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Pressure Ulcer Incidence and Patient Education

Background

The study by Chaboyer et al. (2016) identifies the problem of hospital-acquired pressure ulcers as a significant patient safety concern with poor patient outcomes and rising healthcare costs. This is a nursing issue since pressure ulcers are an indicator of nursing care quality. The objective of the study is to evaluate the effectiveness of a pressure ulcer prevention care bundle for at-risk patients, focusing on patient education and promotion. The purpose is to determine whether such approaches can be used with evidence-based support across healthcare facilities.

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The study by Robineau et al. (2019) seeks to observe the impact of patient education on the management of pressure ulcers in patients with chronic neurological disease. The problem is that neurological diseases often lead to decreased mobility, causing pressure ulcers in 75% of patients in the first 12 months. The objective of the study is to assess the impact of a patient education intervention on pressure ulcer prevention. The research questions is whether there is enough evidence to develop therapeutic education programs for pressure ulcer prevention. It is a nursing issue as patients in acute care with neurological diseases need to be given the tools by healthcare staff to manage pressure ulcers in and beyond inpatient hospitalization.

Nursing Practice Issue

The PICOT question focuses on identifying whether patient education has an effect on number of hospital-acquired pressure ulcers. The articles both address concepts of patient education in the management of pressure ulcers. Chaboyer et al. (20focususes on an inpatient population that has limited mobility, thus at risk for pressure ulcers. This reflects the acute care inpatient of the PICOT question. This study introduces a patient education and pressure ulcer prevention bundle by emphasizing mobility, skincare, and diet. Meanwhile, Robineau et al. (2019) focus on a sample of adults with a spinal cord injury regardless of cause located in a rehabilitation facility. The population matches the PICOT question in terms of lacking mobility and being at-risk, so the results will be homogenous. The study introduces an intervention and observes its impact on pressure ulcer development underlining the case for therapeutic education for at-risk individuals.

Methods

Chaboyer et al. (2016) uses a pragmatic cluster randomized trial. Hospitals were stratified into two groups by recent pressure ulcer rates and randomized within groups to either the intervention or standard care. The intervention consisted of educational materials such as a DVD, a brochure, and a poster as well as trained nurses partnering with the patient’s Data on hospital-wide strategies and number of beds were collected along with baseline patient demographic and clinical data. Daily patient skin status and care strategies received by the patient were collected, with the primary outcome measure being incidences of new hospital-acquired pressure ulcers. This method and trial design have the benefit of comparing intervention with the regular standard of care in hospital clusters allowing to identify of statistically meaningful changes. However, these types of methods require greater complexity in design and analysis, creating the potential for error and requiring a greater number of participants for statistical power.

Meanwhile, in Robineau et al. (2019), there was no control group. Eligible participants attended 2 group workshops on pressure ulcer prevention. The patients then underwent individual interviews at 3, 6, and 12-month intervals where they were assessed with a variety of scales including “Hospital Anxiety and Depression Scale, Rosenberg self-esteem scale, Schwarzer self-efficacy scale, a quality of life scale, (SF-36) and the revised Skin Management Needs Assessment Checklist (Revised SMnac).” These methods and trial design have the benefit of tracking individual patients in a small-scale study to identify a wide variety of influences of therapeutic education. Interviews along with some of the scales are capable of presenting a qualitative basis to quantitative data collected by skin management assessments to correlate the efficacy of the intervention. The disadvantage is that the sample size in this type of study is small and not randomized, lacking control to compare the data. Furthermore, interviews and other qualitative measures may create instances of bias, particularly if there is no blinding or randomization.

Results

Chaboyer et al. (2016) found that the bundled intervention education program had a positive effect, with the control group having twice the hospital-acquired pressure ulcers than the intervention group. However, accounting for clustering and prognostic factors, the incidence rate becomes not statistically significant. The hazard ratio of pressure ulcer development in the intervention group compared to standard care was 0.58. The authors note that there are implications for nursing practice, including challenges in training and engaging patients in the care and prevention program. Acute care nurses experience challenges with the patient condition and varying participation in patients, with the potential that the intervention did not provide enough training or support to nurses in engaging patients in the program.

Robineau et al. (2019) had only 20 patients included in the study, with medina traumatic injury duration of 234 months and 75% pressure ulcer incidence before intervention. The researchers note patient education showed improvements in management ability and an increase in the SMnac score, with only 30% of patients developing an ulcer post-intervention. Both studies present implications of nursing practice by supporting the hypothesis that patient education programs have an impact on individuals and hospital clusters in improving pressure ulcer prevention and management among inpatient populations.

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Outcomes Comparison

The anticipated outcome to the PICOT question is that there will be an improvement in patient understanding and knowledge of pressure ulcers prevention, leading to slightly decreased rates. It is unlikely that rates will drop down significantly since some elements of pressure ulcer prevention are inherently challenging in acute care settings. This matches the outcomes of the selected studies which saw small to moderate decreases in pressure ulcer cases, but faced certain challenges in implementing education aspects.

References

Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Gillespie, B. M., Banks, M., Whitty, J. A., Thalib, L., Roberts, S., Tallott, M., Cullum, N., & Wallis, M. (2016). The effect of a patient-centered care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. International Journal of Nursing Studies, 64, 63–71. Web.

Robineau, S., Nicolas, B., Mathieu, L., Duruflé, A., Leblong, E., Fraudet, B., Gélis, A., & Gallien, P. (2019). Assessing the impact of a patient education programme on pressure ulcer prevention in patients with spinal cord injuries. Journal of Tissue Viability, 28(4), 167–172. Web.

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