WEPONDI PHILEMON

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FACTORS AFFECTING WOUND HEALING AMONG PATIENTS AT SURGICAL
WARD OF JINJA REGIONAL REFERAL HOSPITAL JINJA DISTRICT
A RESEARCH REPORT SUBMITTED TO UGANDA NURSES AND MIDWIVES
EXAMINATION BOARD IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR AWARD OF THE DIPLOMA IN
NURSING UNDER THE MINISTRY OF
EDUCATION AND SPORTS.
BY
APAKO BETHMASE GRACE
NSIN NUMBER: JUL18/U007/DND/005
MAY 2022

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ABSTRACT TITLE PAGE
FACTORS AFFECTING WOUND HEALING AMONG PATIENTS AT SURGICAL
WARD OF JINJA REGIONAL REFERAL HOSPITAL JINJA DISTRICT
A RESEARCH REPORT SUBMITTED TO UGANDA NURSES AND MIDWIVES
EXAMINATION BOARD IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR AWARD OF THE DIPLOMA IN
NURSING UNDER THE MINISTRY OF
EDUCATION AND SPORTS.
BY
APAKO BETHMASE GRACE
NSIN NUMBER : JUL18/U007/DND/005
May 2022
APPROVED BY:
NAME OF SUPERVISOR: MS NAKANJAKO ELIZABETH
SUPERVISORS’ SIGNATURE…………………………DATE: …………..…
NAME OF PRINCIPAL: MS MULABIZA MEBRA.
PRINCIPAL’S SIGNATURE…………………………DATE………………….

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ABSTRACT
In Uganda about 10% of the surgical procedures become septic with the commonest isolated
organism being staphylococcus aureus.
This promted the researcher to conduct a study on factors affecting wound healing among
patients at surgical ward of JRRH, Jinja district were there has been an increase on number of
patients by 20% and a nurse patient ratio of 1:7 despite the hospital measures to promote wound
healing.
A descriptive study design employing quantitative method of data collection, were 30
respondents were chosen for the study and data presented in texts, figures, and frequency tables.
According to local and systemic related factors affecting wound healing (40%) of the
respondents reported to have diabetes.
Concerning social economic related factors all respondents (100%) reported that treatment was
costly and were depressed while (93%) experienced social stigma
Regarding measures taken to promote wound healing all respondents (100%) reported to be on
antibiotic treatment.
In conclusion all the respondents were on antibiotic treatment, wound treatment was costly and
they were depressed due to stigma and their states.
Therefore there is need for provision of counselling services, health education, and out reaches to
the communities to create awareness

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Copy Right
Copy Right ©2017 by Apako Bethmase Grace

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AUTHORISATION
RULES GOVERNING USE OF STUDENTS WRITTEN WORK FORM JINJA SCHOOL
OF NURSING AND MIDWIFERY.
Unpublished research report submitted to Jinja school of nursing and midwifery and deposited in
the library, is open for inspection, but is to be used with due regard to the rights of the author.
The author and the school of nursing granted privilege of loan or purchase of microfilms or
photo copy to accredited borrowers provided credit is given in subsequent written or published
work.
AUTHOR: APAKO BETHMASE GRACE
AUTHOR’S SIGNATURE: ………………………DATE: …………………
ADDRESS: ……………………………………………..
SUPERVISOR: MS NAKANJJAKO ELIZABETH.
SUPERVISOR’S SIGNATURE: …………………………………..
CONTACT ADDRESS: …………………………………… DATE: ……………..
PRINCIPAL: MS MULABIZA MEBRA.
PRINCIPAL’S SIGNATURE…………………….. DATE: ………………………
ADDRESS: JINJA SCHOOL OF NURSING AND MIDWIFERY.

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DECLARATION
I, APAKO BETHMASE GRACE, here by firmly declare that the views in this research report
are my original work and has never been presented to any institution before for any award.
Signature. ……………………………………….
Date. ……………………………………………..

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DEDICATION
I dedicate this research book to my parents Mr. Opolot David and Mrs. Opolot Margret, my dear
friends Eunice Masika, Ahabwe Ian, and my brother Etiang Amos for the support and
encouragement towards my studies . May God Bless You

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ACKNOWLEDGEMENT
Report writing has not been easy from the start. Therefore my sincere appreciation goes to the
Almighty God. Secondly I extend my appreciations to my family especially my father Mr.
Opolot David for all the inspiration and encouragement that has kept me going this far. And to
my friends who were there for me especially Atholere Lilian.
Great thanks goes to the staff of Jinja Regional Referral Hospital who assisted me during the
time of data collection.
In a special way I would like to appreciate the efforts of my supervisor Mrs Nakanjjako
Elizabeth with whom I worked hand in hand with to accomplish the task.
I would also like to appreciate members of my discussion group ,Ms Masibo Beatrice, staff of
JSNM, myself and lastly to all my mentors who put in much efforts to that I succeed especially
Ms Esther Nambafu.
May the almighty God bless you in Abundance.

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TABLE OF CONTENTS
ABSTRACT TITLE PAGE............................................................................................................. i
ABSTRACT....................................................................................................................................ii
Copy Right.....................................................................................................................................iii
AUTHORISATION....................................................................................................................... iv
DECLARATION............................................................................................................................ v
DEDICATION............................................................................................................................... vi
ACKNOWLEDGEMENT............................................................................................................vii
LIST OF FIGURES. ...................................................................................................................... xi
LIST OF TABLES........................................................................................................................xii
LIST OF TEXTS..........................................................................................................................xiii
ABBREVIATIONS ..................................................................................................................... xiv
DEFINITION OF TERMS ........................................................................................................... xv
1.1 Introduction............................................................................................................................... 1
1.2 Problem statement..................................................................................................................... 3
1.3 Purpose of the study.................................................................................................................. 4
1.4 specific objectives..................................................................................................................... 4
1.5 Research questions.................................................................................................................... 4
1.6 Justification of the study........................................................................................................... 5
CHAPTER TWO:........................................................................................................................... 6
LITERATURE REVIEW ............................................................................................................... 6
2.1: Introduction.............................................................................................................................. 6
2.2: Local and systemic related factors affecting wound healing................................................... 6
2.3: Socio-economic factors affecting wound healing.................................................................... 8
2.4: Measures to promote wound healing....................................................................................... 9

