A qualitative study of the thoughts and experiences of the hospital nurses

providing pressure injuries prevention and management

Introduction
The main purpose of this assessment is to allow students to demonstrate their knowledge of the
various methodological approach and techniques discussed during the lesson and critically
evaluate and analyze the research publications including a detailed explanation, justification, as
well as analysis of the approach and methodologies used. Regarding an unspecified increment in
notified care facility pressure injuries of the surgical patients across one health center in Sydney,
Australia, the goal of the study was to investigate nurses' knowledge and perceptions about
pressure injuries pain assessment and management and see if there was a link between
knowledge and understanding, attitude, as well as years of work experience. The major aim of
this research is to learn more about nurses' experiences with pressure injury prevention and
treatment in a hospital context (Barakat-Johnson, et Al. 2019).

Design: A multi-site cross-sectional research was conducted.

Methods: Nurses were asked to participate in the survey online or offline that used a customized
version of something like the Pressure Ulcer Skills Test as well as the Staff Attitude Scale.

Brief Overview
Hospital-acquired pressure injuries, which include nursing services, are a commitment to quality
in health facilities and treatment. Factors outside the power of nursing personnel can obstruct the
effective execution and successful implementation of treatments to avoid pressure injuries. There
is little research on physicians' and nursing experiences with pressure injury prevention and
control in hospitals. Pressure injuries are common in intensive care units and the hospitalized
patients, with rates ranging between 5% through 32% dependent on the individuals studied. Age
and experience, reduced mobility, comorbid conditions, and nutritional deficiencies are all risk
factors (European Pressure Ulcer Advisory Panel). When individuals with all these risk
characteristics are brought to the hospital, they are frequently admitted to a geriatric unit.
Pressure ulcers are described as regions of localized injury to the skin and underlying tissue
caused by pressure or pressure combined with shear, generally over a bony prominence (Alharbi,
et Al. 2020).

They cause discomfort, immobilization, and recuperation time, as well as affecting health-related
and wellness standards of living. Additionally, complications developed in the hospitals, such as
pressure ulcers, are more expensive than other types of inpatient difficulty. As a result, pressure
ulcer protection is a statistically significant healthcare concern both regionally and globally.
However, further research into innovative techniques for the prevention, management, treatment,
and management of pressure ulcers is needed, as well as ensuring that practice is recommended
as first-line evidence. It's possible that pressure injuries can be avoided and preventative
measures are frequently viewed as a nursing issue. Various techniques can also be used to focus
on a methodical and organized risk assessment among all hospitalized patients, including
reassessments as the patients' circumstances change. According to research by Saving et al.,
technologies aimed at avoiding pressure ulcers, such as pressure-relieving mattresses, reduced
the need for repositioning planning. In the Danish setting, avoiding pressure ulcers formed part
of the healthcare quality initiative at Odense University Hospital, which began in 2012. The
program created an internal structure with the goal of determining the number of pressure ulcers
and their causes, as well as developing a pressure ulcer prevention guideline. According to the
study, the personnel had an insufficient understanding of pressure injuries and how to treat them
(Barakat-Johnson, et Al. 2020).

A straightforward depiction of an idea is a research methodology. The researcher puts an

emphasis on the data collected throughout the analytical procedure and throughout the graphs
and charts and also the presentation of the data. It's a representation of the respondents'
experience written in a language that's comparable to their own. The qualitative research method
was moderate, allowing for changes during the procedure to improve that the focus was on areas
that had not before been addressed. The researcher's views, preferences, sensitivities, and
sensibilities influence the interpretations of the themes that emerge. According to the Danish
law, and ethics committee clearance was not required based on the research design. All of the
participants signed an informed consent form. Personal data were stored in accordance with
Danish legislation in accordance with good professional practice as well as confidentially
(Garner, 2019).

Various studies utilizing various tools, cutoff points, and healthcare practitioners have been
conducted to assess nurses' understanding of pressure injury prevention (assistant, registered, and
students). Only 23.5 percent (130/553) of caregivers in Belgian institutions had a 60 percent
manner that ensures pressure injury prevention, according to cross-sectional multinational
research. Demarr'e et al. found that professional nurses including medical assistants (n = 145) in
nursing home residents had a poor mean level of knowledge (28.9%). In comparison, a study of
healthcare professionals in a Swedish hospital revealed that all respondents were well-versed in
the prevention and treatment of pressure ulcers. Gunningberg et al. investigated the mitigation of
PUs on hospital wards and discovered that more than 50 % of participants (60 percent mean
score) had a learning deficiency. Healthcare practitioners (n = 742) had a PU level of knowledge
that was below the average (51.1 percent, 13.3/26) on Pressure ulcer prevention, according to
Simonetti et al. Furthermore, Qaddumi & Khawaldeh concluded that the majority of Nurses
working (73 percent) lacked knowledge of infection prevention and control that was below the
national average. Nurses, on the other hand, got the lowest scores in the themes of PU etiology,
preventative strategies to minimize stress and strain, and hazard identification.

