Nurses Practice Concerning Postoperative Clean Wound Dressing

Abdulkareem Salman Khudhair

Instructor, Department of Fundamentals of Nursing, College of Nursing, University of Basra, Basra- Iraq

ABSTRACT

AdescriptivestudywascarriedoutatthesurgicalwardsofAl-SadderTeachingHospitalstartedfrom2th August to2thDecember,2016.Thestudyaimstoassesnurse’spracticeconcerningpostoperativewoundcare,andtoidentifyingtherelationshipbetweennurse’spracticeandtheirdemographiccharacteristic.

APurposive“non-probability”sampleconsistingof(25)nurseswasselectedfromAl-SadderTeachingHospital.Thedatawerecollectedthroughtheuseofdirectobservation,whichcomprisedof(19)itemsasmeanofdatacollection.Thedatawereanalyzedthroughtheapplicationofdescriptivestatisticalanalysisthatincludefrequencyandpercentage,theapplicationofinferentialstatisticsthatincludingthemeanofscore,andChi-squaretest.

Themajorityofthenursesweremales(60%),withagegroup(25-29)yearsold(28%),nursinginstitutegraduate(48%),themajorityofnurseshavethanless(1-5)yearsofexperience(44%).Theresultindicatedthat therewerenosignificantassociationsbetweenthenurse’sgender, age, levelofeducationandtheirpractice.Thereweresignificantassociationsbetweenthenurse’syearsofexperienceandtheirpractice.

Theresultsdemonstratedapracticedeficitinthemostitemsofpost-operativecleanwoundcareforpatientinsurgicalunits.

Specialtrainingsessionsshouldbedesignedandpresentedtothesenurses,developingassessmentsheetforskillsanddailynursingnoteforpost-operativewoundcare.

Keyword: Nurses Practice, Concerning Postoperative, Clean Wound dressing

INTRODUCTION

Theskin,thebody’sfirstlineofdefense,protectingtheunderlyingstructurefrominvasionbyorganisms(1). Maintaininganintactskinsurfaceisimportantbecausea break or disruption in this integrity is potentiallydangerousandpossiblylifethreatening(2).Maintenanceof skin integrity and promotion ofwound healing areimportantaspectsofnursingcareinallcaresetting(3).Awoundisadisruptionofnormalanatomicalstructureandfunctionthatresultsfrompathologicalprocessbeginninginternallyorexternallytotheinvolvedorgans(4). Thegoalofwoundcareistopromotetissuerepairandregenerationsothatskinintegrityisrestored(5).Woundcanbetreatedbyleavingthemtoair;nodressing(protectivecoveringplacedoverawound)isapplied(1).Thewoundisbelievedto be at risk for infection development related to the

dryingofthewound,resultinginlessbacterialgrowth(2).

Dressings are important component of post-operativewoundmanagement.Agooddressingshouldmaintainamoistwoundenvironmentandthuspromotewound healing, be able to remove excessive exudatethatmight lead tomacerationof thewound,provideagood barrier against bacterial or fluid contamination,andbeadherenttotheskinbutatraumaticonremoval(6).The nurses play an important role in the therapeuticsuccess and outcome of the patient becauseminimizethepatientriskfactorforinfectionthroughmaintainingstrictaseptictechnique,inspectingthesolutionforsignsofcontamination,monitoringthepatientcloselybefore,during and after an exchange and recording his vitalsigns(7).

DOI Number: 10.5958/0976-5506.2018.00559.4

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Furthermore surgical site infection (SSI) isusually associated with increased hospital stay, coastand lethality, because of that knowledge of the mainrisk factors for this typeof infection is crucial for theestablishmentpreventivemeasuresregardingmodifiableriskfactors(8).

Manynosocomialinfectionsarecausedbypathogenstransmittedfromonepatienttoanotherbywayofhealthcareworkers(HCWs)whohavenotwashedtheirhandsbetweenpatientsor(HCWs)whodonotpracticecontrolmeasures such as use of hand disinfection, glove useetc(9).

TheImportanceofthecurrentstudycanbeshowedthroughthataccordingtotheinternationalcommitteeonwoundmanagement.Todaywound infection increasedthe financial cost on the patients, increase the use ofantibiotics, increase in the consumption of medicalsuppliesandincreaseof timeconsumingforpersonnelinthehealthsector(10).

Thepostoperativewoundinfectionwasconsideredthe most important health problem in Iraq hospitals.In spite of restricted policies and procedures relatedto disinfection and sterilization techniques, as well asfollowingtheappropriatemanagementasnotedintermsofpatient’spreparationpreoperativelyand through thesurgery, therefore the importance of the standardizedmethods towound care showed in this research paperliesinthefactthatitcanbesuccessfullyappliedtoalltypesofsurgicalwounds.

