Vacuum assisted closure

knowledge and practice on management of Vacuum Assisted Closure (VAC) will be widely discussed in the study. In this chapter, the researcher will explore a literature review regarding research on knowledge and practice on management of Vacuum Assisted Closure (VAC) (Couch & Stojadinovic, 2011). The researcher searched the literature using key words of “knowledge, practice, Vacuum Assisted Closure (VAC) dressing, Vacuum Assisted Closure (VAC) treatment nurses and Vacuum Assisted Closure (VAC) management” using search engine from Google Scholar, PubMed, scihub. Along with that, it is also needed to be mentioned that the literature review will only include articles that are between the year of 2010 to 2017 to maintain and enhance the reliability and authenticity of the research study.

Vacuum assisted closure can be defined as the sophisticated development of the a standard wound healing or wound sealing technique that provides the a standardized surgical procedure where the vacuum is utilized to assist in the drainage procedure of blood or any other kind of bodily fluid secreting for any open wound site or surgical site. On more elaborative note, according to the Kim, Franczyk, Gottlieb and Song (2017), the vacuum assisted techniques are by far the simplest and easiest technique for wound sealing or wound management. The mechanism of the VAC is to introduce a piece of foam that has an open cell structure into the site of the wound and along with that, a wound drain is also associated with a laterally perforated wound drain. The wound area is covered with a transparent adhesive membrane that serves the purpose of protecting the wound. According to the Mahandaru and Seswandhana (2012), the VAC wound sealing provides the most efficient cleaning and conditioning of the wound to the patients due to the fact that the membrane remains securely secured with the healthy skin around the wounded skin. Now it has to be mentioned that the plastic membrane restricts the airflow in the wound area and creates a partial vacuum within the wound. According to the Hussain, Singh and Singh, (2010), the presence of the partial air vacuum that is generated in the wound site produces a pressure that considerably reduces the size of the wound and helps in the removal of the fluid from the wound. Another significant benefit of this procedure is the fact that in this procedure the entire wound area is homogenously exposed to the negative pressure effect, which on one hand prevents the possibility of occlusion of the drain perforations and on the other hand prevents localized tissue necrosis due to uneven areas of high pressure

Knowledge on management of Vacuum Assisted Closure (VAC) among nurses

The vacuum assisted closure of wound sealing is considered to be the safest and most effective procedure, as it provides the best protection from any infections to the wound site and also helps tremendously in accelerating the process of healing. However, it has to be mentioned in this context that the negative pressure wound therapy is a very critical clinical procedure and each and every step of the procedure needs to be completed with utmost caution. As argued by the Cray (2017), the vacuum assisted closure if not performed correctly can lead to severe complications like infection, ulceration and many more related adversities which an potentially interfere with optimal care and safety of the patients. There are many consequences that have been reported as the adverse effect of the negative pressure wound therapy, for instance, bleeding and haemorrhage can be considered the biggest threat to the patients due to a faulty VAC procedure. Although, as argued by Cray (2017), necrosis,  untreated coagulopathy, nonenteric and unexplored fistulas, friable or infected blood vessels, spinal cord injury, and many more have also been reported frequently following a flawed VAC procedure. However, it also needs to be understood that the negative pressure wound therapy is a considerably complex procedure and in order to attain a successful and effective wound management. Among all the different reasons behind the errors with the VAC procedure, the lack of operational knowledge and experience in the nursing staff has been discovered as the most threatening contributing factors to the same. According to the Pliakos et al. (2010), the level of knowledge and training the nursing staff about the complicated wound management techniques like VAC is even lesser in the developing nations of South Eastern and Middle Eastern Asia. According to the survey study by the authors, have discovered that the training and understanding of the nursing staff of these underdeveloped nations are very basic. Along with that, the basic challenges in the nursing staff that has been discovered in the nursing staff regarding the lack of knowledge can be the extreme workload and the acutely low staff ratio that hinders the nursing staff to participate in the professional development programs. As per the article by Bondokji et al., (2013), the nursing staff of Riyadh upon survey have explained that they have found learning the specialized skills in the chaotic wards very difficult and often they have to perform these practices in the chaotic ward setting, along with that it has also been discovered from the nursing staff that they are often required to perform negative pressure wound therapy with proper prior training program and without necessary safety equipments which increases the chances for errors and misconducts.

