INTRODUCTION:

The skin is the largest organ, covering the entire outside of the body. It serves as a protective shield against heat, light, injury and infection. Maintaining the skin integrity is an important function of the nurses. A nurse should carry out the skin assessment on admission of the patient. Inspection should be conducted systematically, involving the whole body with special attention given to high risk areas such as bony prominences¹. People who are having prominent bony prominences such as undernourished were twice as likely to developed skin problem specially pressure sores². It is a common painful problem in hospitals, nursing homes and patient homes³.

‘Prevention is better than cure’. This often overlooked aspect of health care must be taken seriously as the world enters an era of chronic disease management that will end in a financial crisis if prevention programmes are not implemented⁴.

Pressure sores remains a major health problem affecting approximately 3 million adults. An estimation of 1.3 to 3 million patients in US has pressure sore but the incidence is highest in long term care facilities. In 1993, pressure sores were noted in 280,000 hospital stays and 11 years later the number raised to 455,000⁵. It occurs in 10% to 17% of all hospitalized patients and 20% to 40% of all nursing home patients^6.

In India, the incidence of pressure sore in hospitalized patients ranges from 2.7% to 29%, greater than 50% has been reported for patient in critical care settings⁸and the prevalence from 3.5% to 69% in general, 1.4% to 3.8% in older people above 65 years and 0.0 to 8% in younger patient⁷.

In the worldwide geriatric population 71% of patients more than >70 years have pressure sores. 14% of the population will be 60 years old or above and who are bed ridden⁸.

Pressure sores are increasingly being used as indicators of poor quality care. Failure of nursing care is blamed for most pressure sore in both hospitals and nursing homes. It is estimated that pressure sores can increase nursing care by 50%⁹. The best intervention is prevention. However, once developed, the nurse needs to treat the underlying cause by providing quality nursing care¹⁰.

Pressure sores are extremely difficult to heal. Estimate of complete healing are as low as 10% and as few as 13% of them heal by 2 weeks in acute care settings. One goal of Healthy People 2010 is to reduce the prevalence of pressure sores in nursing home patients by 50%¹¹.

NEED FOR STUDY:

Pressure ulcers - skin breakdown that occurs entirely as a result of exposure to a toxic combination of physical forces, such as pressure and shear. The incidence of pressure ulcers in nursing homes is more accurately described as an event, often associated with medically complicated residents who usually are frail and immobilized¹².

Pressure ulcers affect more than 1 million patients annually across the nation in both hospitals and nursing homes. The costs associated with caring for pressure ulcers exceed $1.3 billion¹³.

Pressure sores are more common in those 65 years of age old and this population is anticipated to double within the next 25 years. So the expectation is 72 million people or 1 in 5 will reach to this age group by 2030¹⁴.

Even patients, at home, also suffered from pressure ulcers ranging 4.1% to 29.7%. Keeping in view the magnitude of the problem, guidelines for the nurses has been developed for prevention and cure of pressure ulcers in various hospital settings¹³.

Pressure ulcers have evolved to the status of marker or red flag, signaling a need that adjustments to the system may be required¹⁵.

A cross-sectional study was conducted to evaluate nurses' knowledge about pressure ulcer prevention, wound assessment, and staging. 106 baccalaureate nurses were asked to indicate whether 33 statements about pressure ulcer prevention and eight pressure ulcers about assessment and staging were true or false. For the prevention, the average number answered correctly was 26.07 (SD 4.93) and for the assessment statements the average was 4.59 (SD 1.62). Nurses working on inpatient clinical nursing units had significantly better scores (P = 0.000). It shows that nurses have an overall understanding of pressure ulcer prevention and assessment principles but knowledge deficits exist. So the study reveals that continuing education efforts are needed to facilitate the implementation of evidence-based care¹⁶.

In view of the above and from the investigator’s work experience in clinical areas, the investigator felt the need and importance to assess the knowledge and practice of staff nurses regarding prevention and management of pressure sores in bed ridden patient. Hence the investigator aimed to develop a self instructional module, thereby assess its effectiveness which in turn enhances the knowledge and practice of staff nurses regarding prevention and management of pressure sores

STATEMENT OF THE PROBLEM:

“Assess the effectiveness of self-instructional module on knowledge and practice regarding prevention and management of pressure sores in bed ridden patients among staff nurses working in selected hospitals, at Bangalore”.