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CHAPTER THREE ...................................................................................................................... 11
METHODOLOGY ....................................................................................................................... 11
3.1: Introduction............................................................................................................................ 11
3.2: Study Design and Rationale................................................................................................... 11
3.3: Study Setting and Rationale................................................................................................... 11
3.4: Study Population.................................................................................................................... 12
3.4.1: Sample size determination.................................................................................................. 12
3.4.2: Sampling procedure. .......................................................................................................... 12
3.4.3: Inclusion criteria. ................................................................................................................ 12
3.5: Definition of Variables .......................................................................................................... 13
3.5.1: dependent variables............................................................................................................. 13
3.5.2: independent variables. ........................................................................................................ 13
3.6: Research instruments............................................................................................................. 13
3.7: Data collection procedure...................................................................................................... 13
3.7.1: Data management. .............................................................................................................. 13
3.7.2: Data analysis....................................................................................................................... 14
3.8: Ethical consideration.............................................................................................................. 14
3.9: The study limitation............................................................................................................... 14
3.10: Dissemination of results....................................................................................................... 14
CHAPTER FOUR......................................................................................................................... 15
RESULTS AND FINDINGS........................................................................................................ 15
4.0 Introduction............................................................................................................................. 15
4.1 Social demographic data of the respondents........................................................................... 15
4.2: Local and systemic related factors......................................................................................... 17
4.3: social economic related factors affecting wound healing...................................................... 20

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4.4: Measure taken to promote wound healing............................................................................. 22
CHAPTER FIVE .......................................................................................................................... 24
DISCUSSION, CONCLUSIONS, RECOMMENDATION, AND IMPLICATIONS TO THE
NURSING PRACTICE ................................................................................................................ 24
5.0: INTRODUCTION ................................................................................................................. 24
5.1: Discussion............................................................................................................................. 24
5.1.1: Social demographic data..................................................................................................... 24
5.1.2: Local and systemic related factors affecting wound healing.............................................. 25
5.1.3: social economic related factors........................................................................................... 26
5.1.4: Measures taken to promote wound healing among patients............................................... 28
5.2 CONCLUSION....................................................................................................................... 29
5.3 RECOMMENDATIONS........................................................................................................ 30
5.4 NURSING IMPLICATIONS.................................................................................................. 30
REFERENCES ............................................................................................................................. 31
APPENDICES .............................................................................................................................. 35
APPENDIX I : Statement of consent............................................................................................ 35
APPENDIX II : QUESTIONNAIRE FOR THE PATIENTS ...................................................... 36
APPENDIX III :APPROVAL LETTER....................................................................................... 42
APPENDIX IV: MAP OF UGANDA SHOWING JINJA ........................................................... 43
APPENDIX V : MAP JINJA SHOWING STUDY AREA.......................................................... 44

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LIST OF FIGURES.
Figure 1: on the age of the wound. ............................................................................................... 17
Figure 2: Results on the common foods eaten by the respondents............................................... 18
Figure 3: showing the number respondents who have ever carried out wound dressing. ............ 20
Figure 4: showing respondents use of local herbs. ....................................................................... 22

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LIST OF TABLES.
Table 1: Showing the socio demographic data of the respondents (n=30)................................... 15
Table 2: showing results on underlying condition........................................................................ 17
Table 3: showing responses on a balanced diet. ........................................................................... 19
Table 4: showing length of hospital stay. ..................................................................................... 20
Table 5: showing the number of respondents who had experienced stigma................................. 21

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LIST OF TEXTS
Text 1: on whether they had wounds. ........................................................................................... 17
Text 2: on whether wound treatment is costly.............................................................................. 21
Text 3: on whether the respondents were depressed..................................................................... 21
Text 4: On The Weight Of Various Respondents......................................................................... 22
Text 5: on whether they were on antibiotic treatment. ................................................................. 23

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ABBREVIATIONS
WHO: world Health Organization
BAPEN: British association for parenteral and enteral nutrition.
SSI : Surgical Site Infection.
DFU : Diabetic Foot Ulcer.
BMI : Body Mass Index.
PU : Pressure ulcers.
ECM : Extracellular matrix.
PNI : Psychoneurotic-immunity
PHS : Perceived Health Stigma
JRRH: Jinja Regional Referal Hospital .

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DEFINITION OF TERMS
Health worker: This refers to a person who under goes training for a period of
Time so that he/she acquires skills and knowledge in Handling client or
patient during health care delivery.
Wound healing: Is a process through which dead cell are replaced by new ones.
A wound: Is a break on the continuity of the skin caused by a sharp or blunt Object.
A patient: Is any recipient of health care services that are performed by health Care
professionals.
Inflammation: Is localized physical condition in which part of the body reacts to injury or
infections through swelling, reddening, pain and heating.
Factor: Is a circumstance, fact or influence that contributes to a result.
Infection: Is the successful invasion and multiplication of microorganisms that are normally
not present in the body. Such as bacteria, virus
Surgery: Is a branch of medicine that treats injuries, diseases, deformities by the physical
removal, repair or readjustment of organs and tissues.
JRRH: Jinja Regional Referral Hospital

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CHAPTER ONE
INTRODUCTION
1.1 Introduction
This chapter will look at the background, introduction, and problem statement, purpose of the
study, specific objectives, research questions and justification for the study.
Wound healing is a dynamic process of replacing dead and missing cellular structures and tissue
layers, the human adult wound healing process can be divided into three or four distinct phases
denoted as inflammatory phase, proliferation phase, remodeling however in the four phase
concept there is hemostasis phase, inflammatory phase, the proliferation phase and the
remodeling phase .M.Mercandetti 2021.
J. K Giri 20th
annual conference of Indian society of wound 2018 shows that Multiple factors
can cause impaired wound healing by affecting one or more phases of the process and are
categorized into local and systemic factors and they include age, stress, diabetes, medication,
obesity, and nutrition.
In a 2018 retrospective analysis of Medicare beneficiaries identified that approximately 8.2
million people had wounds with or without infections, Medicare for acute and chronic wounds
treatment ranged from $28.1 billion to $96.8 billion. The highest expense being for surgical
wounds followed by diabetic foot ulcers having a higher trend towards costs associated without
patient wound care compared with in patient. The increasing cost of health care, an aging
population, recognition of difficult to treat infection threats such as bio film and the continued

