Table 3 Nurses’ knowledge to pressures ulcer prevention (N = 212)
Categories (Mean ± SD) | Items | Frequency of answers (%) |
|---|---|---|
Etiology and development 1.67 ± 1.10 | 1. Which statement is correct? | |
a. Malnutrition causes pressure ulcers. | 9 (4.2) | |
b. A lack of oxygen causes pressure ulcers. a | 31 (14.6) | |
c. Moisture causes pressure ulcers. | 159 (75) | |
d. I don’t’ know | 13 (6.2) | |
2. Extremely thin patients are more at risk of developing a pressure ulcer than obese patients. | ||
a. The contact area involved is small and thus the amount of pressure is higher. a | 72 (34.0) | |
b. The pressure is less extensive because the body weight of those patients is lower than the body weight of obese patients. | 26 (12.2) | |
c. The risk of developing a vascular disorder is higher for obese patients. This increases the risk of developing a pressure ulcer. | 67 (31.6) | |
d. I don’t’ know | 47 (22.2) | |
3. What happens when a patient, sitting in bed in a semi upright position (60-), slides down? | ||
a. Pressure increases when the skin sticks to the surface. | 41 (19.3) | |
b. Friction increases when the skin sticks to the surface. | 99 (46.7) | |
c. Shearing increases when the skin sticks to the surface. a | 62 (29.3) | |
d. I don’t’ know | 10 (4.7) | |
4. Which statement is correct? | ||
a. Soap can dehydrate skin and thus the risk of pressure ulcers is increased. | 5 (2.4 | |
b. Moisture from urine, feces, or wound drainage causes pressure ulcers. | 160 (75.5) | |
c. Shear is the force that occurs when the body slides and the skin sticks to the surface. a | 33 (15.5) | |
d. I don’t’ know | 14 (6.6) | |
5. Which statement is correct? | ||
a. Recent weight loss that has brought a patient below his/her ideal increases the risk of pressure ulcers. a | 73 (34.4) | |
b. Very obese patients using medication that decreases the peripheral blood circulation are not at risk of developing pressure ulcers. | 54 (25.5) | |
c. Poor nutrition and age have no impact on tissue tolerance when the patient has a normal weight. | 40 (18.9) | |
d. I don’t’ know | 45 (21.2) | |
6. There is NO relationship between pressure ulcer risk and | ||
a. Age. | 58 (27.4) | |
b. Dehydration. | 48 (22.6) | |
c. Hypertension. a | 83 (39.2) | |
d. I don’t’ know | 23 (10.8) | |
Classification and Observation 2.12 ± 1.14 | 7. Which statement is correct? | |
a. A pressure ulcer extending down to the fascia is a grade 3 pressure ulcer. a | 30 (14.2) | |
b. A pressure ulcer extending through the underlying fascia is a grade 3 pressure ulcer. | 50 (23.6) | |
c. A grade 3 pressure ulcer is always preceded by a grade 2 pressure ulcer. | 84 (39.6) | |
d. I don’t’ know | 48 (22.6) | |
8. Which statement is correct? | ||
a. A blister on a patient’s heel is always a pressure ulcer of grade 2. | 9 (4.2) | |
b. All grades (1, 2, 3, and 4) of pressure ulcers involve loss of skin layers. | 28 (13.2) | |
c. When necrosis occurs, it is a grade 3 or a grade 4 pressure ulcer. a | 137 (64.6 | |
d. I don’t’ know | 38 (17.9) | |
9. Which statement is correct? | ||
a. Friction or shear may occur when moving a patient in bed. a | 81 (38.2) | |
b. A superficial lesion preceded by non-blanchable erythema is probably a friction lesion. | 56 (26.4) | |
c. A kissing ulcer (coping lesion) is caused by pressure and shear. | 49 (23.1) | |
d. I don’t’ know | 26 (12.3) | |
10. In sitting position, pressure ulcers are most likely to develop on the: | ||
a. Pelvic area, elbow, and heel. a | 146 (68.9) | |
b. Knee, ankle, and hip. | 23 (10.8) | |
c. Hip, shoulder, and heel. | 36 (17.3) | |
d. I don’t’ know | 7 (3.0) | |
11. Which statement is correct? | ||
a. All patients at risk of pressure ulcers should have a systematic skin inspection once a week. | 16 (7.6) | |
b. The skin of patients seated in a chair, who cannot move themselves, should be inspected every 2 to 3 h. | 123 (58.0) | |
c. The heels of patients who lie on a pressure-redistributing surface should be observed minimum a day. a | 56 (26.4) | |
d. I don’t’ know | 17 (8.0) | |
Risk assessment 0.90 ± 0.62 | 12. Which statement is correct? | |
a. Risk assessment tools identify all high-risk patients in need of prevention. | 51 (24.1) | |
b. The use of risk assessment scales reduces the cost of prevention. | 32 (15.1) | |
c. A risk assessment scale may not accurately predict the risk of developing a pressure ulcer and should be combined with clinical judgment. a | 92 (43.3) | |
d. I don’t’ know | 37 (17.5) | |
13. Which statement is correct? | ||
a. The risk of pressure ulcer development should be assessed daily in all nursing home patients. | 17 (8.0) | |
b. Absorbing pads should be placed under the patient to minimize the risk of pressure ulcer development. | 77 (36.3) | |
