Knowledge about pressure ulcer prevention, classification and management: A survey of registered nurses working with trauma patients in the emergency department

Abstract

Aim

One group of patients who are at risk of pressure ulcer development is trauma patients. The present study aimed to examine trauma nurses’ knowledge about pressure ulcer prevention, classification and management.

Methods

In a cross sectional exploratory study all qualified registered nurses working with trauma patients in the emergency department (ED) of Kashani and Bahonar hospitals, Iran were invited to participate. To assess the nurses’ knowledge about pressure ulcer prevention classification and management Pieper’s Pressure Ulcer Knowledge Test (PPUKT) was used.

Results

Of 185 eligible nurses, 159 participated in the study (response rate of 86%). Of these, 80.5% (n = 128) were women and 19.5% (n = 31) were men. The mean years of nurses’ experience was 10.3 ± 7.2 years. The percentage of correctly answered questions was 64.6%. Nurses had the highest level of knowledge in the section about wound characteristics (77.3%) and the lowest level in the section about pressure ulcer onset (57%).

Conclusion

This is the first study that specifically examines trauma nurses knowledge about pressure ulcer prevention, classification and management. According to the results, nurses did not have sufficient knowledge about pressure ulcer prevention, classification and management. There is a need to improve their knowledge with educational programs.

Introduction

According to the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) definition, a pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, that occurs as a result of pressure, or pressure in combination with shear (EPUAP & NPUAP, 2007). With regard to skin integrity, pressure ulcers (in hospitalized patients) represent an important problem because of the high numbers found and the associated emotional and financial costs (Iranmanesh et al., 2011, Cooper, 2013, Moore et al., 2011). Patients with major trauma are at high risk of pressure ulcer development (Baldwin and Ziegler, 1998). Mobility and activity are two main predictors of pressure ulcer development that are highly impaired in patients with major trauma. Trauma patients usually remain immobile for long periods of time in the ED prior to their admission to a ward. Nurses in the ED may focus on the care of patients with life threatening conditions and pay less attention to skin care.

In a retrospective study, Ackland et al. (2007), examined the factors predicting cervical collar-related pressure ulceration in major trauma patients in a level 1 trauma center in Australia. The results of the study showed that risk of pressure ulcer development due to a cervical collar in trauma patients increased by 66% for every 1 day increase in cervical collar time. In another study, Ash (2002) surveyed development of pressure ulcers in a British spinal injuries unit and reported that 56% of patients developed a pressure ulcer at some stage between injury and discharge from the unit. The study also showed that some factors, such as increased length of hospital stay, density of spinal lesion, surgical stabilization of neck injury before transfer to the spinal injuries unit, tracheostomy on admission to the spinal injuries unit and delayed transfer to the spinal injuries unit after injury are related to pressure ulcer development in this group of patients. Baumgarten et al. (2003) surveyed risk factors for pressure ulcer development among elderly patients with hip fracture at 20 hospitals in the USA. The reported incidence of pressure ulcers development was 8.8%. The study also reported that a longer wait before surgery, need for intensive care unit admission, lenghtier surgical procedure and use of general anesthesia increased risk of pressure ulcer development in this group of patients. Lindholm et al. (2008) surveyed potential intrinsic and extrinsic risk factors for the development of pressure ulcers in patients admitted for hip fracture surgery in six European countries and showed that factors such as age (greater than 71 years), skin moisture, dehydration, total Braden scale score and two or more co-morbid conditions (diabetes and pulmonary disease) increased risk of pressure ulcer development in patients with hip fracture.

A good level of nurses’ knowledge is essential in prevention and management of pressure ulcers (Fernandes et al., 2008, Iranmanesh et al., 2011, Iranmanesh et al., 2013). Previous studies about nurses’ knowledge of pressure ulcers reported different findings (Hulsenboom et al., 2007, Källman and Suserud, 2009, Fernandes et al., 2008, Iranmanesh et al., 2011, Iranmanesh et al., 2013). Demarré et al. (2012) examined the knowledge of nurses and nursing assistants about pressure ulcers in Belgium and reported that Belgian nurses have low levels of knowledge about pressure ulcers. Altun and Demir Zencirci (2011) studied the impact of lecture-based interactive workshops on Turkish nurses’ knowledge about pressure ulcers. They reported that nurses’ knowledge is poor and that lecture-based interactive workshops improve their knowledge and allow them to overcome training deficiencies. In another study Källman and Suserud (2009) examined Swedish nurses’ and nurse assistants’ knowledge, attitudes and practice relating to pressure ulcers. In contrast to the Demarré et al. (2012) findings, they reported that nurses have a good level of knowledge and positive attitudes towards pressure ulcer prevention and care.

In the Iranian context, Iranmanesh et al. (2013) assessed orthopedic nurses’ knowledge about pressure ulcers. They found that orthopedic nurses in Iran have insufficient knowledge about pressure ulcers. They concluded that they need advanced educational programs regarding pressure ulcer prevention and management. While nurses’ knowledge regarding pressure ulcers has been surveyed in several studies, no study was found that assessed trauma nurses’ knowledge regarding pressure ulcers. Educating nurses with regard to pressure ulcers first requires a primary assessment of their previous understanding of the topic. This study aimed to fulfill this need.