Practice on management of Vacuum Assisted Closure (VAC) among nurses

Considering the practice standards of the vacuum assisted wound closure technique in the clinicak setting it has to be mentioned that these specialized procedure are still very new to the remote developing areas. Until recent years the use of specialized wund management techniques like VAC had been only utilized in the war induced large scale injuries and for military personnel in the middle eastern nations like Iraq, Saudi Arabia and many more (Eisenhardt et al., 2010). Although with the innovations in the health care sector for the most of the Saudi Arabia, and yet the VAC assisted wound management is still very expensive and not all sectors of the society can afford it. Schintler, (2012) have argued that, with the VAC or NPWT in general is fast becoming an in integral part of the contemporary wound management techniques and hence the primary health care facilities have also attempted to introduce this technique, although the tragic lack of training and experience in the nursing staff has become a serious restrcution in the path for successful implementation of this technique.

A research methodology provides the systematic and step by step framework that defines and directs each and every step that the research study will need to take in order to achieve the goals and outcomes set by the research scientists. A research methodology deals will all the different techniques and methods that are going to be opted by the research study and organizes them in a neat array for the researchers to follow. According to the article by Mertens (2011), the research methodology is a systematic framework or tool that helps to conduct the research in a harmonious and organized manner so that none of the steps are being missed while conducting the research. And along with that the research methodology also helps the researchers gain a better understanding of the techniques and activities being attempted in the research and contributes to successful and effective implementation of all the procedures

The research study will opt for Quantitative research technique for this study, the quantitative measures are known to focus on objective measurements and the statistical, mathematical, or numerical analysis of data collected. Such data are collected with the help of tools such as polls, questionnaires, and surveys. Data can also be collected through manipulation of already existing statistical data with the help of computational techniques. This technique of quantitative research has the focus on numerical data collection and the following generalization of the numerical data collected across individual cohorts. The primary objective behind the selection of the quantitative approach is to indicate the relationship that exists between an independent variable and another dependent or outcome variable within a population. A quantitative research design has either descriptive or experimental approach. While a descriptive study founds only associations between variables; an experimental study is known to establish causality (Neuman & Robson, 2014).

Research methodology

The research study design selected for this study is cross sectional study. Cross sectional design is a type of observational study that analyses data collected from a population, or a representative subset, at a specific point in time.

This research study is aimed at exploring and evaluating the level of knowledge and understanding of the nurses about the vacuum assisted closure in case of wound management taking the demographics of Riyadh into consideration, followed by the practice scope of VAC in the same clinical setting. Lastly, the research study will compare and contrast the link between knowledge and practice scope in the Riyadh clinical setting in the nursing professionals. The research scientists have chosen the cross sectional study design for the research study. Now it has to be mentioned in this context that the cross sectional design study is utilized in research studies that are attempting to prove or disprove any assumption that is being made. Long with that it also needs to be mentioned in this context that a cross sectional study is cost effective and time saving. Along with that, a cross sectional study is able to capture a specific point in time and is contains multiple variables at the time of the data snapshot (Brannen, 2017). Moreover, multiple findings and outcomes can be considered for analysis to craft new theories, or studies or in-depth research with this approach. Hence, the researchers have opted for the cross sectional study for this research study.

The study will be conducted in surgical ward in one of the hospital in Riyadh, Saudi Arabia Five surgical ward had been chosen and in each ward there is 35 registered nurse to be a sample for the researcher study.

• Total population
  • 175 registered nurses from surgical ward in one of the hospital in the Riyadh.
• Total sample size

The research division of the National Education Association has published a formula for determining sample size.

s = X²NP(1-P)d²(N-1)X²P(1-P)

s= required sample size

X²= the table value of chi-square for 1 degree of freedom at the desired of freedom     at the desired confidence level (3.841)

N= the population size

P= the population proportion (assumed to be .50 since this would provide the maximum sample size

d= the degree of accuracy expressed as a proportion (.05)

The sampling technique that has been used in the research study is the convenience sampling technique.  This sampling technique is also known as the non-probability sampling technique. Here the subjects are selected due to their convenient accessibility and proximity to the researcher. In other words, this sampling method involves getting participants wherever they can be found and typically wherever is convenient (Venkatesh, Brown & Bala, 2013). In convenience sampling one does not identify  inclusion criteria prior to the selection of subjects. All participants have equal chances of participation.

Description of study type

Convenience sampling technique might be effective in exploration stage of the study as well as while conducting pilot data collection. The aim is the identification of shortcomings related to questtionire design so that these can be addressed.

