The Efficacy Of Patient Teaching In The Prevention Of Surgical Wound Breakdown Amongst Post-Op Patients In Surgical Ward Of Madonna University Teaching Hospital, Rivers State

ABSTRACT

This study was conducted to assess the efficacy of patient teaching in the prevention of surgical wound breakdown amongst post-op patients in surgical ward of Madonna University Teaching Hospital, Rivers state. The specific objectives were to assess the level of knowledge of determinants of surgical wound among post operative patients; to assess the factors associated with practice of patient teaching for prevention of surgical wound breakdown in post operative patients; and to assess the role of patient teaching in managing surgical wound on the post operative patient in surgical ward of Madonna University Teaching Hospital. The study employed a quantitative descriptive survey design, using a semi-structured questionnaire. Using the Taro Yamane formula, 100 respondents were selected for the data collection and descriptive statistics of frequency and percentages were used to analyze the data. Results revealed that a high percentage of 87.2% of respondents knew the correct definition of postoperative wound infection. The results also indicate that the casusative organisms of surgical wound to include Staphylococcus aureus (28.2%), Pseudomonas aeruginosa (25.2%), Escherichia coli (7.8%), and Staphylococcus epidermidis (7.1%). The factor to post operative wound infection include obesity (22.6%), underweight (85.7%), presence of preoperative cutaneous abscess, necrosis (85.7%), use of an iodized alcohol skin antiseptic agent (85%), and parietal or abdominal drainage (65%). the factors that are associated with practice of patient teaching among nurses for prevention of surgical wound breakdown in post operative patients. They include nurses’ experiences (87.2%), cultural barriers (22.6%), work place culture (85.7%), lack of time 85.7%), heavy workload (85%), insufficient staffing (85%), and complexity of patients’ condition (82%). lastly, results showed the role of patient teaching in managing surgical wound to include Patient teaching has affected my activity pattern (94.4%), Patient  teaching improves knowledge (68%), Patient  teaching has helped my nutrition knowledge (30%), Patient  teaching informs about the appropriate dietary counselors for wound control and management (92.2%), and Patient  teaching helps improve  surgical wound management (82.2%). The study concluded that Compliance to infection prevention guidelines can lead to reduce rates of infections among operative patients and make for more effective patient teaching and health outcome. It recommended that the management should be conducting quarterly evaluation of the performance of the health workers towards patient teaching and education to ensure its function is adding value to the care of post operative patients and reducing the incidence of surgical wounds infection.

CHAPTER ONE

INTRODUCTION

This chapter is the introductory chapter which presents the background of the study, the statement of the problem, the significance of the study, purpose of the study / broad objective, specific objectives of the study, research questions, hypothesis of the study, scope of the study and operational definition of terms.

Background to the study

Post-operative wound infection is an infection in the tissues of either an incision or organ occurring within thirty (30) days after an operation or within one year if an implant is present in the body (Tietjen et al., 2014). Abdominal surgeries, surgeries lasting over two hours, infected wounds, and the presence of multiple diagnoses in the individual present the highest risk of developing post operative wound infections. Generally, factors increasing an individual’s risk include malnutrition, decreased blood volume, lengthy post-operative wound infection, hypothermia, poor tissue perfusion, diabetes mellitus, and the use of immunosuppressive agents such as steroids (Tietijen et al., 2014).

Post-operative wound infection prolongs patient hospitalization, leading to increased usage of pharmaceutical services, more laboratory investigations and other services thereby, creating an economic burden on the health care system in developing countries bearing in mind that resources are scarce in this sector. The cost of providing these  health  services to patients that have been hospitalized longer than expected is an unforeseen cost that result in economic burden that deprive the health sector of the much needed resources that can be utilized to provide health services for  the  hard-to-reach population (Mukwato, 2016, Chanda, 2014).

Health literacy is often indicated to accommodate an individual approach by substituting the three domains of health “healthcare, disease prevention, and health promotion” with “being ill, being at risk, and staying healthy” (Sørensen, 2012). Health literacy bears significance in improving prevention and control of infectious diseases, whereas health knowledge and behavior are important components of health literacy. Given the current high incidence of Post-operative wound infection among patients, improving health literacy of patients on healthy behaviours and precautions serves as an important channel in controlling infections and adverse post-op effects. Patient teaching can improve patient knowledge on infections, risk factors and promote the development of appropriate behaviors toward infection prevention and control. Health promotion is based on health education, which is founded on health knowledge. Health education effectively slows spread of infectious diseases, and conducting health sensitization programs not only provides patients with proper knowledge and behavior toward infections but also benefits the public health (Kalinowski, 2015).

In 2003, Central Board of Health observed that the rates of nosocomial infections related to poor infection prevention practices were unacceptable. For example, a hospital accreditation survey conducted in 2002 by the Ministry of Health, reported high rates of post operative infections, showing a post operative wound infection of 30% or more among caesarean section patients. In addition, the high rate of attrition, illness and death among health workers are cited as partly contributing to the high risk of infection inherent in the health care professionals when adequate precautions are not taken. In Zambia, the first edition of Zambia Infection Prevention Guidelines was developed in 2003 by the Central Board of Health. The sole purpose of developing the Infection prevention guidelines was to provide standard guidelines for infection prevention practices applicable at all levels of the health care system in Zambia, which are technically sound and also feasible in the current environment of health care services in Zambia (CBoH, 2013). These basic guidelines such as hand washing with soap and water, and other specific procedures such as sterilization can go a long way in curbing post- operative wound infection in most of our health facilities in Africa and the world over.

Considering the economic implication on the health care system and suffering endued by patients as a result of post operative wound infection, it becomes clear that Infection prevention guidelines as recommended by the Ministry of Health and John Hopkins Information Education on Gynaecology and Obstetrics (JHPIEGO) that are cost effective are adhered to by all health care providers. It is also clear that knowledge of determinants of post operative wound infection by health care providers is important especially nursing staff who spend 24 hours nursing post operative patients in the fight against post-operative wound and infection.

Smith et al. (2012) stated that the relationship between nursing and infection control was first identified by Florence Nightingale in 1854 during the Crimean war when she served in a military hospital in Scutari in Italy. At that time, the conditions in the hospitals were deplorable. Nightingales observations in Scutari led her to believe that improving hygienic conditions would decrease the number of deaths. Kamisky (2014) believe that Nightingale championed the cause of improved hygiene, food and living conditions for the hospitalized soldiers. She curbed the hospital conditions and called for basic public health, infection control measures, cleanliness, hygiene and education about the importance of the issue. Today nurses are key players in the fight to ensure the survival of infection control practices (Smith et al., 2012). Therefore, this study seeks to assess the efficacy of patient teaching in the prevention of surgical wound breakdown amongst post-op patients in surgical ward of Madonna University Teaching Hospital in order to reduce the rate of hospital acquired infections such as post-operative wound infection.

Statement of problem

Surgical wound infections number approximately 500,000 per year among an estimated 27 million surgical procedures and account for approximately one-quarter of the estimated 2 million nosocomial infections in the United States each year (Haley RW, 2015). The incidence of infection varies from surgeon to surgeon, hospital to hospital, procedure to procedure and patient to patient. During the mid 70s, the average hospital stay in the United States doubled and the cost of hospitalization was correspondingly increased when post operative infection developed after six common operations (Green, J., 2017).

urgical wound infection is a common post operative complication. It causes significant post operative morbidity and mortality, prolongs hospital stay and adds between 10% and 20% to total hospital costs (Nandi PL, 2012). Major complications such as deep sternal infections continue to have a grave impact, increasing the duration of hospitalization as much as twenty-fold and the cost of hospitalization five-hold (Taylor GJ et al, 2013). Any surgical site infection after open heart surgery results in substantial net loss of reimbursement to the hospital compared to uninfected cases, a factor that should motivate the hospitals to minimize the incidence of post operative infections (Boyce JM, 2010). It has been shown that surgical wound infections may occur shortly after surgery or several days post operatively, and the site of infection may be limited to suture line or may extend into the operative site (Balows, 2015). Maniatis et al (2015) suggested that deep seated sepsis developing a few days after an operation and before the wound has been dressed reflect a theatre infection. Ward infections tend to be more superficial and frequently follow the dressing of wounds in the wards.

Few studies done on wound infections in Nigeria did not lay emphasis on surgical wound infections. In a cohort study done by Adebayo Osagie Shittu, Deboye Oriade and Emiola Ruth in 2014 to study wound infections in two health institutions in Ile-Ife, it was noticed that 40% of all infected wounds were caused by trauma and in most cases, located on the extremities. The bacterial isolates were polymicrobial with Staphylococcus aureus being the predominant organism (Adebayo OS, 2013). No emphasis was laid on surgical wound infections as it was considered a minor part of the study. In another study by Oguntibeju OO and Nwobu RAU in Lagos University Teaching Hospital in 2013 to determine the prevalence of Pseudomonas aeruginosa in post operative wound infection, it was found that 20 of the 60 (33%) bacterial isolates were Pseudomonas aeruginosa followed by Staphylococcus aureus (21.7%) (Oguntibeju O, 2014). This study did not assess the prevalence of post operative surgical wound, infection associated factors and the outcome of the patients teaching.

The shortfalls of the above studies partly ignited an interest in a detailed study of the topic. This study sets out to assess how health teaching when utilized can help prevent infection of surgical wounds, and related factors responsible for the infections. This is considered important as the findings will help strengthen hospital infection surveillance system and to plan preventive programme to curb future occurrence considering its health and economic impact.

Objectives of the study

The general objective of this study is to assess the efficacy of patient teaching in the prevention of surgical wound breakdown amongst post-op patients in surgical ward of Madonna University Teaching Hospital. Specifically, this study seeks to;

1. Assess the level of knowledge of determinants of surgical wound among post operative patients.
2. Assess the factors associated with practice of patient teaching for prevention of surgical wound breakdown in post operative patients;
3. Assess the role of patient teaching in managing surgical wound on the post operative patient in surgical ward of Madonna University Teaching Hospital

1.4       Research questions

The following questions were formulated based on the problem identified and the objectives of the research;

1. What is the level of knowledge of determinants of surgical wound among post operative patients?
2. What factors are associated with practice of patient teaching among nurses for prevention of surgical wound breakdown in post operative patients?
3. What is the role of patient teaching in managing surgical wound on the post operative patient in surgical ward of Madonna University Teaching Hospital?

Significance of the study

This study seeks to assess the efficacy of patient teaching in the prevention of surgical wound breakdown amongst post-op patients in surgical ward of Madonna University Teaching Hospital. It also examines the factors that promote or inhibit the practice of healthy behaviours and standard precautions. Findings from the study will be used by the Health authorities, stakeholders, and the hospital management, in planning and developing adequate measures for control and intervention to improve patient teaching nursing students on the spread of communicable diseases. This study will be of most significance to the health care givers and students as it provides interventions and strategies that will result from the study findings.

Also, this research work will contribute to the existing body of literature and knowledge on the subject of standard precautions among health care givers and professionals. This study would also serve as a means of reference source for future researchers as well as educate the public on the results of the findings as well as recommendations made that will be of benefit to the health system and public health of the community and individuals.

Scope of study

This study is focused on the assessment of the efficacy of patient teaching in the prevention of surgical wound breakdown amongst post-op patients in surgical ward of Madonna University Teaching Hospital. This study was carried out in Madonna University Teaching Hospital in Rivers state as the area of study. This study covers the occurrence level of surgical wound in post operative patients in Madonna University Teaching Hospital, the Nurses level of knowledge of determinants of post operative surgical wound among patients, the factors associated with practice of patient teaching among nurses for prevention of surgical wound in post operative patients, and the role of patient teaching in managing the outcome of the surgical wound on the patient in surgical ward of Madonna University Teaching Hospital.

Operational definition of terms

For the purpose of this study, the key terms have been defined as follows:

Patient Teaching otherwise known as patient education is the process by which health professionals and others impart information to patients and their caregivers that will alter their health behaviors or improve their health status.

A surgical wound is a cut or incision in the skin that is usually made by a scalpel during surgery. A surgical wound can also be the result of a drain placed during surgery. Surgical wounds vary greatly in size. They are usually closed with sutures, but are sometimes left open to heal.

Post Operative or Post-op for short for is the care you receive after a surgical procedure. The type of postoperative care you need depends on the type of surgery you have, as well as your health history. It often includes pain management and wound care. Postoperative care begins immediately after surgery.

Pages:  58

Category: Project

Format:  Word & PDF

Chapters: 1-5

Material contains Table of Content, Abstract and References.