WACHEMO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF SURGICAL NURSING
ASSESSMENT OF NURSES KNOWLEDGE ABOUT FRACTURE MANAGEMENT
AND ASSOCIATED FACTORS AT NIGIST ELENI MOHAMMED

MEMORIAL,COMPREHENSIVE SPECIALIZED HOSPITAL,HOSANNA,

ETHIOPIA, 2023
Mr. EYOEL A (BSc, MSc)
Mr.Ayalnesh M (BSc, MSc)
A PROPOSAL SUBMITED TO COLLEGE OF MEDICINE AND HEALTH SCIENCE,
DEPARTMENT OF SURGICAL NURSING WACHEMO UNIVERSITY IN PARTIAL
FULFILMENT OF THE REQUERMENTS FOR THE DEGREE OF BACHELORS SCIENCE
IN SURGICAL NURSING

AUGUST, 2023
HOSSANA, ETHIOPIA

i
 WACHEMO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF SURGICAL NURSING

Name of investigators Firomsa Mosisa

Name of advisors
Full title of the research project
Duration of research
Study area
Total cost of the project
Dawit Abiye
Muluken Esubalew
Betehelihem Nigus
Mr. EYOEL A (BSc, MSc)
Mr.Ayalnesh M (BSc, MSc)
Assessment of Nurses Knowledge about Fracture
Management and Associated Factors at Nigist Eleni
Mohammed Memorial,Comprehensive Specialized
Hospital, Hosanna, Ethiopia, 2023
From ------ to -----2023
Nigist Eleni Mohammed
Memorial,Comprehensive Specialized
Hospital, Hosanna, Ethiopia
2,245 ETB

ii
ACKNOWLEDGEMENT
Firstly, we would like to thank almighty god. We would also like to extend our deepest thanks to
Wachemo University College of Medicine and Health Science Department of Surgical Nursing
for giving us the chance to prepare this proposal. In addition, our special gratitude goes to
Mr.Eyoel Abate and Mr.Ayalnesh for their valuable advice, comments, and suggestions
throughout the preparation of this proposal. Finally, we would like to thank our families and
close friends for their encouragement.

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Table of Contents
ACKNOWLEDGEMENT.................................................................................................................................iii
List of tables................................................................................................................................................vi
List of figures..............................................................................................................................................vi
Abbreviation or Acronyms........................................................................................................................viii
SUMMARY...................................................................................................................................................1
CHAPTER ONE..............................................................................................................................................2
1. INTRODUCTION...............................................................................................................................2
1.1. Background.......................................................................................................................................2
1.2 Statement of the problem.................................................................................................................3
1.3. Significant of the study.....................................................................................................................4
CHAPTER TWO.............................................................................................................................................5
2. LITRATURE REVIEW..................................................................................................................................5
2.1. Over view of fracture........................................................................................................................5
2.2. Types of fracture...............................................................................................................................5
2.3. Overview of fracture management...................................................................................................6
2.4. Nurses’ knowledge about fracture management.............................................................................6
CHAPTER THREE..........................................................................................................................................8
3. OBJECTIVES..............................................................................................................................................8
3.1 General objective...............................................................................................................................8
3.2. Specific objective..............................................................................................................................8
CHAPTER FOUR............................................................................................................................................9
4. METHODS AND MATERIALS.....................................................................................................................9
4.1. Study Area........................................................................................................................................9
4.2. Study period.....................................................................................................................................9
4.3. Study design.....................................................................................................................................9
4.4. Source of population........................................................................................................................9
4.5. Study population..............................................................................................................................9
4.6. Eligibility criteria...................................................................................................................................9
4.6.1 Inclusion criteria.........................................................................................................................9
4.6.2 Exclusion criteria.......................................................................................................................10
All nurses who aren’t at the work place during data collection period.............................................10

iv
 4.7. Sample size determination.............................................................................................................10
4.8. Sampling procedure........................................................................................................................10
4.9. Data collection methods and technique.........................................................................................10
4.10. Study variable...............................................................................................................................11
4.10.1. Dependent variable...............................................................................................................11
4.10.2. Independent variable.............................................................................................................11
4.11. Operational definitions.................................................................................................................11
4.12. Data quality control......................................................................................................................11
4.13. Data processing and analysis........................................................................................................12
4.14. Ethical consideration....................................................................................................................12
4.15. Information dissemination...........................................................................................................12
5 – Work plan............................................................................................................................................13
6 –Budget breakdown...............................................................................................................................13
7. REFERENCES..........................................................................................................................................14
ANNEXES...................................................................................................................................................17