Although PU is a growing concern in developing countries due to increasing demographic

changes and the prevalence of chronic obesity and metabolic disease, it's not really the culture of
Ethiopian nurses to examine patients who are at risk or have acquired PU before admitting them
towards. It is also clear that resources utilized to increase nurses' knowledge and expertise with
current evidence-based works might improve the quality of patient care in Ethiopian society are
limited. Some of the examples are restricted internet connection, a lack of libraries to obtain
opportunities for learners (articles including updates on PU), and in-service instruction on PU or
its mitigation.

Several public hospitals are used in the study, which also included a teaching hospital (Wollega
University Referral Hospital) as well as five public referral hospitals (Nekemte, Gimbi, Nedjo,
and Shambu). The authors purposefully chose five hospitals out of 10 where a significant
proportion of patients are seen, referred, and hospitalized. College's major town (Nekemte) is
located 330 kilometers west of Ethiopia's national capital, Addis Ababa. The statistical analysis
was done using a single figure that shows the result calculation with a 54.4 percent Proportionate
assumption, a 95 percent confidence level, and then a 5% measure of dispersion. A corrective
formula was applied since the demographic source was little than 10,000 (n = 420). With a 10%
systematic error rate, the sample size of this study was 220. The number of individuals in each
selected hospital was then calculated using a proportional population sample to ensure a similar
percentage of participation (Uzelli Yilmaz, et Al. 2021).

Because English is a means of teaching in Ethiopian nursing schools, the questionnaire was
given and also administered in that language. There were three components to the questionnaire
that was utilized to collect information. Demographic variables such as sexual identity, age,
years of healthcare practice in the healthcare profession, degree of current higher learning,
resources of PU information, read publications about PU, and learning exposure to Pressure ulcer
prevention was produced as part one among the information gathering. Section 2 of the data
collecting instrument was the Pressure Ulcer Knowledge Test Tool (PUKT), which was designed
as well as approved by Beeckman et al. in an English form to measure participant understanding
about pressure sores with satisfactory consistency and stability. The complexity, discrimination
index, and reliability of the response choices were all verified for this tool. The full processing
one-week test-retest interclass coefficient of correlation (stability) was 0.88, while the internal
consistency reliability (Cronbach's) was 0.77. The content validity index ranged between 0.78
and 1.00. The subjects' item difficulty indexes varied from 0.27 to 0.87, while item
discrimination scores varied from 0.29 to 0.65 (Ibrahim, & Mokhtar, 2020).

The final section of the data collecting instrument included a list of obstacles to Pressure ulcer
prevention effectiveness. These tools and resources were created using information from the
research. Several of the tool's elements have been changed since they aren't appropriate to
Wollega nurses. Nurses were given two alternatives (‘Yes' or ‘No') for selecting obstacles that
prohibit them from executing PU preventive points. It was used to find out what nurses thought
were the biggest obstacles to practicing PU prevention. Data were cleaned, input into the
computers using EPI dataset version 3.1 statistical programs, and accuracy of record-keeping
was verified. For data processing, IBM Corporation's Statistical Package for The Social Sciences
(SPSS) edition 20.0 (Armonk, NY) was utilized. Category variables are expressed as descriptive
and inferential statistics. The standard deviations as well the means of the dependent variable
were calculated. To evaluate the mean scores of independent ( unrelated ) groups, the Mann-
Whitney U, as well as Kruskal-Wallis H tests, were employed. A p-value of less than 0.05 was
used to evaluate the significance.

Discussion and Conclusion

The most prevalent impediments to nurses practicing pressure sores treatment were found using
a descriptive study. Staff shortages workload (116, 54.7%), a scarcity of pressure-relieving
equipment (117, 55.2%), a lack of proper training (110, 51.9%), and a lack of interdisciplinary
initiative (110, 51.9%) were the main burden. The goal of this study, which employed a
multinational cross-sectional design, was to look at nurses' understanding of pressure injury
prevention in Wollega public hospitals, as well as identify nurses' impediments to practicing
pressure injuries treatment. The findings reported that employees at Wollega hospitals had a
limited understanding of pressure ulcer prophylaxis. Only 18 (8.5 percent) of nurses
outperformed the national average (answered 13 out of 26). Our study found a lower average
level of knowledge (0.43), which is consistent with Tirgari et al., who used the same
questionnaire to investigate 89 Iranian critical care caregivers and found a mean score of 0.44 for
pressure sores understanding (Hashim, et. Al 2021).