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threat of diabetes and obesity worldwide makes chronic wounds a substantial clinical, social and
economic challenge. C.k Sen, 2019.
World Health organization a study by Terence J.Ryan 2019, on wound healing in the developing
world shows that poor wound healing is connected to the reasons for the failure of health care
delivery which are linked in turn to poverty and social unrest. However Conflicts and the
excesses of climate change can ruin the best made plans to manage with limited resources.
Internal displacement and the general mobility of population add considerable unreliability to
follow ups.
In Africa wounds constitute among the major causes of visits to hospitals accounting for about
30-42% of hospital attendance and 9% death every year and it is also among the most under
reported challenges in many parts of Africa probably because of the poor access to hospitals
among others reasons.(Philip F.Builder and Modupe I. Builders,2016).
In Uganda a prospective hospital based study conducted to determine the incidence ,risk factors,
and the causative agent of surgical site infections among 114 emergencypost-operative patients
in Mbarara Regional Referral Hospital in 2014 to 2015 shows that the overall surgical site
infections incidence is 16.4% with 5.9% superficial and47.15% deep. Websiella pneumonia
being predominant organism 50% followed by staphylococcus aureus 27.8%, Ecoli and
P.aeroginosa both count for 11%. Joel Bazira et al., 2013.

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1.2 Problem statement.
Under normal circumstances wounds heal without difficulty due to the body’s innate immunity
but it’s also necessary to know the ideal and recommended method of wound dressing however
some wounds will not heal properly unless factors that impair wound healing are attended to
(Jennifer Sanders 2017).
A study by semi J Najjuka showed that In Uganda about 10% of the surgical procedures become
septic with the commonest isolated organism being staphylococcus aureus.
According to HMIS 2017-2018 the number of patients attending the hospital increased by 20%
in 2021 and 2022 by March to 31.8% consecutively though some recover and are discharged,
there are reports of readmissions and death due to poor wound healing.
Despite the hospital measures to promote wound healing, little has changed as the number of
patients still outweighs the health workers in the wards in the ratio of 1:7, yet the recommended
ratio by WHO is 1:3(Juresh K Sharma et al., 2020)
The researcher therefore finds it necessary to conduct a study on factors affecting wound healing
among patients at surgical ward at JRRH

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1.3 Purpose of the study
The aims of the study were to assess factors affecting wound healing among patients attending
surgical ward at Jinja Regional Referral Hospital
1.4 specific objectives
 To identify the local and systemic related factors affecting wound healing among patients
attending surgical ward.
 To identify the social economic related factors affecting wound healing among patients
attending surgical ward.
 To identify measures taken to promote wound healing among patients attending surgical
ward.
1.5 Research questions
I. What are the local and systemic related factors affecting wound healing among patients
attending surgical ward at JRRH?
II. What are the social economic factors affecting wound healing among patients attending
surgical ward?
III. What are the measures taken to promote wound healing among surgical patients?

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1.6 Justification of the study
Delayed wound healing still remains a major challenge in patients attending hospitals across the
country.
Despite the hospital measures put in place by the ministry of health officials The data collected
will be used by the ministry of health officials to know why there is a delay in wound healing
and increase funding for programs dedicated to promoting proper wound healing.
The data collected will be used by the administration of JRRH to improve on the available
measures in order to improve on the wound healing process and promote wound healing.
The study findings will provide reference for future researchers who may conduct similar studies
thus valuable body for literature.

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CHAPTER TWO:
LITERATURE REVIEW
2.1: Introduction
The chapter describes the various literatures of other authors which is related to the topic of the
study. It is discussed according to the specific objectives of the, which are: Local and systemic
related factors affecting wound healing, Socio-economic factors affecting wound healing,
Measures to promote wound healing
2.2: Local and systemic related factors affecting wound healing
Aging affects all systems in the body including the structure and functions of the skin. Recent
studies show that, with advanced age, all processes including the phases of wound healing are
slow in the body, the structure of the skin changes resulting into altered collagen fiber
remodeling and increasing stiffness, this then leads to delayed wound healing, (Michael J Blair,
et al., 2020).
However, HIV/AIDS is also another factor affecting wound healing. HIV/AIDS infected patients
with CD4 <350 cells/mm (Godfrey kigozi et al.,2013) have a compromised immunity and are
susceptible to infections, (B Nagaba et al,. 2014). Besides immune-suppression, microbial
nutrient availability, skin barrier disruption and vascular supply destruction in burn injuries and
wounds are important parameters to delay wound healing, (MAM Johromi et al., 2018, WHO
2018).
Diabetes delays wound healing in that hyperglycemia correlates with stiffness of blood vessels
which causes slower or reduced circulation, micro-vascular dysfunction leading to reduced tissue

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oxygenation and reduced leukocyte migration into the wound which becomes vulnerable to
infections, (Simona Federica et al., 2020).In relation to the above, peripheral neuropathy can set
in leading to numbness of the area and reduced ability to feel pain which can lead to
chronicisation of the wound hence delaying its healing, (Natalie Butler, et al., 2018).
According to a study by YN Pierpont et al., (2014), excessive adiposity in obesity causes an
increased demand in circulation, compounding to this fact is the greater blood vessel in obese
individuals. Larger blood vessels have a greater diffusion barrier hence they cannot deliver
oxygen as efficiently as capillaries leading to a decrease in perfusion of adipose tissue. This
predisposes to hypoxic environment which becomes a significant destructor in vascular
regeneration and oxygen perfusion needed for wound healing.
Malnutrition can alter and cause the body to experience measurable adverse effects.(BAPEN,
2017),this delays wound healing according to a study by Angela M Quain et al., 2015,optimal
nutrition can alter immune function, collagen synthesis and wound tensile strength, all of which
are essential in the wound healing process. However, delayed wound healing occurs when
catabolic phase drags on too long and protein energy malnutrition occurs. A negative cycle
begins where the body sends extra protein to the wound site; as a result, other organs may not
receive enough protein and lean muscle mass breakdown, (Betsy F, Rosenthal 2020).
Impaired blood and oxygen circulation to tissues especially in patients who smoke delays wound
healing, this is because of the primary toxins associated with smoke such as nicotine and gases
like carbon monoxide and hydrogen cyanide.(Jodi C. and Kristine K 2014).