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List of tables
Table 1 Work plan for the assessment of nurse knowledge about fracture management and
associated factors at Nigist Eleni Mohammed Memorial, Comprehensive Specialized Hospital,
Hossana, Ethiopia, 2023................................................................................................................13
Table 2 Budget breakdown of the assessment of nurse’s knowledge about fracture management
and associated factors at Nigist Eleni Mohammed Memorial Comprehensive Specialized
Hospital, Hossana, Ethiopia, 2023.................................................................................................13
Table 3 Questionnaires socio demographic characteristics...........................................................17
Table 4- Knowledge assessment and associated factors regarding fracture management............18

List of figures
No table of figures entries found.

vi
vii
Abbreviation or Acronyms

viii
ix
SUMMARY
Introduction: Fracture is a complete or incomplete disruption in the continuity of bone structure
and it defined according to its type extent. The nursing staff plays a main role in health
promotion for persons with fracture.
Fractures are blows in bones and defined as a medical condition in which there is a break in the
continuity of the bone. Fracture can caused in a variety of ways but there are three common
causes such as traumatic fracture (Accident), osteoporosis, and stressor or over use (13).
Objective: To assess nurse’s knowledge about fracture management and associated factors at
Nigist Eleni Mohammed Memorial,Comprehensive Specialized Hospital, Hosanna, Ethiopia,
2023
Method: The study will be conducted at Nigist Eleni Mohammed Memorial, Comprehensive
Specialized Hospital, Hosanna, Ethiopia, 2023. Institutional based cross sectional design will be
used and simple random sampling technique will be implemented to select 155 nurses. An
institution-based cross-sectional study will be conducted from --- to ------ 2023. Data will be
collected by face-to-face interviews by using pre tested structured questionnaire.
Work plan: The study will be conducted starting from --- 2023 to -----2023.
Budget breakdown: 2,245 ETB will be required to carry out the study.
Keywords: Fracture, Nurse’s Knowledge, and Management.

1
 CHAPTER ONE

1. INTRODUCTION

1.1. Background
Fracture is a complete or incomplete interruption in the continuity of bone structure and defined
according to its type and extent. Fractures happen when the bone exposed to stress greater than it
can absorb. Fracture can be cause by direct blows, crushing forces, twisting motions, and
extreme muscle contractions (1).
However, traumatic injuries are reason for the majority of fractures; some fractures are
secondary to a disease process like pathologic fractures from malignance or osteoporosis. When
bone is broken adjacent structure are affected which might result in soft tissue edema, bleeding
into the muscles and joints, rupture tendons, nerves and blood vessels damaged. Body organs
might injured by the force that caused the fracture or by fracture fragments (2).
There are many factors for incidence of fracture such as age greater than 40 years, bone loss,
cigarette smoking, comorbidities (e.g. diabetes rheumatoid arthritis), corticosteroids, NSAID,
extensive local trauma, and inadequate immobilization (1).
Hip fractures are common in older adults with 90% of these fractures resulting from a fall.
Greater than 320,000 patients are admitting to hospitals annually due to hip fracture. By age 90,
approximately 33% of all women, and 17% of all men will be have sustained hip fracture (3). In
adults, more than 65 years old, hip fracture occurs more frequently in women than in men
because of osteoporosis. By age 80, one in five women have hip fracture due to the loss of bone
density speeds up dramatically after menopause, which is contributes to maintaining bone
density and strength. Many older adults with hip fracture develop disabilities that need long care
(2).
Femoral shaft fracture happens with a severe direct force because the femur can bend slightly
before an actual fracture occurs. Young adults have a higher incidence of this type of fracture.
The force exerted to cause fracture such as from motor vehicle crush or gun shoot wound often
damages the adjacent soft tissue structures (2).
The nursing staff plays a key role in health promotion and important of health and wellbeing of
fracture patient. Due to better knowledge of its determining causes, it is now possible and easy

