Study design, area and period
The institution-based cross-sectional study design was conducted from March 25 – April 23/ 2018. The study was conducted in Hawassa University comprehensive specialized Hospital, Hawassa. Hawassa is found in southern Ethiopia, on the shores of Lake Hawassa in the great rift valley; 273 km South of Addis Ababa via Debre Zeit and 1,125 km North of Nairobi. Currently, Hawassa town has one comprehensive specialized hospital, one regional hospital, and eight government health centers. Hawassa university comprehensive specialized hospital is a teaching Hospital that gives services for more than five million people including Sidama zone and peoples of the neighboring zones and regions. In this teaching hospital, there are multidisciplinary professionals with different specialties are found, among them the big number is taken by nurses, nearly five hundred nurses currently serving in different units and office in the hospital.
Source and study population
The source population was all nurses working at Hawassa university comprehensive specialized hospital. The study subjects were those nurses working at Hawassa University Comprehensive Specialized Hospital during the data collection period.
Inclusion and exclusion criteria
All permanent staff nurses working at Hawassa University Comprehensive Specialized Hospital who were available during the study period were included in the study.
Sample size determination and sampling procedure
The sample size for the first specific objective
The sample size determined by using a single population proportion formula and considering the following assumptions: nurses knowledge on pressure ulcer prevention 36.15 (22).= standard normal distribution value at 95% confidence level of Zα/2 = 1.96 and margin of error (d) = 5%.
n= (Zα/2)2 P (1-P) (32)
The final sample size was determined considering a 10 % non-response rate, the total sample size was 391 nurses.
Stratification with a Simple random sampling method was used to select the study subjects after proportional allocation for each working ward/unit. The study participants were selected from each ward/unit by a simple random sampling technique from the list of nurses in each stratum.
- Good knowledge: Nurses, who scored mean and above the mean score of the knowledge questions towards pressure ulcer
- Poor knowledge: Nurses, who scored below the mean score of the knowledge questions towards pressure ulcer. (16)
Data collection tools and procedures
Self-administer structured questionnaire containing both closed and open-ended questions were used to collect data. The data was collected from March 25 – April 23/ 2018. The question focused on Nurse's knowledge, perceived barrier, work-related factors and socio-demographic characteristics towards pressure ulcer prevention. Knowledge of nurses was assessed by 41 true/false questions and by using Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) (28), in its version adapted and validated to Brazil(29). Perceived barrier questions that includes Un Proportionate nurse to patient ratio, Lack of guidelines, Shortage of time, Limited resource, Patient factors, Lack of evidence supported by research, Lack of training, lack of job satisfaction, Lack of knowledge were assessed by using a 5 item Likert scale (ranging from strongly agreed, 5 to strongly disagree, 1) adapted from different published literature (11, 16, 21, 22).
Data quality control, processing and analysis
To keep the quality of the collected data all possible attempts were made starting from the development of a data collection instrument to completeness checking of the filled questionnaires. The questionnaire was pre-tested on 20 (5%) nurses who were working at Gondar University Comprehensive Specialized Hospital, one week before the initiation of the main study. And necessary corrections were made and the questions were simplified based on the pretest findings. To ensure the quality of data collection, orientation training about the data collection process was given for data collectors.
EPI-INFO version 7 statistical software was used for data entry. Then it was exported to SPSS version 20.0 for analysis. Frequency distribution and the percentage were computed to describe each variable. Binary logistic regression analysis was employed to determine the association of independent variables with the nurse's knowledge of pressure ulcer prevention. Odds ratio with 95% confidence interval was calculated, the variables that are found with P<0.2 at bivariate analysis were entered to multivariable analysis and statistical significance was declared at p-value less than 0.05. Finally, results were presented using tables and figures.