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2.3: Socio-economic factors affecting wound healing
Disruption in economy and health care delivery worldwide including compliance with hospital
visits following a lock down due to corona virus pandemic lead to delayed wound healing
among patients because they could not access better health care services . ( Oropallo, A et
al.,2021)
According to the study Maiyana Tonic Canic 2019, wound care is costly and remains a challenge
placing economic burden on patients. This in turn leads to poor clinical outcomes and
complications including loss of mobility and disability which can also lead to job loss and stress.
Sometimes Perceived Health Stigma (PHS) from others can lead to social isolation and fear to
attend hospital follow-ups especially in patients with mastectomy, this delays wound healing
because of poor monitoring, (Qian-xin Wang et al.,2017).
Patients opt for traditional medicine or local herbs for treating wounds because they are
relatively csheaper as compared to medical drugs that are costly to purchase. (JohnR S Tabuti et
al.,2012).
According to Yang, L et al.,(2013) experiment on rats’ shows that social isolation (depressed
patients) plays a major role in delayed wound healing, due to a dysregulation of the growth
factors, inflammatory mediators that play a major role in wound healing
According to a study by Joseph D Raffetto, 2016 prolonged hospital stays among patients with
hard to heal conditions remains an economic and social burden to patients with venous leg ulcers
because they require weekly medical care.

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Low skeletal mass among patients before and after surgery increases the hospital costs incurred
to meet their needs and expenditures this therefore delays wound healing among patients (Gani F
et al.,2017).
2.4: Measures to promote wound healing
According to the study by A. Bishop, (2018), Proper nutrition to the patient is essential in wound
healing because it contains various nutrients needed by the body during the healing process.
Nurses should be knowledgeable on the different food types such that they ca provide nutritious
advice to patients and explain the types of nutrients, where it is found and how it is used in the
body, this helps to create awareness and reduce malnutrition, (University of Michigan, 2019).
Provision of psychological intervention before wounding of the patient and after wounding of the
patient reduces stress and promotes wound healing among surgical patients, (H. Robinson et
al.,2015).
A Portes-Castro et al.,((2017) shows that guidelines adhering to prevent infection in the wound
such as use of suture materials with antiseptic coating promotes wound healing. In addition to the
above surgical patients should be made aware of certain signs and symptoms after the operation.
If they notice increase in pain or redness around the area and it is also important to note the
amount of bleeding or swelling around the incision site and consult their physician.
Regardless of the surgical procedure to be undertaken, sterilization of surgical instruments before
and after surgery that come into contact with the wound should be done in order to prevent
transmission of infections, (Denton A, Hallan C, 2020).

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Application of tropical antimicrobial agents such as Povidone Iodine because of its extra
ordinary characteristics for example tolerance, efficacy, lack of associated resistance and broad
spectrum to penetrate bio films. (Paul Lorenz Bigliardi et al, 2017). Remind patients to look out
for signs of infection and provide advice on discharge on the management of wounds.
(L.Bereznick, 2012).
DM. Castilla (2012), noted that oxygen therapy is vital for wound healing in acute and chronic
wounds because adequate tissue oxygenation can trigger healing response and favorably
influence the outcome of other treatment modalities.
The use of stem cells in the therapy of chronic wounds by administering them either topically or
using different matrix like hydrogels, scaffolds, dermal substitutes because Stem cells help to
positively influence wound healing by different direct and indirect mechanisms including
residing cells stimulation, biomolecules release, inflammation control and extra cellular matrix
remodeling. Stem Cells are especially worth mentioning as they can be easily derived from bone-
marrow or adipose tissues. (Kucharzewski, M., et al.,2019)

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CHAPTER THREE
METHODOLOGY
3.1: Introduction
The chapter presents the methodology that was used in the study. This includes, Description of
study design and rationale, Description of study setting and rationale, Study population, Sample
size determination, Sampling procedure, Inclusion criteria, Definition of variables, Research
instruments, Data collection procedure, Description of data analysis and management, Ethical
consideration, Study limitations and Dissemination of results.
3.2: Study Design and Rationale.
The study used was a descriptive cross sectional study design which employed Quantitative
method of data collection. The study design was selected because it will help the researcher to
convert the responses which will be obtained (data) into percentages which will be used to draw
pie charts.
3.3: Study Setting and Rationale.
The study is was carried out at Jinja Regional Referral Hospital in Jinja district. Located at rotary
road, the hospital handles over 200 clients with wounds
The main services provided include; Out-patient Department (OPD) where patients are examined
and treated, Laboratory department which conducts various diagnostic tests like Human
Immune-deficiency Virus (HIV) testing, blood slides for Malaria parasites and other
microbiological tests, theatre, maternity ward, post natal ward, surgical ward, medical ward,

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family planning and antenatal and ART clinic, psychiatric ward, ENT clinic, eye clinic and TB
clinic.
The study area was chosen in order to identify the factors affecting wound healing among
patients at surgical ward of Jinja Regional Referral hospital.
3.4: Study Population.
The study was carried out among patients at surgical ward of Jinja Regional Referral hospital.
3.4.1: Sample size determination
The study included a total of Thirty (30) patients on wards selected and interviewed during the
study. A small number, of respondents was selected for easy data collection because it’s the
recommended number by UNMEB.
3.4.2: Sampling procedure.
A simple random technique was used to pick the respondents because everyone in the target
group has equal chances of being included in the study. Sixty (60) papers, (30) written on “YES”
and (30) “NO”, were distributed to patients on wards and outpatients.
3.4.3: Inclusion criteria.
Only patients on surgical ward consented to the study and were included in the study

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3.5: Definition of Variables
3.5.1: dependent variables.
Are variables whose nature of occurrence is as a result of the independent variable.
These include wound healing among surgical patients
3.5.2: independent variables.
These are variables that exert effect on the dependent variables
These included;
 To investigate the local and systemic related factors affecting wound healing.
 To identify the socio-economic related factors affecting wound healing.
 To identify measures which can be taken to promote wound healing
3.6: Research instruments
The researcher collected data using pretested semi structured questionares written in English
3.7: Data collection procedure
The researcher used the interview method with the help of pretested research questionnaires that
were fully explained to the respondents to collect data.
3.7.1: Data management.
The data collected was stored in notebooks, spring files, computer and flash disk as a backup
copy.