2
access for the diagnosis and treatment options before fragility fractures occur, providing a real
prevention to such complications (4).
Nurses have a great role and several responsibilities to prevent complication and while healing
by constant and timely observations. Maintaining skin care needed to reduce the risk of pressure
ulcers, constant and timely turning, and positioning patients, and teach exercise to maintain the
affected side (4).
1.2 Statement of the problem
When fracture occurs, it can cause injury to the muscles, nerves, or blood vessels in the adjacent
area. The damage may be permanent if it is not discover and treat on time. Approximately 5% to
10% of all fractures have delayed healing resulting in continued morbidity, increased utilizing of
health care services, significant economic consequences, and adverse effects on the quality of
life (5).
The cause for the incidence is multifactorial and often complicated by such factors as the
patient’s age, sex, co-morbidities, life style, physiological status, and occupation. In the United
State, 5.6 million fractures occur each year, corresponding to 2% incidence (6).
Study conducted at Addis Ababa University, Medical Faculty Tikur Anbessa Hospital (TAH)
shows that from the total of 422 adult patients who presented to the emergency department of
(TAH) and had musculoskeletal injures, in nearly half, 49.7% (202 patients) the cause of injury
was road traffic accident (RTA). The highest frequency of fractures happened in the femur
(15.8%) followed by tibio-fibular (14.4%) and hummers (12.9%). Incomplete fractures
comparatively accounted smaller proportions, 23 (11.4%). Transverse fractures stand out the first
125 (61.9%) followed by oblique 38 (18.8%) and comminuted 29 (14.4%) fracture (7).
The management of fracture takes up more time and resource. Surgical fixation of fracture
fragment can give adequate stability and short hospital stay. External fixation is common method
in open fracture treatment. Bone healing may extend for more than 7 months so the patient
requires special and long-standing care for these devices (8).
Orthopedic patient has three types of complication these are complications associated to bone
fracture, complications related to surgery-immobility, and complications related to biomaterial
implant. Around 70% of patients experience complications such as infections, which can delay
healing. Among these complications, pin site infection is the most common infection among

3
patients who have undergone external fixation, and about 20% of these suffer from major
infection while 80% suffer from minor infection (9).
Fractures are common with younger people resulting from high-energy physical trauma such as
motor vehicle accidents and usually occur in the absence of any underlying disease. Nursing is
deliberate as caring for patients in a set of health-related situations. Completely functioning
musculoskeletal system is important for optimal health in the normal active human being,
damage or illness involving the system can have a profound effect on an individual’s ability to
perform the activities of daily living and can result in temporary and permanent disability. So,
nurses play major and vital roles to prevent further injury reduce the risk of immobility
complications resulting from orthopedic devices as traction, external and internal fixators,
promote healing, maximize independence and promote optimal rehabilitation. This caring also
involves teaching about health and the prevention of the illness (10).Nurses play a main role in
playing higher standards of health (11). However, we know little about nurses’ knowledge of
fracture management and associated factors in Addis Ababa. Therefore, the purpose of this study
will be to assess nurse’s knowledge about fracture management and associated factors at Nigist
Eleni Mohammed Memorial, Comprehensive Specialized Hospital.
1.3. Significant of the study
The findings of the study will be serving as an input for health education program that will be
undertake by different organization related to fracture management. In addition, this study will
be have important implications for health intervention programs and with a view of adding to the
existing body of knowledge as well as help for improving care in the study area in particular and
as the country in general. Finally, it helps other researcher as baseline to conduct further research
related issue.

