Pressure ulcers are a globally recognized patient safety problem. The physical consequences associated with pressure ulcers may range from mere scarring to chronic wounds requiring major surgical intervention with the possibility of permanent disfigurement, and in extreme cases, septicemia and death (Grey et al. , 2006). Tables 1 and 2 illustrate death cases in Australia in 1997-1998 where pressure ulcers were the primary or predisposing factors (Prentice & Stacey, 2002).
In addition, even healed ulcers will attain only 80 percent of the skin’s original strength, consequently making the area vulnerable to re-injury (Gould, 1986: Thiele, Allen, & Stucky, 1999). Extensive or slow-to-heal pressure ulcers are also prone to infection as they develop (Cutting et al. , 200). Governments in Europe, the United States of America (USA), and the United Kingdom (UK) have recognized pressure ulcers as a national health dilemma and have established national bodies whose particular aims are to improve both the delivery of and access to healthcare services to facilitate prevention and management of pressure ulcer incidence.
Pressure sores remain a significant problem in both acute and community health settings despite being largely preventable. The cost of treating an established pressure sore can be enormous. There are not only emotional and physical consequences to the individual, but also a significant drain on health system resources (Gunningberg, 2005). Considerable research has been devoted to this problem and yet many clinicians and administrators are faced with findings that are often ambiguous and lacking validation.
Despite a plethora of information on the prevention of pressure sores, they remain a significant problem in both hospital and community settings. The need to reduce the incidence of pressure sores has been well documented. In considering how this goal might be achieved, nursing care has been highlighted as a major influence, with good preventive strategies being central (Schoonhoven et al, 2002).
In order to deliver high quality care, it is essential that nurses base their practice on the best available evidence, and if they are to function effectively in order to prevent this phenomenon, they must possess current knowledge about pressure ulcer prevention and management. That said, it is important to add that knowledge alone is insufficient, as nurses must actually use the knowledge they have in their clinical setting. Different international studies that have explored how nurses’ knowledge, attitudes and practices in relation to pressure area care are reviewed below.
3. 1. 1 Nurses’ Attitudes and Practices Towards Pressure Ulcers Findings concerning the relationship between nurses’ attitude, behavior, and perceived issues towards pressure ulcer prevention have been highlighted in numerous studies. As regards these variables, a study of three hundred working nurses in an acute care setting in six urban teaching hospitals took place In Ireland ((Moor & Price, 2004). The study demonstrated a positive attitude towards the prevention of pressure ulcers.
Nevertheless, factors such as personal attitudes and social pressures influence a nurse’s behavior in the work place (Moor & Price, 2004). These factors affected the prevention practices, causing nurses’ practices to be judged as unsystematic and unreliable (Moor & Price, 2004). Moreover, more than half of the sample (51%) of the nurses regarded pressure ulcer prevention as a low priority. Another important finding in this study is that 67 percent of the nurses had not received any formal training in pressure ulcer prevention and management since becoming qualified as a nurse.
The researchers concluded that positive attitudes alone are not enough and should always be accompanied by sound knowledge and practices (Moor & Price, 2004). In this study, the response rate was 40% and the research used a questionnaire to eliminate their effect over the object. A structured questionnaire was used to reduce the risk of bias. These steps added to the strength of this study. Similarly, in the United States, Bostrom and Kenneth (1992) reviewed a group of nurses regarding their knowledge of pressure ulcer risk factors, interventions for maintaining skin integrity, and factors that obstruct preventative care.
The study revealed a high knowledge of risk factors, but found that the nurses “lacked interest” and sited prevention as less important than care. In fact, it can be argued that to achieve a high level of prevention, nurses, as the key providers of health care, should have a positive attitude towards pressure ulcer prevention strategies. Similarly, positive attitudes among nurses can play a key role in healthcare setting (Omery & Williams, 1999).
If nurses tend to accept and integrate research findings into their nursing practice, they can minimize or prevent a number of preventable complications (Omery, 1999). This view could be acceptable in nursing practice if nurses have sound knowledge and a positive attitude towards changing and incorporating evidence-based findings. Gunningberg et al. , (2001) in their study “A 2-year Follow-up of Quality Indicators” highlighted the same conclusion and argued that staff attitude and belief can contribute to prevent pressure ulcer development.