Older adults' knowledge of pressure ulcer prevention: a prospective quasi-experimental study

hartigan i. , murphy s. & hickey m . (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study. International Journal of Older People Nursing 7 , 208–218
doi: 10.1111/j.1748‐3743.2011.00274.x Aim. To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies. Background. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. Methods. A quasi‐experimental uncontrolled pre‐test, post‐test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre‐ and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. Conclusion. The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. Implications for practice. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.     

Health beliefs and expectations implicit in decision-making in a Hong Kong Chinese surgical population

Aims and objectives. This study was undertaken to explore health beliefs and expectations implicit in decision‐making preferences of Chinese patients admitted for a surgical procedure in a regional hospital in Hong Kong. Background. Patient participation in decision‐making about healthcare options is presently being advocated; however, its nature is complex and inadequately explored and understood. Method. Twenty surgical patients, 10 who desired active participation and 10 who desired passive participation, were interviewed about their reasons for their decision‐making preference. Results. From thematic analysis of the interviews, ‘trust’ and ‘certainty’ emerged as important concepts. Of particular interest is how ‘certainty’ was construed differently by participants: participants who desired to be passive and have minimal participation in decision‐making did not focus on ‘certainty’ as meaning the predictability of the treatment outcome, but rather ‘certainty’ related to trust and belief in the ability of the doctor to choose the best option for them. Alternatively, participants who desired greater participation in decision‐making spoke much more about the ‘certainty’ of the treatment outcome. Conclusions. These findings suggest that patients’ desire for participation in decision‐making about surgery may be related to beliefs, expectations and understanding about certainty. Relevance to clinical practice. It could potentially benefit patients if this concept was explored further prior to patients undertaking decisions about undergoing surgery.     

Health,utilisation of health services, ‘core’ information,and reasons for non‐participation: a triangulation study amongst non‐respondents

Aim. To explore health, use of health services, ‘core’ information and reasons for non‐participation amongst males. Background. Gender may provide an explanation for non‐participation in the healthcare system. A growing body of research suggests that males are less likely than females to seek help from health professionals for their problems. The current research had its beginnings with the low response rate in a prior voluntary survey and health examination for Finnish males born in 1961. Design. Data triangulation among 28 non‐respondent middle‐aged males in Helsinki was used. Methods. The methods involved structured and in‐depth interviews and health measurements to explore the views of these males concerning their health‐related behaviours and use of health services. Results. Non‐respondent males seldom used healthcare services. Despite clinical risk factors (e.g. obesity and blood pressure) and various symptoms, males perceived their health status as good. Work was widely experienced as excessively demanding, causing insomnia and other stress symptoms. Males expressed sensitive messages when a session was ending and when the participant was close to the door and leaving the room. This ‘core’ information included major causes of concern, anxiety, fears and loneliness. Conclusions. This triangulation study showed that by using an in‐depth interview as one research strategy, more sensitive ‘feminist’ expressions in health and ill‐health were got by men. The results emphasise a male’s self‐perception of his masculinity that may have relevance to the health experience of the male population. Relevance to clinical practice. Nurses and physicians need to pay special attention to the requirements of gender‐specific healthcare to be most effective in the delivery of healthcare to males.     

Living with multiple losses: Insights from patients living with pressure injury

Background

Pressure injury is a common problem. Its prevention and treatment is predominantly focussed on views, perceptions and knowledge of healthcare staff rather than on patient experience, particularly those patients living in their own homes.