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 CHAPTER TWO
2. LITRATURE REVIEW
2.1. Over view of fracture
Bone tissue delivers compact support for the body, protects vital organs such as those in the
cranial and thoracic cavities, and harbors containing bone marrow where blood cells formed. A
typical bone ailment is fracture, which occurs when the bone is not able to withstand outside
force like direct blows, twisting injuries and fall (12).
Fractures are blows in bones and defined as a medical condition in which there is a break in the
continuity of the bone. Fracture can caused in a variety of ways but there are three common
causes such as traumatic fracture (Accident), osteoporosis, and stressor or over use (13).
2.2. Types of fracture
All fractures can broadly describe as closed or open fracture. Simple fractures (more recently
called “closed fracture”) are not obvious as the skin has not ruptured and remains intact.
Compound fractured (now commonly called “open fracture”) break the skin, exposing the bone,
and causing additional soft tissue injury and possible infection. A single fracture means that one
fracture only has occurred and multiple fractures refer to more than one fracture occurring in the
same bone. Fractures are termed complete if the break is completely through the bone and
described as incomplete or “greenstick” if the fracture occurs partly across the bone shaft. This
latter type of fracture is often the result of bending or crashing forces applied to the bone. A
complicated fracture is a fracture of the bone combined with a lesion of an organ, artery, and
nerve bundle or joint (14).
Osteoporotic fractures mostly affect the spine and hip, less frequently the wrist, pelvis, and
proximal humerus. Some of these fractures are also associated with an increased mortality, with
an incidence of around 24% in the first year after a hip fracture.
In addition, these fractures cause significant problems in terms of economic resources. In most
European countries, the annual costs associated with hospitalization for fractures (in terms of
length of hospitalization) where higher than they are due to other chronic illnesses such as
chronic obstructive bronchial pulmonary disease, stroke, and myocardial infarction (4).
Fracture is the most traumatic large-organ injuries in human. Successful healing depends on a
complex biological process that results in fracture union (5).

5
Cross sectional study in India showed that fracture was the commonest injury among the victims
of non-fatal road traffic accidents, and the common people who suffer were in the productive age
group of 18-37 years (15).
2.3. Overview of fracture management
The management of orthopedic settings clarification for a variety of factors that includes casts
and supports, braces medications, surgery, and rehabilitation therapy. Orthopedic medical device
has been extremely successful in restoring mobility, reducing pain and improving the quality of
life for millions of individuals. Fracture management modalities include a wide variety of
devices including wires, pins, screws, plate’s spinal fixation devices, and artificial ligaments
(16).
Nursing management is a service based on scientific knowledge and skills, as well as, trust, that
the nurse will be done what is right, needed. In addition, what will be benefited the patient and
their well-being (17)
2.4. Nurses’ knowledge about fracture management
A cross sectional study showed that at university of Baghdad the orthopedic nurses have
inadequate or deficit knowledge in aspects related to postoperative care for the patient
undergoing external fixation surgery in orthopedic wards (9).
The other study conducted in Iraq related that 70% of nurses had poor knowledge about fracture
management and in another study conducted in Medial city there is inadequate nurse’s
knowledge in the orthopedic wards regarding nursing management of patients with multiple
fracture (18).
A descriptive study in Iran indicated that the orthopedic nurses have inadequate or deficit
knowledge of wound management in orthopedic wards. No significant relationship found
between orthopedic in nurse’s practice and their gender, years of employment in nursing field,
years of experience orthopedic wards and duration of the training sessions. While a significant
relationship was to found between orthopedic nurses and their age, marital status, level of
education, sharing in training session and the number of training session that orthopedic nurses
were engaged to it (19).
According to study conducted in China nurses have low knowledge regarding osteoporosis in
orthopedic ward and there is significant variation on educational level factor associated with