OBJECTIVES:

· To assess the pretest level of knowledge of staff nurses regarding prevention and management of pressure sores in bed ridden patients.

· To assess the pretest level of practice of staff nurses regarding prevention and management of pressure sores in bed ridden patients.

· To determine the effectiveness of Self Instructional Module on knowledge and practice regarding prevention and management of pressure sores in bed ridden patients among staff nurses.

· To correlate the knowledge of staff nurses with their practice regarding prevention and management of pressure sores in bed ridden patients.

· To find out the association between knowledge and practice of staff nurses and their selected demographic variables.

OPERATIONAL DEFINITION:

Assess:

It refers to the statistical measurement of knowledge and practice of staff nurses on prevention and management of pressure sores in bed ridden patients as elicited through knowledge questionnaire and observational rating scale.

Effectiveness:

It refers to significant gain in knowledge and improvement in practice after administration of SIM as determined by significant difference between pre and post test scores as elicited through knowledge questionnaire and observational rating scale.

Self-Instructional Module:

It refers to systematically organized series of self-learning content for the staff nurses on prevention and management of pressure sores in bed ridden patient.

Knowledge:

It refers to the correct response of the staff nurses to the items in the structured questionnaire on prevention and management of pressure sores in bed ridden patients.

Practice:

It refers to the actions performed by the staff nurses to prevent and manage pressure sores in bed ridden patients as elicited through observational rating scale.

Pressure sore:

It refers to the skin which is a sloughed, ulceration of tissue found especially over bony prominences of bed ridden patients.

Prevention and Management of Pressure Sore:

It refers to the actions taken by the staff nurses to avoid the occurrence of pressure sores and to provide nursing care to the pressure sore areas in bed ridden patient.

Bed ridden patients:

It refers to those patients who are confined to bed due to their illness and are at high risk to get pressure sores.

Staff nurses:

It refers to both male and female individual who have completed their diploma or degree in nursing and who have registered in State Nursing Council.

ASSUMPTION:

· Staff nurses will have some knowledge on prevention and management of pressure sore.

· The knowledge of the staff nurses influences the practices regarding prevention and management of pressure sore in bed ridden patient.

· Self instructional module will enhance the knowledge and practice of the staff nurses regarding prevention and management of pressure sore in bed ridden patients.

DELIMITATION:

The study is delimited to the staff nurses,

· Both male and female.

· Working in selected hospitals, Bangalore.

RESEARCH HYPOTHESIS:

H₁: There will be significant difference in the pre test and post test knowledge of the staff nurses on prevention and management of pressure sores in bed ridden patients.

H₂: There will be significant difference in the pre test and post test practice of the staff nurses on prevention and management of pressure sores in bed ridden patients.

H₃: There will be significant correlation between the knowledge of staff nurses and their practice regarding prevention and management of pressure sores in bed ridden patients.

H₄: There will be significant association between posttest knowledge and practice of staff nurses and their selected demographic variables.

RESEARCH METHODOLOGY:

Research Approach:

Evaluative approach was used.

Research Design:

The research design used for the study was pre-experimental - one group pre and post test without control group design.

Variables:

· Independent Variable:

Self Instructional Module on Prevention and management of pressure sores.

· Dependent Variable:

Knowledge and Practice of staff nurses on Prevention and management of pressure sores.

· Extraneous Variable:

Extraneousvariables such as, age, sex, marital status, professional status, years of experience, areas of experience, source of information and training programme undergone.

Setting of the Study:

The study was conducted in KC General Hospital, Malleswaram, Bangalore and Government General Hospital, Yelahanka, Bangalore.

Population:

The target population for the present study was staff nurses.

Sample and sample size:

In this present study the sample consist of 50 staff nurses working in selected hospitals, Bangalore.

Sampling Technique:

The staff nurses who fulfilled the inclusive and exclusive criteria were selected through convenient sampling technique - a method of non-probability sampling.

RESULTS:

Section I: Demographic characteristics of samples.

With regard to the

· Age of the staff nurses, highest 48% were between 21-30 years, 32% were between 31-40 years, 12% were between of 41-50 years and only 8% of them were above 5 years of age.