Nurse strategies for optimising patient participation in nursing care

The study’s rationale: Patient participation is an essential factor in nursing care and medical treatment and a legal right in many countries. Despite this, patients have experienced insufficient participation, inattention and neglect regarding their problems and may respond with dependence, passivity or taciturnity. Accordingly, nurses strategies for optimising patient participation in nursing care is an important question for the nursing profession. Aim and objective: The aim was to explore Registered Nurses’ strategies to stimulate and optimise patient participation in nursing care. The objective was to identify ward nurses’ supporting practices. Methodological design and justification: A qualitative research approach was applied. Three focus groups with experienced Registered Nurses providing inpatient somatic care (n = 16) were carried out. These nurses were recruited from three hospitals in West Sweden. The data were analysed using content analysis technique. Ethical issues and approval: The ethics of scientific work was adhered to. According to national Swedish legislation, no formal permit from an ethics committee was required. The participants gave informed consent after verbal and written information. Results: Nurse strategies for optimising patient participation in nursing care were identified as three categories: ‘Building close co‐operation’, ‘Getting to know the person’ and ‘Reinforcing self‐care capacity’ and their 10 subcategories. Conclusions: The strategies point to a process of emancipation of the patient’s potential by finding his/her own inherent knowledge, values, motivation and goals and linking these to actions. Nurses need to strive for guiding the patient towards attaining meaningful experiences, discoveries, learning and development. The strategies are important and useful to balance the asymmetry in the nurse–patient relationship in daily nursing practice and also in quality assurance to evaluate and improve patient participation and in education. However, further verification of the findings is recommended by means of replication or other studies in different clinical settings.     

Boundaries around the 'well-informed' patient: the contribution of Schutz to inform nurses' interactions

Aim. The aim of this paper is to explore the operation of two different types of knowledge in health care and the position of the nurse to assist in the confluence of knowledge to develop the well‐informed patient. Background. If patients are to be active participants in their care they require useful information. Interactions in contemporary health care mostly involve ‘medico‐scientific’ knowledge, that refers to the ‘science’ of patients’ conditions, as opposed to ‘everyday’ knowledge, which refers to information that can assist patients in lifestyle matters relating to their condition. Theoretical perspective. This paper draws on the work of the ‘well‐informed citizen’ as proposed by Schutz in the analysis of two patient case studies of practices in the acute care setting of the hospital. Method. Data collection was undertaken through fieldwork, incorporating participant observation and discussions with patients in general medical/surgical areas. Results. Two patient case studies representative of the findings are analysed. Analysis identifies the predominant use of ‘medico‐scientific’ knowledge to the detriment of ‘everyday’ knowledge during interactions between patients and all health professionals. Conclusions. There is predisposition in the acute context to interact in ‘medico‐scientific’ knowledge as opposed to ‘everyday’ knowledge that does not facilitate a comprehensive understanding by patients of how they can best manage their lifestyle. Relevance to clinical practice. Using the notion of Schutz's ‘well‐informed’ citizen this study identifies strategies for nursing staff to capture and explore the development of ‘everyday’ knowledge that can assist patients to become more informed and improve their health management.     

Mental health nurses' perspectives of people who self‐harm

Self‐harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self‐harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self‐harm. Data were collected using semi‐structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self‐harm: (i) Nurses’ level of preparedness to work with people who self‐harm; and (ii) The healthcare system. Several sub‐categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self‐harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self‐harm and an accurate understanding of the functions of self‐harm focuses therapeutic interactions to manage psychological distress and reduce further self‐harm and lessen the risk of suicide.     

Patient participation in patient safety still missing: Patient safety experts' views

The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi‐structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as ‘acceptable’ in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high‐quality and safe care.     

Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient,significant other and therapist perspectives

Purpose.?To explore how therapy in a home and day hospital setting impacts on rehabilitation processes and outcomes from the perspective of the patients, their significant others and their treating occupational therapists.

Method.?Fourteen participants with severe traumatic brain injury received a one-to-one, goal-directed, client-centred outpatient occupational therapy programme (a) in their home for 6 weeks and (b) in a day hospital clinic for 6 weeks. The experience of rehabilitation in both settings was explored using semi-structured interviews with the participants, their significant others and their treating occupational therapists.

Results.?Participants and their significant others described the two environments as disparate with home-based therapy perceived as more relaxing, normal, satisfying and effective. The approach to therapy at home was commonly described as ‘real-life’ whereas the therapy approach in day hospital was characterised as ‘simulation of real life tasks’ and ‘remedial exercises’. Participants' experience of therapy relationships at home was characterised as ‘friendship’, in which the therapist was a ‘visitor’, whereas in the hospital, participants were characterised as ‘patients’ and therapists as ‘bosses’ and ‘teachers’.

Conclusion.?The experience of home-based therapy was perceived as more convenient, positive and preferred by patients and their family members. Therapists described more therapeutic benefits and the ability to work more effectively on activity and participation level goals in the client's real-life environment.     

Systematic review of pressure injury prevalence in Australian and New Zealand hospitals

BackgroundPressure injuries have a major impact on patients and healthcare organisations. The complications of pressure injuries increase morbidity and mortality rates and are costly to individuals and healthcare systems. The total prevalence rate of pressure injuries within acute care hospitals in Australia and New Zealand is unknown, and despite a focus on prevention, pressure injuries still occur within these hospital settings.AimTo report the prevalence of pressure injuries within acute care settings in Australian and New Zealand hospitals and to identify the stage and location of pressure injuries and analyse the methods used to conduct pressure injury point prevalence studies.MethodsA systematic review of studies published in CINAHL, MEDLINE and Cochrane databases and a two-part grey literature search, including a customised Google search and a targeted website search, was undertaken up to July 2019. The systematic review was prospectively registered with PROSPERO (CRD42018105566).FindingsThe overall prevalence of pressure injuries in acute-care hospitals in Australia and New Zealand is 12.9% (95% CI, 9.5%–16.8%) and the hospital-acquired pressure injury prevalence is 7.9% (95% CI, 5.7%–10.3%). Stage I and stage II are the most common pressure injuries. The most frequent locations for pressure injuries are the sacrum/buttock/coccyx area (41%) and the heels (31%). The reporting of details about methodology varies considerably between studies.DiscussionPressure injuries remain a significant problem within acute-care hospital settings. Total prevalence rates are decreasing over time with the numbers of stage I and II pressure injuries decreasing faster than other pressure injuries.ConclusionThe findings from this study can be used to set performance benchmarks within acute-care hospitals in Australia and New Zealand. Pressure injuries are preventable and pressure injury prevalence studies can be used to monitor the effectiveness of nursing care processes to improve patient outcomes.     

Qualitative analysis of patients’ intensive care experience during mechanical ventilation

Aim. To understand patients’ intensive care experience while receiving mechanical ventilation in intensive care units. Background. The mechanically ventilated patient’s experience in the intensive care unit is unique. Notably lacking are international studies on patients’ experience, particularly those living in Asia. A better understanding of patients’ experience is needed for nurses to develop approaches to take care of these patients. Design. A phenomenological approach formed by the ideas of Heidegger was used. Methods. Eleven participants surviving from mechanical ventilation were interviewed in‐depth. Patients were asked to describe their experience by responding to the question ‘what is it like to experience mechanical ventilation treatment at an ICU?’. Giorgi’s phenomenological analysis procedure was used to analyse the data. Results. Five mutually exclusive themes emerged, which were: ‘being in an unconventional environment’, ‘physical suffering’, ‘psychological suffering’, ‘self‐encouragement’ and ‘self‐reflection’. ‘Self‐encouragement’ and ‘self‐reflection’ enhanced patients’ self‐confidence, which was beneficial to recovering. Conclusion. Patient’s experiences while receiving mechanical ventilation in the intensive unit were poignant and frightening. Relevance to clinical practice. Critical care nurses should place the highest priority on recognising and meeting the needs of ventilated patients in intensive care units. An intensive care unit should be a place for the patient to live as a human being; not just a place to survive.     

Patients' perceptions of barriers for participation in nursing care

Scand J Caring Sci; 2011; 25; 575–582
Patients’ perceptions of barriers for participation in nursing care Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient’s wishes and abilities. There are still few empirical studies of patients’ perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape‐recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients’ experiences of barriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients’ participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research.     

The importance of moral emotions for effective collaboration in culturally diverse healthcare teams

Moral emotions shape the effectiveness of culturally diverse teams. However, these emotions, which are integral to determining ethically responsive patient care and team relationships, typically go unrecognised. The contribution of emotions to moral deliberation is subjugated within the technorational environment of healthcare decision‐making. Contemporary healthcare organisations rely on a multicultural workforce charged with the ethical care of vulnerable people. Limited extant literature examines the role of moral emotions in ethical decision‐making among culturally diverse healthcare teams. Moral emotions are evident in ethnocentric moral perspectives that construct some colleagues' practices as ‘other’. This article examines how moral emotions are evoked when cultural dissonance influences nurses' moral perceptions. We use a qualitative investigation of teamwork within culturally diverse healthcare organisations. We use Haidt's ( 2003 ) account of moral emotions to examine practice‐based accounts of 36 internationally educated and 17 New Zealand educated nurses practising in New Zealand. The study provides evidence that moral emotions are frequently elicited by communication and care practices considered ‘foreign’. The main implication is that although safe practice in healthcare organisations is reliant on highly functioning teams, collaboration is challenged by interprofessional power relations of contested culturally shaped values. We address practice‐based strategies that enable engagement with moral emotions to enhance effective teamwork.     

