Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI

Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives

CONTEXT/OBJECTIVE

Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge.

DESIGN

The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention.

SETTING

The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west).

PARTICIPANTS

30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States.

INTERVENTIONS

n/a.

OUTCOME MEASURES

Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence.

RESULTS

Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently.

CONCLUSION

Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans' lives.

Provider perspectives of community-acquired pressure injury prevention in veterans with spinal cord injury

CONTEXT/OBJECTIVE

Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). Most studies and interventions focus on the prevention of pressure injuries acquired in the hospital. The goal of this study is to better understand SCI provider perspectives of the risks, actions and resources needed to prevent CAPrIs.

DESIGN

Qualitative descriptive, semi-structured interviews of SCI providers analyzed using a deductive-inductive approach.

SETTING

Three geographically different veteran health administration spinal cord injury/disorder centers.

PARTICIPANTS

30 interprofessional SCI providers.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Provider perspective of risks, actions and resources for CAPrI prevention in veterans with SCI.

RESULTS

30 interviews revealed a model of provider perspectives of CAPrI prevention including veteran risk characteristics, veteran preventive activities and provider, family, community caregiving resources.

CONCLUSION

Understanding provider perspectives of Veteran CAPrI preventive risks, actions and resources guides more appropriate interventions to prevent CAPrIs in individuals living with SCI.

Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique

STUDY DESIGN

Delphi Technique.

OBJECTIVES

Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT).

SETTING

Veteran Health Administration Hospital, Chicago, Illinois, USA.

METHODS

Concept mapping of current pressure injury (PrI) guidelines and qualitative research describing risks, actions, and resources needed to prevent CAPrIs associated with SCI were used to develop 40 veteran checklist items (Items) along with 37 associated provider actions (Actions) for the tool. The Delphi technique was used to refine Items and Actions with a panel of interprofessional SCI providers (n = 15), veterans with SCI (n = 4), and caregivers (n = 3) to determine consensus on a 4-point Likert scale (strongly agree-strongly disagree) for each Item and Action. A 75% agreement was set for responses rated as strongly agree or agree.

RESULTS

Panelists were 60% female, 62% White, 33% veterans with SCI or caregivers, 33% wound care certified with a mean age of 59 years. Two survey rounds were required for consensus for 41 Item and 38 Action CAPP-FIT. Response rate was 95% for both rounds. Delphi round 1 showed all but two Actions affirming agreement above 75%. Substantive comments from panelists required revision to 5 Items and 9 Actions and one additional Item/Actions related to coping, meeting threshold percent agreement in Round 2.

CONCLUSIONS

The CAPP-FIT could become a useful tool for Veterans living with SCI, caregivers, and SCI providers.

Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study

BACKGROUND

community-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life.

AIM

To evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors.

METHODS

This was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships.

RESULTS

The skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy.

CONCLUSION

Community-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.

Finnish and Swedish prehospital emergency care providers' knowledge and attitudes towards pressure ulcer prevention

BACKGROUND

Despite the knowledge that transportation by emergency medical services may increase the risk of pressure ulcers (PU), there is still lack of knowledge about the possibility of prehospital emergency care providers to be a part of preventing and reducing the risk of PUs.

METHODS

A survey was carried out during 2017 in Finland and Sweden. Validated questionnaires were used.

RESULTS

A total of 179 (72.7%) Finnish and 188 (28.8%) Swedish prehospital emergency care providers participated in the study. The overall rate of correct answers and the mean total knowledge score was 58.8% (SD 21.8), 20/34, in the Finnish group and 70.5% (SD 15.7), 24/34, in the Swedish group (p < 0.000). The percent of the total and the mean attitude score was in the Finnish group 71.3% (SD 0.48), 37.1/52, and in the Swedish group 69.4% (SD 0.77), 36.1/52 (p < 0.813). Half of the Finnish and most of the Swedish participants felt they needed more education about PUs (Fin 50.2% & Swe: 76.0%).

CONCLUSIONS

Prehospital emergency care providers don't see themselves as responsible for PU prevention. Therefore, there is a need for increasing the level of knowledge on PU prevention and classification among prehospital emergency care providers. They could play a key role in developing methods to improve PU prevention and identifying patients in risk of developing PUs.