The inclusion criteria in any of the research are to ensure that directs and defines only the most valid and most authentic collected data is being utilized in the research study design. However, in case of quantitative study design, the inclusion criteria is mainly focused on the population setting that has been sampled for the research and the relevance and reliability of that particular study design (Edmonds & Kennedy, 2016). For this study, the primary goal is to discover and evaluate the level of understanding of VAC in the nurses and the impact of the understanding on the clinical practice. It is crucial to incorporate only the experienced and permanent nursing staff in the study to ensure optimal and authentic data collection. Hence, all registered nurses in surgical ward have been selected for the purpose of research.

Similarly, excluding unreliable and irrelevant data from the research study is equally important and hence, it is crucial for this study to exclude all the staff who are not experienced and have not had chance to encounter the wound management on a considerable basis (Yvonne Feilzer, 2010). The staff that are newly graduate have been completely excluded from the study due to their lack of experience and the staff on long vacation have also been excluded for lack of availability.

In this research study, for the purpose of data collection that researcher will be utilizing the tools like questionnaire surveys. A questionnaire can be defined as the data collection tool utilized in the research studies comprising of a set of questions for gatheringccolelcting valuable information from respondents. For this research study, the questions used in the survey will be close ended with only two options of true or false. The questionnaire will be distributing to the registered nurses on selected day and the questionnaire paper will be collected on the same day. All the question compulsory to be answered by the sample.

Pilot studies are meant to analyse the questionnaire and determine its suitbality. By analysisng the questionnaire prior to the research, researchers can understand whether the questions can be interpretated in the same manner by all participants. In addition,  one can understand the time frame required for completion and whether the required data could be collected. The researcher must should adjudge the questionnaire with a small cohort that is similar to the intended participants.

A pilot test study will be commenced in three different wards for the registered nurse who will be included in the study.

The questionnaire will be distributing to the registered nurses on selected day and the questionnaire paper will be collected on the same day. All the question compulsory to be answered by the sample.

Data anlaysis is a crucial step in conducting a research since accurate data analysis determines the reliability of the results and subsequent findings. Data anlaysis refers to the process of inspection, transformation and remodelling of data with the aim of reaching conclusions for the research question. The form of data collected determines the data analysis method (Nieswiadomy & Bailey, 2017).

Data analysis for the proposed research would be done  with the help of suitable statistical data analysis tool. SPSS version 2.1 would be used for carrying out the research data analysis in an appropriate manner. SPSS is a computer based software program used widely for data entry and analysis with the aim of creating tables and graphs that can be thereby interpreted. SPSS is valuable since it is capable of handling large quantities of data and performing diverse types of analysis. It is easy to use the system and interpret the results. Descriptive statistics would be done in temrs of means, standard deviation for variable. Inferential statistic would be carried out for testing correlation and significance. Independent t-test and ANOVA would be done for testing the significance differences. A correlation between levels of knowledge and practice would be determined with the help of Pearson’s correlation. This would be done for determining whether the level of knowledge would be having any relation to practice (Parahoo, 2014).

The study findings are to be accurately translated into a written format with suitable interpretation of the results. The inferences drawn from the study are to be articulated appropriately. A discussion is to be put up that draws relation between the research objectives and the generated findings. The conclusion section would need to draw in main insights from the data analaysis and provide summary of the key findings. It is necessary to disseminate the findings of the study to the relevant stakeholders. Dissemination of the study findings is crucial for promoting translation of research inot practice. This is of much value in the present context since healthcare devliery is ensured through the implementation of research findings that consider advanced technologies (Houser, 2016).

Conclusion:

On a concluding note, it can be stated that the vacuum assisted closure is a wound healing technique that has revolutionized the wound management in the health care setting. This highly specialized technique is not only safe and secure to perform for the patients, but when used with the right tools and equipments this technique provides the best wound protection and healing experience to the patients. Many of the authors have commented on the effectiveness of this procedure to facilitate rapid healing and protection from infection or tissue necrosis with the aid or the negative pressure effect technology and hence this technology has easily become one of the safest and most reliable technique for wound management.

However it has to be mentioned that the VAC assisted wound management requires an expertise and understanding in the nursing staff to be competed effective and successfully. Although unfortunately the literature review has discovered the lack of proper knowledge and understanding in the nursing staff of the developing nations regarding the implementation of VAC and hence many incidence of further infection, necrosis, and coagulopathy had been reported due to faulty VAC. This research study will attempt to explore the knowledge in the nursing staff of Riyadh regarding the VAC and its effective implementation and will attempt to link the level of knowledge with the present practice standards so that the gaps can be correctly identified and addressed

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