Pressure Ulcer Management Among ICU Nurses in Saint Elizabeth Facility

Introduction

According to Martin et al. (2017), critical care nurses are usually faced with complex cases involving patients. In managing these cases, we as nurses ought to be very proficient and competent in all areas including PU. Pressure ulcers is a common health problem among patients in Saint Elizabeth Facility. By definition, it is an injury to the skin or underlying tissue caused by pressure or shear. Sari (2013) defines PU as a kind of ulcers is usually caused by unrelieved pressure on underlying tissues which ultimately results into lesions especially on bony prominence. It is known to cause considerable amount of burden on both nurses and patients themselves. In the ICU, critically ill patients are exposed to high risks of developing pressure ulcers. The purpose of this study will to ascertain the knowledge of my colleague nurses on prevention of pressure ulcers. The objectives of the study is to analyze and establish the importance of this knowledge in relation to intensive care units which is prone to risks of development of pressure ulcers on our patients.

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The study found that it is of undeniable importance for ICU nurses to be adequately equipped with and reflect this knowledge in their caring practices. The treatment and prevention of this health problem require a holistic approach for all stakeholders involved to ensure quality health care. In addition, the study found that in most cases, ICU nurses view pressure ulcers as being less important as compared to other healthcare aspects. It is thus important to review the knowledge of nurses in regard to pressure ulcers. In my study I found that 80% of answers given by critical care nurses in Saint Elizabeth facility were correct.

Pressure Ulcer Knowledge Initiative

The healthcare facility in which I am employed is dedicated in providing and ensuring quality care within a safe environment. I choose this study to understand my colleague nurses knowledge on PU prevention. In this guided the study, I interviewed my colleague nurses by the use of questionnaires to sixty ICU nurses. Stratified sampling was used in the selection of nurses to be used in my research process. In the sampling of nurses, I used the random method to reduce bias in the selection process. The ICU nurses I interviewed in the research were of mixed gender and different educational levels. The reliability of my data collected was measured through Pearson's Co-efficient and I found it to be around 0.75.Validity throughout the study was ensured through discussions with relevant experts and hospital supervisors. I used both qualitative and quantitative methods of data analysis in data analysis and statistical data presented in the form of tables. In further clarification of this data, I used Pieper's Pressure Ulcer Knowledge Test on the sixty ICU nurses.

Aim of the study: My study was driven by the need to assess the level of ICU nurses' knowledge about prevention of pressure ulcers. The following were the questions and objectives of the study:

• Is there a relationship between knowledge and prevention of PU?
• IS there a relationship between PU knowledge and age?
• Is there a relationship between PU knowledge and gender of ICU nurses?
• Is there a relationship between PU and experience of ICU nurses?
• Is there a relationship between prevention of PU and hospital management?
• Is there a relationship between PU prevention and technology, facilities of equipment?
• Is there a relationship between knowledge and the number of staff?

Pressure Ulcer prevention knowledge principles

The pressure ulcer prevention principles upon which this initiative in my workplace is built include safety and patient centeredness (Institute of Medicine, 2001). When nurses have knowledge on pressure ulcer prevention, all reasonable efforts to promote safety are taken to reduce pressure ulcers on patients. The principle of safety includes preventing harm and promoting the best health outcomes, not unlike the ethical principles of non-maleficence and beneficence (Dempsey, 2009; Institute of Medicine, 2001). Patient centeredness includes ensuring that the patient comes first, care is planned and given in accordance with client values, beliefs, and preferences, and that client safety is maintained at all times (Institute of Medicine, 2001).

Involvement and Roles in Pressure Ulcer Knowledge

In the ICU nursing profession, it is always important for us to provide quality healthcare and caregiving practices to patients. This coupled with the fact that patients have become more aware of their rights to receive adequate and high-quality care requires attention with regard to knowledge of nurses about pressure ulcers and its subsequent prevention (Crowe & Bowles, 2016). Due to high ratios of these occurrences, quite a significant financial and emotional burdens on both patients and nurses have become very common. According to Cooper (2013), the knowledge should be guided by interdisciplinary approaches and educational programs for nurses. In addition, we nurses ought to be encouraged to indulge in research on the subject so that they comprehend the importance of this knowledge. My questionnaire questions included sore classification, wound characteristics and preventive measures known to the ICU nurses.

However, Saifollahi et al. (2015) argues that PU knowledge for both nurses and nursing students is determined by individual and educational characteristics. Though there have been numerous efforts to promote it, the problem is still eminent, and knowledge has been so far deficient. This has subsequently affected the quality of PU care given to patients in my facility. An improvement in knowledge, on the other hand, would help reduce cases of hospital stays and the number of patients suffering from the same. Adequate knowledge is thus very crucial for ICU nurses in determining whether a patient is at a great risk of PU and the necessary measures to take in prevention.

