KNOWLEDGE, ATTITUDE AND PRACTICE OF SURGICAL PATIENT HEALTH EDUCATION AMONG NURSES AT GENERAL HOSPITAL MINNA

ABSTRACT

This descriptive, correlational study was to identify the knowledge, attitude and practice of nurses at General Hospital Minna (GHM) and examine the relationship between them. One hundred and twenty surgical nurses participated in the study (96% response rate). The instrument used for data collection was a questionnaire which is composed of three parts: Demographic characteristics, Nurses’ knowledge questionnaire, and Nurses’ practice questionnaire. The latter two questionnaires were tested for content validity from 3 experts in surgical field and were translated into Hausa language using back translation technique. The Cronbach’s alpha coefficients determining internal consistency reliability of Knowledge Questionnaire and Practice Questionnaire were .85 and .87, respectively. The data were analyzed by using descriptive statistics and Pearson product-moment correlation.

The results revealed that the nurses had low level of knowledge (M = 69.67%, SD = 8.53) and high level of practice (M = 89.95%, SD = 4.06). There was a weak, significantly negative correlation between knowledge and practice regarding low level including: identifying best method for pre-operative shaving, recognizing best time for pre-operative hair removal, understanding prevention of infection for patients with immunodeficiency disorder, and recognizing best agent for pre-operative shaving. Some areas of practices were less practiced including: assessing patient’s body mass index to monitor nutritional status and advising patients to shower before surgery with antimicrobial agents. These findings suggest that nurses’ knowledge and some certain areas of practice regarding surgical patient health education need further improvement.

CHAPTER ONE

INTRODUCTION

1.1 Background of study

Health is one of the most important services provided by the government in every country of the world. In both the developed and developing nations, a significant proportion of the nation’s wealth is devoted to health. For example, the World Health Reports (2006) gave Nigerian government’s expenditure on health as a percentage of the nation’s Gross Domestic Product (GDP) for year 2001, 2002, and 2003 as 5.3 percent, 5 percent, and 4.7 percent respectively. This is to show the fact that Nigerian government health care expenditures are not only significant in absolute terms but also relative to the Gross Domestic Product.

Developing nations’ expenditure on health, however, ought to be more substantial than that of the developed nations. This is because in developing countries like Nigeria, with relatively low level of mechanization and automation, health assumes additional dimension of importance in terms of implications for economic activities. The Federal Ministry of Health in Nigeria (1998) noted that the health of the people not only contributes to better quality of life, it was also essential for sustained economic and social development of the country as a whole. Hence, health is regarded as a critical resource in the process of economic development.

Incidence of surgical patient health educations may vary from hospital to hospital in different countries. Developed countries, such as the USA, the United Kingdom (UK), and Sweden have the lower incidence of surgical patient health educations ranging from 2% to 6.4% (Anderson, Kaye, Classen, Arias, & Podgorny, 2008; Gunningberg, Persson, Akerfeldt, Strdsberg, & Swenne, 2008; Taylor et al., 2004). In developing countries, such as India, Pakistan, Nepal, Turkey, and Iran, the incidence of surgical patient health educations is higher ranging from 5.5% to 25% (Desa, Sathe, & Bapat, 2008; Giri, Pant, Shankar, Sreeramareddy, & Sen, 2008; Lohsiriwat, & Lohsiriwat, 2009; Mustafa, Bukhari, Kakru, Tabish, & Qadri, 2004; Razavic, Ibrahimpoor, Kashani, & Jafarian, 2005).

In Nigeria, a study principally conducted with surgical patients showed that the prevalence of postoperative wound infection in medical college hospitals in Nigeria ranged from 6% to 18% (Hadi, 1991). A retrospective study conducted in General Hospital Minna (GHM) showed that the incidence of surgical patient health education was 28.49% (Parvin, Mondol, & Gegum, 2002). In addition, another retrospective study conducted in Comilla Medical College Hospital found that the incidence of surgical patient health education was 22.05% (Islam, Akhter, & Sickder, 2007). A prospective study conducted in two medical college hospitals found that overallsurgical patient healthincidence was 11% (Saha & Ashrafuzzaman, 2008).

