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Nurses Practice Concerning Postoperative Clean Wound Dressing

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 DOI Number: 10.5958/0976-5506.2018.00559.4

Nurses Practice Concerning Postoperative

Clean Wound Dressing

Abdulkareem Salman Khudhair

Instructor, Department of Fundamentals of Nursing, College of Nursing, University of Basra, Basra- Iraq

ABSTRACT

A descriptive study was carried out at the surgical wards of Al-Sadder Teaching Hospital started from 2th
August to 2th December, 2016.The study aims to asses nurse’s practice concerning postoperative wound
care, and to identifying the relationship between nurse’s practice and their demographic characteristic.

A Purposive “non- probability” sample consisting of (25) nurses was selected from Al- Sadder Teaching
Hospital. The data were collected through the use of direct observation, which comprised of (19) items as
mean of data collection. The data were analyzed through the application of descriptive statistical analysis
that include frequency and percentage , the application of inferential statistics that including the mean of
score, and Chi - square test.

The majority of the nurses were males (60%), with age group (25- 29) years old (28%), nursing institute
graduate (48%), the majority of nurses have than less (1 -5) years of experience (44%). The result indicated
that there were no significant associations between the nurse’s gender, age, level of education and their
practice. There were significant associations between the nurse’s years of experience and their practice.

The results demonstrated a practice deficit in the most items of post-operative clean wound care for patient
in surgical units.

Special training sessions should be designed and presented to these nurses, developing assessment sheet for
skills and daily nursing note for post-operative wound care.

Keyword: Nurses Practice, Concerning Postoperative, Clean Wound dressing

INTRODUCTION drying of the wound, resulting in less bacterial growth(2).

The skin, the body’s first line of defense, protecting Dressings are important component of post-
the underlying structure from invasion by organisms(1). operative wound management. A good dressing should
Maintaining an intact skin surface is important because maintain a moist wound environment and thus promote
a break or disruption in this integrity is potentially wound healing, be able to remove excessive exudate
dangerous and possibly life threatening(2). Maintenance that might lead to maceration of the wound, provide a
of skin integrity and promotion of wound healing are good barrier against bacterial or fluid contamination,
important aspects of nursing care in all care setting(3). A and be adherent to the skin but a traumatic on removal(6).
wound is a disruption of normal anatomical structure and The nurses play an important role in the therapeutic
function that results from pathological process beginning success and outcome of the patient because minimize
internally or externally to the involved organs(4). The goal the patient risk factor for infection through maintaining
of wound care is to promote tissue repair and regeneration strict aseptic technique, inspecting the solution for signs
so that skin integrity is restored(5). Wound can be treated of contamination, monitoring the patient closely before,
by leaving them to air; no dressing (protective covering during and after an exchange and recording his vital
placed over a wound) is applied(1). The wound is believed signs (7).
to be at risk for infection development related to the
 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6 252

Furthermore surgical site infection (SSI) is was (2). The first part of the questionnaire sheet included
usually associated with increased hospital stay, coast (4) items relative to the deogra-phic data of the nurses
and lethality, because of that knowledge of the main who work in the surgical wards and intensive care unit
risk factors for this type of infection is crucial for the and included; age, gender , level of education , years of
establishment preventive measures regarding modifiable experience.
risk factors (8).
The second part of the questionnaire was comprised
Many nosocomial infections are caused by pathogens (19) items that concerned with nurses practice relative
transmitted from one patient to another by way of health postoperative clean wound care. Data were collected
care workers (HCWs) who have not washed their hands through direct observation with the nurses of the sample
between patients or(HCWs)who do not practice control by using Descriptive statistical procedure(Frequency (F)
measures such as use of hand disinfection, glove use and percentage (%)) and Inferential statistical procedure
etc(9). (Mean of score and Chi-square (X2) test) in analyzing the
data of the study. The mean of score, which was equal
The Importance of the current study can be showed
to (2), was considered significant if greater than (2)
through that according to the international committee on
and less than (2) was considered non-significant. Chi-
wound management. Today wound infection increased
square was used to determine the significant relationship
the financial cost on the patients, increase the use of
between the nurse’s practice and their demographic
antibiotics, increase in the consumption of medical
characteristics at p≤ 0.05.
supplies and increase of time consuming for personnel
in the health sector (10). RESULT OF THE STUDY