Assessment of GPs' beliefs relating to the care of people with intellectual disabilities: A Taiwan-based,opportunity-guided approach

Purpose. This study was designed to investigate general practitioners' (GPs) beliefs about the perceived importance of their role in, and their satisfaction with, providing healthcare to people with intellectual disabilities. The identification of healthcare issues with potential for improvement was assessed using gap analysis and an opportunity-guided method.

Method. A cross-sectional census survey by a mail-structured questionnaire recruited 331 GPs (response rate = 16%) who provided information on healthcare for people with intellectual disabilities in 2006 in Taiwan.

Results. The results indicated that GPs considered their role in providing healthcare for people with intellectual disabilities to be important (mean score 7.2 – 8.3). However, the respondents generally did not feel satisfied (mean score 4.6 – 5.5) with their achievements in treating patients with intellectual disabilities. We found that the gender and educational level of the respondents were statistically correlated to the perceived importance they considered their work to have, while the factors of age, medical practice setting and training experience in intellectual disability were statistically correlated to GPs' perceived satisfaction in providing healthcare to people with intellectual disabilities (p < 0.05). Those healthcare issues of ‘training and experience in intellectual disability’, ‘multi-disciplinary and multi-sectoral cooperation’, ‘adequate competence in disability diagnosis’, ‘genetic consulting services’, ‘duty of disease prevention and health promotion’, and ‘adequate medical consultation time’ were the five most promising areas to be improved in healthcare for people with intellectual disabilities according to the opportunity-guided analysis.

Conclusions. This study highlights that health professionals need to examine carefully healthcare issues pertaining to people with ID, and that much more effort is required to develop appropriate healthcare policies based on the opportunity-guided health issues identified here.     

In their own words: early childhood asthma and parents’ experiences of the diagnostic process

Scand J Caring Sci; 2010; 24; 299–306
In their own words: early childhood asthma and parents’ experiences of the diagnostic process This paper explores the experiences of parents of asthmatic children in the period leading up to their child receiving a formal medical diagnosis. To what extent did the parents face difficulties in obtaining this diagnosis? How did they describe their encounters with the healthcare professionals? In particular, did parents portray themselves as passive and dominated or active and participating during the prediagnosis phase? In‐depth interviews with individuals and participants in a focus group exposed the prediagnosis phase as a distinct and memorable phase of the disease, often recalled as a period of frustration and uncertainty. Results show that instead of accepting the authority of the professional, parents eventually acquire knowledge elsewhere about the diagnosis and the healthcare system, and act according to that knowledge. As a fundamental uncertainty appears involved in the diagnostic process, parents dealing with this uncertainty use a number of strategies to gain control of the process of alleviating their child’s disease. The paper discusses the status of the information that the researcher obtained from parents. Lay narratives cannot be treated as simple reports of an external reality. As the parental role is rooted in normative conceptions about what constitutes ‘responsible parenthood’, information given to the observer may therefore be influenced by the informants’ concern with their appearance as moral persons or adequate parents. Although a research strategy based on one‐sided interviews has limitations, using parents as a source of information offers a rare glimpse into the realities of patient‐physician encounters.     

Healthcare professionals’ knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review

AimThis systematic review reports on healthcare professionals’ knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals’ knowledge and attitudes.BackgroundSurgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies.DesignThis review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines.MethodsA search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals’ knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals’ knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections.ResultsA total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals’ role in prevention. Only three studies examined the effects of interventions on healthcare professionals’ knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge.ConclusionsOverall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals’ knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient.Tweetable abstractKnowledge and attitudes of surgical site infection prevention amongst healthcare professionals.