Prevention of Pressure Ulcers: Attitudes and Perceived Hindrances of Nurses - A Critique of Two Studies

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Measurement and Evaluation for Healthcare Practices
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Introduction
The prevention of pressure ulcers (PU) is a very important indicator for acute care hospitals.
Pressure ulcers have commonly been perceived to be output measure of quality in nursing care
and in general health of patients. Pressure ulcers substantially restrict most of the elements of
one’s general health and well-being, and quality of life (Langemo, 2012). An attitude is cultured
and influenced by facts, purpose, and the extent of passion for or against a given matter. An
individual with a positive attitude towards something will have higher chances of undertaking a
helpful behaviour associated with the matter (Megens, and Weerman, 2012). For example,
nurses who have an optimistic attitude in the prevention of pressure ulcers do demonstrate better
practice in its prevention (Demarré et al., 2012). Gunningberg et al. (2015) observed a
worthwhile association between positive feeling to and the prevention of PU. The major
hindrances to evidence-based practices at one’s own level of healthcare include negative
feelings, lack of knowledge, and weak skills (Tacia et al., 2015). The increased PU prevalence in
hospitals has been given much attention (Sullivan, and Schoelles, 2013), in addition to the fact
that it comes with dire consequences, and very costly to treat. Therefore, it is critical that the
association between nurses’ attitude and the prevention of PU be examined comprehensively. In
order to achieve this objective two research papers with distinct designs on the same clinical
interest have been selected for critiquing. The quantitative and qualitative researches conducted
by Etafa et al. (2018) and Roberts et al. (2016) respectively will be critiqued.
Research Question
The research question for the qualitative study was “what are the perspectives of nurses about the
importance and effect of a pressure ulcer prevention care bundle (PUPCB) intervention on

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healthcare practice?” whereas that for the quantitative study was “what are the attitudes and
perceived hindrances of nurses on the prevention of PU?” the quantitative research question was
aimed at exploring the nurses’ attitude and their perceived hindrances to the its prevention at
public hospitals, whereas the qualitative research question was aimed at examining the
perceptions of nurses of the importance and effect of a PUPCB on healthcare.
Both research questions were basically aimed at achieving the same answer but with different
approaches due to the chosen research design.
Research Design and Underlying Philosophy
The quantitative research method used a multiple cross-sectional study design to gather data
from registered nurses from six different hospitals in Addis Ababa. A positivism approach
enables future predictions and is effective in generalization in different social contexts. However,
the approach prevents a researcher from detaching oneself from the hypothesis and it is possible
then he is being unjust to himself. A multiple cross-sectional study design is a type of
observational study that examines data collected from a population, a representative subset, at a
specific time. This type of approach was appropriate for the study because it is applicable when
examining different groups of people with different interests in the variable under study but who
share some common characteristics such as educational background or profession. Additionally,
cross-sectional designs are used to examine trends in the prevalence of a given disease or
severity for a given period of time (Sedgwick, 2014). The study by Etafa et al. (2018) examined
222 staff nurses assigned to six public hospitals in the month of April 2018. The objective was
to evaluate nurses’ attitudes in the prevention of PU and to find out their alleged hindrances to
the prevention of PU. This kind of objective and the nature of the study population justifies the