· Sex, highest 98% of them were females and lowest 2% were males.

· Professional status, higher 44% had completed GNM, 32% had completed B.Sc. Nursing, 20% of them had completed Post Basic B.Sc Nursing and only 4% had M.Sc. in Nursing.

· Years of experience, higher 40% were having 1-5 years of experience, 24% of staff nurses had above 10 years of experience, 22% was having 5-10 years of experience and 14% were having less than1 year of experience.

· Areas of experience, highest percentage 42% were working in ortho ward, 20% were working in neuro ward, 18% of them were working in surgical ward, 12% were working in ICU and lowest 8 % were working in medical ward.

· Source of information of staff nurses, highest 80% had no information, 12% of them had their knowledge from professional conferences, and 8% had their source of information from mass media. It seems that most of the staff nurses were not informative.

· Training progamme attended, highest 80% were not attended any of the training programme, 18% of them had attended the training programme more than a week ago and only 2% had their training less than one week of time.

Section II: Assessment of the pretest and posttest knowledge and practice of staff nurses on prevention and management of pressure sores in bed ridden patient.

· The overall mean percentage of pretest knowledge was 47.13%, whereas in post test the mean percentage was 75.73%. The difference in mean percentage was 28.6.

· The overall mean percentage of pretest practice was 29.93%, whereas in post test the mean percentage was 67.20%. The difference in mean percentage was 37.27.

Section III: Comparison of pretest and posttest knowledge of staff nurses

Level of pre and posttest knowledge of staff nurses.

Figure 1: percentage distribution of staff nurses by their overall knowledge.

In pretest highest 68% of them had average knowledge and 32% of them had poor knowledge whereas during post test 50% of them had good knowledge, and 34% and 16% of them had average and excellent knowledge respectively.

Table 1: Awise comparison of mean, SD, and mean percentage of pre and posttest knowledge of staff nurses. n=50

Area of knowledge items	Max scores	Pre test			Post test			Difference in Mean%
Area of knowledge items	Max scores	Mean	SD	Mean%	Mean	SD	Mean%	Difference in Mean%
General information related to pressure sore.	3	1.70	0.814	56.66	2.50	0.707	83.3	26.64
Definition and stages of pressure sore.	3	1.40	0.926	46.66	2.20	0.881	73.33	26.67
Pressure prone areas.	3	1.46	0.885	48.66	2.24	0.744	74.66	26
Causes, sign and symptoms and complication of pressure sore.	5	2.26	0.899	45.2	3.78	0.887	75.6	30.4
Prevention	7	3.52	1.313	50.28	5.32	1.115	76	25.72
Management	9	3.80	1.604	42.22	6.68	1.316	74.22	32
Overall	30	14.14	2.703	47.13	22.72	2.556	75.73	28.6

The highest mean practice score in pre test 4.92±2.049 which is 35.14% was for the area of “prevention" and lowest score 4.40±1.565 which is 27.5% was for the area of "Management". In post test the highest mean score 10.26±1.998 which is 64.13% was for the area of "Management” and lowest score 9.90±2.073 which is 70.71% was for the area of "prevention”.

CONCLUSION:

The self-instructionalmodule was effective.

Section V: Comparison of pre and posttest knowledge with their demographic variables:

The overall mean percentage score for pre test was 47.13% whereas for the post test it was 75.73% revealing a difference of 28.6%.

Further the highest difference in mean percentage 29.23% was obtained by those who had attended training programme more than 1 week and lowest 26.66% was obtained by the staff nurse who had attended training programme less than 1 week.

Section VI: Comparison of and posttest practice with their demographic variables:

The overall mean percentage score for pre-test was 29.93% whereas for post-test it was 67.2% revealing a difference of 37.27%.

Further the highest difference in mean percentage of 39.47% was obtained by the staff nurses who attended professional conferences and lowest 36.74% was obtained by the staff nurses who are not informative.

Section VII: Hypothesis testing.