PU knowledge also equips ICU nurses with the ability to assess the types of prevention to be used and how they are to be applied. Such ability, however, is subject to the drive towards planning, evaluating and implementing pressure ulcers preventive measures. Relevant to the same is the fact ICU nurses ought to work closely with physicians in the process of health care giving. Thus this kind of knowledge should not only be acquired but putting it into practice becomes more difficult putting into consideration that ICU nurses must collaborate with other health practitioners (Coleman et al.,2013). In most cases, ICU nurses may be aware of PU and relevant preventive measure, but its actual practical prevention now becomes difficult. As the saying goes, knowledge is important, but when combined with adequate skills, it becomes more helpful. This scenario also applies to ICU nurses who in turn should be skilled enough for this knowledge to take effect in prevention and treatment of pressure ulcers. Accordingly, it is even better if PU knowledge and skills are boosted by the nurse's physical, mental and emotional strengths in the workplace.

From previous research by Qaddumi & Khawaldeh (2014), it has been found that PU knowledge can be improved by enrolling ICU nurses in relevant educational programs. Formal training and higher educational status can be positively associated with ICU nurses knowledge about pressure ulcers. Training, in this case, does not have to be necessarily an external process but can be an in-service training process which will reduce the amount of time involved in the learning process of colleague nurses. Completion of these educational programs usually leads to improved levels of knowledge proving to be a necessity in the process of PU prevention (McInnes et al.,2015). Experience in the nursing profession is another factor promoting this kind of knowledge and hence entry level ICU nurses should be encouraged to work closely with their experienced peers. Therefore, stakeholders in the healthcare sector must be involved in developing such suitable educational programs that are flexible enough to allow ICU nurses to continue with providing care at the same time learning about PU. Similarly, hospital management and supervisors should also be actively involved in ensuring that nurses are well equipped and competent enough about all aspects of pressure ulcers. It is thus a team effort through a personal drive by the ICU nurses facilitates the process even more. As important as the above aspects are, for it to effectively be applied in the prevention of pressure ulcers, reliable facilities, equipment and leadership styles must be readily available. This is particularly so because even with that kind of knowledge and skill, without proper technology, facilities, and support from hospital leadership, it would ultimately be very difficult for prevention to take effect. Nursing leadership is another factor that determines success of the knowledge-seeking process. If leadership provided adequate staffing, then it would be possible to take training and educational programs in shifts with minimal disruptions to the caregiving process. The relationship between the number of nursing staff and level of knowledge is usually directly proportional whereby most ICU nurses agree with this notion. It is thus a leadership responsibility to ensure that there is no staff shortage which would otherwise enhance knowledge seeking processes.

From internationally conducted research by Gunningberg et al. (2015), ICU nurse's knowledge about pressure ulcers prevention is not up to standard and more efforts ought to be applied in improving this. This can be reflected by the sub-optimal practices which in any case do not comply with the best available guidelines. Public hospitals are more prone to lack of this knowledge as compared to private hospitals which are better equipped with knowledge, facilities and technology (Lawrence, Fulbrook & Miles, 2015). Consequently, it has led to an increase in the prevalence of this health problem contrary to tackling it. High-income countries prove be in a better situation than in low-income countries whereby male respondents show a poor level of PU knowledge in comparison with female ICU nurses. PU prevention should be an important goal for ICU nurses to help counter the common belief that they consider it to be less important than other health complications. Prevention of PU should go hand in hand with evidence-based practice that requires maximum quality of care to patients at the same time preventing cases that are preventable. Consequently, if ICU nurses were to put evidence-based practice as their main quality control guidelines, then knowledge about PU will ultimately improve and prevention of the same possible. Bu integrating evidence-based practice, nurses will be able to be accurate in their understanding of pressure ulcers patients and hence apply accurate treatment and prevention mechanisms.

Methodology and Data Presentation

In this study, data was collected by the use of questionnaires. Each questionnaire contained three sections namely wound characteristics, sore classification, and preventive measures. The questionnaires were distributed among sixty ICU nurses who were supposed to answer the questionnaires to their best of knowledge. Also, the questionnaires were designed to include a subsection of discussing age, gender and years of experience. Authority to interview the correspondents was guaranteed by the hospital management. The questionnaire design was guided by the objectives and questions of the study. The research design was descriptive in nature whereby data was presented in a descriptive essay. After collection of statistical data, analys...