Practices by nurses to prevent pressure ulcers among patients at a level five hospital in Kenya

Abstract

Introduction

Pressure ulcer refers to a breakdown of skin due to prolonged pressure or shear. The incidence of pressure ulcers is about 20% in most clinical settings, despite existence of numerous national and international guidelines. The study was carried out in July 2018. The aim of this study was to assess the level of adherence to the Nursing Council of Kenya (NCK) procedure manual pressure ulcer guidelines among nurses working at Embu Level 5 Hospital and the associated challenges.

Methods

This was an institution based descriptive cross-sectional study. Data was collected using a researcher developed self-administered questionnaire based on NCK procedure manual guidelines. 145 respondents were selected using stratified random sampling combined with systematic random sampling. Data was analyzed using SPSS version 21 and NVIVO version 12.

Findings

On adherence to NCK guidelines, 53.91% always adhered, 36.5% sometimes adhered and 9.6% never adhered. The main reported challenges to adherence of guidelines were shortage of staffs (36.3%) and inadequate equipment (24.7%). Others were lack of the guidelines in the wards, lack of time for documentation and patient turning. Availability of guidelines in the wards (X²=5.546, df=1, P=0.019), lack of time for documentation (X²=5.642, df=1, P=0.018, RR=2.63) and patient turning (X²=5.817, df=1, P=0.016, RR=2.72) were statistically significant at P=<0.05.

Conclusions and Recommendations

Adherence to NCK guidelines was low, and significant challenges were lack of guidelines in the ward, lack of time for documentation and patient turning. The NCK should revise the guidelines to match the current international guidelines and evidence based practice. For instance, the use of soap and massage of pressure areas is outdated. NCK should collaborate with hospitals to facilitate dissemination of the guidelines instead of having them only in the procedure manuals to increase adherence. The hospital should ensure standard operating procedures and check-lists are availed in each ward. The hospital should employ more nurses to enhance adherence.