The postoperative wound infection was considered Table 1: Distribution of nurses by their
the most important health problem in Iraq hospitals. demographic data.
In spite of restricted policies and procedures related
to disinfection and sterilization techniques, as well as Gender F %
following the appropriate management as noted in terms Male 15 60%
of patient’s preparation preoperatively and through the Female 10 40%
surgery, therefore the importance of the standardized Total 25 100%
methods to wound care showed in this research paper Age F %
lies in the fact that it can be successfully applied to all 20-24 4 16%
types of surgical wounds.
25- 29 7 28%
METHOD 30- 34 4 16%
35 -39 4 16%
A descriptive design was conducted on the surgical
40- 44 3 12%
wards in AL-Sader Teaching Hospital started from
August 2th to December 2th, 2016 in order to assess 45 & over 3 12%
nursing practice concerning postoperative wound care Total 25 100%
for patients. Level of education F %
Secondary nursing school 9 36%
A probability sample of (25) nurses males and
Nursing institute graduate 12 44%
females, who were in the surgical wards and intensive
care units .The nurses were assigned for the study Nursing college graduate 4 16%
according to; there working at the surgical wards and Total 25 100%
who should have one year of experience and more. A Years of experience F %
questionnaire format was used for data collection, which 1–5 11 44%
consisted of (2) parts. The overall number of the items 6 – 10 8 32%
included in the questionnaire was (19). The items were
11 – 15 3 12%
rated on three level liker scale: always, some time, and
15 - & over 3 12%
never and scored as 3, 2, and1, respectively, cutoff point
Total 25 100%
 253 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6

This table reveals that the majority of the sample were males (60%), (25- 29) years old(28%), nursing institute
graduate (48%), (1 -5) years of experience (44%) .

Table 2: Mean of scores of the nurse’s practice concerning post-operative wound care.

Some
Items always never Ms Rs Assessment
time

1 Warmed irrigant or solution. 3 2 20 1.4 46.66 Inadequate

2 Performed hand hygiene. 10 7 8 2.8 93.32 adequate

3 Prepared waterproof bag. 20 2 3 2.68 95.32 adequate
4 Provided privacy. 6 4 15 1.64 54.66 Inadequate
5 Applied gown and goggles, if needed. 7 4 14 1.72 57.32 Inadequate
Put on cleans gloves, removed and discarded
6 19 1 5 2.56 85.32 adequate
soiled dressing.
Prepared equipment and opened sterile
7 4 9 12 1.68 55.99 Inadequate
supplies.
8 Applied sterile gloves. 4 - 21 1.32 43.99 Inadequate
9 Obtained necessary culture. - - 25 1 33.33
Applying clean draw sheets around the
10 - 3 22 1.12 37.32 Inadequate
patient’s site of dressing.
11 Irrigate the wound. 3 2 20 1.32 43.99 Inadequate
12 Dried wound edges with sterile gauze. 4 6 15 1.56 51.99 Inadequate
13 Assess the wound. 4 3 18 1.44 47.99 Inadequate
14 Assisted client to comfortable position. 7 9 9 1.92 63.99 Inadequate
15 Applied appropriate dressing. 13 7 5 2.32 77.32 adequate
16 Disposed of used equipment. 3 6 16 1.48 49.32 Inadequate
17 Removed gloves, gowns and goggles. 7 1 17 1.6 53.32 Inadequate
18 Performed hand hygiene. 5 2 18 1.48 49.32 Inadequate
19 Documentation. 2 3 20 1.28 42.66 Inadequate

The findings of this table indicate that the nurses have adequate practice concerning post-operative care on items
2, 3, 6, & 15 and inadequate on the remaining items.

Table 3: Association between nurse’s practice and their gender.