SSI is a significant clinical problem leading to morbidity and mortality.surgical patient healthcaused pain, misery, and possible deformity (Fry & Fry, 2007).surgical patient healthalso added to functional disability and emotional stress to the patients and in some cases disabling condition led to reduce quality of life (Ponce-de-Leon, 1991). Furthermore,surgical patient healthmight require that the patient undergoes additional surgical procedures or it may result in death (Fry & Fry). Patients withsurgical patient healthhad 2 to11 times higher risk of death compared to patients withoutsurgical patient health(Kirland, Briggs, Trivett, Willson, & Sexton, 1999). The Institute of Medicine reported that SSIs caused death in 44,000 to 98,000 patients per year in the USA (Seltzer, McGrow, Horsman, & Korniewicz, 2002). A study found that mortality rate was 7% in patients diagnosed withsurgical patient health(Whitehouse, Friedman, Kiraland, Richarden, & Sexton, 2002).

SSI also causes unnecessary increased health care cost resulting in financial constraints to both patients and health care system as a whole. In the USA, a study revealed thatsurgical patient healthcaused prolonged hospitalization 14 extra days and it was estimated that direct cost of hospitalizations per infected patient was US$ 24,344, compared to US$ 6,636 per uninfected patient (Whitehouse et al., 2002). Yet another study conducted in a European university hospital found that patient withsurgical patient healthspent additional postoperative length of hospital stay of 16.8 days and additional hospital cost was US$ 11,586 (Weber et al., 2008).surgical patient healthhas a significant impact on quality of life and economic status.surgical patient healthpatients spent significantly more time in out-patient department visits, emergency room visits, investigation services, readmission in hospital, and other health care services than patients without SSI. It was found that average estimated total cost of caring patient withsurgical patient healthwas US$ 5,155 compared to US$ 1,773 in patient withoutsurgical patient health(Barnard, 2003).

Intrinsic and extrinsic risk factors were related to the development of surgical patient health educations. Intrinsic factors include advanced age, malnutrition, metabolic diseases, smoking, obesity, hypoxia, immunosuppression, and length of pre-operative stay. Extrinsic factors include duration and application of skin antiseptics, preoperative shaving, antibiotic prophylaxis, pre-operative skin preparation, inadequate sterilization of instruments, surgical drains, surgical technique, surgical hand scrub, and dressing technique (Nandi, Rajan, Mak, Chan, & So, 1999; Seibert, 1999; Seltzer et al., 2002).

Among several contributing factors to SSI, nurse’s responsible factor seems to be a significant importance, particularly nurses’ lack of knowledge and skills. A study found that the malnutrition rate was high in patients before undergoing gastrointestinal surgery due to nurses’ lack of knowledge and inability to evaluate nutritional status of the patients (Aydin & Karaoz, 2008). Nurses applied unsterile and inappropriate technique of using glove in surgical wound care and surgical procedures (Hampton, 2003) and 85% of nurses used inappropriate dressing technique in caring for surgical patients (McFadden & Miller, 1994). According to Small (1996), it was found that nurses violated hospital’s protocol for pre-operative hair removal due to their negligence. A survey study found that the nurses lacked of potential knowledge and practice in respect of wound care and also conducted poor management of wounds with inappropriate usage of dressing technique (Hollinworth, Taylor, & Dyble, 2008).

