Valley View University

P.O.BOX AF 595
Adentan-Accra
4th February, 2025.

The Chairperson
Institutional Review Board
P.O Box, 1
Dodowa.

Dear Chairperson,

APPLICATION FOR ETHICAL APPROVAL

Protocol Name: PREVENTIVE PRACTICES AND MANAGEMENT OF PRESSURE

ULCER AMONG ORTHOPEDIC NURSES AT KORLE-BU TEACHING HOSPITAL

I write to submit to you the above-named protocol and essential documents for approval by

your committee. I look forward to receiving any comments that you may have in relation to

the above.

Thank you for your co-operation.

Yours Sincerely,
…………………
Priscilla Archer

i
ii
 GHANA HEALTH SERVICE

DODOWA HEALTH RESEARCH CENTRE INSTITUTIONAL REVIEW BOARD (DHRCIRB)

APPLICATION FORM FOR PROTOCOL SUBMISSION

(Please complete in BLOCK letters and submit together with full Protocol for IRB Consideration)
Title of study: PREVENTIVE PRACTICES AND MANAGEMENT OF PRESSURE ULCER AMONG

ORTHOPEDIC NURSES AT KORLE-BU TEACHING HOSPITAL

PART I: ADMINISTRATIVE INFORMATION OF PRINCIPAL INVESTIGATOR (S)

1.2 Details of Principal Investigator

Surname: Archer

First Name: Priscilla

Others:

Institutional Affiliation(s): VALLEY VIEW UNIVERSITY

Full Postal Address: P.O.BOX AF 595 ADENTA-ACCRA

Telephone/ Mobile: 0599650994

Email; [email protected]

1.3 Details of Co-Principal Investigator (if applicable)

Surname:
...............................................................................................................................................................

First Name:
.................................................................................................................................................................................
Others:
......................................................................................................................................................................................

iii
Institutional Affiliation(s):

Full Postal Address:

Telephone/Mobile:
Email

PART II: INFORMATION ON COLLABORATOR (S)

1.4(a) Names of First Collaborator:

Institutional Affiliation (s):

Full Address:

Telephone/ Mobile:

Email:

1.4(b) Names of Second Collaborator (if applicable):

Institutional Affiliation (s):
Full Address:
Telephone/Mobile:
Email:

PART III: INFORMATION ON SPONSOR (S)

1.7 Names of Sponsoring Agency (please specify name of lead person)

Institutional Affiliation (s): Self-sponsored project by Priscilla Archer

Full Address:

Telephone:/Mobile: 0599650994
Email: [email protected]

PART IV: INFORMATION ON PROPOSED STUDY

1. Nature of Protocol (Please tick appropriate column)

Institutional Protocol Academic Protocols √ Individual Others(specify)

 

iv
 PhD MSc MPhil MP M Undergraduate Fellowship

   H A √ 

2. Type of Study (Please tick which of the below is applicable to your study)
Type A B. Type B Type C
i) Clinical Trial iv. Social Science √ v. Implementation Research

ii) Biomedical Study/Epidemiological Study a. Economic studies 

iii) Others (specify): b. Policy Studies 

c. Exploratory studies √

d. Monitoring and
Evaluation studies 
h. Other (Specify) 
......................................................................................................
..................................

3. Study Site(s)

i. Name of Study Site: Region:

GREATER ACCRA
KORLE-BU TEACHING HOSPITAL, District: ACCRA METROPOLITAN ASSEMBLY
ACCRA.
Sub-District:

ii. Name of Study Region:

Site:
District:

Sub-District:

iii. Name of Study Region:

Site:
District:

Sub-District:

v
4. Date of Initial Submission to DHRCIRB: 7th February, 2025

5. Duration of Study: 6 months Start of Study: October, 2024 End of Study: April, 2025

PART V: TYPE OF REQUEST (please tick appropriate column)

A) New Submission: 1. Yes √ 2. No 

B) Request for Amendment: 1. Yes  2. No 

C). Type of Amendment:

i. Additional information to protocol 
ii. Change of study site 
iii. Additional study site 
iv. Additional PI(s) 
v. Change of PI(s) 
vi. Amendment of Informed Consent 
vii. Amendment of Data collection tools (Questionnaires, Interview Guides) 
viii. Others (please specify) 

vi
As the Principal Investigator / Co-investigator / Researcher/ Student Investigator on this project, your signature
on the proposal confirms that:
1. You will ensure that all procedures performed under the study will be conducted in accordance with all
relevant policies and regulations that govern research involving human participants.
2. You understand that if there is any change from the project as originally approved you must submit an
amendment to the IRB for review and approval prior to its implementation. Where you fail to do so,
the amended aspect of the study is invalid.
3. You understand that you will report all serious adverse events associated with the study within seven
days verbally and fourteen days in writing.
4. You understand that you will submit progress reports each year for review and renewal. Where you fail
to do so, the IRB is mandated to terminate the study upon expiry.
5. You agree that you will submit a final report to the IRB at the end of the study.

Name of person completing the form: PRISCILLA ARCHER

Role on the study: PRINICIPAL INVESTIGATOR

Signature: ………………………………

Date: 7th February, 2025

For Student’s Supervisor(s)

I have thoroughly read through the proposal and all the accompanying research instruments.

First Supervisor
Name in Full: MS. DOROTHY BAFFOUR AWUAH …………………………. ………………………..
Signature Date:

vii
 Second Supervisor
……………………..………… …………………………. ……………….………..
Name in Full Signature Date

Third Supervisor
………………………..… ……………………..…. …………………..……..
Name in Full Signature Date

PART VI: FOR DHRCIRB OFFICIAL USE ONLY

1. Protocol ID No: ............................. Date Received: ......................... Month received:........................Year

received: ...............

2. Process of Protocol Consideration:

i. Full Board Review  ii Recommended for Expedited Review 
3. Date of Initial Review: .........................................................................................

4. Outcome of Initial Review:

i. Outright approval ii. Conditional iii. Redesign document  iv. Pending  Other (specify):
 approval  

5. Date of Re-submission: ........................................................

6. Outcome of Resubmission Review:

i. Approved  ii. Conditional  iii. Pending  Others (specify): 

7. Date of Final Approval: ......................................................

viii
8. Status of Approved Study:

i. Started  ii. Ongoing  iii. Completed  iv. Yet to Start 

vi. Suspended  vi. Discontinued  vii. Others (specify) 

9. Request for Presentation of Study by PI (s) (1) Yes  (2) No 

10. Submission of Reports:

A. Submitted  B. Not Submitted 

Type of Report Submitted:

i. Initial/ Inception report 

ii. Interim Report 

iii. Progress report 

iv. Adverse Report/Serious Adverse report 

v. Final /Completion report 

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 PI TO COMPLETE
Title of Study: PREVENTIVE PRACTICES AND MANAGEMENT OF
PRESSURE ULCER AMONG ORTHOPEDIC NURSES AT KORLE-BU Yes No N/A
TEACHING HOSPITAL
Vulnerable/High Risk Group

1 Is a vulnerable population being studied?   √

If yes, tick the vulnerable population being studied?

 Pregnant women Elderly  Prisoners

 Adolescents Refugees  Persons with mental/

Behavioural disorders
 Children Those who cannot give consent (unconscious)
 Others

2 Is the justification for studying this vulnerable population adequate?   √

3. Have adequate provisions been made to ensure that the vulnerable   √

population is not being exploited?

Responsible Technical Officer’s Comments:

Scientific and Technical Issues

1. Is the rational for the study clearly stated in the context of present √  
knowledge?

2. Is the hypothesis to be tested fully explained?   √

3. Is the project design scientifically sound? √  

4. Where present, is the control arm adequate?   √

5. Are the inclusion and exclusion criteria complete? √  

6. Are the types and methods for subject allocation defined? √  

7. Are the procedures for participant recruitment, admission, follow up and √  

completion described?

8. Are the drugs and/or devices to be used fully described?  √ 

x
 9. Does the project design include criteria for stopping and discontinuing the √  
research?

10. Are the clinical procedures to be carried out fully described?   √

11. Are the laboratory tests and other diagnostic procedures fully described?   √

12 Is the Statistical basis for the study design and is the plan for analysis of the √  
data described?

 √ 
Has the Protocol undergone scientific review?
13.
(if applicable please provide evidence)

PI TO
COMPLETE

Yes N/A
No

Informed Consent, Decision-making & Confidentiality

1. Is the information sheet free of technical terms, written in √  

laypersons’ language, easily understandable & complete?

2. Does it make it clear that the proposed study is research? √  

3. Does it explain why the study is being done and why the subject is √  
being asked to participate

4. Does it clearly state the duration of the research?  

√

5. Does it provide participants with a full description of the nature, √  

sequence and frequency of the procedures to be carried out?

6. Does it explain the nature and likelihood of anticipated discomfort  √ 

or adverse effects, including psychological and social risks, if any-
and what has been done to minimize these risks, and the action to
be taken if they occur?

Principal Investigator’s Name: PRISCILLA ARCHER

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7. Does it outline the possible benefits, if any, to the research √  
participants?

8. Does it outline the possible benefits, if any, to the community or to  

society?
√

9 If confidentiality is not possible due to the research design, has √  

this been conveyed to all relevant persons?

10 Does it inform the research participants that their participation is √  

voluntary and refusal to participate (or discontinue participation)
will involve no penalty or loss of medical benefits to which the
participant was otherwise entitled?

11. Does it describe the nature of any compensation or √  

reimbursement to be provided?

12 Does it provide the alternatives to participation?

√  

13. Does it provide the name and contact information of a person who √  
can provide more information about the research project at any
time?

14. Has provision been made for subjects incapable of reading and   √
signing the written consent form (e.g. illiterate patients)? (Please
attach)

15 Does it conclude with a statement such as ‘’I have read the √  

foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any question I have
asked have been answered to my satisfaction. I consent
voluntarily to participate as a subject in this study and
understand that I have the right to withdraw from the study at
any time without it affecting seeking medical care’’

PI TO COMPLET

Yes No

xii
16. Does it provide information to the research participants on the costs to the  
participants involved in terms or time, travel, man-days lost from work, etc. and
reimbursements, if any?

17. Has provision been made for subjects incapable of giving personal consent (e.g. for  
cultural reasons, children or adolescents less than the legal age for consent in the
country in which research is taking place, subjects with mental illness, etc)? (Please
attach).

18. Does it outline the procedure that will be followed to keep participants informed of the √ 
progress and outcome of the research?

Other materials, documents and study instruments (Patient recruitment material, Questionnai
1 Is the Participant Recruitment Material (e.g. advertisements, notices, media articles,  √
transcripts of radio messages) provided both in English and in the local language?

2. Do these materials make claims that may not be true?  √

3. Do they make promises that may be inappropriate in the research setting (e.g. provide  √
undue incentives or emphasize remuneration?

4. Does the study involve questionnaires, diaries, study instrument? √ 

5. Are these attached to the proposal (In English and local language)? √ 

6. Are the questionnaires written in lay language and easily understood? √ 

7. Are the questionnaires relevant to answer the research questions? √ 

8. Are the questionnaires worded sensitively?  √

9. Does the consent information and form describe the nature and purpose of the √ 
questions to be asked?

10. If applicable, does the consent information and form make it clear that some of the  √
questions may prove embarrassing for the participant?

xiii
 11. Does the proposal describe how confidentiality of the questionnaires will be √ 
maintained (i.e. will they be coded or anonymized)?

12. Does the consent information and form state that the participant is free to not answer √ 
any question?

13. Where applicable, does the informed consent form make it clear that the in-depth  
interview or focus group discussion is likely to be audio or video taped?

14. Where applicable, does the consent form mention how and for how long these tapes  
are going to be stored?

Principal Investigator’s Name: PRISCILLA ARCHER

Clinical Trials

Yes No N/A

1. Is this a new drug or vaccine trial?   √

2. If applicable, is clearance from the national drug regulatory authority   √

attached?

3. Is the Investigator’s Brochure (including safety information) attached?   √

4. Is the Adverse Drug Reaction/Adverse Event Reporting form attached?   √

5. Has a Data Safety Monitoring Board been established?   √

xiv
6. Are the names of the chairperson and members of the DSMB available for   √
the records?

Human Biological Materials

1, Will human biological materials (tissues, cells, fluids, blood, genetic material   √
or genetic information) be collected as part of the research?

2. Does the consent information and form fully describe the nature, number   √
and volume of the samples to be obtained and the procedures to be used for
obtaining them?

3. Does the consent information and form indicate if the procedures for   √
obtaining these materials are routine or experimental and if routine, are
more invasive than usual?

4. Does the consent information and form clearly describe the use to which   √
these samples will be put?

5. Does the consent information and form include the provision for the subject   √
to decide on the use of left-over specimens in future research of a restricted,
specified or unspecified nature?

6. Does the consent information and form cover for how long such specimens   √
can be kept and how they will be finally destroyed?

7. Does the proposal describe how specimens will be coded/anonimized?   √

8. Where applicable, does the consent form mention that genetic   √

testing/genomic analysis will be carried out on the human biologic
materials?

Reviewer’s Comments:

xv
 VALLEY VIEW UNIVERSITY

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF NURSING

PREVENTIVE PRACTICES AND MANAGEMENT OF PRESSURE ULCER

AMONG ORTHOPEDIC NURSES AT KORLE-BU TEACHING HOSPITAL

BY

PRISCILLA ARCHER

A PROPOSAL SUBMITTED TO THE DEPARTMENT OF NURSING, GHANA

VALLEY VIEW UNVERSITY IN PARTIAL FUFILLMENT FOR THE AWARD

OF BACHELOR OF SCIENCE DEGREE IN NURSING

FEBRUARY, 2025

xvi
TABLE OF CONTENTS

xvii
 LIST OF ABBREVIATIONS

DHRCIRB Dodowa Health Research Centre Institutional Review Board

xviii
 ABSTRACT

Background: Pressure ulcers (PUs) is among the five most prevalent hospitalized cases

among patients of alarming proportion, due to the adverse impairment and millions being

affected globally. Pressure ulcer is defined as a localized injury to the skin tissue over bony

prominence, as a result of pressure, or pressure in combination with shear, which eventually

results in a disruption in blood supply to tissues resulting in skin breakdown. Hospital-

acquired pressure ulcers in instances of orthopedic cases were adverse occurrence because

patients admitted to the hospital with orthopedic issue that need to be treated or managed

might end up with a pressure ulcer, due to the fact that some were immobile.

Aim: The aim of the study is to assess the preventive practices and management of pressure

ulcer among orthopedics nurses at Korle –Bu Teaching Hospital.

Methodology: The study will employ a quantitative descriptive design.

Purposive sampling technique will be used to collect data from 187 respondents. Data will be

collected through questionnaires and analyzed by statistician using SPSS version 24.0

Expected outcome: It is expected that the respondents will be enlighten

on pressure ulcers.

Keywords: Pressure Ulcers, Orthopedics, Korle-Bu Teaching Hospital, Nurses,

Preventive Practices,

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 BACKGROUND OF THE STUDY

INTRODUCTION

Pressure ulcers (PUs) is among the five most prevalent hospitalized cases among

patients of alarming proportion, due to the adverse impairment and millions being affected

globally (Shiferaw, Aynalem & Akalu, 2020). Pressure ulcer was defined by National

Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel, (2014) as a

localized injury to the skin tissue over bony prominence, as a result of pressure, or pressure in

combination with shear, which eventually results in a disruption in blood supply to tissues

resulting in skin breakdown. Hospital-acquired pressure ulcers in instances of orthopedic

cases were adverse occurrence because patients admitted to the hospital with orthopedic issue

that need to be treated or managed might end up with a pressure ulcer, due to the fact that

some were immobile. Which may prolong the length of stay as well as cause permanent

damages like “permanent disabilities’’ (Jocelyn, Thiara, Lopez, & Shorey, 2017).

Globally, pressure injuries were direct cause of death in 7-8% of all patients with

paraplegia, with approximately 60,000 people dying of complications of pressure injuries.

Individuals with pressure ulcers have a 4.5-times greater risk of death than persons with the

same risk factors but without pressure injuries (Ferris & Harding, 2019). Moore and

O’Connor (2019) ascertain that Europe has the highest prevalence of pressure ulcers. The

authors stated that the highest PU prevalence reported was from the Netherlands, and the

lowest was reported from Finland. According to Health and Social Care Information Centre

(HSCIC) in 2014, prevalence of PUs in the United Kingdom (UK) was 4.7% in care homes

and a comprehensive review study show a widespread range of PU prevalence rates among

hospitalized patients such as; 3.1% to 30.0% in the United States (US), 1% to 54% in Europe,

6% in Australia, and 2.7% to 16.8% in Asia (Tubaishat, Papanikolaou & Habiballah, 2015;

Hahmel, Lichterfeld, Blume-Peytavi, & Kottner, 2017). In the USA, pressure ulcers remain a

1
major health problem affecting approximately 3 million adults and the total cost of treating

PU for 19 patients, was estimated at $129,248 annually (Beckman, Defloor, Schoonhoven, &

Vanderwee, 2016).

Pressure ulcers are caused by a complex range of interacting factors related to the

mobility and activity status of patients, skin perfusion, nutritional status, and sensory function

(Chung et al., 2022). Neurologic diseases such as dementia, delirium, or peripheral

neuropathy are important risk factors for pressure-induced skin and soft tissue injuries

because sensory loss is common among these patients, so they may not perceive pain or

discomfort arising from prolonged pressure (Jaul et al., 2018). Other contributory risk factors

include edema, diabetes, reduced subdermal fat, chronic pulmonary disease, erythema,

obesity, advanced age, cerebrovascular or cardiovascular disease, recent lower extremity

fractures, incontinence, and a number of drugs (Lannering et al., 2016). Pressure ulcers

usually form on bony parts of the body, such as the heels, elbows, hips and tailbone (NHS,

2023).

According to Sachdev, (2024), the following are signs and symptoms of pressure

ulcers; discoloured patches of skin that do not change colour when pressed – the patches are

usually red on white skin, or purple or blue on black or brown skin, a patch of skin that feels

warm, spongy or hard and pain or itchiness in the affected area of skin. However, the 4 stages

in pressure ulcers and they are; stage 1 called the mildest stage is when the pressure sores

only affect the upper layer of the skin. Also, stage 2 happens when the sore digs deeper below

the surface of your skin. Stage 3 is when the sores have gone through the second layer of skin

into the fat tissue. Lastly, stage 4 is when the sores are the most serious. To the extent that

some may even go so deep and affect your muscles, ligaments, and bones (Altomara, 2024).

The treatment of pressure ulcers depends on the stages (Ramirez, 2023). In stage 1,

the first and most important thing to do with any pressure sore is to stop the pressure. Change

2
your position or use foam pads, pillows, or mattresses. In stage 2, clean the wound with a

saline (saltwater) solution and dry it gently. Keep the sore covered with a bandage. Stage 3 is

called debridement. Dead tissues are being removed with the use of a scalpel or special

ointments are applied to dissolve it. As said by NHS (2024), skin infections, sepsis,

amputation, bacteria in a bloodstream, Bone and joint infections and cancers are

complications of pressure ulcers. Hopskins, (2017) outlined some preventive measures of

pressure ulcers and they are; changing positions every 2 to 3 hours in bed or every 15 minutes

in a wheelchair, reducing pressure on areas that may be susceptible to pressure ulcers by

using a special air or gel mattress, padding that protects bony areas, like the elbows or ankles

or a wheel chair cushion. skin care as recommended by your practitioner for incontinence,

and regularly checking for bedsores, if you’re immobilized.

Guifo and Essomba (2018) asserted that pressure ulcers were frequent complications

of bedridden patients in most African countries. The authors stated that the cumulative

incidence of pressure ulcers was 20% in general and 50% in the population at risk. In other

studies, Anthony and Safari (2020) emphasized that recently, the prevalence of pressure

ulcers in Africa reported was similar to figures from the recent review of prevalence in

Europe of which the figures were high. In the Democratic Republic of the Congo, pressure

ulcers remain a real public health problem with majority of patient developing pressure ulcers

during their time at the hospital (Valimungighe & Akinja, 2018).

Similar, in Ethiopia it was reported that the collective prevalence of pressure ulcers in was

relatively high. This was due to the fact that up to 90% of patients developing pressure ulcers

on admission (Shiferaw & Akalu, 2020). In addition, Onigbinde and Oniyangi (2016)

asserted that most patient admitted on the ward in most Nigerian hospitals with spinal cord

injury, orthopedic injury and head injury develop pressure ulcers even before they were

discharged. According to Angmorterh & Ofori in 2020, the situation in Ghana was not

3
different, most patients on the ward end up developing pressure ulcers with most commonly

occurring at the head, sacrum and heels which were often referred to as the jeopardy areas,

due to the prominent bony features at these anatomical areas.

Pressure ulcers are largely preventable in nature, and their management depends on their

severity (Bhattacharya & Mishra, 2016). The authors stated that the role of nutrition and

pressure-release devices such as cushions and mattresses were all part of the treatment

measures for preventing and quick healing process of pressure ulcers .According to Boyko

and Yang (2018) the prevention of pressure ulcer formation was directed at alleviating the

risk factors for the individual patient. The authors stated that the primary focus of minimizing

episodes of prolonged pressure ulcer was either by placing appropriate padding at pressure

points or by frequent patient repositioning to help in preventing pressure ulcers.

1.1 PROBLEM STATEMENT

In the late 20th century pressure ulcer was one of the most devastating complications and

expensive in the management of its recovery in the history of nursing (Shiny, 2010).

According to Ebi and Mijena (2019), pressure ulcer is a preventable medical complication of

immobility that has psychological, economic and social impact on individual and family. Its

cost of treatment was more than twice of cost of prevention. Muhammed and Walle (2020)

further added that pressure ulcer is largely avoidable, but its prevalence rate keeps increasing.

The authors stated that, this was due to the inadequate knowledge nurses have on pressure

ulcers.

In addition, Dalvand and Gheshlagh (2018) established that the inadequate knowledge on

pressure injury (PI) can have a detrimental effect on preventive care strategies. The

researchers added that the overall knowledge of nurses on PI prevention was lower than the

recommended level (60%). Also, pressure ulcers is a major burden of hospitalization

4
worldwide, and nurses were at the forefront of prevention (Saleh & Anthony, 2019). The

authors asserted that nurses have limited knowledge about critical parameters of pressure

ulcers. Prevention practices were observed to be unreliable and uncoordinated related to a

significant shortage of staff and logistics for pressure ulcer prevention (Sawant & Shinde,

2017).

According to Dilie and Mengistu (2016), pressure ulcer development is now generally

considered as an indicator for quality of nursing care. The author stated that in Ethiopia, most

nurses have adequate knowledge on pressure ulcer prevention practices, they also have

favorable attitudes towards prevention practices and most of them also have good pressure

ulcer prevention practices (Barakat-Johnson, Barnett, Wand, & White, 2018). Meanwhile, in

Ghana, when it comes to factoring sources based on pressure ulcers in hospitals it becomes

difficult due to lack of documentation (Jonsson & Engman 2016). Hence the aim of this

current study is to assess the preventive practices and management of pressure ulcer among

orthopedics nurses at Korle –Bu Teaching hospital.

1.2 RESEARCH QUESTIONS

The study seeks to answer the following research questions;

1. What are the beliefs and knowledge of nurses on pressure ulcer management at the

Korle Bu Teaching Hospital?

2. What are the attitudes of nurses towards pressure ulcer management at the Korle Bu

Teaching Hospital?

3. What are the preventive measures and management of nurses’ during pressure ulcer

management at the Korle Bu Teaching Hospital?

4. What are the relationships between nurses’ knowledge, attitude and preventive

measures/management on pressure ulcer at the Korle Bu Teaching Hospital?

5
1.3 OBJECTIVES OF THE STUDY

The objectives of the study are to;

1. Assess nurses’ beliefs and knowledge on pressure ulcer management at the Korle Bu

Teaching Hospital.

2. Assess nurses’ attitude towards pressure ulcer management at the Korle Bu Teaching

Hospital.

3. Identify preventive measures and management of nurses on pressure ulcer

management at the Korle Bu Teaching Hospital.

4. Significant relationship between nurses’ knowledge, attitude and preventive

measures/management on pressure ulcer at the Korle Bu Teaching Hospital.

1.4 PURPOSE OF STUDY

The purpose of the study is to assess the preventive practices and management of pressure

ulcer among orthopedics nurses at Korle –Bu Teaching hospital.

1.5 SIGNIFICANCE OF THE STUDY

It is expected that this study will provide a resourceful data for the following group of people;

Respondent: The findings will enlighten respondents on pressure ulcers. It will also help

them to take certain precaution measures that would prevent the development of pressure

ulcer. This will help to curtail the elevation incidence rate of pressure ulcer in Ghana.

Study setting: The verdicts in this study will bring consciousness and understanding about

the prevalence of pressure ulcer to Korle-Bu teaching hospital, which will help then put

measures in place to promote health education on pressure ulcer, its prevention and

management.

Nursing Practice and Education: The study will help nurses to design health education

programs on prevention pressure ulcer among the patients. Those who are already suffering

from pressure ulcer would be able to know how to manage and comply with treatment.

6
Ghana Health Service: The Ghana health service would be able to document the various

prevalence rates and help reduce the high rates in Korle-Bu teaching hospital. The Health

service will be able to explore the concerns of the individuals who suffers from pressure ulcer

and how to manage them to provide them with quality of life.

Other Researchers: The study will expect to help other researchers who will want to

conduct similar studies in other areas for more data. This would help to document and add to

the data base of the condition.

1.6 DELIMITATION OF THE STUDY

According to Simon and Goes, (2013) delimitations are the characteristics that limit the

scope and describe the boundaries of the study, these limit the extensity to which a study can

be conducted. The study will be delimited to orthopedic nurses who were doing their rotation,

those who have worked with patients within the past six months, and completed the study

survey in Korle-Bu Teaching Hospital.

1.7 OPERATIONAL DEFINITION OF TERMS

The following definitions of terms are hereby provided as a guide for the reader:

Preventive practices: is the recurrent act of keeping something from happening which is

establish as specific, population-based and individual-based interventions for primary and

secondary (early detection) prevention, aiming to minimize the burden of diseases and

associated risk factors (Centers for Disease Control and Prevention, 2012).

Pressure ulcer: Is defined as “localized damage to the skin” along with its “underlying soft

tissue”. This damage usually occurs over bony prominences and could be as a result of

medical device or injury results due to “intense and/or prolonged pressure or pressure in

combination with shear” (National Pressure Ulcer Advisory Panel, 2016).

7
Pressure ulcer management: is the reduction and relieving of pressure on the skin,

debriding of necrotic tissue, wound cleansing, bacteria load management and the use of

aseptic wound dressing technique (National Pressure Ulcer Advisory Panel, 2014).

Orthopedics Nurses: is a specialist that focuses on musculoskeletal diseases and disorders

(Palmer, 2018).

Korle-Bu Teaching Hospital: is the premier health-care facility in Ghana. Located in Accra,

it is the only public tertiary hospital in the southern part of the country. It is a teaching

hospital affiliated with the medical school of the University of Ghana.

8
 CHAPTER TWO

2.0 INTRODUCTION

This chapter reviews related literature on the subject matter. It brings other researchers’

opinion and contributions from journals, articles and previous researches made on the subject

matter. Reviewing literature allows the researcher to plan the study methodology and serves

as a basis for the topic to be researched into (Borman & Maritza Dowling, 2018). The

purpose of the literature review was to make the reader to be aware of what was already

known about the problem under study. Again, it helps any researcher to provide the context,

informing methodology, identifying innovation, minimizing duplicative research, and

ensuring that professional standards were met (Maggio, Sewell, & Artino, 2016). It also

informs professionals and patients of the best available evidence when making healthcare

decisions; influence policy; and identifies future research priorities (Smith & Noble, 2017).

The search engines used in the literature were databases such as MEDLINE, Google Scholar,

Research Gate, and CINAHL. The literature has been done under the following thematic

areas;

1. Assess nurses’ beliefs and knowledge on pressure ulcer management.

2. Assess nurses’ attitude towards pressure ulcer management.

3. Identify preventive measures and management of nurses on pressure ulcer

management.

9
 4. Significant relationship between nurses’ knowledge, attitude and preventive

measures/management on pressure ulcer.

2.1 NURSES’ BELIEFS AND KNOWLEDGE ON PRESSURE ULCER

MANAGEMENT

Ebi and Mijena (2019) conducted a study among 212 randomly selected nurses in

public hospitals in Wollega. Quantitative cross-sectional design was used in the study. Data

was collected using structured two validated self-administered questionnaire and analyzed

using SPSS v18. The study showed that 91.5% had inadequate knowledge to pressure ulcer

prevention. The mean of nurses' knowledge in all theme and per item were 11.31 (SD = 5.97)

and 0.43 (SD = 0.22) respectively. The study participants had the highest mean item score

(2.65 ± 0.87) in nutrition theme, whereas, scored lowest on etiology and development (0.27 ±

0.18) and preventive measures to reduce duration of pressure (0.29 ± 0.18).

The study also identified significant nurses read articles and received training.

Shortage of pressure relieving devices, lack of staff and lack of training were the most

commonly cited perceived barriers to practice pressure ulcer prevention. This study

concluded on areas where measures can be made to facilitate pressure ulcer prevention in

public hospitals in Wollega zones, such as increase regular adequate further training of nurses

regarding pressure ulcer/its prevention points.

Additionally, Muhammed and Walle (2020) conducted a hospital-based cross-

sectional study among 356 female nurses in Ethiopia. Simple random sampling technique

was used in the study. Data was collected through structured questionnaire with closed and

open-ended questions and analyzed using SPSS v18. The findings of the study showed that,

the mean knowledge score of nurses was 25.22 out of 41 item questions. Fifty-two point 5 %

of nurses score above the mean. Males [AOR = 0.44, 95% CI (0.26–0.73)], working a

maximum of eight hours [AOR = 3.57, 95% CI (1.48–8.61), not having training [(AOR =

10
2.31, 95% CI (1.14–4.61)], Low salary [AOR = 3.47, 95% CI (1.03–11.67)] were

significantly associated with inadequate knowledge. This was because the female nurses were

not given equal working hours as the men hence have less exposure to most condition like

pressure ulcer making them have fewer experiences with such patients. The study concluded

that generally, the nurses knowledge of pressure ulcers were inadequate. Being female,

working less than or equal to eight hours, not having the training and low working salary are

contributors to a low level of knowledge for pressure ulcers.

Also, Shrestha and Shrestha (2017) conducted a descriptive cross sectional study

among 100 nurses working in Gandaki Medical College Teaching Hospital in India. Data was

collected using structured self-administered questionnaire and analyzed using SPSS v18. The

study revealed that 59% of the respondents had adequate knowledge where as 41% of nurse’s

knowledge was found to be inadequate. Significant association was not found between age,

working ward, experience, education, training, duration and knowledge of pressure ulcer

management among Nurses. The study concluded that more than half of the nurses had the

adequate knowledge but there is still need of education and training related pressure ulcer

management.

In China, Jian, Li and Lommel (2020) conducted a cross-sectional study among 1,806

nurses from 10 tertiary general hospitals in Hunan Province. The study used a self-designed

questionnaire of which data were collected and analyzed using SPSS v18. The study showed

that among all nurses involved in this study, 41.7% had insufficient PI-prevention

knowledge, 46.6% had negative PI-prevention attitudes, and 21.8% had poor PI-prevention

behaviour. Nurses with a bachelor's degree or above were more likely to have adequate PI-

prevention knowledge. Increased PI-prevention training frequency increased the nurses'

positive attitude scores for PI prevention; longer years of service and a higher number of PI-

prevention trainings attended predicted better PI-prevention behaviours. The study concluded

11
that Chinese nurses' PI-prevention knowledge and attitudes in this study were unsatisfactory,

while their PI-prevention behaviour was acceptable. Therefore, increasing PI-prevention

training frequency can help improve Chinese nurses' PI-prevention attitudes and further

behaviour.

In addition, Appiah et al., (2023) conducted a study on the attitude and practices

toward PU (Pressure Ulcer) among 30 orthopedic nurses in a tertiary hospital in Ghana. The

study used an exploratory descriptive qualitative approach. Purposive sampling approach was

employed, and data was analyzed using thematic content analysis. Participants were engaged

in face-to-face interviews which were transcribed verbatim. The findings of the study showed

that two themes and eight subthemes were generated from the analysis of this study. The two

themes were preventive practices and attitude towards PU.

The study identified that there were no specific protocols illustrated on the wards for

managing pressure ulcers. Nevertheless, the study participants were keen on preventing

pressure ulcers and hence engaged in practices such as early patients’ ambulation, early

identification of PU signs, removing creases and crumps from patient beds, nutritional

management for PU prevention, and dressing of PU wounds. The study concluded that

practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence,

the nurses recommended the need for accepted guidelines on pressure ulcer management to

be illustrated in the various orthopedic wards in the country.

2.2 NURSES’ ATTITUDE TOWARDS PRESSURE ULCER MANAGEMENT

Etafa and Melese (2018) conducted a self-reported multi-center institutional based

cross-sectional study among 222 nurses at public hospitals in Addis Ababa, Ethiopia. The

findings of the study showed that majority of the nurses had (n = 116, 52.2%) negative

attitude towards pressure ulcer prevention. The mean scores of the test for all participants was

3.09out of 11(SD =0.92, range = 1-5). Similarly, the study revealed several barriers need to

12
be resolved to put in to practice the strategies of pressure ulcer prevention; Heavy workload

and inadequate staff (lack of tie) (83.1%), shortage of resources/equipment (67.7%) and

inadequate training (63.2%) were among the major barriers identified in the study. The study

concluded that Addis Ababa nurses have negative attitude to pressure ulcer prevention.

Also, Habiballah (2018) conducted a study among 112 nurses working in intensive care

units in three hospitals in Jordan. Data were collected using self-administered questionnaire

and analyzed through SPSS v20. The findings of the study asserted that most of the nurses

have a positive attitude of acceptance towards pressure ulcer prevention. This was due to the

majority of the nurses having previous experience and previous training on pressure ulcer

prevention. The study concluded that positive attitudes should be supported since nurses with

a positive attitude will be more willing to implement pressure ulcer prevention measures.

Also, any barriers which exist to prevent nurses who have a positive attitude from delivering

the prevention strategies should be investigated.

In addition, Avsar and Moore (2019) conducted a quantitative study among 442 nurses in the

USA. The study used a semi-structured questionnaire. The findings of the study showed that

in measuring nurses' attitudes toward PU prevention two distinct instruments were used: the

'Moore and Price Attitude Scale' and the 'Attitude towards Pressure Ulcer Prevention

Instrument'. The mean attitude score within the studies was 73% (standard deviation=9.2%).

The lowest attitude score was 51%, while the highest score was 89%. The results obtained

from the studies indicated that 86% (n=18) yielded positive attitude results. The study then

concluded that overall, nurses are positively disposed towards PU prevention. However, it is

important to highlight that the nurses have difficulties translating this positive attitude into

actual PU prevention strategies.

Similarly, Aslan and Giersbergen (2016) conducted a descriptive study among 426

nurses in Turkey. Data were collected and analyzed using SPSS 18 packaged software. The

13
study showed that the average age of the nurses who took part in the study was 31.86 ± 7.09

years and the average work experience was 8.88 ± 7.41 years; 36.9% (n: 157) were working

in intensive care units. The nurses' average score on the Attitude towards Pressure Ulcer

Prevention Instrument was 43.74 ± 4.29 (84.12%). The study concluded that the attitudes of

the nurses towards the prevention of pressure ulcers was positive. However, to read

guidelines and training time about pressure ulcer prevention affect positively attitudes

towards the prevention of pressure ulcers.

Additionally, Ünver and Sürücü (2017) also conducted a descriptive and cross-

sectional study among 101 nurses working in surgical units of a university hospital in Turkey.

The study used a structured questionnaire and data were collected and analyzed using

Pearson's chi-squared. The study showed that the mean age of nurses' was 32.0 ± 6.3 years

and, the average duration of clinical experience was 72.3 ± 61 months. A total of 54.5% were

working in surgical wards and, 40.6% gained additional education about pressure ulcer care.

The mean total attitude score was found to be 80.5% (41.8 ± 4.8). Previous education

significantly affected the total attitude score of nurses (p < 0.05). From the study, it was

concluded that surgical nurses had a positive attitude towards pressure ulcer prevention and

nurses who had previous education about pressure ulcer care has higher attitude score than

who had not. Therefore, it is recommended that effective in-service education programs be

developed at hospitals or that nurses be required to attend courses to help them to improve

their pressure ulcer care.

Mirshekari and Forouzi (2017) also conducted a descriptive cross-sectional study

among 88 nurses in south east Iran. A self administered questionnaire was designed for

respondents. Data were collected and analyzed using SPSS v18.0. it was found from the

study that the response rate was 100 % (n=88), although not all participants answered every

question. The results showed that 78% were women. The mean age of participants was 30.2

14
years. The item 'heavy workload/staff shortage' perceived highest barrier towards pressure

ulcer prevention (mean±standard deviation (SD): 3.37 ± 0.66). The item 'uncooperative

patients' achieved the lowest perceived barriers score (mean ± SD: 2.65 ± 0.75).

Nurses who had more nursing experience in an ICU setting perceived barriers more

than those with less nursing experience in ICU setting. Those who had no previous exposure

to PU prevention education perceived barriers more than those had previous exposure to PU

prevention education. The study therefore concluded that understanding intensive care

registered nurses' perceptions of PU prevention barriers will enable nurse leaders to develop a

variety of intensive teaching to disseminate information about these barriers.

Also, Kim and Lee (2019) conducted a study among 202 Korean nurses and indicated that the

nurses were very welcoming to the treatment of pressure ulcers as the nurses regularly assess

the risk factors of pressure ulcers during the hospitalization period for all patients in the

hospital when performing pressure ulcer prevention care. However, the plan for preventive

nursing care was not properly reviewed.

2.3 PREVENTIVE MEASURES USED BY NURSES’ DURING PRESSURE ULCER

MANAGEMENT

Similarly, Getie and Mesfin (2020) also conducted a cross-sectional study among 422

nurses working in public hospitals of Eastern Ethiopia. Data were collected using pretested

structured self-administered questionnaire. The collected data were entered into EpiData

version 3.1 and exported to SPSS version 22.0 for analysis. The study showed that 51.9% of

nurses were reported that they have good pressure ulcer prevention practice. On observation

45.2% of nurses were practicing proper pressure ulcer prevention activities. Pressure ulcer

prevention practice was statistically associated with nurses with bachelor degree and above

qualification level, availability of pressure-relieving devices being satisfied with their job and

good knowledge. Therefore, it was concluded that the self-reported practice and results from

15
observation was substantially low. However, continuing education and training should be

considered for nurses to enhance their practice regarding pressure ulcer prevention practice.

Additionally, Ingwu and Ogbogu (2019) conducted a cross sectional descriptive study

among 85 caregivers at the National Orthopedic Hospital, Enugu. Descriptive analysis and

Chi-square statistical test were used as a self-administered questionnaire was structured. The

findings of the study revealed poor knowledge 67.3% of pressure ulcer prevention among

caregivers. Inadequate staffing 93.5%, heavy workload 92.9%, were highest perceived

barriers to pressure ulcer prevention. The test of hypothesis showed that there is a significant

relationship between years of service of caregivers and knowledge of pressure ulcer. The

study concluded that in-service training, recruitment of more staff and ensuring availability of

the necessary equipment are some of the important steps to improve nurses' knowledge and

practice regarding prevention of pressure ulcer.

Nuru and Zwedu (2015) conducted an institution-based cross-sectional study among

248 nurses in Gondar University hospital, Uganda. A pretested and structured self-

administered questionnaire was used for data collection. Data were entered using EPI info

version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. The

study showed that nearly half (54.4 %) of the nurses had good knowledge; similarly, 48.4 %

of them had good practice on prevention of pressure ulcer. Educational status, work

experience and having formal training were significantly associated with knowledge on

prevention of pressure ulcer.

While, satisfaction with nursing leadership, staff shortage and inadequate facilities and

equipment were found to be significantly associated with the practice on prevention of

pressure ulcer. The study concluded that knowledge and practice of the nurses regarding

prevention of pressure ulcer was found to be inadequate. Having higher educational status,

attending formal training and being experienced were positively associated with knowledge;

16
while shortage of facilities and equipment’s, dissatisfaction with nursing leadership and

inadequate staff number showed negative association with practice of nurse's pressure ulcer

prevention. In-service training and upgrading courses are some of the important steps to

improve nurses' knowledge and practice on prevention of ulcer pressure.

Olorunfemi and Akhigbe (2020) conducted a descriptive research study among 200

Nurses at the University of Benin Teaching Hospital, Benin City, Nigeria. A stratified

probability sampling method, and a self-structured questionnaire were designed,

administered, and retrieved. Data collected were analyzed using Statistical Package for the

Social Science software (SPSS). The study showed that the knowledge of Nurses on pressure

injury treatment and prevention had a mean score of 34 (±0.29). The result also revealed a

low level of practice of pressure injury prevention with composite percentage scores of

39.5%. The study then concluded that there is good knowledge toward pressure injury

prevention, but the practice level is low and this is found to be associated with a shortage of

workforce and availability of materials for the prevention of pressure injury. Therefore, the

hospital managers should employ more nurses to facilitate and improve the quality of care

given to the non-ambulant patient in the hospital to prevent pressure injury.

Finally, Nasreen and Waqas (2021) also conducted a cross-sectional study among 253

nurses conducted in Lahore General Hospital. The study participants were selected by

convenience sampling technique. An adopted questionnaire was distributed among study

participants. Data were entered and analyzed in SPSS version 21. The results from the study

showed that Nurses have poor knowledge (35.2%) regarding risk factors of pressure ulcer

development, patient’s position every two hourly (49%), knowledge about the use of the risk

assessment scale fore pressure ulcers was (37.2%), in order to give pressure ulcer prevention

education to patient’s and caregivers (36%).

17
 Nurses’ overall knowledge was only (8.3%) had good knowledge, (11.1%) have fair

knowledge and (80.6%) have poor knowledge about pressure ulcer prevention (82.6%) have

poor practices, (7.1%) have fair practices and (10.3%) have good practices of pressure ulcer

prevention. Nurse’s job experience has a significant association with their practices and

knowledge toward pressure ulcer prevention. The study concluded that nurse’s overall

knowledge and practices toward pressure ulcer was poor and this was due to the working

experience and the limited staff at the hospital. Therefore, it is recommended that nurses need

to get continuing education and training about pressure ulcer prevention that will enhance

their knowledge and practices can be improved.

2.4 SIGNIFICANT RELATIONSHIP BETWEEN NURSES’ KNOWLEDGE,

ATTITUDE AND PREVENTIVE MEASURES/MANAGEMENT ON PRESSURE

ULCER

Fu et al., (2024) conducted a multicenter cross-sectional among nurses in 10 tertiary

hospitals in China. A self-designed questionnaire was structured and data were analyzed

using SPSS v18. A total of 255 nurses participated in this study. The mean KAP score was

75.6 ± 16.9. The mean scores of the knowledge, attitude, and practice dimensions were 26.2

± 10.6, 38.2 ± 6.1, and 11.3 ± 4.3, respectively. The dimensions were ranked according to

score (from low to high) as follows: knowledge (2.6 ± 1.1), practice (2.8 ± 1.1), and attitude

(3.8 ± 0.6). Multivariate linear regression analysis showed that more training sessions and an

advanced professional title were associated with higher KAP scores.

The study concluded that the overall KAP score on ASF was low in nurses. Nurses

had a positive attitude towards ASF, but their knowledge and practice required significant

improvement. Those who had received more training and held a more advanced professional

title exhibited higher KAP scores regarding ASF. Therefore, nurse managers should establish

18
a relevant knowledge training system, strengthen relevant training, and improve nursing

practices for ASF in order to achieve a high level of KAP in nurses who treat ASF patients.

Alshahran et al., (2023) conducted a study on Nurses’ knowledge and attitudes

towards pressure injury prevention in intensive care units at three Saudi Arabian hospitals. A

quantitative cross-sectional study was used. A semi-structured questionnaire was developed.

Data were collected and analyzed using SPSS v 18. The study showed that the pre-

intervention phase included 190 participants, and the post-intervention phase included 195

participants. Participants completed a paper-based survey at two different time points

between June 2021 and March 2022. The mean pre-intervention scores for nurses’ knowledge

and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively.

Following the educational intervention, the knowledge and attitude scores increased

significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury

prevention was positively associated with positive attitudes towards prevention practices.

Age, clinical nursing experience, and experience in intensive care units were identified as

factors correlated with knowledge of pressure injury prevention. A Bachelor’s qualification

or higher predicted better knowledge and attitudes towards pressure injury prevention. The

study concluded that Nurses’ knowledge and attitudes towards pressure injury prevention

greatly improved following tailored, evidence-based education. Therefore, the implication is

that Nurses’ knowledge and attitudes towards pressure injury prevention should be examined,

and education provided to ensure evidence-based prevention practices are implemented.

Abrahams et al., (2023) conducted a quantitative, cross-sectional study in Namibia

among 50 nurses. A self-administered questionnaire was employed. Data were analysed using

the statistical software programme (SPSS) version 27. From the study, it was found that good

knowledge (n = 35; 70%), attitude (n = 39; 78%), and practices (n = 47; 94%) were noted by

nurses. The degree of knowledge, attitudes, and practices did not significantly correlate with

19
any demographic category (p > 0.05). the study concluded that nurses have good knowledge,

positive attitudes and practices on prevention and management of pressure ulcers. By the

implications, the study posited that nurses will competently manage the pressure ulcers

occurring in the clinical setting. Therefore, an observational study is recommended to assess

practices in the clinical setting.

2.5 SUMMARY

A preventive practice used among orthopedics nurses in managing pressure ulcers across the

globe was assessed under this chapter based on several literatures. The review of literature

was under three sub-headings namely: nurses’ beliefs and knowledge on pressure ulcer

management, nurses’ attitude towards pressure ulcer management and preventive measures

used by nurses’ during pressure ulcer management. Both qualitative and quantitative studies

were reviewed in accordance to the study objectives which were guided by Tannahill’s

Model. The literature review under this study was done in countries like Nigeria, Ethiopia,

Ghana and USA. The conclusion that was made in all the studies revealed that almost all the

participants have some information on pressure ulcers and a positive attitude towards it

prevention. Thus, this current study sought to determine the preventive practices used among

orthopedics nurses in managing pressure ulcers at Korle-Bu Teaching hospital. Findings

determined if the nurses share similar ideologies like previous researches which have been

conducted on pressure ulcer management.

20
 CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION

Research methodology entails the strategies, processes or techniques utilized in the collection

of data or evidence for analysis in order to unearth new knowledge or develop a better grasp

of a phenomenon (Goundar, 2018). The procedure and research design techniques used to

gather the data for this study are described in this chapter. This chapter's main points center

on the following topics: research design, research settings, target population, sampling

strategies, sample size, inclusion and exclusion criteria, data collection tool, validity and

reliability of tool, data analysis, and ethical considerations.

RESEARCH DESIGN

Research design is a crucial part of any study since it outlines the objectives of the

investigation and specifies the standards for judging the findings and conclusions reached

(McCombes, 2019). A research design is referred to as the procedures for gathering,

analyzing, interpreting, and reporting data in research projects; the general strategy for

bridging the gap between the empirical and the conceptual research problem (Lelissa, 2018).

The plan, framework, or strategy for a study known as research design is used by the

researcher to guide the research process as it progresses from the research aim or question to

a probable conclusion or outcome; this can be quantitative, qualitative, or a combination of

21
both well known as the mixed method (Abutabenjeh & Jaradat, 2018). In order to determine

the preventive practices and management of pressure ulcer among orthopedic nurses at Korle-

Bu Teaching Hospital, the current study would use a quantitative descriptive design.

Quantitative research design is the technique and measurements that produce

quantifiable/discrete values; data collected results from empirical observations and measures

(Rovai, Baker & Ponton, 2015). Quantitative research is regarded as the organized inquiry

about phenomenon through collection of numerical data and execution of statistical,

mathematical or computational techniques (Slevitch, 2011 as cited in Adedoyin, 2020). A

quantitative research design is deemed suitable for this study because this approach uses

statistical data as a tool for saving time and resources (Bryman, 2001 cited Eyisi, 2016).

Descriptive research design is a scientific method that involves observing and describing the

behavior of a subject without influencing it in any way; it may be characterized as simply the

attempt to determine, describe or identify a phenomenon (Ahmed, 2022). As a result, the

study participants will be studied in their natural habitats without any environmental

modifications. Descriptive research aims to accurately and systematically describe a

population, situation or phenomenon (McCombes, 2022). This type of research design is

recommended for studies like this where the researchers gather data to bring out insight on

the preventive practices of pressure ulcer management among orthopedic nurses at the Korle-

Bu Teaching Hospital

3.2 RESEARCH SETTING

A research setting is a physical, social, or experimental context within which research is

conducted (Grove et al., 2015). Korle-Bu Teaching Hospital will be the setting to be utilized

in this project. It is the premier healthcare facility in Accra, and touted as one of the best in

West Africa. It was established in 1923 and has currently, a bed capacity of 2000. It is the

first largest teaching hospital in Ghana and the second largest in West Africa. The hospital

22
serves as one of the biggest health delivery facilities in the country. It provides all the general

health needs as well as providing sophisticated and scientific investigative procedures for its

attendants. It covers a total land space of approximately 441 acres and hemmed in by the

Korle Lagoon, Korle-Gonnor, Lartebiorkorshie and Mamprobi to the east, south, north and

west correspondingly (Ministry of Health, 2021). The Trauma and Orthopedics Centre

receives trauma cases in the Metropolis as well as the regions and sometimes from other

West African Sub County and works in relation with other Sub-BMCs in the Hospital. It is

one of the leading Centre’s that provides the highest quality of care to all accident and

orthopedic cases it receives, bringing them to near or full recovery. The unit comprises of 5

wards with 123 numbers of beds and the total number of staff as 415, which is being headed

by a head of department and a DDNS (Trauma and Orthopedics Record’s Unit- Korle Bu

Hospital, 2021). The study setting will be selected because it is one of the health care

facilities that has been in existence for years providing services to a vast majority of the

population, thus preventive practices and management of pressure ulcer among orthopedic

nurses will be assessed based on their experience.

3.3 TARGET POPULATION

Target population for a survey is the aggregation of a unit for which the survey data was used

to make inference (Pilot & Hungler, 2013). The target population for this study will be 350

orthopedic nurses at the Korle Bu Teaching Hospital.

3.4 INCLUSION CRETERIA

Inclusion criteria are characteristic that includes the key features of the target population that

the investigators will use to answer their research question (Peters & Marnie, 2020). The

inclusion criteria for selecting participants for this study will be; Nurses at the orthopedic

units and Nurses who are on duty and consent to partake in the study.

3.5 EXCLUSION CRITERIA

23
 Exclusion criteria are defined as features of the potential study participants who meet the

inclusion criteria but present with additional characteristics that could interfere with the

success of the study or increase their risk for an unfavorable outcome (Patino & Ferreira,

2018). For this study, the researcher will exempt the following group of nurses from the

study; Nurses on rotation and Nurses who have worked for less than 6months.

SAMPLING TECHNIQUE AND SAMPLE SIZE DETERMINATION

A sample is a group of people, objects, or items that are taken from a large population for

measurement (Martínez-Mesa, González-Chica, Duquia, Bonamigo & Bastos, 2016).

Sampling is the process of choosing a sample from an individual or from a big population for

a certain type of research goal (Bhardwaj, 2019). Sampling is done following probability and

non-probability approaches (Showkat & Parveen, 2017). In a probability sampling technique,

each member of the population has a chance of being chosen for the sample, and a simple

random sampling is one type where the sample members are chosen at random and solely by

chance (McCombes, 2019).

A purposive sampling technique will be employed because it allows the researcher(s) to

collect data from a random subset of a population to draw conclusions about the whole

population. The sample from the population will be derived using Taro Yamane’s (1967)

simplified formula to determine the sample size:

N
n= 2.
1+ N (e)

Where n = sample size, N = total population (00), e = Level of precision (0.05). Substituting

values into the sample size determination formula gave,

350
n= 2
1+350 (0.05)

n = 186.67

24
Therefore, 187 respondents will be selected to be involved in this study.

DATA COLLECTION TOOL

Data collection instruments refer to the devices/instruments used to collect data, such as a

paper questionnaire or computer-assisted interviewing system used for measuring, observing

or documenting quantitative data (Godfred, 2019). Questionnaire is a research instrument

consisting of a series of questions for the purpose of gathering information from respondents

(McLeod, 2018). Questions that will be used in the research are solely closed-ended; this is

intended to restrict respondents’ answers and hence, provide an objective based on

comparative analysis.

The questionnaire will be partitioned into four different sessions namely section A to D.

The section A will consist 11 questions on socio-demographic data of respondents, section B

will employ 7 questions to assess nurses’ beliefs and knowledge on pressure ulcer

management, section C will explore 8 questions on nurses’ attitude towards pressure ulcer

management, and D will consist of 10 questions on preventive measures and management of

nurses on pressure ulcer management. All the questions will be typed in English.

DATA COLLECTION PROCEDURE

Ethical clearance will be obtained from the Dodowa Health Research Centre Institutional

Review Board (DHRCIRB). An introductory letter from the School of Nursing and

Midwifery, Valley View University together with the clearance letter will be submitted to the

administration of the Korle-Bu Teaching Hospital to seek permission and then Head of

Department of Trauma, Accident and Orthopedic unit and finally to the Deputy Director for

Nursing Services (DDNS) of the orthopedic unit to commence data collection to collect data.

A visit will be paid to the hospital for formal introduction by the researcher. The data

25
collection will be done by the use of semi-structured questionnaires that will be administered

to a total number of 187 respondents that fit within the target population who will be selected

from the hospital using a purposive sampling technique to take part in the study. The

questionnaires will be distributed to respondents via personal delivery by the researcher in

order to aid respondents in understanding the content of the questionnaire and filling it out

appropriately. More so, respondents will be informed not to fill in any details about

themselves that may reveal their identity to maintain anonymity and they will be assured of

confidentiality. Respondents will use about 20 to 30 minutes to answer the questionnaire.

VALIDITY AND RELIABILITY

The credibility of every study significantly depends on its validity and reliability.

(Saunders et al. 2014). Validity indicates that the research could be adapted to use or purpose

for which it would be meant to measure. To ensure validity and reliability of this study, data

collection instrument will be measured and assessed through a pre-testing, peer review and

thorough scrutiny by the supervisor to review and edit the work. Pretesting will be done by

testing the data collection tool. This will be done by conducting a pilot study at the University

Hospital, Legon by administering 10 samples of the questionnaires designed to a few

respondents and the Cronbach’s Alpha value that will be derived after data analysis will

be utilized to confirm the reliability of the research instrument. This will help reduce

measurement error, reduce respondent burden, determine whether or not respondents are

interpreting questions correctly, and ensure that the order of questions is not influencing the

way a respondent answers the questionnaire.

DATA ANALYSIS

Data analysis is the process of inspecting, cleansing, transforming, and modeling data with

the goal of discovering useful information, informing conclusions, and supporting decision-

making (Guillaumet et al., 2019). To make sure that errors are fixed and there are no

26
mistakes, the primary data acquired from the field was first cross-checked. Data analysis will

be done using the data analysis software; Statistical Package for Social Sciences (SPSS V.

24) after the data has been collected. Individual questions on the instrument will be coded

before data entry and then the software will be used to process the data. The analysis will be

done in descriptive and inferential statistics form in which it will be presented in frequencies,

percentages, mean and standard deviations.

ETHICAL CONSIDERATION

Four ethical principles which will be used to ensure that the study was ethically acceptable. T

hese principles are beneficence, justice, non-maleficence and autonomy and confidentiality

(Harriss, MacSween & Atkinson, 2019). Ethical clearance will be obtained from the Dodowa

Health Research Center Institutional Review Board. Prior to the day of data collection, the

obtained ethical clearance from the DHRC/IRB together with a letter from the Head of Depar

tment of Nursing, Valley View University will be sent to the Korle-Bu Teaching Hospital to

seek an approval for conducting the study within the facility. After approval, the prospective

respondents will be well-informed about the purpose of the study. The supervisor will be con

sulted for guidelines to follow in observing all the ethical principles. Verbal consent will be

sought from the respondents before the questionnaire will be administered to them.

Respondents will be informed that they could opt out of the study if they want to do so.

Names of participants will not be collected in order to ensure anonymity and all information

which will be provided will be treated as confidential. The following ethical principles will

be used;

Non maleficence

By taking time to be involved in the study, some inconvenience will be caused to

respondents. This will however be minimized by strictly going according to the questionnaire

27
and making sure that items on the questionnaire will not be too much in order to maximize

time.

Autonomy

Respondents have a choice to answer questions or not. In addition, they can opt out of the

study at any point if they feel inclined to do so. No money or reward was given to

respondents. Informed consent will be obtained from each participant. Consent forms will be

signed by both the researcher and the respondents.

Confidentiality

All information provided will be treated strictly confidential. There will be no need for

respondents to write their names. Names will not be included in the excel spread sheet.

Justice

At all times the respondent rights will be respected. The respondents will be told of the

benefits and risks associated with the study.

Beneficence

The respondents will be told of the benefits of the proposed study which will include

contributing to existing knowledge on family-centered care.

28
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Appiah EO, Appiah S, Oti-Boadi E, Boadu BA, Kontoh S, Adams RI, Appiah C, Sarpong C.

Attitude and preventive practices of pressure ulcers among orthopedic nurses in a

tertiary hospital in Ghana. PLoS One. 2023 Sep 8;18(9):e0290970. doi:

10.1371/journal.pone.0290970. PMID: 37682963; PMCID: PMC10490930.

Anthony, D., & Safari, R. (2020). Prevalence of pressure ulcers in africa: A systematic

review and meta-analysis. Journal of Tissue Viability. Retrieved from

doi.org/10.1016/j.jtv.2020.10.003 on 22nd May,2024

Aslan A, Yavuz van Giersbergen M. Nurses' attitudes towards pressure ulcer prevention in

Turkey. J Tissue Viability. 2016 Feb;25(1):66-73. doi: 10.1016/j.jtv.2015.10.001. Epub

2015 Nov 18. PMID: 26681635.

Avsar P, Patton D, O'Connor T, Moore Z. Do we still need to assess nurses' attitudes towards

pressure ulcer prevention? A systematic review. J Wound Care. 2019 Dec 2;28(12):795-

806. doi: 10.12968/jowc.2019.28.12.795. PMID: 31825774.

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Beckman D., Defloor T.,Schoonhoven L. & Vanderwee K. (2015). Knowledge and attitudes

of nurses on pressure prevention: a cross-sectional multicenter study in Belgian

Hospital. Retrieved on 21st May, 2024

Bhattacharya S. & Mishra R.K. (2015). Pressure ulcers: Current understanding and

modalities of treatment. Indian J. Plast. Surg. Retrieved from DOI:10.4103/0970-

0358.155260 on 26th May, 2024.

Boyko T.V., Longaker M.T. & Yang G.P. (2018). Review of the current management of

pressure ulcers. Ad. Wound Care (New Rochelle). Retrieved from DOI:

10.1089/wound.2016.0697 on 26th Mayy, 2024.

Dalvand S., Ebadi A. & Gheshlagh G.R (2018). Nurses’ knowledge on pressure injury

prevention: a systematic review and meta-analysis based on the pressure ulcer

knowledge assessment tool. Retrieved from DOI.org/10.2147//CCID. 3186381 on 24 th

May, 2024.

Dilie A. & Mengistu D. (2015). Knowlegde, attitudes and perceived barriers to expressed

pressure ulcer practice in Addis Abab government hospitals, Addis Ababa, Ethiopia,

2015. Advances in Nursing. Retrieved from Doi:10.1155/2015/796927 on 25 th May,

2024.

Ebi E.W., Hirko F.G. & Mijena D.A. (2019). Nurses’ knowledge to pressure ulcer prevention

in public hospitals in Wallega: A cross sectional study design. Retrieved from

DOI:10.1186/s12912-0190346-y on 27th May, 2024.

Ferris, A., & Harding, K. (2019). Pressure ulcers in patients receiving palliative care: A

systematic review. In Palliative Medicine (Vol. 33, Issue 7, pp. 770–782). SAGE

Publications Ltd. Retrieved from doi.org/10.1177/0269216319846023 on 24th May,

2024

Fu, L., Chen, Y., Lin, L., Xu, Z., & Zhuang, Y. (2024). Knowledge, attitude, and practice of

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 critical care nurses and their influence on acute skin failure patients in China: A

multicenter cross‐sectional study. Japan Journal of Nursing Science, 21(2), e12582.

Getie A, Baylie A, Bante A, Geda B, Mesfin F. Pressure ulcer prevention practices and

associated factors among nurses in public hospitals of Harari regional state and Dire

Dawa city administration, Eastern Ethiopia. PLoS One. 2020 Dec 15;15(12):e0243875.

doi: 10.1371/journal.pone.0243875. PMID: 33320888; PMCID: PMC7737888.

Guifo, M. L., & Essomba, A. G. (2018). Epidemiology and Therapeutics Aspects of Pressure

Ulcers in Two Sub-Sahara African University Teaching Hospitals. ARC Journal of

Surgery, 4(2). Retrieved from doi.org/10.20431/2455-572x.0402001 on 26th May, 2024.

Ingwu JA, Nwaordu AH, Opara H, Israel OE, Ogbogu C. Caregivers' knowledge and practice

toward pressure ulcer prevention in national orthopedic hospital, Enugu, Nigeria. Niger J

Clin Pract. 2019 Jul;22(7):1014-1021. doi: 10.4103/njcp.njcp_413_17. PMID:

31293270.

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities

and the development of pressure ulcers among older adults. BMC geriatrics, 18, 1-11.

Jiang L, Li L, Lommel L. Nurses' knowledge, attitudes, and behaviours related to pressure

injury prevention: A large-scale cross-sectional survey in mainland China. J Clin Nurs.

2020 Sep;29(17-18):3311-3324. doi: 10.1111/jocn.15358. Epub 2020 Jul 14. PMID:

32497357.

Jocelyn, C. H. S., Thiara, E., Lopez, V., & Shorey, S. (2017). Turning frequency in adult

bedridden patients to prevent hospital-acquired pressure ulcer: A scoping review.

International Wound Journal, 15(2), 225-236. Retrieved from DOI:

10.1111/iwj.12855 on 25th May, 2024.

Lannering C, Ernsth Bravell M, Midlöv P, Östgren CJ, Mölstad S. Factors related to falls,

weight-loss and pressure ulcers--more insight in risk assessment among nursing home

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 residents. J Clin Nurs. 2016 Apr;25(7-8):940-50. doi: 10.1111/jocn.13154. Epub 2016

Jan 27. PMID: 26813994.

Mirshekari L, Tirgari B, Forouzi MA. Intensive care unit nurses' perceived barriers towards

pressure ulcer prevention in south east Iran. J Wound Care. 2017 Mar 2;26(3):145-

151. doi: 10.12968/jowc.2017.26.3.145. PMID: 28277998.

Moore, Z. E., & Webster, J. (2018). Dressings and topical agents for preventing pressure

ulcers. Cochrane Database of Systematic Reviews, (12). Retrieved from

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009362.pub3/full on

27th May, 2024.

Muhammed, E. M., & Walle, T. A. (2020b). Nurses’ knowledge of pressure ulcer and its

associated factors at Hawassa University comprehensive specialized hospital

Hawassa, Ethiopia, 2018. BMC Nursing, 19(1), 1–8. Retrieved from

doi.org/10.1186/s12912-020-00446-6 on 27th May, 2024.

Nuru N, Zewdu F, Amsalu S, Mehretie Y. Knowledge and practice of nurses towards

prevention of pressure ulcer and associated factors in Gondar University Hospital,

Northwest Ethiopia. BMC Nurs. 2015 May 16;14:34. doi: 10.1186/s12912-015-0076-

8. PMID: 26034398; PMCID: PMC4450466.

Onigbinde, A. T., & Oniyangi, S. O. (2016). Pressure ulcer incidence among high-risk

inpatients in Nigeria. British Journal of Nursing, 21(12 SUPPL.). retrieved from

doi.org/10.12968/bjon.2012.21.sup12.s4 on 27th May, 2024

Saleh, M. Y. N., & Anthony, D. (2019). Nurses’ knowledge and practice of pressure ulcer

prevention and treatment: An observational study. Journal of Tissue Viability, 28(4),

210–217. Retrieved from doi.org/10.1016/j.jtv.2019.10.005 on 26th May, 2024.

Sawant, N., & Shinde, M. (2017). Nurses Knowledge and Practices towards Prevention of

Pressure Ulcer in Tertiary Care Hospital. International Journal of Science and

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 Research (IJSR), 6(5), 739-45. Retrieved from

https://www.ijsr.net/archive/v6i5/ART20173233.pdf on 29th May, 2024

Shiferaw, W. S., Aynalem, Y. A., & Akalu, T. Y. (2020). Prevalence of pressure ulcers

among phospitalized adult patients in Ethiopia: a systematic review and meta-

analysis. BMC dermatology, 20(1), 1-10. Retrieved from

https://link.springer.com/article/10.1186/s12895-020-00112-z on 1st June, 2024

Simon, M. K., & Goes, J. (2013). Assumptions, limitations, delimitations, and scope of the

study. Retrieved from https://lucalongo.eu/courses/2021

2022/researchDesign/semester2/material/Assumptions-Limitations-Delimitations-and-

Scope-of-the-Study.pdf on 24th May, 2024.

Ünver S, Fındık ÜY, Özkan ZK, Sürücü Ç. Attitudes of surgical nurses towards pressure

ulcer prevention. J Tissue Viability. 2017 Nov;26(4):277-281. doi:

10.1016/j.jtv.2017.09.001. Epub 2017 Sep 13. PMID: 28967528. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/28967528/ on 7th August, 2024

Valimungighe, M., & Akinja, S. (2018). Epidemiological and Clinical Characteristics of

Patients with Pressure Ulcers in Butembo, Democratic Republic of the Congo. Archives

of Current Research International, 12(4), 1–6. Retrieved from

doi.org/10.9734/acri/2018/39276 on 21st May , 2024

33
 Budget

An approximate amount of two thousand seven hundred and sixty-five Ghana Cedis (GHC

2,765.00) will be needed to complete this project. The justification is shown in Table 2.

Table 1: Budget Justification

Activity Unit Price (GHS) Quantity Amount (GHS)

Ethical Clearance 50 1 50

Data Analysis of final results 500 1 500

Typing 1.0 per page 100 pages 100

Printing 0.5 per page 70 pages 35

Binding 15 per book 4 copies 60

Internet services 10 per day 40 days 400

Nose mask 1 pack 30days 20

Food/Water 25 per pack 40 days 1,000

Miscellaneous 600

TOTAL 2,765.00

34
 Budget Justification

Ethical Clearance: Using the GHS 50 fee from the previous year as a baseline, the ethical

clearance fee is anticipated to still cost GHS 50.

Data Analysis of final results: A statistician will analyze the data collected; this analysis is

expected to cost GHS 500.

Typing, Printing and Binding: This is anticipated to cost a total of GHS 195. This will

include all typing and printing tasks for a variety of organizations and people, including the

IRB, the environment, and the supervisor.

Internet services: The researcher is anticipated to consume at least GHS 10 each day of

internet use for the following 40 days, with an internet usage cap of GHS 400.

Nose mask: A pack of nose mask will be purchased at the sum of GHS 20.

Food/Water: The researchers are expected to spend GHS 1,000 on food and water. This has

been pegged at GHS 25 per pack for at the next 40 days of their research journey.

Miscellaneous: An amount of GHS 600 has been allocated to mitigate any unforeseen

contingences that may arise outside of listed items.

35
36
 Timeline of the Study

ACTIVITIES Nov - Dec JANUARY, 2025 FEBRUARY-MARCH, 2025 APRIL, 2025

2024

Development
of proposal
Submission of Proposal to
Supervisor
Ethical Clearance

Awaiting
Clearance
Collection of
Data
Data analysis

First draft of chapters 1- 4

1st & 2nd week Correction of

chapter 1 – 4

2nd & 4th week Submission of

chapter 5 and proof reading
Submission to
the university

37
 APPENDIX A
Informed Consent Form

This informed consent form is for participants in selected communities in Team who the

researcher is inviting to participate in research titled “PREVENTIVE PRACTICES AND

MANAGEMENT OF PRESSURE ULCER AMONG ORTHOPEDIC NURSES AT

KORLE-BU TEACHING HOSPITAL”

Principal Investigator: PRISCILLA ARCHER

Name of Organization: Valley View University

General Information about the Researcher

I am PRISCILLA ARCHER a student of Valley View University. I am conducting a

research on the Preventive Practices and Management of Pressure Ulcer among

Orthopedic Nurses at Korle-Bu Teaching Hospital. I am going to give you information

and invite you to be part of this research. You have the free will to decide whether to

participate in this study or not. Before such decision is made, you are free to contact us

anytime about the research. This consent form may contain words that you do not understand.

Please ask me to stop as we go through the information and I will take time to explain, if you

have questions later, you can still ask me.

Purpose of the Study

The purpose of the study is to assess the preventive practices and management of

pressure ulcer among orthopedics nurses at Korle –Bu Teaching hospital.

38
Type of research

This study will employ a quantitative descriptive research design. This research will

use a structured questionnaire to collect data which will take about 20 to 30 minutes of you

time.

Participant selection

You are being invited to take part in this research because your level of knowledge on

preventive practices and management of pressure ulcer among orthopedics nurses can

contribute much to my understanding and knowledge of this study.

Voluntary participation

Your participation in this research is wholly voluntary. It is your choice whether to

participate or not. The choice that you make will have no bearings on your work. You may

change your mind later and stop participating even if you agreed earlier. Also, participants

can refuse not to be part of the study without it affecting the findings.

Procedures

 With the help of a self-structured questionnaire, questions will be asked through

questionnaire and you will be answering them.

 Participants are to give truthful and accurate response during data collection section.

Duration

The research takes place in one-month total. During that time, I will distribute

questionnaire to the participant (you) which will last for about 20 to 30 minutes to answer.

Risks

There is a risk that you may share some personal or confidential information by

chance, or that you may feel uncomfortable talking about some of the topics. However, I do

not wish for this to happen. You do not have to answer any question or take part in the study

39
if you feel the questions are too personal or if answering them makes you uncomfortable. The

only risk involved in this study will be the time you will spend in answering the

questionnaire.

Benefits

There will be no direct benefit to you, but your participation is likely to help me find

more about the preventive practices and management of pressure ulcer among orthopedics

nurses.

Reimbursement

You will not be provided any incentive to take part in the research.

Confidentiality

The information that I will collect from this research will be kept private. Any

information about you will have a number on it instead of your name. Only the researcher

will know what your number is. It will not be shared with or given to anyone except my

supervisor, Dodowa Health Research Centre Institutional Review Board and the university

administration.

Sharing the Results

Nothing that you tell me today will be shared with anybody outside the research team,

and nothing will be attributed to you by name. The knowledge that I get from this research

will be shared with you and the hospital before it is made widely available to the public.

Results will be published so that other interested people may learn from the research. Also

results of this study will be shared with DHRC-IRB.

Right to Refuse or Withdraw

You do not have to take part in this research if you do not wish to do so. You may

stop giving answers during the interview at any time that you wish without your work being

affected.

40
Who to Contact

If you have any questions, you may contact any of the following: Priscilla Archer,

P.O. Box AF 595, ADENTA ACCRA, 0599650994. Email:

[email protected] proposal has been reviewed and approved by Dodowa

Health Research Centre Institutional Review Board (DHRC IRB), which is a committee

whose task it is to make sure that research participants are protected from harm. If you have

any queries, concerns or complaints regarding the ethical procedures of this study, contact

Ms. Adjoa Brenya, email: [email protected].

CERTIFICATE OF CONSENT

I have been invited to participate in research about Preventive Practices and

Management of Pressure Ulcer among Orthopedic Nurses at Korle-Bu Teaching Hospital. I

have thoroughly read the information sheet on the above study. I have been given the

opportunity to ask questions concerning the study. I have read the foregoing information, or it

has been read to me. I have had the opportunity to ask questions about it and any questions I

have been asked have been answered to my satisfaction. I consent voluntarily to be a

participant in this study.

Name of Participant…………………………...………Sign………………Date…../…../……..

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participants, and to

the best of my ability made sure that the participant understands that the following will be

done:

1. There will be confidentiality of information.

41
 2. The participant has the right to refuse or withdraw from the research or study

3. The participant will not be provided any incentive to take part in the research.

4. The knowledge gotten from the research will be shared with the hospital and will be

published so that other interested people may learn from the research.

I confirm that the participant was given an opportunity to ask questions about the study, and

all the questions asked by the participant have been answered correctly and to the best of my

ability. I confirm that the individual has not been coerced into giving consent, and the consent

has been given freely and voluntarily.

Name of Researcher/person taking the consent________________________

Signature of Researcher /person taking the consent: __________Date _______________

Day/month/year

42
 QUESTIONNAIRE

VALLEY VIEW UNIVERSITY

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF NURSING

Dear respondents,

I am a final year student from the Nursing Department of Valley View University,

researching the topic; “PREVENTIVE PRACTICES AND MANAGEMENT OF

PRESSURE ULCER AMONG ORTHOPEDIC NURSES AT KORLE-BU TEACHING

HOSPITAL”. You have been selected as one of the respondents for this study. Any

information supplied will be used for research purposes only and your confidentiality is

strictly assured. Participating in this study will not be detrimental to you in any way,

however, you reserve the right to withdraw from the study at any time. Kindly provide

accurate answers by indicating with a tick [√] against each question or by answering with

words where necessary. Please note that your name is not required and that all information

given will be treated strictly confidential. Thanks for your cooperation.

Kindly read each question carefully and provide the appropriate answer by ticking [√] in the

spaces provided.

43
DEMOGRAPHIC DATA

1. Age:

[ ] 20-30

[ ] 31-40

[ ] 41-50

[ ] 51 and above

2. Gender:

[ ] Male

[ ] Female

[ ] Other

3. Education Level:

[ ] Diploma

[ ] Bachelor’s Degree

[ ] Master’s Degree

[ ] Doctorate

[ ] Other (please specify): __________

4. Years of Nursing Experience:

[ ] Less than 1 year

[ ] 1-5 years

[ ] 6-10 years

[ ] 11-15 years

[ ] More than 15 years

5. Current Work Setting:

44
 [ ] General Ward

[ ] Intensive Care Unit (ICU)

[ ] Surgical Ward

[ ] Orthopedic Ward

[ ] Other (please specify): __________

6. Have you received formal training on pressure ulcer prevention?

[ ] Yes

[ ] No

7. How many times have you attended pressure ulcer prevention training in the past year?

[ ] None

[ ] 1-2 times

[ ] 3-4 times

[ ] More than 4 times

OBJECTIVE 1: NURSES’ BELIEFS AND KNOWLEDGE ON PRESSURE ULCER

MANAGEMENT

Kindly read each question carefully and provide the appropriate answer by ticking [√] in the

spaces provided.

QUESTION YES NO I DON’T KNOW

1. Do you know that pressure ulcer is a damage to the skin and

underlying tissue caused by prolonged pressure on the same area?

2. Are pressure ulcers caused by sustained pressure or friction on the

skin that damages it?
3. Immobility, malnutrition, low level of physical activity or poor
mobility, friction and shear forces are significant risk factors for
pressure ulcers.

4. The use of specialized support surfaces (mattresses, cushions) is

crucial for preventing pressure ulcers in high-risk patients.

5. The use of advanced wound care therapies (e.g., negative pressure

wound therapy, skin substitutes) should be reserved for more

45
 complex pressure ulcers.

6. Inadequate staffing and resources can hinder the identification and

management of pressure ulcer risk factors.
7. A multi-disciplinary team (nurses, physicians, dietitians, physical
therapists) is essential for effective pressure ulcer management.

