Preventing pressure ulcers : – risk assessment and patient participation

Abstract: Background: Pressure ulcers are considered as an adverse event. Identifying patients at risk is the first step in pressure ulcer prevention. The patient should receive relevant information about their risk status and be encouraged to participate in their own preventive care. PURPOSE T is a new pressure ulcer risk assessment instrument, and the CBPM system shows the patient’s pressure points visually in real time. Aim: This thesis aimed to evaluate the psychometric values, usability and feasibility of PURPOSE T and to investigate the possibility of improving patient participation through the CBPM system. Method: The study setting was a university hospital and three nursing homes. Nurses (n=28) risk assessed patients (n=235) with PURPOSE T in an observational, descriptive and comparative study (I). Focus group interviews were then conducted with the nurses (II). A mixed-method study evaluated the feasibility of PURPOSE T with patient record review (n=60), individual patient interviews (n=15) and focus group interviews with nurses (n=15) and assistant nurses (n=8) (III). A descriptive study with patients (n=31) evaluated if the CBPM system increased patient participation (IV). Results: Study I demonstrated good inter-rater and test-retest reliability of PURPOSE T. Study II showed that PURPOSE T had good clinical usability. It was an efficient risk assessment instrument performed at bedside; the nurses gained a deeper understanding and awareness of risk factors. Study III showed that PURPOSE T has good clinical feasibility. More patients were identified at risk for pressure ulcers and were prescribed more preventive interventions in comparison with patients assessed with the Modified Norton Scale. These results were mirrored in the focus group interviews with the nurses´ and assistant nurses’ experiences. Risk assessment took the same amount of time despite being more comprehensive; the instrument encouraged more preventive actions, and nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers. Study IV showed that the CBPM system increased the patients’ knowledge, and as they became aware of increased pressure, they started to take preventative action in their own care. Thus, patient participation increased. Conclusion: The evaluation of PURPOSE T in Sweden demonstrates good results and could be considered as replacing the Modified Norton Scale at a national level. Providing information to the patient needs to be a priority, and new information and communication technologies, such as the CBPM system, need to be taken advantage of, to benefit the patients.