NURSES KNOWLEDGE IN THE MANAGEMENT OF POSTOPERATIVE WOUND IN SANTCHOU DISTRICT HOSPITAL

Abstract

Postoperative wound infections have been responsible for increase cost, morbidity, mortality, increase hospital stay in an infected patients and continues to be a major problem worldwide. Despite improvements on the management of postoperative wound, instrument sterilization methods, and the best efforts of infection prevention strategies to promote healing, postoperative wound infections remain a major cause of hospital acquired infections in surgical patients in most hospitals in most developing nations. The main objective of this study was to assess nurses‟ knowledge on the management of postoperative wound at the Santchou District Hospital. A descriptive cross-sectional design was used. The study included 60 nurses selected through a simple random technique. The main instrument for data collection was a structured questionnaire; the questionnaire was made up of closed and opened questions. The data collected was analyzed using SPSS Pakage, and result presented in bar chat, table and pie chat. Majority of the nurses in Santchou District Hospital have good knowledge in the management of postoperative wound, Majority of the nurses‟ encountered challenges like in adequate dressing material, over load, highly infected wounds and lack of nurses.

Nurses should constantly carry out research and seminars on postoperative wound care so as to improve on their management styles thus preventing complications which may result due to poor management like surgical site infection and prolong patient stay in the hospital.

CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background Of The Study

The earliest known record of the management of postoperative wounds was found on clay tablets of Mesopotamian origin, were wound care was thought to have come about through trial and error, with primitive cultures employing age-old techniques and wisdom (Forrest et al., 1982). In ancient Egypt, wound care had a spiritual basis were open wound was seen as a possible entry point for microorganism, thus requiring the use of a repellent in the form of face donkeys to pack the wound, to ensure the integrity of the vessel (Eaglstein et al., 1962). This intervention is said to contain the use of adhesive tape and gauze bandaging, while some wounds were left open and covered with fresh meat on the first day followed by treatment with astringents, herbs and honey (Griggs et al., 1997). Throughout history, various interventions have been utilized to enhance healing in surgical wounds and to overcome the unique challenges posed by it management (Shah et al., 1992). As medicine shifted from the realm of the spiritual to the scientific, so did the need to understand the outcomes of medical intervention, were wound healing is promoted by wound toilet and surgical debridement (WHO, 2005).

By the mid-19th century, the formation of pus was considered an inevitable consequence of surgery, but not part of the healing process. Surgery that healed without pus was described as “healing by first intention.” Nurses distinguished between creamy white or yellow laudable pus. (Anderson RC, 2009) and the bloody, watery, foul-smelling “malignant pus”.

Today, the nurse describe immediate postoperative closure of the wound is simply called “primary wound closure.” Closure of a “clean wound” is typically accomplished by a primary closure technique in healthy patients undergoing an uncontaminated laceration repair, closure of a biopsy, plastic reconstructive surgery, or closure of a clean surgical wound. The wound is usually closed by using sterile techniques with sutures or synthetic adhesive closure materials. The goal is to have an operative closure that creates a functional scar with complete healing. However, there is only a small window of opportunity to close the wound by primary intention, usually 4 to 8 hours. An additional factor is the ability of the nurse to approximate the wound edges. ( If it is not possible to exact functional wound closure because of the wound structure, nonlinear margins, asymmetrical dimensions, or the potential of interfering with the function of a joint,  wound  closure  may  be  delayed  and  require  the  expertise  of  a  plastic  surgeon  or  a specialized orthopedic surgeon. Other reasons for wound closure delay include contamination or simply a significant lapse of time. In these cases, healing by secondary intention is the next best option.