METHOD

Adescriptivedesignwasconductedonthesurgicalwards in AL-Sader Teaching Hospital started fromAugust 2th to December 2th, 2016 in order to assessnursing practice concerning postoperative wound careforpatients.

A probability sample of (25) nurses males andfemales,whowere in thesurgicalwardsand intensivecare units .The nurses were assigned for the studyaccording to; thereworking at the surgicalwards andwho should have one year of experience andmore.Aquestionnaireformatwasusedfordatacollection,whichconsistedof(2)parts.Theoverallnumberoftheitemsincludedinthequestionnairewas(19).Theitemswereratedonthreelevellikerscale:always,sometime,andneverandscoredas3,2,and1,respectively,cutoffpoint

was(2).Thefirstpartofthequestionnairesheetincluded(4) itemsrelativetothedeogra-phicdataof thenurseswhoworkinthesurgicalwardsandintensivecareunitandincluded;age,gender,levelofeducation,yearsofexperience.

Thesecondpartofthequestionnairewascomprised(19) items thatconcernedwithnursespractice relativepostoperative clean wound care. Data were collectedthroughdirectobservationwiththenursesofthesamplebyusingDescriptivestatisticalprocedure(Frequency(F)andpercentage(%))andInferentialstatisticalprocedure(MeanofscoreandChi-square(X2)test)inanalyzingthedataofthestudy.Themeanofscore,whichwasequalto (2), was considered significant if greater than (2)and less than (2)was considered non-significant.Chi-squarewasusedtodeterminethesignificantrelationshipbetween the nurse’s practice and their demographiccharacteristicsatp≤0.05.

RESULT OF THE STUDY

Table 1: Distribution of nurses by their demographic data.

Gender F %

Male 15 60%

Female 10 40%

Total 25 100%

Age F %

20-24 4 16%

25-29 7 28%

30-34 4 16%

35-39 4 16%

40-44 3 12%

45&over 3 12%

Total 25 100%

Level of education F %

Secondarynursingschool 9 36%

Nursinginstitutegraduate 12 44%

Nursingcollegegraduate 4 16%

Total 25 100%

Years of experience F %

1–5 11 44%

6–10 8 32%

11–15 3 12%

15-&over 3 12%

Total 25 100%

253 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6

Thistablerevealsthatthemajorityofthesampleweremales(60%),(25-29)yearsold(28%),nursinginstitutegraduate(48%),(1-5)yearsofexperience(44%).

Table 2: Mean of scores of the nurse’s practice concerning post-operative wound care.

Assessment R sMsneverSome timealways Items

Inadequate46.661.42023Warmedirrigantorsolution.1

adequate93.322.88710Performedhandhygiene.2

adequate95.322.683220Preparedwaterproofbag.3

Inadequate54.661.641546Providedprivacy.4

Inadequate57.321.721447Appliedgownandgoggles,ifneeded.5

adequate85.322.565119Putoncleansgloves,removedanddiscardedsoileddressing.6

Inadequate55.991.681294Preparedequipmentandopenedsterilesupplies.7

Inadequate43.991.3221-4Appliedsterilegloves.8

33.33125--Obtainednecessaryculture.9

Inadequate37.321.12223-Applyingcleandrawsheetsaroundthepatient’ssiteofdressing.10

Inadequate43.991.322023Irrigatethewound.11

Inadequate51.991.561564Driedwoundedgeswithsterilegauze.12

Inadequate47.991.441834Assessthewound.13

Inadequate63.991.92997Assistedclienttocomfortableposition.14

adequate77.322.325713Appliedappropriatedressing.15

Inadequate49.321.481663Disposedofusedequipment.16

Inadequate53.321.61717Removedgloves,gownsandgoggles.17

Inadequate49.321.481825Performedhandhygiene.18

Inadequate42.661.282032Documentation.19

Thefindingsofthistableindicatethatthenurseshaveadequatepracticeconcerningpost-operativecareonitems2,3,6,&15andinadequateontheremainingitems.

Table 3: Association between nurse’s practice and their gender.

TotalNever Sometime AlwaysGender

2661723955FMale

100%64.66%14.66%20.68%%

2091123265FFemale

100%53.59%15.31%31.10%%

47528471120F Total

100%59.79%14.95%25.26%%

X 2 calculated = 4.33 df= 2 X2 tabulated= 5.991 P ˃ 0.05

Thefindingofthistablepresentedthattherewerenosignificantassociationsbetweenthenurse’sgenderandtheirpractice.

