Knowledge and practices of intensive care unit nurses on the prevention of nosocomial pressure ulcers using a bundle protocol: an educational intervention study in Uganda

Abstract

Introduction: Nosocomial pressure ulcers are wounds acquired within the hospital setting, pausing a burden to the patient families and the care teams due to patient discomfort and increased costs to treat and hospital resources. Globally, patients in intensive care units (ICUs) are most impacted, and the incidents go up to 33%, while a study done in Mbarara Regional Referral Hospital stated it at 19.3%. These incidents are preventable with the use of pressure ulcer prevention guidelines. This study aimed to investigate the effect of an educational intervention with a care bundle protocol on the knowledge and practices of intensive care unit nurses of Mulago National Referral Hospital in the prevention of nosocomial pressure ulcers. Methods: This was a single-group quasi-experimental pre-test and post-test study that purposively selected 26 ICU nurses of Mulago National Referral Hospital. Their baseline knowledge andpractice were assessed with a knowledge assessment questionnaire and an observation checklist, respectively. The nurses were then trained on the pressure ulcer prevention bundle protocol, and the training lasted two weeks. ICU nurses’ knowledge and practices were assessed two weeks after the training. Data was collected between May and July 2024 and was analyzed using STATA version 17. Independent sample t-test, Wilcoxon-rank sum test and ANOVA were used to compare variables. Results: The median (IQR) age of the study participants was 37.5 (32, 49). A biggest number of the participants were females [18] 69.2% and just above a third had attained a diploma [10] 38.5% or a Bachelor’s degree [10] 38.5%. About two thirds of the participants [17] 65.4% had never received refresher training on prevention of pressure ulcers and just above a third of them had practiced for 3–5 years in critical care. The participants reported to care for about the median (IQR) of 3 [2, 4] pressure ulcers weekly. The critical care nurses’ knowledge of pressure ulcer prevention increased to (SD) 63.2% (11.8) from (SD) 40.5 (10.6), yet practice increased to 62.6% from 37.6% with a P value of 0.001, which was statistically significant. Conclusion: An educational intervention with a pressure ulcer prevention protocol brought about a significant change in participants’ knowledge and practice. More in-service training sessions on pressure ulcer prevention protocols and their availability to staff are recommended.