Effects of patient's factors and wound care practices on wound healing among Orthopedic inpatients in Kenyatta National Hospital
Ngugi, Margaret W
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Background: Wound healing is a complex and dynamic process of restoring cellular structures and tissue layers. The wound healing process is affected by several factors among them, local factors such as patient characteristics and/or systemic factors including nutritional status as well as the overall general health of the patient. Similarly, wound healing may be affected by professional interventions such as nursing care, surgical and medical practices. Patients with fractures have twin problem of both muscular as well as skeletal derangement which are likely to synergize thus affecting the rate of wound healing and recovery. Objective: To determine the effects of patient's factors and wound care practices on wound healing on orthopedic inpatients in Kenyatta National Hospital (KNH). Methods: This was a descriptive observational study involving 90 adult orthopedic inpatients and 31 nurses working in orthopedic wards at KNH. A self administered structured questionnaire and a checklist were used to collect qualitative and quantitative data. Univariate analysis was used for the description of characteristics of the study sample while bivariate analysis was used to describe factors associated with wound healing. Odds of development of non-healing/chronic wounds were calculated at approximately 95% Confidence Interval. Results: There was a significant (Z=2.62; p <0.05) rate of healing of wounds among the study participants. Advanced age, lack of sleep and poor nutritional status significantly (p <0.05) affected the rate of healing. The use of betadine as a common antiseptic significantly (p < 0.05) improved the rate of wound healing among dirty infected wounds. However, the use of systemic antibiotic did not improve the rate of wound healing among the participants. In 81.1 % of the wound dressing instances, nurses were found to dress wounds without an assistant and the reported knowledge of wound care was not observed during actual care. Conclusion: In our study, patient's factors and the care practices were found to influence wound outcome. Adequate nutrition, exercise and sleep significantly influenced the recovery of wounds while on the other hand, advanced age was related to slow rate of wound healing. The reported and observed wound care practices among ~e nurses were not consistent while aseptic technique was not strictly followed most of the time probably as a result of inadequate supplies and shortage of nurses. Therefore nurses need empowerment in terms of resources so as to enable them practice effectively.