Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study
Section snippets
Background
Pressure ulcers are related to reduced quality of life for patients (Gorecki et al., 2009) and high costs for the healthcare system (Bennett et al., 2004). Evidence-based international guidelines built on current research are available to health care professionals. However, studies show that pressure ulcer prevention is lacking (Moore and Cowman, 2012, Vanderwee et al., 2011). Although pressure ulcers are considered adverse events in healthcare, the problem remains. In European studies, the
Design
A cross-sectional study design was used. Clinical data (pressure ulcer prevention and pressure ulcer prevalence) were collected during one day, September 30, 2009, and data on nurse staffing and workload were collected for one month, September 2009 (Gunningberg et al., 2011a, Gunningberg et al., 2011b).
Settings
The study was conducted in one university hospital (1100 beds) and one general hospital (350 beds) in two county council districts in Sweden. The university hospital had developed a hospital-wide
Ethical description
The study was approved by the Research Ethics Committee of the Faculty of Medicine at Uppsala University (No. 01-502). It followed the principles of the Declaration of Helsinki and the national and local ethical guidelines for research (CODEX). The patients received verbal and written information about the study and gave their verbal consent; if necessary relatives were consulted. The patients were informed that they were free to withdraw at any time. All data were treated confidentially.
Results
The total sample consisted of 825 patients with a mean age of 68.4 years and a median length of stay prior to the survey day of 6.0 days (IQR = 2.0–16.0). The gender distribution was almost equal. Eighteen percent of patients were assessed as being at risk for developing pressure ulcers (Braden score <17). The prevalence of hospital-acquired pressure ulcers Category 1–4 was 12.6% and 4.7% when Category 1 was excluded. The median value of total hours of care at the two hospitals was 8.0. The
Discussion
The present study combined patient characteristics, hospital type, unit type, nurse staffing and workload in regression models to identify associations between documented risk and skin assessment within 24 h of admission, use of pressure-reducing mattresses and planned repositioning. The findings show that statistically significant results varied between the four dependent variables.
Prevention care was related to patients’ high age and risk scores (Braden <17), which is in accordance with
Strengths and limitations
The present study employed a cross-sectional design, which is appropriate for describing the status of phenomena and for describing relationships among phenomena (Polit and Beck, 2008). A cross-sectional design provides only a “snapshot” of the prevalence of a phenomenon at a particular point in time. In our study, the month of September was selected purposely, because staffing and hospital activities are normal and not affected by, for example, vacations.
The pressure ulcer prevalence
Conclusion
Patients at risk of developing pressure ulcers (Braden <17) had higher odds of having risk assessment documented within 24 h of admission, and of receiving pressure-reducing mattresses and planned repositioning. Hospital type was also associated with the four dependent variables. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need
Acknowledgements
We wish to thank Nancy Donaldson, RN, DNSC., FAAN CALNOC, senior scientist, for her inspiring collaboration in the research project. Lena Hagman was responsible for the data collection at the general hospital. Grants from Uppsala-Örebro Regional Research Council are gratefully acknowledged, as is the Centre for Research & Development, Uppsala University/County Council of Gävleborg.Conflict of interest: None.Funding: Uppsala-Örebro Regional Research Council are gratefully acknowledged and Center
References (33)
- et al.
The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers
International Journal of Nursing Studies
(2005) - et al.
Clinical microsystems. Part 1. The building blocks of health systems. Joint Commission
Journal of Quality and Patient Safety
(2008) - et al.
Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data
International Journal of Nursing Studies
(2009) Categorical Data Analysis
(2002)- et al.
Perceived adverse patient outcomes correlated to nurses’ workload in medical and surgical wards of selected hospitals in Kuwait
Journal of Clinical Nursing
(2009) - et al.
Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses
Journal of Clinical Nursing
(2010) - et al.
Creating and analyzing a statewide nursing quality measurement database
Journal of Nursing Scholarship
(2004) - et al.
A national prevalence study of pressure ulcers in French hospital inpatients
Journal of Wound Care
(2008) - et al.
Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in Belgian hospitals
Worldviews on Evidence-Based Nursing
(2011) - et al.
The cost of pressure ulcers in the UK
Age Ageing
(2004)
Preventing pressure ulcers with the Braden scale: an update on this easy-to-use tool that assesses a patient's risk
American Journal of Nursing
Benchmarking for small hospitals: size didn’t matter!
Journal for Healthcare Quality
Nursing-sensitive benchmarks for hospitals to gauge high-reliability performance
Journal for Healthcare Quality
CALNOC Code-Book Part I & II, Coordinating and Using CALNOC Data in the Hospital Setting
Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel monograph
Advances in Skin and Wound Care
Cited by (47)
Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review
2023, Journal of Tissue ViabilityFactors Associated with Intensive Care Units' Nurses Frequency of Performing Pressure Injury Prevention: A Cross-sectional Study
2022, Applied Nursing ResearchCitation Excerpt :Workload, uncooperative patients, presence of other priorities, and shortage of resources were identified as barriers to perform PIP. Regarding the issue of workload and its implications for PIP, scholars have consistently observed that workload impacts the amount of time that nurses have to engage in preventing PI (Sving et al., 2014). In many instances, nurses are not provided with the opportunity to determine their workload, with issues such as patient acuity often overlooked during scheduling and staffing (Coventry et al., 2015).
Effectiveness of negative-pressure wound therapy compared to wet-dry dressing in pressure injuries
2022, Journal of Tissue ViabilityKnowledge and practices of operating room nurses in the prevention of pressure injuries
2022, Journal of Tissue ViabilityCitation Excerpt :Nurses did not conduct risk assessments because they felt that it was not within the scopes of their responsibilities; they had high workloads and dealt with emergency cases. Yet this finding was comparable with other studies that reported 45.6% [33], 46.1% [34], and 40% [31]. Over two-thirds of the nurses (70.1%, n:234) adopted PI prevention strategies during the intraoperative period which was slightly higher than Tallier et al. by 62.0% [35].
Pressure ulcers prevention: Turkish nursing students' knowledge and attitudes and influencing factors
2020, Journal of Tissue ViabilityThe International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture
2019, International Journal of Orthopaedic and Trauma NursingCitation Excerpt :The Perioperative Risk Assessment Measure for Skin (PRAMS) is an example of validated risk assessment measure specific to the perioperative period (Meehan et al., 2016). Although it is universally agreed that PU/PIs can be prevented, and even though guidelines are available, pressure injuries remain a significant problem for hospitalized patients (Sving et al., 2014). Samuriwo (2010) suggests that nurses who place a high value on pressure ulcer prevention appear to be more proactive and determined to deliver care that protects their patients’ skin.