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3.7.2: Data analysis.
The data collected was analyzed through tallying and presented in frequency tables; figures
using Microsoft excel computer programs and text.
3.8: Ethical consideration.
On approval of the research proposal by the school, a letter of introduction was provided by the
Principal Jinja School of Nursing and Midwifery and then delivered to the hospital director
JRRH who introduced the researcher to the In charges of the wards and other units, who then
introduced the researcher to the respondents to get their consent. The respondents were of
absolute confidentiality
3.9: The study limitation.
Limited funds might delay the researcher from completing the study in time. The researcher
mobilized for funds from relatives and well wishers.
The high cost of stationary and internet access. The researcher looked for cheaper place where
these services could be obtained.
Limited research books about the study topic in the school library. The researcher relied on the
internet to access more data.
3.10: Dissemination of results.
The study results were disseminated to the following stake holders;
 Jinja regional referral hospital
 Uganda Nurses and Midwives Examination Board
 Jinja School of Nursing and Midwifery

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CHAPTER FOUR
RESULTS AND FINDINGS
4.0 Introduction
This chapter presented data from analysed questionnaires on factors affecting wound healing
among patients attending surgical ward at Jinja regional referral hospital.
4.1 Social demographic data of the respondents.
Table 1: Showing the socio demographic data of the respondents (n=30)
Response Frequency (n=30) Percentage (%)
0n age ranges
0-10 01 3.3
11-24 11 36.7
25-45 15 50
46-80 03 10
Regarding sex
Males 18 60
Females 12 40
On Educational level
Degree 01 3.3
Diploma 02 6.7
Certificate 03 10
Primary level 24 80

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Concerning Marital status
Single 12 40
Married 15 50
Divorced 03 10
Widowed 00 0.0
On the Number of children
1-4 17 57
5-9 06 20
10 & above 03 10
None 04 13
According to study findings to the table1, the following are the variables present;
On age half of the respondents15/30 (50%) where between the age ranges of (25-45) while the
minority 1/30(3.3%) were in the ranges of (1- 10).
Regarding sex the majority18/30 (60%) were males as the minority 12/30 (40%) were females.
On educational level the majority24/30(80%) never went beyond primary level as the least
number 1/30(3.3%) had degrees.
Concerning marital status the majority 15/30(50%) were married as the minority 3/30(10%) were
divorced.
On the number of children majority17/30(57%) had over four children while the minority
4/30(13%) did not have any.

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4.2: Local and systemic related factors.
Text 1: on whether they had wounds.
In text1 above all respondents (100%) reported to have wounds.
Figure 1: on the age of the wound.
Regarding the age of the wound majority of respondents18/30 (60%) had 1 month old wound
and above as the minority 2/30 had 0-7 days old wound.
Table 2: showing results on underlying condition.
Diabetes 12 40
Anaemia 03 10
HIV/AIDS 04 13.3
septicemia 06 20
No condition 05 16.7
2
4
6
18
0
2
4
6
8
10
12
14
16
18
20
0-7 days 8-14 days 15-21 days 1 month and above
Respondents
Days
Key

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obesity 0.0 0.0
According to the findings on table 2 the majority of the respondents 12/30(40%) suffered from
diabetes while the minority 3/30(10%) suffered from anaemia.
Figure 2: Results on the common foods eaten by the respondents.
According to results on figure 3 above on common foods majority of the respondents
16/30(53%) feed on carbohydrates and vitamins while the minority 5/30(17%) feed on proteins,
carbohydrates and vitamins.
17%
53%
30%
PROTEIN+CHO+VITAMINS VITAMIN+ CHO CHO+PROTEINS 4th Qtr

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Table 3: showing responses on a balanced diet.
Number of meals
One meal 02 7
Two meals 08 26
Three meals 20 67
Knowledge on balanced diet
Had knowledge 12 40
Had knowledge deficit 18 60
In table 3 above majority of the respondents 20/30(67%) had three meals in a day while the
minority2/30(7%) had one meal.
In table 3 above majority of the respondents18/30(60%) had knowledge deficit on a balanced
diet as the minority 12/30(40%) had knowledge

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4.3: social economic related factors affecting wound healing.
Figure 3: showing the number respondents who have ever carried out
wound dressing.
According to results on figure 3 the majority of the respondents 18/30 (60%) reported to have
ever carried out wound dressing as the minority 12/30(40%) had not
Table 4: showing length of hospital stay.
response Frequency(n=30) Percentage (%)
0-7 15 50
8-14 09 30
15-21 04 13.3
1 month and above 02 6.7
60%
40%
yes no

21
According to results on table 4 above, half of the respondents 15/30(50%) had finished (0-7)
days while the minority 2/30(6.7%) were 1 month old in the ward.
Text 2: on whether wound treatment is costly.
In the text 2 above all the respondents (100%) reported that wound treatment is costly.
Table 5: showing the number of respondents who had experienced stigma.
Response Frequency(n=30) Percentage (%)
Yes 28 93
No 02 7
According to results in table 5 above, Majority of the respondents 28/30(93%) experienced
social stigma as the minority 2/30(7%) had not.
Text 3: on whether the respondents were depressed.
On the text 3 above all the respondents30/30 (100%) reported that they were depressed.