6
better knowledge including age (36-45 years), marital status (married) and educational status
(bachelor degree or above) (21).
A quasi-experimental research done in Egypt shows that unsatisfactory knowledge about skin
traction and their complication according to the result of highest percent of nurses didn’t
attended any training before the implementation of the educational protocol. While there was an
improvement in the level of knowledge post implementation of the protocol, which observed
that, the majority of the nurses have a satisfactory of level of knowledge in follow up. Therefore
there was high significant statistical difference in total nurses knowledge about skin traction (11).
Study done in South Africa Stellenbosch University shows that knowledge and clinical practice
of nurses for adult post-operative orthopedic pain management so the majority of respondents
experienced and permanent nurses employed on day duty for more than five years’ experience
after their basic qualification. Their years of experience should demonstrate high clinical skills
and knowledge of pain management. However, few respondents had obtained the diploma in
orthopedic nursing science, which could have an impact on optimal pain management in the
orthopedic wards (23).
In Ethiopia, there is no literature on nurse’s knowledge on fracture management but there are
related articles in surgical ward about nurse’s knowledge on palliative care and it shows that
majority of nurses have poor knowledge about palliative care in orthopedic ward (24).
According to the study conducted in southern Ethiopia, Hawasa showed that there is low nurse’s
knowledge about post-operative pain management (25).
There is no direct literature related associated factor that affect nurses knowledge about fracture
management, but there is associated factors that affect nurses knowledge to ward pressure ulcer
management in surgical ward. Cross sectional study conducted in Addis Ababa, Ethiopia by
2015 showed that there is negative effect on nurse’s knowledge due to the absence of standard
guideline, nurses who work in settings lacking specific policies and guidelines towards pressure
ulcer prevention that has poor knowledge (27).

7
CHAPTER THREE
3. OBJECTIVES
3.1 General objective
 To assess nurses knowledge about fractures management, and associated factors at Nigist Eleni
Mohammed Memorial,Comprehensive Specialized Hospital, Hosanna, Ethiopia, 2023.
3.2. Specific objective
 To determine nurses knowledge about fractures management and associated factors at Nigist
Eleni Mohammed Memorial, Comprehensive Specialized Hospital, Hosanna, Ethiopia, 2023.
 To identify factors related to nurses knowledge and fracture management at Nigist Eleni
Mohammed Memorial, Comprehensive Specialized Hospital, Hosanna, Ethiopia, 2023.

8
 CHAPTER FOUR
4. METHODS AND MATERIALS
4.1. Study Area
The Study will be conducted at Nigist Eleni Mohammed Memorial, Comprehensive Specialized
Hospital. It situated in southern part of Ethiopia, Hossana town, which is the capital city of the
SNNP regional state, located in southern Ethiopia, 232km away from Addis Ababa. Based on
figures from the central statistical agency in 2017, Hossana has an estimated total population of
1,232,196whom 50.3 are females and 49.7 are males. Nigist Eleni Mohammed Memorial,
Comprehensive Specialized Hospital found in Hossana town. Currently the hospital provided
outpatient service, in-patient service, emergency service, surgery, maternal health service, and
different specialty level service to Hossana town and surrounding zone people. The hospital has
---- beds, a-----bed intensive care unit and. The hospital has a team of dedicated specialist
Doctors (---), GP (--), Midwifery (---), HO (---), Nurses 224, laboratory technician (---) and
pharmacist (---) other all trained professionals committed to the welfare of patients. Referral
receives critically ill patients referred from hospitals in the Hadiya Zones Patients who are
admitted to Emergency, ICU and wards are among the various types of illnesses, both medical
and surgical patients.
4.2. Study period
The study will be conducted from ----- to -----in Nigist Eleni Mohammed Memorial,
Comprehensive Specialized Hospital, Hosanna, Ethiopia, 2023.
4.3. Study design
Institutional based cross sectional study will be conducted.
4.4. Source of population
All nurses who work in Nigist Eleni Mohammed Memorial, Comprehensive Specialized Hospital
4.5. Study population
All nurses who will be randomly selected in Nigist Eleni Mohammed Memorial, Comprehensive
Specialized Hospital during study period.
4.6. Eligibility criteria
4.6.1 Inclusion criteria
Nurses who voluntary to participate in the study
All employ of nurses currently assigned and working in the NEMMCSH

