Strict adherence to standard guidelines in wound management helps maintain the rule of asepsis and decreases the risk of contamination of the wound or transmission of organism from one patient to another [22]. Unfortunately, many healthcare facilities in resource constrained countries particularly in Africa continue to battle with this important piece of the healthcare delivery puzzle. In Ghana, increasing number of days of hospital admissions have been partly blamed on nosocomial/hospital acquired infections which wound infections often constitute a greater share of this public health concern [23, 24].
In light this, the regulatory body for nurses and midwives in Ghana, the NMC, has over the years instituted, by law, professional policy guidelines for all nursing and midwifery procedures including wound dressing [25]. Sadly, adherence to these policy protocols to the latter remains a mirage in many healthcare facilities, especially those owned by government. Beyond the financial, infrastructural limitations confronting many of these health facilities, several empirical studies have also pointed to wanton nonadherence to these professional guidelines on the part of clinicians, particularly nursing staff who turn to perform these clinical roles [12, 26].
Ghana’s efforts towards attaining the United Nations Sustainable Development Goals (SDGs) 3&4 will remain a dream if existing gaps in quality of healthcare, patient safety and risk reduction in clinical settings are not closed. Since, nursing staff constitute over 50% of the workforce in Ghana’s healthcare system [20], their professional actions and inactions turn to have deleterious effect on many health outcome indicators including incidence and prevalence of HAIs [12]. In view of this, the researchers sought to explore and examine the current practices of nurses in the management of wounds and determine factors associated with adherence or otherwise to NMC of Ghana protocol guidelines for wound management.
In line with findings in some of the reviewed literature, it was found that even though over two thirds of the staff demonstrated knowledge of standard policy protocols, similar to findings by [7, 12, 26, 27], there was an incommensurate application of the knowledge in real practice of their duties. Alhassan et al [12] made similar observations when they discovered that even though nurses knew of the NMC policy guidelines for nasogastric tube feeding, majority of them, regrettably, did not apply this knowledge in the execution of their duties when independently observed. In this study, it was also observed that a huge gap existed between self-rated/subjective scores of staff and the objective assessment ratings by independent assessors. This observation was consistent for wound management guidelines for septic and aseptic wounds, consistent with similar studies in Ghana (12,28,29] and others [30, 31] among nurses.
Perhaps, potential bias of social desirability responses by staff could account for this discrepancy. These findings thus are a testament for future researchers to retrain from one-sided assessment of adherence from the view point of clinical staff in particular since they turn to have higher inclination of providing socially desirable responses just to please researchers. A combination of objective and subjective clinical staff assessments on adherence to standard policy protocols is therefore advocated given the empirical evidence demonstrated in this study.
In terms of the factors associated with nursing staff likelihood of adhering of otherwise to standard nursing protocols, it was discovered that increasing years of work experience did not necessarily correlate positively with adherence to policy protocols in wound management. Indeed, increasing years of work experience had a negative association with adherence likelihood. This observation is contrary to similar studies where years of work associated with better professional practices by nurses and other clinical personnel [12, 26, 32]. Perhaps, the differences in methodology, cadre of respondents and clinical settings could explain these variances in findings.
Conversely, professional category of the respondents positively correlated with the likelihood of adherence to policy protocols for septic and aseptic wound management. It was found that nursing officers for instance were more likely to adhere to the policy protocols relative to lower ranks like nurse-assistants/enrolled nurses. Previous studies have made similar conclusions on the association between higher professional ranks and compliance with standard clinical guidelines for nursing care [33]. However, a study by Alhassan et al [12] found contrary results when lower cadre of nurses were found to follow policy protocols for nasogastric tube feedings than higher professional ranks. The authors suggested, neglect of professional duties and over delegation of these professional tasks to lower rank nurses who turn to master the skill and acquire better dexterity on the job over time since the nursing professional is also an art beyond being a science [33–35]. In this current study, the authors did not go further to explore reasons for these revelations and would recommend future researchers consider exploring, perhaps employing a blended qualitative and quantitative approach, to unearth reasons for these findings. Until this additional scientific step is taken, any conclusions will remain mere speculations and scientific guesses.