OBJECTIVE 2: NURSES’ ATTITUDE TOWARDS PRESSURE ULCER

MANAGEMENT

Kindly read each question carefully and provide the appropriate answer by ticking [√] in the

spaces provided.

1. Pressure ulcers are largely preventable with proper care and attention.

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

2. Preventing pressure ulcers is a priority in your daily nursing practice?

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

3. Addressing pressure ulcer risk factors early can significantly reduce their incidence.

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

4. The current staffing levels are adequate for effective pressure ulcer prevention?

46
 [ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

5. Pressure ulcer prevention is one of the most important aspects of my nursing practice.

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

6. Pressure ulcer prevention should be a collaborative effort involving multiple healthcare

professionals.

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

7. The confidence in the ability to assess the risk of pressure ulcers in my patients.

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

8. Workload affects the attitude towards pressure ulcer prevention?

[ ] Strongly agree

[ ] Agree

[ ] Disagree

[ ] Strongly disagree

47
OBJECTIVE 3: PREVENTIVE MEASURES USED BY NURSES DURING

PRESSURE ULCER MANAGEMENT

Kindly read each question carefully and provide the appropriate answer by ticking [√] in the

spaces provided.

1. How often do you assess patients for pressure ulcer risks during their hospitalization?

[ ] Never

[ ] Sometimes

[ ] Always

2. What preventive measures do you regularly implement to prevent pressure ulcers?

[ ] Regular repositioning of patients

[ ] Use of pressure-relieving devices

[ ] Nutritional management

[ ] All of the above

3. How often do you reposition patients to prevent pressure ulcers?

[ ] Never

[ ] Sometimes

[ ] Always

4. How often do you assess patients' skin condition for signs of pressure ulcers?

[ ] Never

[ ] Sometimes

[ ] Always

5. How frequently do you use pressure ulcer risk assessment scales in your practice?

[ ] Never

[ ] Sometimes

48
 [ ] Often

[ ] Always

6. Do you educate patients and caregivers about pressure ulcer prevention?

[ ] Never

[ ] Sometimes

[ ] Often

[ ] Always

7. How well do you think the current preventive measures in your ward are working to reduce

pressure ulcers?

[ ] Not effective

[ ] Slightly effective

[ ] Moderately effective

[ ] Very effective

8. Are pressure-relieving devices readily available in your ward when needed?

[ ] Never

[ ] Sometimes

[ ] Often

[ ] Always

9. What factors do you think affect your ability to perform pressure ulcer prevention

effectively?

[ ] Staff shortage

[ ] Lack of equipment

[ ] Time constraints

49
 CURRICULUM VITAE

Priscilla Archer

Email: [email protected]

PERSONAL DETAILS

Name: Priscilla Archer

Date of Birth: 30th May, 1998

Nationality: Ghanaian

Religion: Christian

Marital Status: Single

Sex: Female

Languages Spoken: English And Twi

Contact: 0599650994 / 0557719787

PERSONALITY PROFIE

A hardworking and dependable person, with the ability to work well both independently and

in a team. I have extensive knowledge of working with the public which has taught me

value of friendliness, open-mindedness and confidentiality in taking care of patients.

CAREER OBJECTIVE

 To employ my knowledge and expertise with the intention of securing a professional

career with opportunity for challenges and career advancement while gaining

Knowledge.

EDUCATIONAL BACKGROUND

Name Of School Certificate Years

S.D.A Preparatory School (JHS) B.E.C.E (2011)

Baidoo Bonsoe (SHS) W.A.S.S.C.E (2012-2015)

50
S.D.A Nursing Midwifery College RNAC (2017-2019)

Valley view university Degree (Present)

KEY COMPETENCES

 A highly organized and dedicated young man who believes in teamwork

 And has a positive attitude towards work

 Very determined, hardworking with the learn and adapt to new environment quickly

 Possess very good oral and written communication skills which thrives on working in a

challenging environment

WORKING EXPERIENCE

 I have 2years clinical experience

 Nagel Memorial Hospital (Takoradi)

 St. Francis Catholic Hospital (Eikwe)

 Amanfrom Polyclinic (Amanfrom)

 Kasoa Polyclinic (Kasoa)

HOBBIES

 Reading

 Singing REFERENCE

 Elder. Bismark Cudjoe  0240748810

51
 SUPERVISOR’S CURRICULUM VITAE

DOROTHY BAFFOUR AWUAH

PERSONAL DETAILS

ADDRESS: ...................................P.O.BOX M68 SUAME, KUMASI, ASHANTI REGION

TELEPHONE: ..................................................0557149430/0262652266

E-MAIL: ...........................................................dorsims2005@yahoo.co.uk

HOME TOWN: ................................................ADWUMAKASI-KESI, ASHANTI REGION

PLACE OF BIRTH: ..............................................KUMASI, ASHANTI REGION, GHANA

DATE OF BIRTH..................................................OCTOBER 14 1976

NURSING REGISTRATION NUMBER: ...............14DB264341911

EDUCATIONAL BACKGROUND

QUALIFICATIONS SCHOOLS ATTENDED YEAR OBTAINED

MASTER OF PUBLIC HEALTH SAINT LOUIS UNIVERSITY 2014

MASTER OF SCIENCE IN NURSING SAINT LOUIS UNIVERSITY 2014

BACHELOR OF SCIENCE IN NURSING ADVENTIST UNIVERSITY OF THE

PHILIPPINES

2010 SENIOR SECONDARY SCHOOL CERTIFICATE S.D.A SECONDARY SCHOOL,

AGONA 1996

WORK EXPERIENCE

ORGANISATION POSITION YEARS WORKED

NURSING & MIDWIFERY COUNCIL OF GHANA

EXAMINER (PRACTICAL) NOV. 2021 TO DATE

VALLEY VIEW UNIVERSITY LECTURER NOV. 2014 TO DATE

AHENFIE RADIO HEALTH MATTERS PRESENTER DEC. 2013 TO OCT. 2014

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BAGUIO ADVENTIST CLINIC VOLUNTEER MISSIONARY NURSE 2011-2012

SANTOS MUNAR DENTAL CLINIC DENTIST ASSISTANT SEPT. 2010- MAR 2011

HINDOL PRESCHOOL S. KOREA ENGLISH TEACHER 2001-2006

COMPUTER LITERACY:

HIGH LEVEL OF SKILLS WITH MICROSOFT OFFICE, WORD, POWER POINT,

RESEARCH SKILLS FOR USE ON THE INTERNET, ONLINE TEACHING WITH E-

LEARNING MODUL, AND EAGER TO LEARN MORE IN OTHER AREAS.

LANGUAGES

• TWI

• ENGLISH

• KOREAN

HOBBIES: READING, RESEARCHING, LISTENING TO MUSIC AND SEEKING THE

WELFARE OF PEOPLE

REFEREES:

1. DR. NINON P AMERTIL PH.D., RN DEAN OF SCHOOL OF NURSING AND

MIDWIFERY, VALLEY VIEW UNIVERSITY, OYIBI, ACCRA, GREATER ACCRA

REGION, GHANA.

2. NANCY P. DELOS REYES RN, MW, MSN HEALTH MINISTRIES DIRECTOR, SDA

CHURCH, MOUNTAIN PROVINCES MISSION, BAGUIO CITY, PHILIPPINES.

3. DR. ELIZABETH BAUTISTA, PH.D. RN SAINT LOUIS UNIVERSITY, SCHOOL OF

NURSING, GRADUATE SCHOOL. BAGUIO CITY, PHILIPPINES

53
Research Publications

Appiah, E.O., Oti-Boadi, E., Appiah, S. Mohammed Ali Bakkari, Menka, M.A., Baffour,

A.D., Kontoh, S., Menlah, A., Garti, I. & Agyekum Boateng, S. (2023). Acceptance

of HPV vaccination in boys among mothers from selected churches in Accra, Ghana.

BMC Public Health 23, 1053. https://doi.org/10.1186/s12889-023-16028-5

Appiah, E.O., Oti-Boadi, E., Ani-Amponsah, M., Goku, M. D, Baffour, A. D, Menlah, A.,

Ofori-Appiah, C. (2023). Barriers to nurses’ therapeutic communication practices in a

district hospital in Ghana. BMC Nurs 22, 35. https://doi.org/10.1186/s12912-023-

01191-2.

Appiah, E.O., Appiah, S., Oti-Boadi, E. Hammond, D., Baffour Awuah, D., Menlah, A.

Garti, I., & Baidoo, M. (2022). Experiences of women awaiting cervical cancer

screening results from selected hospitals in Accra, Ghana. BMC Public Health 22,

1467. https://doi.org/10.1186/s12889-022-13874-7.

Appiah, E.O., Appiah, S. Kontoh, S., Mensah, S., Baffour Awuah, D., Menlah, A. &

Baidoo, M., (2022). Pediatric nurse-patient communication practices at Pentecost

Hospital, Madina: A qualitative study. International Journal of Nursing Sciences 9(4)

481-489. https://doi.org/10.1016/j.ijnss.2022.09.009.

Appiah, E. O., Appiah, S., Menlah, A., Baidoo, M., Awuah, D. B., & Isaac, N. B. (2021).

Experiences of infection prevention and control in clinical practice of nursing students

in the Greater Accra Region, Ghana: An exploratory qualitative study. SAGE Open

Medicine. https://doi.org/10.1177/20503121211054588

Prevalence and Predictors of Dysmenorrhea, Its Effect, And Coping Mechanisms Among

Adolescents in Shai Osudoku District, Ghana. Kwabena Acheampong, Dorothy

Baffour Awuah, Daniel Ganu, Stella Appiah, Xionfeng Pan, Atipatsa Kaminga,

54
 Aizhong Liu, Obstetrics and Gynecology International, Volume 2019, Article ID

5834159, 7page, Published 20 May 2019

Health-Seeking Behaviour of Orthopedic Trauma Patients Attending Saint Joseph Hospital in

Koforidua, Ghana. Dorothy Baffour Awuah, Kwabena Acheampong, Yeboah

Francis, IOSR Journal of Nursing and Health Science, e-ISSN:2320-1959.p- ISSN:

2320-1940 volume 7, Issue1 Ver. VI. (Jan.-Feb. 2018) PP 43-50

Assessment of Nutritional Status and Prevalence of Hypertension among Pregnant Women

Attending Antenatal Clinic in Adventist Hospital, Accra-Ghana. Kwabena

Acheampong, Dorothy Baffour Awuah. World Wide Journal of Multidisciplinary

Research and Development, E-ISSN: 2454-6615 (2018)

Prevalence of Hypertension and its Association with Obesity among Women Attending

Valley View University Hospital, Accra. Kwabena Acheampong, Stella Appiah,

Dorothy Baffour Awuah, Yeboah Saka Arhin, International Journal of Health

Sciences and Research ISSN:2249-9571 (2017)

Prevalence of Anemia among Pregnant Women Attending Antenatal Clinic of a Selected

Hospital in Accra, Ghana. Kwabena Acheampong, Stella Appiah, Dorothy Baffour

Awuah, Yeboah Saka Arhin, International Journal of Health Sciences and Research

ISSN:2249-9571 (2017)

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