9
4.6.2 Exclusion criteria
All nurses who aren’t at the work place during data collection period
4.7. Sample size determination
The overall minimum sample size will be determined using single population proportion formula
by considering; Z=standard normal distribution (Z=1.96) with confidence interval of 95% and
=0.05, p=0.5, d=0.05. In addition, by assuming this the final sample size will be calculated as:
Ni= (z α/ 2)2 ×p (1−p)/d 2
Where n= minimum sample size required for the study
P=prevalence/ population proportion (p=0.5); the proportion is determined based on previous
study in Determinants of Nursing care plan Implementation in North East Ethiopia (16)
d=is a tolerable margin of error (d=0.05)
z 2 × p ×q
Ni=
d2
1.96× 0.5 ×1−0.5
=
0.05
=384.16≈384
Since the total population is less than 10,000, we used correction formula. The exact sample size
will calculated as follows.
Nf = (Ni *N)/ (Ni +N)
Where Ni = calculated sample size Nf = exact sample size
N= sample population=224
= (384x224)/ (384+224) = 86,016/608
= 141.47≈141
= 141+10% none response rate = 141+14.1 = 155.1≈155
4.8. Sampling procedure
The sampling included list of the nurses who will be obtained from the department, a lottery
method will be employed to select the first candidate, and then simple random sampling
technique will be used to select the surveying nurses.
4.9. Data collection methods and technique
Data will be collected by using a structured self-administered questionnaire, in relation to all
workers in all wards in Nigist Eleni Mohammed Memorial, Comprehensive Specialized Hospital

10
to collect information on fracture management and associated factors prepared by group
students.
4.10. Study variable
4.10.1. Dependent variable
 It is Knowledge about fracture management.
4.10.2. Independent variable
 Socio demographic characteristics
 Age
 Sex
 Marital status
 Education level
 Monthly income
 Year of experiences
4.11. Operational definitions
Fracture management: - is consider as reducing the fracture (open or closed) in manner that
restore normal anatomy and maintain the reduced position through an immobilization/ fixation
technique that is sufficient to withstand the potential for loss of reduction through deforming or
external forces.
Knowledge: - refer to respondents understanding fracture management. Therefore, yes or no
measuring items will be measure respondents understanding.
Nursing: - is a profession within which the health care sector focused on the care of individuals,
families, and communities so they may attain, maintain, or recover optimal health and quality of
life.
Nursing knowledge: - is means by which the means by which the whole purpose of caring for
the patients achieved because it underpins what we actually do. Since nursing is a dynamic and
evolving profession, in which knowledge is central to its accountability. Nurses need to acquire a
wide range of theoretical and practical knowledge in order to provide the appropriate level of
care for patients.
4.12. Data quality control
Questionnaires whose internal consistencies will be checked by our advisors will be used after
carefully adapting them into the current context and without changing the original meaning.
11
Questionnaires will be checked thoroughly for its completeness, objective, and variable based
before it will be distributed to respondents, data will be monitored during the data collection
period by the principal investigator and advisor. Finally, data will be also checked for
consistency and completeness before entry to computer software for analysis.
4.13. Data processing and analysis
Data will be processed manually by using different materials like scientific calculator, pen,
pencil, Microsoft excel and A4 paper.
4.14. Ethical consideration
The research proposal will be obtain from Wachemo University and will be submit to Nigist
Eleni Mohammed Memorial, Comprehensive Specialized Hospital. An informed written consent
will be obtained from all subjects for their participation after the nature of the study fully
explained to them. The purpose and the procedure of the data collection will be clearly stated and
the confidentiality and privacy will be ensured. The entire study respondents will be informed
that the data will be keep private, confidential and used only for research purposes.
4.15. Information dissemination
Results will be disseminated to Wachemo council administration and Wachemo University,
School of Nursing and Midwifery, department of surgical Nursing, through documentation. Then
it will be present and defend in an open public defense seminar. Copies of the study will be
disseminated to the relevant offices and stakeholders.

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5 – Work plan
Table 1 Work plan for the assessment of nurse knowledge about fracture management and
associated factors at Nigist Eleni Mohammed Memorial, Comprehensive Specialized Hospital,
Hossana, Ethiopia, 2023.
Activities Duration
Topic selection and final submission July 01 to July 04,2023
Topic approval and assigning advisor July 01 to July 04,2023
Proposal development July 04 to august 21,2023
Revised proposal submission
Proposal defense Sep 02,2023
Data collection Sep 05 to Sep ----,2023
Data analysis and report writing
First draft research submission to respective advisor
Second draft research submission to respective advisor
Final research submission to the department
Research Defense
Submission of the revised research to the department

6 –Budget breakdown
Table 2 Budget breakdown of the assessment of nurse’s knowledge about fracture management
and associated factors at Nigist Eleni Mohammed Memorial Comprehensive Specialized
Hospital, Hossana, Ethiopia, 2023.

