Description of Medical-Surgical Nurses' Care of Patients at Risk for Pressure Ulcers (PU)

2.50
Hdl Handle:
http://hdl.handle.net/10755/622154
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Description of Medical-Surgical Nurses' Care of Patients at Risk for Pressure Ulcers (PU)
Other Titles:
Global Practices for Pressure Ulcers
Author(s):
Mayer, Barbara J.
Lead Author STTI Affiliation:
Gamma Gamma
Author Details:
Barbara J. Mayer, PhD, RN, CNS, rofessional Experience: 2014-present Director of Nursing Quality and Practice, Stanford health Care, Palo Alto, California 2015-present Clinical Instructor, Stanford University, Palo Alto, California 2009-2014 Director of Professional Practice, St. Vincent Medical Center, Los Angeles, California 2002-2009 Director of Nursing Education, Palomar Health, Escondido, California Clinical Nurse Specialist, Critical Care Author of book chapters and publications related to critical care nursing Speaker on various topics including critical care nursing, violence in the workplace, nursing education, patient education, quality PI, Co-PI on three research studies related to pressure ulcers Author Summary: Barbara has a clinical background in critical care and has served in a variety of leadership positions. She is an author and international speaker. Her research focuses on identifying the barriers and facilitators influencing nurses’ care delivery decisions. She is currently the Director of Nursing Quality and Practice for Stanford Health Care and holds a faculty position in the Department of General Medicine at Stanford University.
Abstract:

Purpose: The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and the perceptions of implementing PU prevention measures of nurses caring for patients in MS units.

Methods: The study was conducted in three (3) community hospitals in California within the same healthcare system using an interpretive description approach (Bertero, 2015). Purposive sampling was used to recruit medical surgical nurses. Six (6) focus groups were conducted including a total of thirty (30) participants. Participant comments were coded following each focus group session. Initial impressions and preliminary themes were explored in subsequent focus groups, allowing the investigator to refine and reorient the inquiry. Demographic information was collected to describe study participants.

Results:  A total of 30 nurses working in MS units participated in six focus groups. A brief demographic questionnaire revealed the majority of participants were female (90%) and ranged in age between 26-61 years with a mean age of 41 years. Academic educational preparation included a Bachelor’s degree in nursing (67%); pressure ulcer prevention continuing education within the last 12 months (83%), with 74% of classes attended by participants including instruction on evidence-based protocols. The majority of participants were employed full time (87%) and years of nursing experience ranged from 1 year to 38 years, with a mean of 12 years. Findings in this study are not dissimilar to those that have been reported elsewhere, but serve to orient us to today’s environment in the wake of the 2008 CMS ruling. Four (4) major themes emerged from analysis of the data: 1) nurses’ knowledge of PU prevention improved following an educational activity and nurses’ experience caring for patients at risk for development of PU was a significant factor in acquiring and maintaining their knowledge level; 2) an accurate risk assessment is essential in determining appropriate PU prevention measures. Risk was determined using a standardized assessment tool, the Braden Scale. However, participants related inconsistent use and interpretation of the scale, rendering patient scores suspect in determining risk. The presence of diagnoses and conditions known by participants, through previous experience, to be associated with patients at risk for PU development was more important in determining the level of patient risk for PU; 3) many factors were identified as influencing nurses’ implementation of PU prevention measures. Factors identified as facilitating implementation of PU prevention measures were: nurses’ personal motivations, the use of evidence-based treatment protocols to guide decision-making, the use of expert consultants, and leadership support. Factors identified as barriers to implementation of prevention measures were: staffing concerns, lack of equipment and supplies, patient cooperation; family influences, and balancing nurses’ ethical need to provide safe, compassionate care with the desire to respect the wishes of the patient; and 4) regulatory mandates, specifically the 2008 CMS ruling on non-payment for hospital acquired PU, were perceived as having improved nurses’ care of patients at risk for PU.

Conclusions: This study was undertaken to describe nurses’ knowledge of PU development and prevention and to discover factors affecting nurses’ ability to implement PU prevention measures. When interventions are omitted assumptions are often made that the nurse lacks the knowledge, skill or desire to provide quality care (Waugh, 2014). This study revealed that, in the case of PU development and prevention, nurses’ knowledge was satisfactory, nurses understood the importance of PU prevention, and were motivated to carry out prevention measures. However, barriers and facilitators to implementation of prevention measures were identified. Because every hospital, shift, and patient encounter presents a unique set of circumstances, organizations must assess and identify contributing factors and implement improvements based on their own assessments to ensure quality care. Findings suggest several actions that could be taken to improve nurses’ assessment of PU and implementation of prevention measures. Education promoting a common understanding and consistent use of the Braden Scale is essential to its effectiveness in guiding PU prevention measures. Methods within the practice setting to validate consistency should be implemented. Evidence-based protocols allow the nurse autonomy to implement measures aligned with the patient’s individual risk factors. Protocols also remove the necessity of consulting the patient’s physician, allowing timely implementation. The prudent organization should consider implementation of the wound care nurse role and/or expanding the involvement of wound care nurses in the direct provision of PU prevention measures, and provide regular formal and informal education regarding PU prevention for the RN as well as assistive staff such as the CNA. Finally, organizational recognition of the importance of PU prevention is required to facilitate consistent implementation of prevention measures. This includes providing adequate staff both in numbers and quality, leaders serving as role models, and public recognition of positive outcomes by leadership.

