EXPLORING CLINICAL PERSPECTIVES FOR THE RISK OF PRESSURE/SHEAR INDUCED TISSUE DAMAGE USING DESCRIPTIVE INSIGHTS FROM HEALTHCARE PRACTITIONERS
Abstract
Introduction
Pressure ulcers are a global concern, are costly and detrimental to health systems and patients. Despite there being a plethora of assessment scales and devices there is a deficit in how mobility is assessed. The devices do not differentiate between healthy, protective movement and agitated movement. Assessment scales mostly assess for immobility. There is a gap in practice where assessment is not made for the ‘high mover’ cohort within the bed/chair-fast. These patients are at risk of pressure ulcer formation.
Methods
An interpretivist, qualitative think aloud design. Following ethical approval the study was held on two units in a community hospital. Participants comprised healthcare staff including nurses, doctors, physiotherapists, healthcare assistants and student nurses. Semi structured interviews were held over nine months. Data was collated in Nvivo and Graneheim and Lundmans content analysis approach was used for data analysis.
Results
A total of twenty-one healthcare staff were interviewed; nine nurses, six HCAs, two doctors, two physiotherapists and two student nurses. A total of 15 codes or descriptors of patient movements were created to describe the movements of bed/ chair-fast patients. High movers can be identified using descriptors such as impulsive, climbing, agitated, excited, restless, continuous, erratic, shuffling, confused, side to side. Low movers can be identified by descriptors such as rigid, restricted, needs assistance
Conclusions
It is critical that a Nurse assess their patients’ mobility to factor in the high moving bedfast or chair-fast cohort to ensure that the appropriate intervention strategy is implemented. As part of this preventive strategy, the nurse should not only consider the type of movement, but also the rationale for the movement and address factors causing the movements. The purpose of these descriptors is to furnish an algorithm to allow nurses identify the most suitable PU prevention strategy for this cohort of patient.