Nurses’ knowledge, attitude and barriers towards pressure ulcers’ prevention in two referral hospitals in Botswana

Abstract

Background: Pressure ulcers (PUs) are outlined as a localised injury to the skin and underlying tissue typically over a bony prominence as a consequence of pressure or pressure in combination with shear or friction (Black et al., 2007:148; Moore & Cowman, 2014:2; Dealey et al., 2015:309). Awareness and positive attitudes are essential to provide effective pressure ulcers' prevention (Kaddourah et al., 2016:1). There is insufficient data in Botswana about pressure ulcers' prevention, hence the need for this study, which aimed to investigate nurses' knowledge, attitudes and barriers towards the prevention of pressure ulcers in Botswana. Nurses in Botswana should implement evidence-founded care for pressure ulcer prevention. Referral hospitals in Botswana are used as academic hospitals. Therefore, more information was needed to comprehend how nursing care in these institutions can be developed. The study took place in two referral hospitals in Botswana. Objectives: There is a lack of evidence on nurses' knowledge, attitudes and barriers towards pressure ulcers prevention in Botswana. The aim of the research was to describe nurses' knowledge, attitudes and barriers towards pressure ulcers prevention in two referral hospitals in Botswana.Design: The research adopted a non-experimental cross-sectional descriptive study design.The study used quantitative methods, and the sampling size was 300 respondents. The inclusion criteria were registered nurses who were practising in wards that encounter pressure ulcers in their daily nursing practise. The exclusion criteria were registered nurses who were not practising, and those who were on leave and who were working in wards that are less likely to encounter pressure ulcers. A structured self-reporting questionnaire was used to collect data.Data analysis: Data were run on SPSS Version 25. Descriptive statistics, such as frequencies and percentages were used. Hierarchical linear modelling was used to determine if biographical variables affect knowledge, attitude and barriers. Cronbach's alpha was used to measure reliability. The knowledge assessment questions instrument was not deemed to be reliable as the group Cronbach's alpha was only 0.440. The subsections were also not reliable; therefore, the questions were assessed individually. The overall Cronbach's alpha for the attitude scale was 0.624 and was reliable. T-tests and ANOVA were used to compare groups. The principal component exploratory factor analysis was used to classify the barriers' questions. The Kaiser Meyer Olkin (KMO) of sampling adequacy was 0.707. The effect size of 0.5 equates with a medium effect size and is statistically significant. Non-parametric correlations were used to study the strength of a relationship between variable. (i) Results: The results show that 228 nurses responded to the study. The respondents had very good knowledge on the theme of nutrition, but showed a lack of knowledge of pressure ulcers prevention on the themes of aetiology and development, risk assessment, classification and observations, reduction of the magnitude of pressure and shearing and measures to reduce the duration of pressure or shear. Most of the respondents indicated a negative attitude towards pressure ulcers' prevention. Factor analysis was used to classify barriers towards pressure ulcers' prevention as knowledge barriers, psychological draining barriers and resource barriers.