<b>Introduction: </b>Post-operative infections, such as surgical site infections (SSIs), are a significant concern in healthcare settings. Nurses play a crucial role in the prevention and management of these infections. The use of nursing theory could contribute to the prevention of SSIs. The aim of this study was to evaluate the role of nursing theory in the management of surgical site infections (SSIs) in a hospital environment. <b>Method: </b>A cross-sectional study was conducted using descriptive and analytical methods to assess the role of nursing theory in the management of Post-operative infections (POI) in a hospital setting in October 2023. The study population consisted of nurses working in the Surgery, Emergency, and Maternity units at Cibitoke District Hospital. A sample size of 71 nurses working full or part time in the Surgery were invited to participate in this study. A questionnaire was used to collect the data, and SPSS version 21.0 software was used for analysis. <b>Results: </b>The study found that nursing theory did not have any statistically significant place in the management of POI (p-value = 0.523). However, the results showed that experience was the only significant factor influencing the management of POI (p-value = 0.004). This is explained by the analysis of the net effects of the explanatory variable where we noticed that those who had more experience were more likely to manage post-operative infections. The participants’ knowledge regarding nursing theory in the management was poor as they scored less than 30% in all the variables used to measure their knowledge. <b>Conclusion:</b> The study revealed that nurses’ knowledge of nursing theories and their applications in the management of SSIs was poor. Continuing professional development, curriculum review, and in-service training were highly recommended.
The infection results from a complex interaction between the patient’s defense mechanism, the site of the surgical intervention and the bacteria which will lead to microbial proliferation resulting in cellular, tissue or general reactions, most often resulting in an inflammatory syndrome. Postoperative infection is an infection that occurs in the immediate or distant aftermath of a surgical procedure and is directly related to the latter [
According to the WHO, the constant is that postoperative infections threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance, and that in low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In this case, the WHO reports that post-operative infections occupy third place (20%) of nosocomial infections [
In developed countries such as those of Europe and the United States, the prevalence of post-operative infections is estimated at 1.9 to 2% in general surgery [
In developing countries, study conducted in Sudan in 2015 to determine the level of nurse’s knowledge and practice regarding postoperative infection prevention who work in the surgical departments of the military hospital revealed a poor knowledge score as only 37.6% of the participants were able to give a correct answer regarding the prevention of postoperative infection [
To our knowledge, few similar studies have been carried out on this matter. It is in this context that our study was carried out in this health institution to evaluate the place of nursing theory in the management of post-operative infections in a hospital environment in order to improve nursing practice in this care structure. The following specific objectives were addressed: 1) Determine the factors associated with the management of post-operative infections; 2) Evaluate the nurses’ knowledge regarding nursing theory in the management of post-operative infections.
The study focused on Florence Nightingale’s environmental theory for controlling post-operative infection. Nightingale identified the five environmental factors which include air, water, light, heat, cleanliness and calm. She believed that these environmental factors can contribute to the healing of infections occurring in the healthcare setting. Postoperative infections are infections occurring in the hospital environment following the lack of adequate cleanliness when handling instruments or during the procedure, or even following one or the other of these environmental factors. Florence was the first theorist to identify the relationship between nursing and infection control. Her theory explains the importance of practicing hospital infection control measures such as maintaining and using sterile materials, bedding hygiene, but also maintaining an ambient temperature that is cool in order to avoid perspiration at the site of operation that could encourage the multiplication of germs. Therefore, applying this theory by maintaining a healthy environment by practicing the five environmental factors could reduce the incidence of postoperative infections.
