure ulcers annually, while approximately 60,000 acute care patients die from related complications [9]. The estimated cost of managing stage III/IV pressure injury per patient is $70–150 thousand, and the total cost for treatment of pressure ulcers in the United States is estimated at $9–11 billion per year [9, 10].

1.2: Statement of problem

Pressure ulcer has been identified as a major burden of hospitalization worldwide, and nurses areat the forefront of its prevention [22]. Despite efforts to prevent pressure ulcers many patients still face challenges that hinder their ability to effectively prevent these wounds. These challenges include a lack of awareness and education about pressure ulcer prevention, limited mobility and physical limitations, inadequate access to appropriate preventive equipment and resources, and insufficient support and guidance from health care professionals and financial difficulties. These difficulties not only lead to increased healthcare costs and prolonged hospital stays but also negatively impact patients’ quality of life.[23, 24].

In a bid to prevent pressure ulcer occurrence, nurses tend to neglect patients comfort: frequent repositioning could interfere with patient’s personal wish, by this I mean nurses have included frequent repositioning in their daily schedule in order to prevent bedsores and this without coming close to our beloved patients to know their feelings about this. Nurses have not implemented IEC on bedsores to patients and that is the reason why they don’t comply with nurses’ efforts, thus pressure ulcers remain inevitable.

1.3: Research Questions

1.3.1 General Research Question

What are the difficulties patients faces in the prevention of P.U.?

1.3.2. Specific research questions

1. Do patients have knowledge on pressure ulcers?
2. What are the problems patients faces in preventing pressure ulcers?
3. What are the challenges patients faces in complying to or adhering to nursing advice?

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