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Table 4: Association between nurse’s practice and their age.

TotalNever Sometime AlwaysAge

187812383F20-29

100%43.31%12.31%44.38%%

1521052819F30-39

100%69.08%18.42%12.5%%

135971721F40-49

100%71.86%12.59%15.55%%

47428368123FTotal

100%59.72%14.34%25.94%%

X 2 calculated = 8.40 df= 10 X2 tabulated= 18.307 P ˃ 0.05

Thefindingofthistablerevealedthattherewerenosignificantassociationsbetweenthenurse’sageandtheirpractice.

Table 5: Association between nurse’s practice and their level of education.

TotalNever Sometime AlwaysLevel of education

1711302021FSecondarynursingschool

100%76.0311.6912.28%

2281434045FNursinginstitutegraduate

100%62.7217.5419.74%

76101155FCollegeofnursing

100%13.1614.4872.36%

37518371121FTotal

100%48.8118.9332.26%

X 2 calculated = 3.72 df= 4 X2 tabulated= 9.488 P ˃ 0.05

Thefindingofthistablepresentedthatthereweresignificantassociationsbetweenthenurse’slevelofeducationandtheirpractice.

Table 6: Association between nurse’s practice and their years of experience.

TotalNever Sometime AlwaysYears of experience

199972577F1-9

100%48.7512.5638.69%1511012921F

10-19100%66.8819.2013.90%114851613F

20&more100%78.9410.5310.53%46428370111F

Total 100%60.99%15.08%23.93%%

X 2 calculated = 20.72 df= 6 X2 tabulated= 12.592 P ˂ 0.05

Thefindingofthistablepresentedthatthereweresignificantassociationsbetweenthenurse’syearsofexperienceandtheirpractice.

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DISCUSSION OF THE RESULTS

Asurgicalwoundisgenerallyconsideredtobecleanandasaresultisoftenjudgedaslessofclinicalchallengethansomeotherwoundtypes(14).

The nursing care is a very important factor inpatients’ satisfaction or dissatisfaction with theirexperiences in hospital, and nurses’ attitudes towardsand communication with patients are the essentialdeterminantsofthepatientsatisfaction(15).

Throughout the courseof thepresent study, it hasnoticedthatthemajority(60%)ofthestudysamplewasmales.Thehighest proportion(28%)of themwere(25-29)years old. concerning level of education, nursinginstitute graduate (48%), (1 -5) years of experience(44%).

Throughout the use of observational checklist thehighly percentage of nurse’s have adequate practicesin items concerning (2, 3, 6& 15).These findings areindicate that the postoperative wound care so patientmayat riskof infections, thatmaysometimes lead todeath.

Throughouttheuseofstatisticalanalysistherewereno significant relationships between nurse’s practicesandtheirage,genderinsurgicalunits(table3,4),whiletheywerehighsignificantrelationshipsbetweennurse’spractices and their level of education and years ofexperience(table5,6)sonurseswithlowcertificationandinadequate skills cannot do difficulty responsibilitieslikegooddressingforpatients, thisresultsagreeswiththe study conducted by Atiyah and Khudhur 2012that found academic nurses had performed adequatepracticesrelativetopostoperativewounddressingthanpracticalones(16).

CONCLUSIONS

1. According to the findings of the study and theirdiscussion,theresearcherconcludedthat:

2. Themajorityofthestudynurseweremales(60%),(25-29)yearsold(28%),nursinginstitutegraduate(48%),(1-5)yearsofexperience(44%).

3. The results demonstrated a practice deficit in themostitemsofpost-operativewoundcareforpatientinsurgicalunits.

4. There is no significant relationship between age,gender and nurse’s practices about postoperativewoundcareforpatientinsurgicalcareunits.

5. Thereisasignificantrelationshipbetweenlevelofeducation,yearsofexperienceandnurse’spracticeabout post-operative wound care for patient insurgicalunits.

RECOMMENDATIONS

1. Special training sessions should be designed andpresentedtothesenurses.

2. Nursesshouldbeprovidedwithin-serviceeducationregardingnursing forpostoperativewoundcare insurgicalunits.

3. Abookletshouldbedesignedanddistributedtoallnurseworkinginsurgicalunits

4. The study recommended developing assessmentsheet for skills and daily nursing note for post-operativewoundcare.

The Source of Funding is self-approved by theUniversityofBasraNursingCollege

IhavethestatementinArabic

Thefundingsourceissubjective

The Interest is a benefit for the Iraqi society,especiallyBasrasociety

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