Tertiary intention (delayed primary closure) occurs when a wound is initially left open after debridement of all nonviable tissue. Wound edges may be surgically approximated following a period of open observation, when the wound appears clean and there is evidence of good tissue viability and tissue perfusion. Tertiary intention can also refer to subsequent surgical repair of a wound initially left open or not previously treated. This method is indicated for infected or detrimental wounds with high bacterial content, wounds with a lengthy time lapse since injury, or wounds with a severe crush component. (AM J Infection Control, 2017)

Advances in wound technology, such as negative-pressure wound therapy, have provided an array of options in facilitating wound management. As part of delayed or tertiary closure in military surgical practice, free flaps and rotational flaps are used to provide soft tissue coverage, along with the innovation of secondary intention wound granulation through vacuum-assisted closure dressings and hemostatic bandages. (Smith H. April 18, 2017)

Globally the prevalence of postoperative complications ranges from 50% to 75% of postoperative patients (Philip & Schroeder, 2007). In United Kingdom, a recent study has reported that 30% of postoperative patient experienced pain post-surgery (Hussainet al., 2011). In sub-Saharan Africa, there are variations of postoperative complication reported from one place to another. In Nigeria, it was reported that 95% of postoperative patients experienced various degrees of postoperative pain (Kolawoleet al., 2003).

In Cameroon, a study conducted on postoperative wound management following major abdominal and thoracic operations found that 40% of patients experienced complications during postoperative management (Ocittiet al., 2000). It was reviewed that Nurses had low level of practice and high level of knowledge with a mean of 20.6% on postoperative wound care (Ameh, et al., 2009).

In every major surgery, a patient has 2-5% chances of developing an infection, at the site of incision and those who get these infections are more likely to stay in the hospital twice as long as patients without infections (Mathieu, et al., 2006). The infected patients usually suffered from pain, discomfort and often die in the process when the wound is poorly managed.

1.2 Statement of Problem

Postoperative wound infections have been responsible for increase cost, morbidity, mortality, increase hospital stay in an infected patients and continues to be a major problem worldwide. Despite improvements  on  the  management  of  postoperative  wound,  instrument  sterilization methods, and the best efforts of infection prevention strategies to promote healing, postoperative wound infections remain a major cause of hospital acquired infections in surgical patients in most hospitals in most developing nations. In every major surgery, a patient has chances of developing an infection, at the site of incision and those who get these infections are more likely to stay in the hospital twice as long as patients without infections. The infected patients usually suffered from pain, discomfort and often die in the process when the wound is poorly managed. Santchou District Hospital have an increase rate of poor management of postoperative wound care due to negligence of the nurses therefore when nurses have a very poor altitude is going to rendered the care of the patient. This study shall be carrying out to assess nurses‟ knowledge on the management of postoperative wound.

1.3 Objectives

1.3.1 General Objective

The main objective of  the  study  was  to  assess  nurses‟  knowledge  on  the  management  of postoperative wound care at the Santchou Health District.

1.3.2 Specific objectives

1. To investigate nurses knowledge in the management of postoperative wound in Santchou Health District.
2. To investigate the benefit of proper management techniques of postoperative wound care in Santchou Health Area.
3. To identify challenges faced by nurses during wound care at the Santchou Health District

1.4 Research Questions

1. Do nurses have knowledge in the management of postoperative wound?
2. What is the benefit of proper management techniques of postoperative wound?
3. What are  the  challenges  nurses  at  the  Santchou  Health  Area  Faced  during  wound management?

1.5 Significance of the study

The study findings will help come up with solutions for postoperative  wound  infection which will help to hasten wound healing. Findings in this study will highlight importance of proper postoperative wound care in reducing cost that can results due to management of postoperative wound infections. Improving the better practice of postoperative wound care will enable nurses to prevent mortality, prolong hospitalization as well as reduced costs on the patients.

1.6 Scope of the study

This study is carried out to assess nurse‟s knowledge in the management of postoperative wound at the Santchou Health district

1.7 Operational Definition of Terms

Wound: Is a tissue following loss of skin integrity, provides a moist, warm and nutritive environment that is conducive to microbial colonization

Wound dressing: is the process by which a soiled dressing is removed, the wound is cleansed and a sterile dressing applied

Infection: The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body and may cause wound breakdown, herniation of the wound

Nosocomial infection: (hospital-acquired infection) is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections

Postoperative: Pertaining to the period of time after surgery. It begins with the Patient‟s emergence from anesthesia and continues through the time required for the acute effects of the anesthetic and surgical procedures to abate

Management: this is an ongoing treatment of wound by providing appropriate environment for healing both direct and indirect methods.