The present study was carried out at Cibitoke district Hospital in October, 2023, which is located in the North-west of the country in the Cibitoke province, Rugombo commune, Burundi at 52 km from the Bubanza province on National Road number 5 (RN5) and 72 kilometers (44.7 miles) of Bujumbura, the capital city. The main objective of this study was to evaluate the place of nursing theory in the management of post-operative infections in a hospital environment among 71 nurses working full and part time in the Operating Room, Internal Medicine and Maternity units of Cibitoke District Hospital. Cibitoke District Hospital is a public rural hospital with 226 beds that serves a population of 242,469 habitats as the primary level hospital for national referrals, built in 1965 and inaugurated in 1968. Across-sectional study design was used to evaluate the 87 nurses working full and part time in the Operating Room, Internal Medicine and Maternity units. The YAMANE formula (1967-1986) was used to calculate the sample size of the population.
n = N 1 + N ( e ) 2
n = 87 1 87 1.2175 + 87 ( 0.05 ) 2 = 87 1 + ( 87 × 0.0025 ) = 87 1 + 0.2175 = 87 1.2175 = 71
where:
n = sample size;
N = population size;
e = margin of error at 95% = 0.05.
A self-report method involving questionnaire completion with five components addressing demographic data, patients’ habits and lifestyle factors; healthcare planning structure’s factors; nurses’ knowledge factors and environmental factors was used to collect data. Therefore, the questionnaire was analyzed and undergoes a face validity before being distributed to the participants chosen in this study after verbal consent. However, the distribution of the questionnaire was done according to these latter taking into account their placement in their services of this hospital. The filling was done under the supervision of the investigator to avoid collaboration in order to exclude bias and direct them in the event of misunderstanding. After filling the questionnaires, they were collected for useful purposes.
The data were analyzed using SPSS 21 software, and the results were presented in tables and graphs. Bivariate analysis, a statistical technique that examines relationships between two variables at a time, was used to test our hypothesis regarding the role of nursing theory in the management of postoperative infection in a hospital setting. The analysis included measures of association between variables at different levels and chi-square tests for observed data with two groups and more than two groups. Our dependent variable was qualitative (management of postoperative infections), while the independent variables were categorical (level of study, experience, and nursing theory). The participant responses to the questionnaire were categorized the levels of nurses’ knowledge based on their scores. Scores above 50% were considered good/high score of knowledge, while scores below 50% were considered poor/low knowledge. The purpose of the study was to determine whether nursing theory plays a significant role in the management of postoperative infection in a hospital environment.
The current results from our study show that 51.0% of the participants were male compared to 48.0% female with an age range of 20 - 54 years (mean age = 33.13 years). The majority of the participants (34.0%) were 20 to 25 years old; 31.0% were 31 to 40 years old; 17.0% 41 to 50 years old. The majority of participants (40.0%) had experience of 1 - 5 years; 25.0% 6 to 10 years; 20.0% less than a year, and finally 14.0% were over 10 years old. 65.0% of participants had the baccalaureate level in nursing training while 34.0% had the A2 level. The majority of participants (38.6%) worked in Maternity; 31.40% in Surgery and 30.0% in Emergency (
Our study findings show that the majority (91.40%) of our participants affirmed that patients’ hygiene, nurses, or clothing could contribute to the occurrence of
| Characteristics | Frequency (n = 70) | |
|---|---|---|
| Age | 20 - 25 years | 24 (34.0%) |
| 26 - 30 years | 6 (8.0%) | |
| 31 - 40 years | 22 (31.0%) | |
| 41 - 50 years | 12 (17.0%) | |
| Morethan 50 years | 6 (8.0%) | |
| Mean | 33.13 years | |
| Range | 20 - 54 years | |
| Sex: | ||
| Male | 36 (51.0%) | |
| Female | 34 (48.0%) | |
| Length of work experience: | ||
| Less than one year | 14 (20.0%) | |
| 1 - 5 years | 28 (40.0%) | |
| 6 - 10 years | 18 (25.0%) | |
| More than 10 years | 10 (14.0%) | |
| Education level: | ||
| A2 | 24 (34.0%) | |
| Bachelor | 46 (65.0%) | |
| Hospital Department: | ||
| Surgery | 22 (31.4%) | |
| Emergency | 21 (30.0%) | |
| Maternity | 27 (38.6%) | |