22
Figure 4: showing respondents use of local herbs.
According to figure 4 above
Majority of the respondents 67% reported not to use local herbs and the minority 33% used.
4.4: Measure taken to promote wound healing.
TEXT 4: On the weight of various respondents
In text 4 above all respondents 30/30(100%) reported to have lost weight.
67%
33%
yes no

23
Table 6: Measures taken to promote wound healing.
Knowledge on measures
YES 09 30
NO 21 70
Danger Signs of an infection
YES 06 20
NO 24 80
According to table 6 above;
Most of the respondents21/30 (70%) had knowledge deficit to the measures taken to promote
wound healing as the minority9/30(30%) knew some of the measures.
The highest number of respondents24/30(80%) did knew not the danger signs of an infection on
wound while the minority 06/30(20%) knew.
Text 5: on whether they were on antibiotic treatment.
Concerning results on text 4 above majority of the respondents 30/30(100) reported to be on

24
CHAPTER FIVE
DISCUSSION, CONCLUSIONS, RECOMMENDATION, AND IMPLICATIONS TO
THE NURSING PRACTICE
5.0: INTRODUCTION
This chapter discusses findings and related literature review, it also presents the conclusions,
recommendations and implication to the nursing practice.
5.1: Discussion
5.1.1: Social demographic data.
According to social demographic data on age as seen in table 1, the highest numbers of
respondents (50%) were between the ages of (25-45) years while the minority (10%) were
between (46-80) years. This could be because of the jobs and activities done by the majority that
would predispose them to getting wounds and they are the dominants number with in the
population in the country.
Concerning sex, the majority of the respondents (60%) were males while the minority (40%)
were females. This could be attributed to the fact that males have greater responsibilities and
self-neglect with poor hygiene than women. On addition, males do activities that predispose
them to getting wounds.
Regarding educational level the majority (80%) never went past primary level as the minority
(3.3%) were degree holders. This could be attributed to the high levels of poverty coupled with
early marriages affecting communities.

25
On marital status, half (50%) of the respondents were married as the smallest number (10%)
were divorced. This could be because they were above the age recommended in Uganda for one
to get married.
On the number of children the majority 57% had (1-4) children while minority 13% didn’t have
any children. This could be because they practise family planning.
5.1.2: Local and systemic related factors affecting wound healing.
According to text 1 above, all respondents 100% reported to have a wound. This therefore
qualified them to be my study population and so took part in the research study.
Concerning results in figure 1, majority of the respondents 60% had 1month old wounds as the
minority (7%) had 0-7 day old wound. This could be because of alterations in the process of
wound healing caused by infections and inadequate blood and oxygen supply to the wound. This
is contrary to a study by Kristine K and Jodi C (2014) who showed that, delayed wound healing
in patients who smoke was due to primary toxins and gases like carbon dioxide and hydrogen
cyanide.
Regarding results on table 2, (40%) of the respondents had diabetes, while the minority (10%)
had anaemia, this could be delaying wound healing because of the micro nutrient availability,
stiffness of blood vessels and reduced blood circulation to the wound. This is in line with a study
by Simona Federica et al.,(2020) on treatment of impaired wound healing in diabetes showed
that hyperglycaemia correlates with stiffness of blood vessels which caused slowed circulation,
micro- vascular dysfunction leading to reduced tissue oxygenation and reduced leukocyte
migration into the wound which becomes vulnerable to infections.

26
According to results in figure 2, above on common foods, majority of the respondents (53%)
feed on carbohydrates and vitamins while the minority (17%) feed on proteins, carbohydrates
and vitamins. This could be because may be they are on a diet restriction or they are affordable
and readily accessible which lead to inadequate nutrition. This is in line with a study by Hellas
Cena and Philip Calder, (2020) on defining a healthy diet showed that intake of certain types of
nutrients and specific food groups would promote the prevention of common non communicable
diseases.
Regarding results in table 3 on balanced diet, majority of the respondents (60%) had knowledge
deficit on a balanced diet as the minority (40%) were knowledgeable; this led to poor feeding
habits hence malnutrition. This is in relation to a study by Angela M Quain et al.,(2015) on
nutrition and wound care management showed that optimal nutrition would alter immune
function, collagen synthesis and wound tensile strength that were essential in the wound healing
process.
5.1.3: social economic related factors
Concerning results in figure 3, majority of the respondents (60%) had ever carried out wound
dressing as the minority (40%) had not, this could be because they were financially unstable and
the hospitals were inaccessible. This is similar to a study by Oropallo A et al., (2021) on wound
care during the covid 19 pandemic which showed that the patients could not access better
services during the lock down so they were attending to online services.
Regarding results in table 4 on hospital stays half of the respondents (50%) were (0-7) days old
as the majority (7%) were a month old. This could be because they were new admissions in the
ward, this is contrary to a study by Joseph D Raffetto, (2016) showed that prolonged hospital

27
stays among patients with wounds remains an economic and social burden to them due to weekly
care.
According to study findings in text 2 all respondents (100%) reported to spending a lot to wound
treatment. This could be due to disruption in economy and their low income levels. This is
similar to a study by Maiyana Tonic Canic, (2019) showed that wound care was costly and
placed an economic burden on them leading to poor clinical outcomes due loss of mobility,
disability and job loss.
Regarding study findings in table 5, majority of the respondents reported to have experienced
social stigma (93%) while the minority did not. This could be due to poor relationships and
wrong perception by the society. Similarly to the above, a study by Qian-Xin Wang et al., (2017)
on perceived health related stigma among patients with breast cancer showed that social stigma
led to social isolation and fear to attend hospital follow ups especially in patients with
mastectomy.
According to study findings in text 3, all respondents (100%) agreed to being depressed. This
could be due to immobility, disability, job loss and frustration. This is in agreement with the
study by Yang, L et al., (2013); experiment on rats showed that depression among patients
delayed wound healing because of a dysregulation of the inflammatory mediators and growth
factors that played a role in wound healing.
According to study findings in figure 4, majority of the respondents don’t use local herbs (67%)
while minority of respondents use local herbs (33%). This could be because of knowledge
deficit, local herbs are not so effective and were expensive, this is contrary to a study by John R