The results, nevertheless, are lower than those reported from previous research using the same
measuring equipment. And using the same cutoff threshold, Qaddumi & Khawaldeh found that
Jordanian caregivers are better educated about Pressure ulcer prevention compared to nurses
working in public hospitals in Wollega. Similarly, Beeckman et al. observed a level of
knowledge of 49.6% among 533 Belgian caregivers in multicenter research using the same test
and a cutoff criterion of 60%. The research also discovered that nurses' knowledge scores are
unaffected by their educational level (p = 0.72). Nevertheless, other researches show that people
who have finished post-secondary studies have an improved knowledge score. Additionally,
nurse practitioners' year of study (p = 0.001) and the number of departments visited during
clinical setting (p = 0.001) were shown to be strongly associated to education level by Simonetti
et al. Nurse practitioners with the relatively long working period, preceding formal training and
skill set, and then who collaborate in intensive care health institutions or emergency departments
had a relatively high level of knowledge, according to Hulsenboom et al.   According to a study
of Turkish caregivers, nurse practitioners who researched news stories on PUs (P =.002) or who
had previously attended a presentation on PUs had a better level of understanding. In contrast to
the current study's findings, Tiragari et al. found a significant difference between past exposures
to PU instruction. Inadequate information isn't the only reason people don't practice preventive.

A low level of education, as well as training, was also highlighted as a perceived obstacle by
regular nurses. Regular training programs and re-evaluation of PI protection recommendations
and guidelines can help nurses keep their understanding of pressure ulcer prevention up to date.
Keast et al. also suggested that educational institutions for the reduction of PUs be systematic,
organized, and thorough and that they be reviewed on a regular basis to integrate new evidence
and technology. In our nation, Ethiopia, there is no structured training or policy in place to avoid
PU.

Nurses are well-versed in pressure injury avoidance and they also have a favorable attitude
regarding it. More time spent in employment is linked to more positive views. More study is
needed to look at the links between clinical knowledge and practical experience and attitudes
towards pressure injury prevention. More study is needed to see if bettering understanding and
attitudes lead to a persistent decrease in hospital-acquired and healthcare pressure injuries. The
above research study indicates that a more percentage of nurses and the majority of the
caregivers lack the necessary expertise to avoid pressure ulcers. The PU understanding score of
nurses who read publications and attended training indicated a substantial change. The most
commonly reported nurses' hurdles to practice PU management were a deficiency of pressure-
reducing equipment, a scarcity of staff/heavy-duty, and insufficient training. In-service learning
training, including and emphasizing pressure ulcer prevention in nursing programs, and
establishing recommendations are among some of the key aspects to increase nurses'
understanding of infection prevention and control of the pressure. More empirical studies are
needed to assess the actual practice of Pressure ulcer prevention instead of the perception of it
(Barakat-Johnson, et Al. 2018).

There are several limits and limitations to the research that should be noted. Participants who
were chosen at random would have been less motivated to accomplish the information
assessment, and the findings may have been inadequate. Given the significance of using
validated equipment, no pretest was done. Furthermore, even though nurses were told not to
share thoughts or responses with one another, disseminate information, or consult textbooks
while filling out the questionnaires, researchers have no way of knowing if they followed this
advice. Because the PIPB was created as well as tested in hospitals, it is unknown if it can be
utilized in other contexts such as nursing home residents, long-term care, or assisted living
facilities; therefore, more investigation is necessary. Finally, it should be noted that the
quantitative characteristics of the PIPB assessment were evaluated in a sample of Spanish-
speaking nurses using the Spanish version of the questionnaire. This limits the generalizability of
the findings to other situations and languages; the Translated English version of the PIPB
questionnaire needs to be tested in a variety of English-speaking groups before being used.
Therefore, more research with a representative group of the target demographic is needed to
validate the questionnaire's applicability, generalisability, and understandability. Its four-
component structure allows for the computation of an overall score as well as individual factor
scores. The characterization of perceived obstacles is a critical first step in determining if they
are genuine barriers and whether adjustments or changes are required to implement PIs
preventative actions. The main point is that whatever the situation is, the nurses should be fully
trained and educated, and then only they should be given the responsibilities of the PU care
(Perez, et Al. 2021).
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