S/NO Title Budget Unit Quantity Pieces Total

category Measurements birr cost[Birr]

1 Stationary Photocopy Pages 465 3 1395

Materials
Printing Pages 30 5 150

13
 Pencil and Paces 8 25 200
pen

3 Transport Taxi Taxi 500 500

Total =2245

7. REFERENCES
1. Seltzer S, Bare B, Hinkle J, Cheever K. Brunner and Siddhartha’s Textbook of
Medical Surgical Nursing 14th ed. Volume 1, chapter 26, assessment of function. Lippincott
Will beiams and Wilkins, p685: 2014.
2. Lewis SL, Bucher L, Heitkemper MM, Harding MM, Kwong J, Roberts D. Medical-Surgical
Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume: Elsevier
Health Sciences; 2016.
3. Cummings-Vaughn LA, Gammack JK. Falls, osteoporosis, and hip fractures. Medical Clinics.
2011; 95(3):495-506.
4. Casentini C, Chiaramonti G, Amedei A, Cioppi F, Falchetti A, Masi L, et al. The bone care
nurse project. Clinical cases in mineral and bone metabolism. 2011: 8(1):63.
5. Buza III JA, Einhorn T. Bone healing in 2016. Clinical Cases in Mineral and Bone
Metabolism. 2016:13(2):101.
6. Kambli S. Fractured patient’s knowledge regarding care and treatment. International Journal
of Science and Research (IJSR). 2014:3(7):1178-81.
7. Admassie D, Yirga T, Lamisho B. Adult limb fractures in Tikur Anbessa Hospital caused by
road traffic injuries: Half-year plain radiographic pattern. The Ethiopian Journal of Health
Development (EJHD). 2010:24(1).
8. Nettina SM. Lippincott manual of nursing practice handbook: Lippincott Will beiams &
Wilkins; 2006.
9. Tewfik NB, Radhi TA. Assessment of Postoperative Nurses' Practices Concerning Care of
Fracture Treated by External Fixation. Kufa Journal for Nursing Sciences. 2016:6(1):24-32.

14
10. Brooker C, Nicola M, Alexander MF. Alexander's nursing practice: Elsevier. Health
Sciences: 2013.
11. Atiyah HH. Effectiveness of an educational Program on nurses’ Knowledge Concerning
nursing Management for Patients with Compound Fracture at orthopedic 30 Wards in Medical
City Directorate. Indian Journal of Public Health Research & Development. 2018:9(8):321-6.
12. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, et al. Endocrine Regulation of
energy metabolism by the skeleton. Cell. 2007; 130(3):456-69.
13. Andy A. Grainger & Allison’s Diagnostic Radiology: 2-Volume Set. Churchill Livingstone;
2015.
14. Uma Devi N, Geethalakshmi S. A brief study on human bone anatomy and bone
Fractures. IJCES Int J Compute Eng. Sci. 2011: 1(3):93-104.
15. Lichtenberger T, Inaba K, Talving P, Barmparas G, Schnüriger B, Green D, etal. Bicyclists
injured by automobiles: relationship of age to injury type and severity—a national trauma
databank analysis. Journal of Trauma and Acute Care Surgery. 2010; 69(5):1120-5.
16. Sathiya K, Kumar M. Prasanna baby, a study to assess the effectiveness of laptop assisted
nursing strategies on knowledge regarding prevention of complications of immobility among
patients with major orthopedic trauma. Journal of Science, 2015; 5(3):185.
17. Halanski M, Noonan KJ. Cast and splint immobilization: complications. JAAOS-Journal of
the American Academy of Orthopedic Surgeons. 2008: 16(1):30-40.
18. Ali BRM. Assessment of Nurses’ Knowledge Concerning Management of Fractures in
Orthopedic Wards. Indian Journal of Public Health Research & Development. 2019; 10(6):1022
-6.
19. Kadhim H. Evaluation of nurses’ practices toward orthopedic wound infection. Iraqi national
Journal of nursing Specialties. 2012; 3(25):58-70.
20. Iranmanesh S, Tafti AA, Rafiei H, Dehghan M, Razban F. Orthopedic nurses’ knowledge
about pressure ulcers in Iran: a cross-sectional study. Journal of wound care. 2013: 22(3):138-43.
21. Peng L, Reynolds N, He A, Liu M, Yang J, She P, et al. Osteoporosis knowledge and related
factors among orthopedic nurses in Hunan province of China. International Journal of
Orthopedic and Trauma Nursing. 2020: 36:100714-31
22. Gourgees S. Evaluation of Knowledge and Practices of Nurses in Orthopedic wards
concerning femur Fractures. Iraqi National Journal of Nursing Specialties.2005:2(18):24-31.