1.2 Statement of Problem

Based on a literature review, approximately 25% of the infections could be prevented by nursing personnel by following proper precautions during nursing care of surgical patients (Parvez, Emmanuel, & Sharma, 2005). Successful nursing care of surgical wounds depended on nurses’ evidence-based knowledge and practice in terms of understanding normal wound healing process, type of surgery, methods of wound closure, preventive techniques, risk factors for surgical wound, and management of the surgical wound care. Using these knowledge and practices, nurses can provide a systemic and holistic patient assessment and management to patient health education (Vuolo, 2006). In India, a study found that nurses had the mean knowledge score of 73%, but the mean practice score was 63% regarding infection control measures. This study also found that there was a positive relationship between knowledge and practice, but their scores were not consistent regarding infection control measure (Vij, Willliamson, & Gupta, 2001). Another study reveled that nurses had low level of knowledge and high level of practice regarding infection control practice and the weak, negative correlation found between knowledge and practice signified that knowledge did not influence the practice (Najeeb & Taneepanichsakul, 2008).

For the surgical patient health education, nurses should have proper knowledge and they should have skills on this matter during pre-operative, intra-operative, and post- operative period. For this study, the intra-operative surgical patient health education by nurses working at operation theatre will not be assessed because in Nigeria operating theater mostly is controlled by surgeons. Preoperatively, nurses need to have knowledge and they should provide care in the following scopes: hygiene and skin preparation, controlling underlying medical conditions, maintaining nutritional status, and antibiotic prophylaxis. Postoperatively, nurses also need to have knowledge and maintain good practice in the following scopes: surgical wound care with aseptic precaution, wound assessment and patient health education, and nutritional support (Click, 2007; Mangram et al., 1999).

practice of surgical patient health education is the result of a complex interaction among the patient, wound related factors and nurses’ evidence-based knowledge and practice of infection prevention (Hollinworth et al., 2008). Application of current knowledge and practices by nurses can help patient health educations, reduce patients’ and hospitals’ expenditure and improve patients’ quality of life. The incidence of surgical patient health education is very high in Nigeria. Information about standard nursing practice guidelines in surgical patient health education are lacking in Nigeria. Currently, infection control training program for nurses is existed, but no special training program on surgical patient health education has yet been conducted in Nigeria. Nurses have a lot of roles to play in surgical patient health education, thus, there is a need to examine their state of knowledge and practice. The e amination of nurses’ knowledge and practices regarding the surgical patient health education has not been conducted in Nigeria. Therefore, this study was proposed with the following objectives.

1.3 Objectives of study

1. To examine the level of nurses’ knowledge regarding surgical patient health education

2. To examine the knowledge, attitude and practice of nurses regarding surgical patient health education

3. To examine the relationship between nurses’ knowledge and practice regarding surgical patient health education.

1.4 Research Questions

1. hat is the level of nurses’ knowledge regarding surgical patient health education

2. hat is the knowledge, attitude and practice of nurses regarding surgical patient health education

3. Is there a relationship between nurses’ knowledge and practices regarding surgical patient health education?

1.5 Hypothesis of study

There is a positive relationship between nurses’ knowledge and nurses’ practice regarding the surgical patient health education.

1.6 Significance of the Study

The findings of this study can contribute to nursing practice, nursing education, and development of further research in the nursing profession as follows:

1. For nursing practice, the research findings help develop and organize training programs to increase nurses’ knowledge and practice for the surgical patient health education.

2. For nursing education, the research findings provide information to guide the development of nursing curriculum and training courses related to the surgical patient health education.

3. For nursing research, the research findings can be used as baseline reference for future experimental research, such as the effectiveness of educational program to increase knowledge and practice regarding surgical patient health education.

1.7 Scope of the Study

This descriptive, correlational study focused on exploring the knowledge, attitude and practice of nurses regarding the surgical patient health education. This study also examined the relationship between nurses’ knowledge and their practice regarding the surgical patient health education. The subjects of the study were surgical nurses who worked in the surgical related wards at General Hospital Minna (GHM), a 500-bed teaching hospital in Nigeria. This study was conducted from November 20019 to January 2022.

For more Nursing Sciences Projects Click here

===================================================================

Item Type: Project Material  |  Size: 57 pages  |  Chapters: 1-5

Format: MS Word  |  Delivery: Within 30Mins.

===================================================================

DOWNLOAD THIS PROJECT MATERIAL NOW! CLICK HERE!

Share: