CHAPTER ONE
INTRODUCTION
1.1 Background
A pressure ulcer is localized damage to the skin and/or underlying soft tissue, usually over a bony
prominence or related to a medical or other device. The injury can present as intact skin or an open
ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or
pressure in combination with shear. The tolerance of soft tissue for pressure and shear also may be
affected by microclimate, nutrition, perfusion, co-morbidities, and condition of the soft tissue.
Pressure ulcers, also known as bedsores or pressure sores, are localized areas of tissue damage
arising due to excess pressure and shearing forces.(Melese.et al 2018).
Pressure ulcer is a preventable medical complication of immobility. It has psychological, economic
and social impact on individual and family. Its cost of treatment is more than twice the cost of
prevention. It is primarily the nurses’ responsibility to pressure ulcer. Pressure ulcers (PUs)
prevention remains a significant challenge for nurses, and its incidence is considered an indicator
of poor quality of care.
Patients and families know that pressure ulcers are painful and slow to heal. Some risk factors for
the development of pressure ulcers/injuries include advanced age, immobility, incontinence,
inadequate nutrition and hydration, neuro-sensory deficiency, device-related skin pressure. A
person who holds a positive attitude toward an issue will have a greater possibility of performing
a supportive behavior related to that issue. For example, the more positive attitude of nurses to PU
prevention, the better practice of PU prevention care demonstrated (Nuru et al; 2015).
Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care
facilities and impose a significant burden on patients, their relatives and caregivers. Nowadays,
pressure ulcers are recognized worldwide as one of the five most common causes of harm to
patients and preventable patient safety problems. In the USA, pressure ulcers remain a major health
problem affecting approximately 3 million adults. A systematic review of 31 studies found that
pressure ulcers significantly limit many aspects of an individual’s wellbeing, including general
health and physical, social, financial and psychological quality of life. According to an
international literature, it has been identified that nurses’ knowledge of the prevention of pressure
ulcers is poor, which is reflected in their practices as they do not comply with best practice
guidelines.
Study conducted in Sweden on nurses’ knowledge and practice of existing guidelines on
prevention of pressure ulcer found that, majority of them had inadequate knowledge and practice
to implement guidelines. Similarly, a study in Belgian Hospital found that knowledge of nurses
about the prevention of pressure ulcers was inadequate. Poor knowledge and practice of nurses
have its own significant contribution for higher prevalence of pressure ulcers. Moreover, a study
in Bahir Dar, Ethiopia found that a total of 71 pressure ulcers were detected in 422 patients, with
the prevalence rate of 16.8 %.
In Cameroon, the prevalence of pressure ulcer was detected in 946 patients which fell between the
ages of 50 to 70 years. in the study, 53% were males while 47% were females .385 patients were
found to be at risk of pressure ulcer with the prevalence rate of 50% in the population at risk .(Marc
Leory ;2016)
Also there are some knowledge gaps that exist in the prevention of bed sores which include heavy
workload/staff shortage, lack of universal guideline for prevention of bed sores lack of trained
personnel in the prevention of bed sores, uncooperative patient/client, other priorities other
pressure ulcers, shortage of pressure relieving devices, inadequate knowledge of nurse about the
prevention of pressure ulcers.
1.2 Problem Statement
Despite the increase in medical knowledge and new effective prevention and treatments, decubitus
ulcer is still a common and debilitating disease that presents a tremendous burden on the affected
individuals, the healthcare systems, and socioeconomic cost ( Hajhosseini ,Niemiec, Albatineh, et
al. 2020).A systematic review revealed that the incidence of decubitus ulcers is estimated to be
approximately 12% ( Albatineh, et al. 2020)The prevalence of decubitus ulcers in hospitalized
patients in the United States is between 5 and 15%, and the prevalence in the intensive care unit is
even high (Longaker, et al. 2020) An average of 60.000 people dies worldwide due to pressure
ulcer related causes. The exact incidence and prevalence of pressure ulcer remains unclear. There
for, the purpose of this sturdy is to determine nurses knowledge in the prevention and management
of pressure Ulcer.In several African countries, the incidence of pressure ulcers varies within and
among countries. In northern Ethiopia, a study conducted to assess the prevalence of Pressure
Ulcer among hospitalized patients in Felegehiwot referral hospital found that among the 422
patients admitted, 71 (16.8%) were found to have Pressure Ulcer. This prevalence was higher in
male respondents (42) than in female respondents (29) . Moshi, Sundelin, Sahlen, and Sörlin,
(2017) found that the most frequently documented complication of traumatic spinal cord injury
was Pressure ulcer (19.7%) in their retrospective study conducted in Kilimanjaro Christian
Medical Center, north-east Tanzania from 2010-2014 .Till date, the burden of pressure ulcer on
our health care system remains subjective due to scare data from Cameroonian studies. We
enrolled a total of 946 patients; 426 from CHU Yaoundé and 520 from HCY. There were 385
patients at risk of pressure ulcers. The cumulative incidence of pressure ulcers was 20% in general
and 50% in the population at risk. Although, The seems to be no publication, the phenomenon
seems to be the same in Buea regional hospital due to several cases of Pressure ulcer among
Hospitalized patient. I wonder whether or not, the Nurses have adequate knowledge on Pressure
ulcer prevention and management that lead to the study
1.3 Research Questions
 What level of knowledge does the nurses in the Buea Regional hospital have about
Pressure Ulcer?
 How do Nurses prevent Pressure Ulcer at the Buea Regional hospital?
 What challenges do Nurses face in the management of Pressure Ulcer in the Buea Regional
Hospital
1.4 Objective
1.4.1 General Objectives:
The purpose of this study is to determine the nurses’ knowledge in the prevention and management
of pressure Ulcer at the Buea Regional Hospital.
1.4.2 Specific Objectives
1. To determine Nurses’ knowledge on bedsores at the Regional Hospital Buea.
2. To Find out how Nurses at the Regional hospital Buea prevent bed sore
3. To Know the challenges faced by Nurses at the Buea Regional Hospital on the
management of bed sores