Nursing practice on post operative wound care in surgical wards at Muhimbili Nationa Hospital, Dar-es-salaam, Tanzania

Abstract

Background: Postoperative wound healing has been a problem which causes high mortality in the developing world; postoperative wound has been reported to cause devastating consequences and a measurable mortality. The objective of the study was to assess nursing practice on postoperative wound care in surgical wards at Muhimbili National Hospital. Methodology: A quantitative descriptive cross-sectional design was employed. Data was collected using a checklist from a convenient sample of 71 nurses in surgical wards at Muhimbili National Hospital. The study was approved by the ethical committee of Muhimbili University of Health and Allied Sciences and permission to conduct the study was granted by Muhimbili National Hospital. Data was analyzed using SPSS program version 19. Results were summarized using frequencies, percentages, and presented using figures, tables and text. Results The result shows that majority of the participants were female 76.5% and 40.8% of the participants aged 25 – 34 years. More than half of the participants were observed to have poor post operative wound care practice 57.7%. Male participants scored higher, and had better practice compared to female however there was no significant difference between the scores (P=0.803). In the preparation phase, hand washing before and after the procedure was observed by less than half of the participants 49.3%. None of the participants ensured cleanliness of the environment and patient’s privacy by screening or closing the room. The study findings revealed that nurses use clean gloves when removing the old dressing 99%, while use of sterile gloves during wound dressing was not observed by 63% of participants. Good practice was observed in applying dressing solution as prescribed 85% participants, dry sterile dressing applied 90%, arrangement of dressing forceps and other items by order to their application using forceps 20%, usage of forceps to dip gauze into antiseptic solution 35% and cleaning of the wound from least contaminated to most contaminated area 34%. Post-operative counseling and instructing the patient not to temper with the wound was done by only 15% of the participants. None of the participant documented wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion Majority of the participants in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession. Participants were reasonably knowledgeable about the principal of wound dressing; however lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the participants did not wash hands before and after the procedures, they did not use single gauze in one direction only, nor cleaned from least contaminated to most contaminated area, which can lead to wound contamination. Recommendation Ministry of health and social welfare should ensure that nurses are more trained at least to undergraduate level of nursing education. This can be achieved by providing more learning opportunities to nurses accompanied by sponsorships from the Ministry of Health and Social Welfare and sophisticated access to loan from Higher Education Loan Board (HELBS) Muhimbili National Hospital should recruits adequate number of nurses to cope with workload and number of patients. Adequate number of nurses will enable nurses to have more time to prepare equipments and to assess, plan, implement and evaluate care of patients with wound. Ministry of health and social welfare should also ensure that nurses caring for patients with wounds have refresher course to update them on issues of personal and patient protection from infection through infection control and prevention seminars. Increase economic power of the MNH to purchase items to ensure adequate supply of dressing materials including dressing packs, toothed forceps, cotton swabs, gauze, kidney dishes, dressing towels, artery forceps, eusol solution and Hydrogen peroxide solution, normal saline and Spirit.