Nurses’ knowledge of pressure ulcer risk factors and prevention in the care of hospitalised adult women: a cross-sectional survey at a tertiary hospital in Harare, Zimbabwe
A cross-sectional survey of 86 nurses at a tertiary hospital in Harare, Zimbabwe, revealed that while they possess strong knowledge of mechanical risk factors and hands-on prevention strategies for pressure ulcers in hospitalized adult women, significant gaps remain regarding systemic contributors such as nutrition, chronic illness, and age-related vulnerability, underscoring the need for targeted in-service training.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In hospitals around the world, a silent injury often develops in patients who must stay in bed for long periods. These are pressure ulcers, also known as bedsores, which occur when the weight of the body presses down on the skin over bony areas like the hips or heels. Without regular movement to restore blood flow, the skin and underlying tissue begin to die, creating painful wounds that are difficult to heal. While the physical cause is simple, preventing these injuries requires a complex understanding of the human body. It is not just about turning a patient over; it involves recognizing how poor nutrition, chronic diseases, and the natural aging process weaken the skin's ability to withstand pressure. Because nurses are the ones who spend the most time with patients, checking their skin and moving them in bed, their understanding of these risks is the first line of defense against these preventable harms.
Researchers in Harare, Zimbabwe, set out to see how well nurses in a major hospital understood these risks, specifically regarding the adult women they cared for. They focused on general medical and surgical wards, where women often spend extended periods in bed due to illness or recovery. The team surveyed eighty-six nurses, including registered professionals, students, and assistants, asking them to agree or disagree with a series of statements about what causes bedsores and how to stop them. The goal was to measure their knowledge not just on general principles, but on specific factors that might make older women or those with mobility issues more vulnerable.
The results showed that the nurses were very confident about the mechanical causes of these injuries. Nearly ninety percent of them correctly identified that staying still for too long is a major danger, and more than ninety percent agreed that checking a patient's skin every day is essential for catching problems early. The staff also strongly supported the use of special cushions and the practice of repositioning patients regularly to relieve pressure. These are the visible, hands-on actions that nurses perform daily, and the study found that the team was well-versed in these core tasks.
However, the picture changed when the questions moved from physical movement to the internal health of the patient. When asked about the role of nutrition, fewer than half of the nurses agreed that poor diet significantly contributes to the formation of bedsores. Similarly, only about half recognized that chronic illnesses, such as diabetes or high blood pressure, make a patient more prone to developing these wounds. The nurses seemed to view the prevention of bedsores as a series of physical tasks rather than a condition deeply connected to the body's overall health. They understood that a patient who cannot move needs to be turned, but they were less likely to connect that need to the patient's nutritional status or long-term medical history.
The study also looked specifically at risks related to women. The nurses correctly identified that women with limited mobility need to be repositioned more often, with nearly ninety percent agreeing with this statement. Yet, when asked if older women face a higher risk simply because of their age, only about two-thirds agreed. This suggests that while the staff could see the immediate problem of immobility, they were less aware of how the aging process itself makes skin more fragile and vulnerable to injury.
The researchers also examined whether a nurse's age, years of experience, or professional title influenced their knowledge. They found no clear link between these factors and how well a nurse understood the risks. Interestingly, nurses who had received specific training on preventing bedsores tended to score higher on the knowledge test, though the difference was not large enough to be considered statistically certain in this group. This hints that education might help, but the small number of participants in the study made it difficult to say for sure.
Ultimately, the study concludes that the nursing staff in this hospital has a strong grasp of the physical actions needed to prevent bedsores, such as turning patients and checking their skin. However, there are significant gaps in their understanding of the internal factors that make patients vulnerable, particularly regarding nutrition, chronic disease, and the specific risks faced by older women. The authors suggest that future training should focus on these systemic issues, helping nurses connect the physical care they provide with the broader health conditions of the patients they serve. To fully understand how these factors play out in real life, the researchers recommend a future study that tracks actual patients to see how these knowledge gaps translate into real-world outcomes.
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