c. c. A patient with a history of pressure ulcers runs a higher risk of developing new pressure ulcers. a | 97 (45.8) | |
d. I don’t know | 21 (9.9) | |
Nutrition 2.65 ± 0.87 | 14. Which statement is correct? | |
a. Malnutrition causes pressure ulcers. | 35 (16.5) | |
b. The use of nutritional supplements can replace expensive preventive measures. | 24 (11.4) | |
c. Optimizing nutrition can improve the patients’ general physical condition that may contribute to a reduction of the risk of pressure ulcers. a | 133 (62.7) | |
d. I don’t’ know | 20 (9.4) | |
Preventive measures to reduce the amount of pressure 2.48 ± 1.32 | 15. The sitting position with the lowest contact pressure between the body and the seat is | |
a. An upright sitting position, with both feet resting on a footrest. | 36 (17.0) | |
b. An upright sitting position, with both feet resting on the floor. | 77 (36.3) | |
c. A backward sitting position, with both legs resting on a footrest. a | 67 (31.6) | |
d. I don’t’ know | 32 (15.1) | |
16. Which repositioning scheme reduces pressure ulcer risk the most? | ||
a. Supine position---side 90 lateral position---supine position---90 lateral position---supine position | 62 (29.2) | |
b. Supine position---side 30 lateral position---side 30 lateral position---supine position. a | 70 (33.0) | |
c. Supine position---side 30 lateral position---sitting position---30 lateral position---supine position | 49 (23.2) | |
d. I don’t’ know | 31 (14.6) | |
17. Which statement is correct? | ||
a. Patients who are able to change position while sitting should be taught to shift their weight minimum every 60 min while sitting in a chair. | 29 (42.1) | |
b. In a side-lying position, the patient should be at a 90 degree- angle with the bed. | 125 (19.8) | |
c. Shearing forces affect a patient’s sacrum maximally when the head of the bed is positioned at 30 degrees. a | 31 (20.8) | |
d. I don’t’ know | 27 (17.4) | |
18. If a patient is sliding down in a chair, the magnitude of pressure at the seat can be reduced the most by | ||
a. A thick air cushion. a | 92 (43.4) | |
b. A donut-shaped foam cushion. | 97 (45.8) | |
c. A gel cushion. | 14 (6.6) | |
d. I don’t’ know | 9 (4.2) | |
19. For a patient at risk of developing a pressure ulcer, a viscoelastic foam mattress | ||
a. Reduces the pressure sufficiently and does not need to be combined with repositioning. | 29 (13.7) | |
b. Has to be combined with repositioning every 2 h.a | 125 (59.0) | |
c. Has to be combined with repositioning every 4 h. | 31 (14.6) | |
d. I don’t’ know | 27 (12.7) | |
20. A disadvantage of a water mattress is | ||
a. Shear at the buttocks increases. | 49 (23.1) | |
b. Pressure at the heels increases. | 44 (20.8) | |
c. Spontaneous small body movements are reduced. a | 69 (32.5) | |
d. I don’t’ know | 50 (23.6) | |
21. When a patient is lying on a pressure-reducing foam mattress, | ||
a. Elevation of the heels is not necessary. | 29 (13.7) | |
b. Elevation of the heels is important. a | 62 (29.3) | |
c. He/she should be checked for “bottoming out” at least twice a day. | 94 (44.3) | |
d. I don’t’ know | 27 (12.7) | |
Preventive measures to reduce the duration of pressure 1.49 ± 0.92 | 22. Repositioning is an accurate preventive method because | |
a. The magnitude of pressure and shear will be reduced. | 50 (23.6) | |
b. The amount and the duration of pressure and shear will be reduced. | 99 (46.7) | |
c. The duration of pressure and shear will be reduced. a | 36 (17.0) | |
d. I don’t’ know | 27 (12.7) | |
23. Fewer patients will develop a pressure ulcer if | ||
a. Food supplements are provided. | 22 (10.4) | |
b. The areas at risk are massaged. | 121 (57.1) | |
c. Patients are mobilized. a | 34 (16.0) | |
d. I don’t’ know | 35 (16.5) | |
24. Which statement is correct? | ||
a. Patients at risk lying on a non-pressure-reducing foam mattress should be repositioned every 2 h.a | 69 (32.5) | |
b. Patients at risk lying on an alternating air mattress should be repositioned every 4 h. | 58 (27.4) | |
c. Patients at risk lying on viscoelastic mattress should be repositioned every 2 h. | 56 (26.4) | |
d. I don’t’ know | 29 (13.7) | |
25. When a patient is lying on an alternating air mattress, the prevention of heel pressure ulcers includes | ||
a. No specific preventive measures. | 11 (5.2) | |
b. A pressure-reducing cushion under the heels. | 83 (39.2) | |
c. A cushion under the lower legs elevating the heels. a | 94 (44.3) | |
d. I don’t’ know | 24 (11.3) | |
26. If a bedridden patient cannot be repositioned, the most appropriate pressure ulcer prevention is | ||
a. A pressure-redistributing foam mattress. | 55 (25.9) | |
b. An alternating-pressure air mattress. a | 83 (39.2) | |
c. Local treatment of the risk areas with zinc oxide paste. | 49 (23.1) | |
d. I don’t’ know | 25 (11.8) | |