Gender Always Sometime Never Total

F 55 39 172 266
Male
% 20.68% 14.66% 64.66% 100%
F 65 32 112 209
Female
% 31.10% 15.31% 53.59% 100%
F 120 71 284 475
Total
% 25.26% 14.95% 59.79% 100%
X 2 calculated = 4.33 df= 2 X2 tabulated= 5.991 P ˃ 0.05

The finding of this table presented that there were no significant associations between the nurse’s gender and
their practice.
 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6 254

Table 4: Association between nurse’s practice and their age.

Age Always Sometime Never Total

20-29 F 83 23 81 187
% 44.38% 12.31% 43.31% 100%
30-39 F 19 28 105 152
% 12.5% 18.42% 69.08% 100%
40-49 F 21 17 97 135
% 15.55% 12.59% 71.86% 100%
Total F 123 68 283 474
% 25.94% 14.34% 59.72% 100%
X calculated = 8.40
2
df= 10 X tabulated= 18.307
2
P ˃ 0.05
The finding of this table revealed that there were no significant associations between the nurse’s age and their
practice.

Table 5: Association between nurse’s practice and their level of education.

Level of education Always Sometime Never Total

F 21 20 130 171
Secondary nursing school
% 12.28 11.69 76.03 100%

Nursing institute graduate F 45 40 143 228

% 19.74 17.54 62.72 100%
F 55 11 10 76
College of nursing
% 72.36 14.48 13.16 100%
F 121 71 183 375
Total
% 32.26 18.93 48.81 100%
X calculated = 3.72
2
df= 4 X tabulated= 9.488
2
P ˃ 0.05

The finding of this table presented that there were significant associations between the nurse’s level of education
and their practice.

Table 6: Association between nurse’s practice and their years of experience.

Years of experience Always Sometime Never Total

F 77 25 97 199
1-9
% 38.69 12.56 48.75 100%
F 21 29 101 151
10-19
% 13.90 19.20 66.88 100%
F 13 16 85 114
20& more
% 10.53 10.53 78.94 100%
F 111 70 283 464
Total
% 23.93% 15.08% 60.99% 100%
X 2 calculated = 20.72 df= 6 X2 tabulated= 12.592 P ˂ 0.05

The finding of this table presented that there were significant associations between the nurse’s years of experience
and their practice.
 255 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6

DISCUSSION OF THE RESULTS 4. There is no significant relationship between age,

gender and nurse’s practices about postoperative
A surgical wound is generally considered to be clean wound care for patient in surgical care units.
and as a result is often judged as less of clinical challenge
than some other wound types(14). 5. There is a significant relationship between level of
education, years of experience and nurse’s practice
The nursing care is a very important factor in about post-operative wound care for patient in
patients’ satisfaction or dissatisfaction with their surgical units.
experiences in hospital, and nurses’ attitudes towards
and communication with patients are the essential RECOMMENDATIONS
determinants of the patient satisfaction(15).
1. Special training sessions should be designed and
Throughout the course of the present study, it has presented to these nurses.
noticed that the majority(60%) of the study sample was
2. Nurses should be provided with in-service education
males. The highest proportion(28%) of them were(25-
regarding nursing for postoperative wound care in
29)years old. concerning level of education, nursing
surgical units.
institute graduate (48%), (1 -5) years of experience
(44%). 3. A booklet should be designed and distributed to all
nurse working in surgical units
Throughout the use of observational checklist the
highly percentage of nurse’s have adequate practices 4. The study recommended developing assessment
in items concerning (2, 3, 6& 15). These findings are sheet for skills and daily nursing note for post-
indicate that the postoperative wound care so patient operative wound care .
may at risk of infections, that may sometimes lead to
death . The Source of Funding is self-approved by the
University of Basra Nursing College
Throughout the use of statistical analysis there were
no significant relationships between nurse’s practices I have the statement in Arabic
and their age, gender in surgical units(table 3,4), while
The funding source is subjective
they were high significant relationships between nurse’s
practices and their level of education and years of The Interest is a benefit for the Iraqi society,
experience(table 5,6) so nurses with low certification and especially Basra society
inadequate skills cannot do difficulty responsibilities
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