28
S Tabuti et al., (2012) on herbal medicine use in the districts of palisa, kanungu and mukono in
Uganda showed that people had knowledge towards herbal medicine use.
5.1.4: Measures taken to promote wound healing among patients
According to results in text 4, all respondents reported to have lost weight, this could be because
of loss of appetite, stress and poor nutrition. This is not in support to a study by A. Bishop, Sarah
Witts and Tanya martins,( 2018) on the role of nutrition in successful wound healing, showed
that proper nutrition is essential because it promoted wound healing.
On results on table 6, highest number of respondents (80%) knew not the danger signs of an
infection while the minority (20%) knew.
Regarding results on table 6, on respondents ‘knowledge on measures majority of the
respondents (70%) showed knowledge deficit while the minority (30%) had knowledge.
This could be because they were not health educated so they had delayed wound healing which
is not in support to a study by H. Robinson and E Broad Bent, (2015) on the effect of relaxation
before and after skin damage on barrier recovery, showed that relaxation of the patient before
and after surgery promotes wound healing.
Concerning results in text 5 on antibiotic treatment all respondents (100%) were reported to be
on treatment, this could be because they were prescribed and essential in wound care. This is
similar to a study by Paul Lorenz Bigliardi,(2017) on povidone iodine in wound healing: a
review of current concepts and practices showed that povidone iodine had many characteristics
that positioned it extra ordinarily well for wound healing including its antimicrobial spectrum,
lack of resistance and efficacy against bio films.

29
5.2 CONCLUSION.
On local and systemic related factors majority of the respondents had diabetes which was the
systemic factor affecting wound healing.
According to social and economic related factors all respondents indicated that wound treatment
was costly besides that they experienced social stigma.
According to measures taken to promote wound healing majority of respondents were on
In conclusion all the respondents were on antibiotic treatment, wound treatment was costly and
they were depressed due to stigma and their states.
Therefore there is need for provision of counselling services, health education, and out reaches to
the communities to create awareness.

30
5.3 RECOMMENDATIONS.
There is need to recruit more health workers by the ministry of health to attend to patients on
surgical ward in order to promote better and consistent service delivery.
The government should supply more wound dressing materials and sterilization machine to the
hospital this will help to promote aseptic techniques and reduce on shortage of materials.
More health programmes like health education on wound care should be delivered in
communities, health facilities and hospitals in order to create awareness and reduce on stigma.
The health facility administration should ensure constant availability of wound dressing
materials on the ward so that wound care is constant.
The health workers should work hand in hand with social workers to mobilise resources and
provide support to patients without care takers.
5.4 NURSING IMPLICATIONS.
Nurses should health educate patients on the importance of wound care and looking out for the
danger signs of infections in a wound.
Nurses should sensitize the public on various wound conditions in order to create awareness and
reduce social isolation.

31
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Wound Healing’ Vol32, no.4.
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Wound Infections in HIV/AIDS patients”. Journal of tissues Elsevier.
Besty F, Rosenthal, DPM FACFAS, FASPS October, 2020,”Recognising the Impact of
Nutrition in healing.”
British Association of Parenteral and Enteral Nutrition (BAPEN) 2017
Chanden K.Sen (2019). Human Wounds and Its Burdens. An updated compendium of
estimates. Advances in wound care 8(2), 39-48,
Cena,H.,Calder,P.C.2019.Defining a Healthy Diety;Evidence of conteprary dietary partern in
health and disease. Nutrients, 12[2],334. http//doi.org/10.3390/nu 12020334
Denton A, Hallac(2020).”Principles of Asepsis 1; The Rationale for using Aseptic
techniques”. Nursing Times (Online):116:38-41.
Doi;10;1371/Journal, pone. 0186547s
Dr. Jeevan Kumar Giri 16-18 march, 2018.Factors Affecting Wound Healing .20TH
ANNUAL
CONFERENCE OF INDIAN SOCIETY OF WOUND MANAGEMENT (ISWM)
Godfrey Kigozi, Richard Musoke, Nehemiah Kigoma, Stephen Watya, et al.,“Male
Circumcision Wound Healing In (HIV) negative (HIV) positive men in Rakai, Uganda.
Published12, August2013. http//:doi.org/10.1111/bju.12406.

32
H. Robinson, P Jarret, E Broad Bent,(2015) ”The Effect of Relaxation before or after Skin
damage on Skin barrier Recovery. Psychosomatic medicine.
Jennifer E. Sanders, MD (October 2, 2017) Pediatric Wound Care and Management in the
Emergency Department
John RS Tabuti, Collins B Kunkunda, Daniel kaweesi and Ossey M.J Kasilo “ Herbal
Medicine use in the Districts of Nakapiripirit, Pallisa, Kanungu, and Mukono in Uganda
“. Journal of ethno biology and ethno medicine 8, article no.35 (2012) 03 September
2012.
Joseph D Raffeto (2016). Pathopysiology of wound healing and alterations in venous leg ulcers.
Kucharzewski, M., Rojczyk, E., Wilemska-Kucharzewska, K., Wilk, R., Hudecki, J., & Los,
M. J. (2019). Novel trends in application of stem cells in skin wound healing. European
journal of pharmacology, 843, 307-315.
Michael J. Blair, Jake D Jones, Allan E Woessner, Kyler P Quinn (2020). Skin structure
Relationship and The Wound Healing response to intrinsic Aging. Irebet. pub.com
Michael Merchandetti, MD,MBA, FACS, (January22,2021). Wound Healing and Repair . chief
editor Joseph A Molnar, MD, PhD, FACS .
Natalie Butler R.D.L.D, (2018).A recent study on the connection between Diabetes Wound
Healing written by Jedhna Deming updated on August, 2018.
Oropallo,a.,Lantis,J,Martin A Rubaiaiy,A,& Wangi, N(2021).Wound Care during the covid 19
pandenic;improving outcomes through the integration of telemedicine. Journal of wound
care, 30(sup2),s12-s17 https//doi.org/10.12968/jowc.2021.30