post-operative infections. Furthermore, 78.60% were aware of the factors that could cause post-operative infections, while only 64.3% of them were able to cite at least two examples. Similarly, 64.2% of our participants stated that the number of personnel in healthcare settings could promote the occurrence of post- operative infections. Finally, majority of the participants (67.2%) did not know that patient’s health status could contribute to the occurrence of POI, among those who agree, only 17.1% were able to give the example of disease that enhance the occurrence of POI such as malnutrition, VIH, etc. (
The results of our study show that 65.70% state that the number of healthcare personnel in a hospital setting could contribute to the prevention of postoperative infections. Moreover, 42% of the participants confirm that different tasks of nurses responsible for monitoring operated patients could increase the incidence of POIs. However, 12.9% were the only ones that were able to state that the lack
of asepsis during wounds care, drugs administrations, patient’s body hygiene, bedding care, etc., were the most factors of nurses’ stated tasks that could increase the frequency of POIs. Additionally, a significant number of participants (48.6%) affirm that demotivation of nursing staff due poor remuneration could lead to the occurrence of POIs, while a great number of participant (70%) assume that regular monitoring of patient after surgical intervention could help in the prevention of POIs (
Our study unveiled that only 40% of our respondents were able to describe the importance of preventing SSIs during surgery, with an average of 28% who knew that the importance of preventing SSIs is attributed throughout the entire patient care process (
In our study, 47.1% of our participants had erroneously stated that the cleanliness of the operating room and hospitalization could influence the occurrence of post-operative infections, while 10% had no ideas. Only 42.9% of the participants had affirmed it (
The current study shows that the nurses’ knowledge on the use of nursing theory while taking care of postoperative infections was poor, as for all the variables used to measure their knowledge scored less that 30%. Even though some of the participants (14.3%) said that they have already used a nursing theory in their practice, only less than 2% well able to give at least two examples of nursing theory and explain how it can be applied in the management of POI. 91.4% affirm that there was no clinical protocol for the management of POI that exist in their hospital while 72.9% could not find rational to use nursing theory when preventing POI (
It emerges from our study that 45.7% of our respondents were unable to utilize the nursing theory during the management of postoperative infections. Despite that more than 50% of our respondents considering this theory, its utilization is not significant (P = 0.239) (
Our study reveals that nurses with vocational nursing training (A2) (66.7%) were more able to describe the process of post-operative infection management compared to the BSN ones (47.8%). Nonetheless, the education level of the participant was not significant correlated to the management of post-operative infections (P = 0.105) (
Our study findings show that 85.7% of nurses who have an experience of less than one year were capable of handling post-operative infections while 14.3% were unable; 42.9% of nurses with an experience of 1 to 5 years were capable of handling post-operative infections while 57.1% weren’t; 44.4% of nurses with an experience of 6 to 10 years were capable to take care of post-operative infections while 55.6% were not and finally, 60% of nurses who have an experience of more than 10 years were able to take care of post-operative infections while 40.0% were incapable. Looking at the significance, we have a positive probability of 0.008 that the experience of nurses could influence the management of post-operative infections (p < 0.05) (
The final Interpretation of our binary logistic model, show that among the three independent variables (the level of education, experiency and knowledge of nursing theory) only the experience of the participants could significantly influence the management of post-operative infections (p = 0.004) (
Finally, our study illustrate that nurses who have an experience of 1 to 5 years are 1.125 times more likely to manage post-operative infections compared to nurses with less than one year, while nurses who have an experience of 6 at 10 years old are 1.133 times more likely to manage well the post-operative infections compared to nurses with less than a year. Moreover, nurses who have an experience of more than 10 years are 1.250 times more likely to do the management of post-operative infections compared those less than one year old (
| Management of POI | Total | P-value | ||
|---|---|---|---|---|
| No | Yes | |||
| Nursing Theory | 49.1% | 50.9% | 100.0% | 0.239 |
| 35.3% | 64.7% | 100.0% | ||
| Total | 45.7% | 54.3% | 100.0% | |
| Management of POI | Total | P-value | ||