Table 3: Comparison between pre and posttest knowledge scores of the staff nurses. n=50

Areas	Paired ‘t’ value	Table value	P value	Level of Significance
General Information	7.483	3.46	P<0.001	Significant
Definition and stages	6.424	3.46	P<0.001	Significant
Pressure prone areas.	7.489	3.46	P<0.001	Significant
Causes, signs and symptoms and complication.	12.129	3.46	P<0.001	Significant
Prevention.	10.967	3.46	P<0.001	Significant
Management.	15.259	3.46	P<0.001	Significant
Total	30.168	3.46	P<0.001	Significant

df=49,significant at p < 0.001 Table value = 3.460

High significant difference was found between the pre and post test knowledge scores (t=30.168, p<0.001). Hence, the research hypothesis H₁which states that here will be significant difference in the pretest and posttest knowledge of the staff nurses on prevention and management of pressure sore is accepted indicating effectiveness of SIM.

Table 4: Comparison between pre and posttest practice scores of the staff nurses. n=50

Areas	Paired ‘t’ value	Table value	Level of Significance
Management	18.529	3.46	P<0.001 Significant
Prevention	20.307	3.46	P<0.001 Significant
Total	23.872	3.46	P<0.001 Significant

df=49, significant at p < 0.001 Table value = 3.46

High significant difference was foundbetween pre and post test practice scores (t=23.872, p<0.001). Hence, the research hypothesis H₂which states that there will be significant difference in the pretest and posttest practice of the staff nurses on prevention and management of pressure sores is accepted indicating effectiveness of STP.

Table 5: Correlation of posttest knowledge of staff nurses with their practice. n=50

Sl. No

Variable

Mean

S.D.

Correlation

Knowledge

22.72

2.556

0.127

Practice

20.16

3.419

The coefficient of correlation is 0.127 which shows mild positive correlation with the posttest knowledge and practice. Hence the research hypothesis H₃ which states that, there will be a significantcorrelation between the knowledge of staff nurses and their practice regarding prevention and management of pressure sores in bed ridden patients is rejected.

Table 6: Association between posttest knowledge scores of the staff nurses and their demographic variables. n=50

Staff nurses	df	χ²	Table value	Level of Significance
Age	6	12.763	12.59	Significant*
Sex	2	1.020	5.99	Not significant
Professional status	6	13.424	12.59	Significant*
Years of experience	6	8.489	12.59	Not significant
Area of experience	8	4.336	15.51	Not significant
Source of information	4	18.271	9.49	Highly significant***
Training programme attended	4	17.584	9.49	Highly significant***

Significant association was found between posttest knowledge score of the staff nurses and their demographic variables such as age, professional status, source of information, training programme attended. Hence the research hypothesis H₄ stating that there will be significant association between posttest knowledge of staff nurses and their selected demographic variables is accepted for these knowledge variables.

Table 7: Association between post test practice scores of the staff nurses and their demographic variables. n=50

Staff nurses	df	χ²	Table value	Level of Significance
Age	6	9.479	12.59	Not significant
Sex	2	0.574	5.99	Not significant
Professional status	6	10.615	12.59	Not significant
Years of experience	6	4.624	12.59	Not significant
Area of experience	8	8.159	15.51	Not significant
Source of information	4	2.330	9.49	Not significant
Training programme attended	4	1.349	9.49	Not significant

No significant association was found between posttest practice score of the staff nurses and their demographic variables Thus, it seems that the differences in the mean scores values were by chance and not true differences. Hence the research hypothesis H₄is rejected in terms of practice variables.

ACKNOWLEDGMENT:

The authors would like to express her gratitude to the her college’s Chairman, Managing Director, Principal, Research Guide & Co-guide and Hospitals at Bangalore, for their support and help in conducting this study.

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Received on 21.10.2023 Modified on 29.11.2023

Int. J. Nur. Edu. and Research. 2024; 12(1):57-62.

DOI: 10.52711/2454-2660.2024.00013

Area of practice items	Max scores	Pre test			Post test			Difference in Mean%
Area of practice items	Max scores	Mean	SD	Mean%	Mean	SD	Mea%	Difference in Mean%
Prevention	14	4.92	2.049	35.14	9.90	2.073	70.71	35.57
Management	16	4.40	1.565	27.5	10.26	1.998	64.13	36.63
Overall	30	8.98	2.966	29.93	20.16	3.419	67.20	37.27