33
Paul Lorenz Bigliardi, Syed Abdul Latiff Alsagoff, Hossam Yehia Elkafawl, Jaikyong 2017,
povidone iodine in wound dressing : a review of current concepts andpractices.
International journal of surgery 44, 260-268.
Phillip F.Builder and Modupe I. Builders “Wound Care”: Traditional African Medicine”.
Submitted November 22nd
,2015, Revised: September 5,2016,
published:December7th
,2016.
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Postes-castro A, Morales. Olivera JM,Lopez, Monterom, et al.,(2017).clinical Evolution of
surgical wound with uncoated polydioxanone and with chiorhexidine coated suture in
postoperative body contour patients after massive weight loss. Comparative clinical
study: cirplast 2017:27(2):61-66
Qian Xing Wang, Yan Bai, Guo-Fang Lu, Cai-Yun Zhang,2017 Perceived Health Related
Stigma among Patients with Breast Cancer. Received 11 june,2017, accepted15,August
2017.
Quian A, Kardori N.(2015) ”Nutrition and wound care management , comprehensive review
.Wound,2015:27(12):327-335
Rachael A. Fayne, Luis J Borda, Andjela N.Egger and Majana Tonic Cannic.(2020) The
Potential Impact of Social Genomics on wound Healing. Advances in wound care 9(6),
325-331
Shipman A.R. MillingtonG.W(201) Obesity and the skin. Br J Dermatol, 2011;165(4):743-750.

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Simona Federica, Spampinto, Graziallaria Carusa and Sarah Merlo (1st
April 2020). Treatment
of Impaired Wound Healing in diabetes: Looking among old drugs.
Seni,J.,Najjuka,C.F.,KATEETE,D.P etal.antimicrobial resistance in hospitalized patients;a
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298[2013].http;//doi.org/10.1186/1756-0500-6-298.
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November 2019. World Health Organization, Wound healing in the World.
University of Michigan Health. Carbohydrates, Proteins, Fats and Bloodsugars.(2020)
.Availableat:https;//www.UOF.health.org/health.Library/uq1238 abc. Published
December19 2019, Accessed September 15 2020.
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Yvonne N. Pierpont, Trish Phuong Dinh, R.Emerick Salas, Erika L.Johnson, Terry G.Wright,
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September 2013, Accepted 17 November 2013. Published 20 February 2014.

35
APPENDICES
APPENDIX I
Statement of consent
I, the undersigned, acknowledge that the researcher has fully explained to me the nature, purpose
and procedure involved in the study.
I appreciate that my participation is completely voluntary and that my refusal or withdrawal from
this study will not in any way affect me.
I therefore, sign here as proof of my consent to participate in the study.
Signature: ………………………………………………………………………
Date: ……………………………………………………………………………
I have explained to the best of my knowledge the purpose of this study to the participant and his/
her consent has been obtained.
Name: ………………………………………………………………………..
Signature: …………………………………………………………………………
Date: …………………………………………………………………………..

36
APPENDIX II
QUESTIONNAIRE FOR THE PATIENTS
You are kindly requested to assist in answering the questions below.
The information will be used for academic work only and will be treated with strict
confidentiality
INSTRUCTIONS
Circle or tick the correct answer for the alternatives and explain where necessary. Thank you
SECTION A: Social demographic data of the respondent
Circle the correct answer from the alternatives and explain where necessary
1. How old are you?
A. (0-10) years
B. (25-45) years
C. (11-24) years
D. (46-80) years
2. What is your sex?
A. Male
B. Female

37
3. Educational level
A. Degree
B. Diploma
C. Certificate
D. Others specify…………………….
4. What is your marital status?
A. single
B. Married
C. Divorced
D. Widowed
5. What is your occupation?
………………………………………………………………………………
6. How many children do you have?
A. 1-4
B. 5-9
C. 10 & above

38
D. None
SECTION B: local and systemic related factors affecting wound healing
7. Do you have a wound?
A. Yes
B.NO
8. How old is your wound?
…………………………………………….
9. What are the common foods that you usually feed on?
A. cassava, potatoes, matooke, posho (maize), rice
B. beans, peas g.nuts, eggs, chicken, meat.
C. Fruits (Jack fruit, mangoes, lemon, oranges, pineapples)
D. Vegetables (nakati, dodo, Sukuma, cabbages, egg plants)
10. How many meals do you have in a day?
A.0ne meal
B. Two meals
C. Three meals
D. Four meals

39
11. Is your meal a balanced diet?
A. Yes
B. NO
12. If yes what do you know about a balanced diet?
…………………………………………………………………………
13. Do you have any of the underlying conditions below?
A. diabetes
B. septicemia
C. HIV/AIDS
D. Anemia.
If any specify …………………………………………..
SECTION C: Social Economic related factors affecting wound healing
14. Have you ever carried out wound dressing?
A. YES
B. NO
15. How long have stayed in the hospital?
A. 0-7

40
B. 8-14
C. 15-21
D. 1 month and above.
16. Do you spend a lot on wound treatment?
A. YES
B. NO
17. Have you ever experienced social stigma due to your condition
A. YES
B. NO
18. Do you feel bad because of your wound?
A. YES
B. NO
19. Have you ever used local herbs to treat your wounds?
A. YES
B. NO

41
SECTION D: Measure which can be taken to promote wound healing among surgical
patients
20. How many kilograms do you weigh?
……………………………………….
21. Did your health worker talk to you on measures taken to promote wound healing?
A. YES
B. NO
22. List down any three measures that can be taken to promote wound healing
…………………………………………………………………………..
………………………………………………………………………
23. Do you know some of the danger signs of infections in a wound?
A. YES
B. NO
24. What advice can you give to patients in order to promote wound healing?
…………………………………………………………………………….
25. Are you on antibiotic treatment?
A. YES
B. NO

42
APPENDIX III :
APPROVAL LETTER

43
APPENDIX IV
MAP OF UGANDA SHOWING JINJA
JINJA CITY

44
APPENDIX V
MAP JINJA SHOWING STUDY AREA
JINJA REGIONAL REFERRAL HOSPITAL

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