Keywords:
Medical-Surgical Nurses; Practice Barriers; Pressure Ulcer Prevention
Repository Posting Date:
25-Jul-2017
Date of Publication:
25-Jul-2017
Other Identifiers:
INRC17M07
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleDescription of Medical-Surgical Nurses' Care of Patients at Risk for Pressure Ulcers (PU)en_US
dc.title.alternativeGlobal Practices for Pressure Ulcersen
dc.contributor.authorMayer, Barbara J.en
dc.contributor.departmentGamma Gammaen
dc.author.detailsBarbara J. Mayer, PhD, RN, CNS, rofessional Experience: 2014-present Director of Nursing Quality and Practice, Stanford health Care, Palo Alto, California 2015-present Clinical Instructor, Stanford University, Palo Alto, California 2009-2014 Director of Professional Practice, St. Vincent Medical Center, Los Angeles, California 2002-2009 Director of Nursing Education, Palomar Health, Escondido, California Clinical Nurse Specialist, Critical Care Author of book chapters and publications related to critical care nursing Speaker on various topics including critical care nursing, violence in the workplace, nursing education, patient education, quality PI, Co-PI on three research studies related to pressure ulcers Author Summary: Barbara has a clinical background in critical care and has served in a variety of leadership positions. She is an author and international speaker. Her research focuses on identifying the barriers and facilitators influencing nurses’ care delivery decisions. She is currently the Director of Nursing Quality and Practice for Stanford Health Care and holds a faculty position in the Department of General Medicine at Stanford University.en
dc.identifier.urihttp://hdl.handle.net/10755/622154-
dc.description.abstract<p><strong>Purpose: </strong><span>The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and the perceptions of implementing PU prevention measures of nurses caring for patients in MS units.</span></p> <p><strong>Methods: </strong>The study was conducted in three (3) community hospitals in California within the same healthcare system using an interpretive description approach (Bertero, 2015). Purposive sampling was used to recruit medical surgical nurses. Six (6) focus groups were conducted including a total of thirty (30) participants. Participant comments were coded following each focus group session. Initial impressions and preliminary themes were explored in subsequent focus groups, allowing the investigator to refine and reorient the inquiry. Demographic information was collected to describe study participants.</p> <p><strong>Results: </strong> A total of 30 nurses working in MS units participated in six focus groups. A brief demographic questionnaire revealed the majority of participants were female (90%) and ranged in age between 26-61 years with a mean age of 41 years. Academic educational preparation included a Bachelor’s degree in nursing (67%); pressure ulcer prevention continuing education within the last 12 months (83%), with 74% of classes attended by participants including instruction on evidence-based protocols. The majority of participants were employed full time (87%) and years of nursing experience ranged from 1 year to 38 years, with a mean of 12 years. Findings in this study are not dissimilar to those that have been reported elsewhere, but serve to orient us to today’s environment in the wake of the 2008 CMS ruling. Four (4) major themes emerged from analysis of the data: 1) nurses’ knowledge of PU prevention improved following an educational activity and nurses’ experience caring for patients at risk for development of PU was a significant factor in acquiring and maintaining their knowledge level; 2) an accurate risk assessment is essential in determining appropriate PU prevention measures. Risk was determined using a standardized assessment tool, the Braden Scale. However, participants related inconsistent use and interpretation of the scale, rendering patient scores suspect in determining risk. The presence of diagnoses and conditions known by participants, through previous experience, to be associated with patients at risk for PU development was more important in determining the level of patient risk for PU; 3) many factors were identified as influencing nurses’ implementation of PU prevention measures. Factors identified as facilitating implementation of PU prevention measures were: nurses’ personal motivations, the use of evidence-based treatment protocols to guide decision-making, the use of expert consultants, and leadership support. Factors identified as barriers to implementation of prevention measures were: staffing concerns, lack of equipment and supplies, patient cooperation; family influences, and balancing nurses’ ethical need to provide safe, compassionate care with the desire to respect the wishes of the patient; and 4) regulatory mandates, specifically the 2008 CMS ruling on non-payment for hospital acquired PU, were perceived as having improved nurses’ care of patients at risk for PU.</p> <p><strong>Conclusions: </strong>This study was undertaken to describe nurses’ knowledge of PU development and prevention and to discover factors affecting nurses’ ability to implement PU prevention measures. When interventions are omitted assumptions are often made that the nurse lacks the knowledge, skill or desire to provide quality care (Waugh, 2014). This study revealed that, in the case of PU development and prevention, nurses’ knowledge was satisfactory, nurses understood the importance of PU prevention, and were motivated to carry out prevention measures. However, barriers and facilitators to implementation of prevention measures were identified. Because every hospital, shift, and patient encounter presents a unique set of circumstances, organizations must assess and identify contributing factors and implement improvements based on their own assessments to ensure quality care. Findings suggest several actions that could be taken to improve nurses’ assessment of PU and implementation of prevention measures. Education promoting a common understanding and consistent use of the Braden Scale is essential to its effectiveness in guiding PU prevention measures. Methods within the practice setting to validate consistency should be implemented. Evidence-based protocols allow the nurse autonomy to implement measures aligned with the patient’s individual risk factors. Protocols also remove the necessity of consulting the patient’s physician, allowing timely implementation. The prudent organization should consider implementation of the wound care nurse role and/or expanding the involvement of wound care nurses in the direct provision of PU prevention measures, and provide regular formal and informal education regarding PU prevention for the RN as well as assistive staff such as the CNA. Finally, organizational recognition of the importance of PU prevention is required to facilitate consistent implementation of prevention measures. This includes providing adequate staff both in numbers and quality, leaders serving as role models, and public recognition of positive outcomes by leadership.</p>en
dc.subjectMedical-Surgical Nursesen
dc.subjectPractice Barriersen
dc.subjectPressure Ulcer Preventionen
dc.date.available2017-07-25T19:47:16Z-
dc.date.issued2017-07-25-
dc.date.accessioned2017-07-25T19:47:16Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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