Abstract:
Introduction
Pressure ulcer refers to a breakdown of skin due to prolonged pressure or shear. The incidence of
pressure ulcers is about 20% in most clinical settings, despite existence of numerous national and
international guidelines. The study was carried out in July 2018. The aim of this study was to assess the
level of adherence to the Nursing Council of Kenya (NCK) procedure manual pressure ulcer guidelines
among nurses working at Embu Level 5 Hospital and the associated challenges.
Methods
This was an institution based descriptive cross-sectional study. Data was collected using a researcher
developed self-administered questionnaire based on NCK procedure manual guidelines. 145
respondents were selected using stratified random sampling combined with systematic random
sampling. Data was analyzed using SPSS version 21 and NVIVO version 12.
Findings
On adherence to NCK guidelines, 53.91% always adhered, 36.5% sometimes adhered and 9.6% never
adhered. The main reported challenges to adherence of guidelines were shortage of staffs (36.3%) and
inadequate equipment (24.7%). Others were lack of the guidelines in the wards, lack of time for
documentation and patient turning. Availability of guidelines in the wards (X2 =5.546, df=1, P=0.019),
lack of time for documentation (X2 =5.642, df=1, P=0.018, RR=2.63) and patient turning (X2
=5.817, df=1, P=0.016, RR=2.72) were statistically significant at P=<0.05.
Conclusions and Recommendations
Adherence to NCK guidelines was low, and significant challenges were lack of guidelines in the ward,
lack of time for documentation and patient turning. The NCK should revise the guidelines to match the
current international guidelines and evidence based practice. For instance, the use of soap and massage
of pressure areas is outdated. NCK should collaborate with hospitals to facilitate dissemination of the
guidelines instead of having them only in the procedure manuals to increase adherence. The hospital
should ensure standard operating procedures and check-lists are availed in each ward. The hospital
should employ more nurses to enhance adherence.
