Surgical Wound Care Practices of Nurses in a Low-Resourced Setting: An Observational Study.

To observe and describe the surgical wound care practices of nurses in a Sri Lankan tertiary care hospital. A cross-sectional observational study. We observed surgical wound care practices of registered nurses (RNs) working in 13 general surgical wards of a 3000-bed tertiary care hospital in Sri Lanka. An observation tool developed based on clinical practice guidelines (CPGs) and a chart audit tool were used for data collection. Field notes were taken to describe contextual details. A convenience sample of RNs and a consecutive sample of adult, postoperative patients were recruited. Patients were included once, while nurses were observed on multiple occasions. Descriptive statistics were used, and field notes were added to contextualise the data. We observed wound care episodes across 250 postoperative patients with 63 RNs. Nurses' hand hygiene (HH) adherence was 58.4% (n = 146) before dressing changes and 43.2% (n = 108) after dressing changes. Wound care education was observed in only 22% (n = 55) of episodes. Documentation of wound care was noted only on 53 (21.2%) occasions. Field notes highlighted the lack of standard wound assessment and management protocols and resource constraints influencing the nurses' adherence to CPGs on many occasions. Our findings suggest that nurses' adherence to CPGs was limited, and there are unwarranted variations in nurses' surgical wound care practices. Unavailability of standard wound care protocols and resource constraints were also identified. These variations appear multifactorial, reflecting limitations in training, staffing, resources and the absence of standardised wound care protocols. Targeted training programs should be conducted for nurses, and context-sensitive wound management protocols should be introduced. As one of the first studies to describe nurses' surgical wound care practices in a resource-limited country, these findings offer valuable insights into both practice and the contextual influences. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines. No patient or public contribution.