15
23. Wulff T. Knowledge and clinical practice of nurses for adult post-operative orthopedic pain
management: Stellenbosch: Stellenbosch University; 2012.
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ANNEXES
Annex-I. Consent Form

Good morning/afternoon, We are here to collect data study entitled on the assessment of nurses
knowledge about fracture management and associated factors among nurses employed in at
Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital. Fourth year surgical
nursing students from Wachemo University School of nursing and midwifery, Department of
surgical Nursing, are conducting this. In addition, we are glad to inform you that, you are one of
the eligible participants, you are welcome to take part in this study, and the interview takes place
for about 15 minute. We are also delighted to tell you relay value your participation as your
individual contribution to the study output will be definitely very significant, however it is up to
you to decide whether to participate in this study or not. We would like to inform you that your
name will be not write in anywhere in this study.
Are you willing to participate in this study?
1. Yes…………..
2. No…………
Annex two. Questionnaires

Section one - Questionnaires socio demographic characteristics

Table 3 Questionnaires socio demographic characteristics

S no Variable Category
1 Age (in years)
2 Sex Male
Female
3 Marital status Single
Married
Divorced

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4 Educational status Diploma
Degree
Master
5 Work experience __________in years/months
6 Monthly income _________in ETB
Section two - Knowledge assessment and associated factors regarding fracture management.

Table 4- Knowledge assessment and associated factors regarding fracture management.

S no Variables Yes No
1 Fracture is breaking in the continuity of a bone
2 Open fracture is a fracture that involves when a
bone is broken through the skin.
3 Is Complete fracture is a type of fracture that
occurs when a bone is broken into several
fragments?
4 Compound fracture is a type of fracture occurs
when there is a break in the bone, causing a
broken ends of the bone the bone to come in to
contact with the outside environment.
5 Discoloration, deformity, and pain at the site of
injury considered as the sign and symptoms of a
fracture.
6 Cast used in a fracture to keep the bones in a
position while the fracture heals.
7 Vital sign are reliable indicators of pain.
8 Patients may not sleep in spite of severe pain.
9 Analgesic medication considered drug choice for
fracture.
10 Non-steroidal anti- inflammatory agents are
effective analgesics for fracture.

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11 Respiratory depression rarely occurs in patients
who have been receiving stable doses of opioids
over a period.
12 Opioids not used in patients with a history of
substance abuse.
13 Compartment syndrome characterized by
persistent pain.
14 Nonunion and mal union are late complication of
fracture.
15 Fat embolism and hypovolemic shock are not late
complication of fracture.
16 Pussy discharge from wound site is sign of the
infection for the patient with fracture.
17 The recommended opioid analgesics for patients
with severe pain of sudden onset of fracture are
intravenous route.
18 Elderly patients can tolerate recommended dose
opioids for pain relief.
19 Benzodiazepines are not effective pain is due to
muscle spasm.
20 It is not important to massage the osseous (bony)
prominences if it is reddish.
21 Stage I pressure ulcer is define as an erythema that
does not whiten.
22 Bedridden patients should reposition every 2
hours.
23 Do training on fracture management.
24 Rehabilitation measures should institute if the
general status of the patient permits.

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