|---|---|---|---|---|
| No | Yes | |||
| A2 | 33.3% | 66.7% | 100.0% | 0.105 |
| BSN | 52.2% | 47.8% | 100.0% | |
| Total | 45.7% | 54.3% | 100.0% | |
| Management of POI | Total | P-value | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| Work experience | Less than one year | 14.3% | 85.7% | 100.0% | 0.008 |
| 1 - 5 Years | 57.1% | 42.9% | 100.0% | ||
| 6 - 10 Years | 55.6% | 44.4% | 100.0% | ||
| More than10 Years | 40.0% | 60.0% | 100.0% | ||
| Total | 45.7% | 54.3% | 100.0% | ||
| B | S.E. | Wald | df | Sig. | Exp(B) | ||
|---|---|---|---|---|---|---|---|
| Step 1a | Experience | −0.231 | 0.271 | 3.726 | 1 | 0.004 | 0.794 |
| Level of education | −0.645 | 0.540 | 1.430 | 1 | 0.232 | 0.524 | |
| Nursing theory | 0.383 | 0.600 | 0.408 | 1 | 0.523 | 1.467 | |
| Constant | 1.704 | 1.092 | 2.433 | 1 | 0.119 | 5.495 | |
| Net effects | |||
|---|---|---|---|
| Sig. | Exp(B) (OR) | ||
| Step 1a | Participants’ Experience | ||
| Less than one year | Ref | Ref | |
| 1 - 5 years | 0.015 | 1.125 | |
| 6 - 10 years | 0.025 | 1.133 | |
| More than 10 years | 0.006 | 1.250 | |
| Constant | 0.019 | 6.000 | |
The current study was carried out to evaluate the place of nursing theory in the management of post-operative infections in a hospital environment in order to improve nursing practice in this care structure and the two specific objectives were addressed: 1) Determine the factors associated with the management of post-operative infections 2) Evaluate the nurses’ knowledge regarding nursing theory in the management of post-operative infections. The results of our study show that the nursing theory does not have a statistically significant role in the management of postoperative infections (p = 0.523). This could be explained by the fact that the managing of postoperative infections requires multidimensional and multi-professional approaches. The literature shows that there are few studies on the treatment of infected wounds, which could depend on physical examination findings such as fever, redness, wound opening, drainage, etc., where local care with wet dressing and empirical antibiotic selection by the caregiver are common practices [
The current results from our study show that 51.0% of the participants were male with an age range of 20 - 54 years (mean = 33.13 years). These results differ from those of Niyongabo, et al. (2022) in their study conducted at the Clinic Prince Louis Rwagasore, in Burundi for assessing nurses’ knowledge, attitude, and practice regarding PU prevention and treatment, where the results showed that the majority of participants were women [
Finally, 47.1% of our participants had erroneously stated that the cleanliness of the operating room and hospitalization could influence the occurrence of post-operative infections, while 10% had no ideas. Only 42.9% of the participants had affirmed it (
The following are recommendations arising from this study:
• To nurses, they should strive to advance their career through ongoing education and by developing a scientific inquiry mindset that will enable them to provide quality care and improve population health effectively and efficiently.
• To healthcare facilities: Develop a continuous professional development plan for staff in service based on ongoing education, nursing theory, etc.
• To the Universities, specifically, the program of nursing, to revise and update the curriculum in regards to post-operative nursing management or wound care and strengthening the implementation of nursing theories into practice to enhance students’ nursing knowledge before they reach the clinical setting.
This study was conducted for evaluating the place of nursing theory in the management of post-operative infections in a hospital environment. Results reveal that the nursing theory does not have a statistically significant role in the management of postoperative infections (p = 0.523). However, the results of our study indicate that only the participants’ experience could significantly influence the management of postoperative infections (p = 0.004). Additionally, the participants’ knowledge regarding nursing theory in the management was poor as they scored less than 30% in all the variables used to measure their knowledge. Continuous professional development of nurses and curriculum revision were highly recommended.
This study has some limitations. This study focuses only on nurses working in the Operating Room, Internal Medicine and Maternity units in one district hospital of Cibitoke.
The authors declare no conflicts of interest regarding the publication of this paper.
Nduwimana, O., Bugingo, L.B., Ishimwe, A.N. and Nibaruta, A. (2024) The Place of Nursing Theory in the Management of Post-Operative Infections in a Hospital Environment: Case of Cibitoke District Hospital. Open Journal of Nursing, 14, 225-238. https://doi.org/10.4236/ojn.2024.145016