Investigation And Analysis On Cognition Status Quo Of Pressure Ulcers Related Knowledge Among Clinical Nurses In Hebei Province

Objective: To fully understand the clinical nurses' cognition status quo of the pressure ulcers(PU) knowledge and status of their clinical practice,meanwhile, to investigate the training requirements of them in our province,so as to find gaps between clinical nursing practice with the latest guidelines and standardize pressure ulcer clinical nursing practice; and to analyze its influencing factors, so as to provide reference information for the management departments to formulate policies. According to the survey results, implement targeted pressure ulcers related knowledge training and clinical practice training with various forms, different content and period, and explore the best training methods suitable for the status of the province, in order to improve clinical nurses' pressure sores knowledge theoretical level and ability of clinical practice, Ultimately, improve the level of care in Hebei Province.Methods: This study is divided into two stages:: The first stage is Hebei clinical nurses' status quo' investigation of the knowledge related to pressure ulcers and the training requirements of them; the second stage is to train nurses and observe the training effect, so that we can explore the best training methods suitable for the current situation in our province. The first stage: A two-stage sampling method is used to choose 1421 clinical nurses from nine hospitals and six secondary level hospitals in Hebei province,and carry out an investigation using self-designed questionnaire "nurses' cognition status quo of pressure ulcers' knowledge and training requirements questionnaire".After the questionnaires were collected, valid questionnaires will be unified coding,then entry EPIDATA3.1 software to establish a database, at last the data transfer SPSS13.0 for statistical analysis. Stage II: Apply case-based learning(CBL) method to implement PU related knowledge training for the 40 clinical nurses from different regions of the province,organized by the Nursing Association of Hebei Province. Before and after the training, Survey the trainees' PU related knowledge to grasp the situation, using the above-mentioned self-designed questionnaire. Evaluate the effectiveness of training by: 1) Comparing the two survey results; 2) According to the appraisal results; 3) Satisfaction surveys.Results:1 The full range span of the total scores of overall nursing and the different groups in Hebei province are large, this questionnaire out of 174, and the overall nursing' total score ranged from 4 to 168, with an average score of18.93 ? 132.85, meanwhile the correct answer rate was 75.9%; and comprehensive hospitals and secondary level hospitals' scores were134.50 ? 17.45,129.87 ? 21.03; and surgery, operating room, intensive care unit(ICU) and medical nurses' scores are 134.71 ? 20.56, 128.33 ? 18.06,134.03 ? 15.69,132.41 ? 18.06. The resulting is normalized percentile score, the passing score is set as sixty percent out of the full score, all nursing groups scores were 70 points or more.2 Hebei nurses' PU theoretical knowledge score is 18.75 ? 3.63,with the correct answer rate of 62.5%; and the clinical practice score is 114.10 ? 17.56,with the correct answer rate of 79.2%.In summary, the correct answers rate of PU clinical practice is higher than the theoretical knowledge.3 Taking the hospital level as grouping variables, the PU related knowledge scores compared between the two groups show that the score difference is statistically significant(P?0.05), and the score of hospitals nurses is higher than secondary level hospitals nurses'.4 Taking the department as grouping variables, four groups of PU related knowledge scores are compared, showing four groups score difference is statistically significantly(P?0.05),and that it still can not be considered the score of medical group, surgical and ICU group is different, and the score of operating room nurses is lower than the other three groups.5 Taking knowledge score as the dependent variable, with general information as independent variables, carry out multiple linear regression analysis,so as to analyze the influencing factors of PU knowledge level. According to the degree of influence factors of descending are: hospital level, technical titles and administrative positions; the higher hospital level, and the technical titles and administrative positions, the better knowledge mastery. Other variables that affect the PU related knowledge level was not statistically significant(P>0.05).6 The top three scores of each dimension score of nurses' PU related knowledge sorted by the correct rate are: the definition of PU(93.0%); PU wound assessment and records(90.5%); high-risk groups of PU(86.4%); and the end three are: PU pain management(14.3%); selection and use of the support surface(19.4%); the mechanism of PU(52.4%).Sorted by the correct rate of each question, the end five questions are attributed : the pathogenesis of PU(2 questions); PU pain management;wound cleansing and debridement; the use of PU risk assessment scales.7 The top five PU knowledge that nurses most need are: each period of the treatment and care for PU(4.46 ? 0.97); selection and application of the wound dressing(4.41 ? 0.97); treatment of infected wounds(4.41 ? 0.99);wound cleaning and debridement(4.37 ? 1.00); PU prevention(4.33 ? 1.11).8 In this survey, 1169 people(82.4%) have taken care of patients with PU,and 258 people(22.1%) were satisfied with the results, meanwhile, 26.1% of the people think their knowledge of PU can meet the care needs of PU patient.9 The top three sources of clinical nurses' pressure ulcers related knowledge are: previous work experience(84.2%); continuing education lectures or seminars(78.2%); communication with colleagues(64.8%).10 The nurses believe that the most effective three ways to learn are:expert on-site guidance or demonstration(1.49 ? 1.07), and continuing education or special subject lectures(2.96 ? 1.27), and full-time study or training(3.56 ? 1.59).11 The top three factors that influence nurses to attend continuing education learning are: the lack of hospital human resources and the busy work(43.7%);lack of PU related training courses and information provided(22.6%);unknown of how to participate in continuing education(10.8%). The top three factors that influence PU clinical care practice are: the lack of PU related knowledge and knowledge training(43.1%); unable to accurately assess the scales of PU(22.2%); shortage of clinical nurses in departments(17.8%).12 The study showed that the differences of the scores of nurses' theory knowledge and clinical practice conditions and the overall score of PU knowledge were statistically significant(P <0.001), before and after training.After the training, the scores of nurses' theory knowledge and clinical practice conditions and the overall score of PU knowledge are higher than before training.Conclusion:1 Hebei clinical nurses' overall PU related knowledge is acceptable, but still not very optimistic, and should be improved.2 The knowledge that they master worst from low to high are: PU pain management, the selection and use of support surface and the mechanism of PU; the treatment and care of each period of PU; the selection and application of the wound dressing; and their strongest demand about PU knowledge are:the pain management of PU; selection and use of the support surface and the mechanism of PU; treatment of treated infected wounds; wound cleansing and debridement; pressure sores prevention knowledge, we should give attention to the PU knowledge when we take PU knowledge training and continuing education.3 Giving targeted training by considering the nursing' mastery of PU knowledge and their knowledge demand, can improve the effectiveness of training and training efficiency.4 The training effect of CBL method is satisfactory in PU knowledge training and well for the status of the province, and the students reflect well,so that it can be extended.