The effectiveness of educational programs in promoting nursesʼ knowledge of pressure ulcers: a systematic review protocol

Abstract

Review question/objective Are educational programs effective in promoting knowledge of pressure ulcers amongst nurses in all types of settings? Background A pressure ulcer is a severe skin complication affecting patients in all health-care settings worldwide. It has been estimated that approximately 20 to 25% of European patients have pressure ulcers.1 Pressure ulcers are considered to be quality indicators that may result in serious physical and emotional suffering, reducing quality of life, increasing healthcare costs, lengthening hospitalizations, and increasing morbidity rates.2 The Joint Commission on Accreditation of Healthcare Organization (JCAHO) (2012) includes prevention of pressure ulcers as one of the National Patient Safety Goals.3 The successful prevention of pressure ulcers requires a multidisciplinary approach. Nurses, as primary caregivers, play an important role in preventing and managing complications of pressure ulcers.4 Literature reveals that a lack of knowledge and skills in nurses can influence the implementation and success of interventions to prevent pressure ulcers5,6 and may be associated with increased prevalence of pressure ulcers.7-9 Therefore, adequate knowledge and training for nurses is needed in preventing, detecting and planning appropriate care to prevent and treat pressure ulcers. Several studies report that nurses' knowledge of pressure ulcer prevention and management is significantly higher when nurses undergo educational programs.10-13 Therefore, it is suggested that continuing nursing education improves nurses' knowledge and the standards of care related to preventing and caring for patients with pressure ulcers.14 Several educational programs have been suggested to improve nurses' knowledge of pressure ulcer prevention and management, such as face-to-face lectures,14,15 lectures combined with photographs and videos,16 workshops,4,17 computer-based instruction,18 e-learning,19 and training courses.20 Altun & Zencirci (2011) evaluated the effects of an interactive lecture-based three-hour workshop and found that nurses' knowledge of the management of pressure ulcers was significantly improved. Two studies found that face-to-face lecture programs could also improve nurses' knowledge of pressure ulcers.14,16 In addition, e-learning programs are new strategies that have been developed in recent years to promote the knowledge and classification of pressure ulcers among nurses.19 The outcome measures of the educational interventions described above mostly focus on nurses' knowledge on the detection of pressure ulcers.4,14-15,17-18,20 Two studies used photographic teaching in determining differences in accuracy rates,16,19 but the results of the effects were not consistent. Furthermore, Beckman, et al (2008) demonstrated that nurses who underwent e-learning and lectures showed no significant differences in accuracy rates in determining stages on pressure ulcers.19 However, another study reported different results of the effects of e-learning programs.20 Some studies suggest that educational interventions have positive effects in improving nurses' knowledge4,14-15,17-18 and ability to differentiate stages in pressure ulcers.16 In summary, most of the studies suggest that educational programs have positive effects in improving nurses' knowledge of pressure ulcers, but these studies used different types of educational interventions and different content in their teaching materials, and focused on different outcome measures. There is no systematic review published related to the effectiveness of educational programs in promoting nurses' knowledge of pressure ulcers. Therefore, this review aims to identify the best available evidence regarding the effectiveness of educational programs on knowledge of pressure ulcers amongst registered nurses in all types of clinical settings.