Providing informal home care for pressure ulcer patients: how it affects carers' quality of life and burden

Practices of Patient Relatives Aimed at Preventing Pressure Injuries and Their Experiences of Coping with the Burden of Care: A Qualitative Study

OBJECTIVE

To determine the practices and coping experiences of the relatives of patients with pressure injuries (PIs).

METHODS

The authors used a qualitative, phenomenologic research design. They interviewed 20 relatives of patients with PIs face-to-face using an in-depth semistructured interview form. The data were analyzed using the Colaizzi phenomenologic method.

RESULTS

Three categories, 8 main themes, and 22 subthemes emerged from the interviews. The category of "the impact of the need for care on the lives of the patient's relatives" was analyzed according to psychological, social, and physical effects. In the category of "practices to prevent pressure injuries," two themes emerged: practices toward the patient and the environment. Relatives of individuals with PIs have psychological, physical, and social needs.

CONCLUSIONS

Providing care to a patient with PIs has psychological, social, and physical effects on the patient's relatives. The care burden mostly affects these caregivers negatively, and they mainly need time for themselves and moral and companion support.

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study

AIMS

To: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home.

METHODS

This mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home.

RESULTS

The CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management.

CONCLUSION

CAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

Effects of home-based chronic wound care training for patients and caregivers: A systematic review

We aimed to review and synthesise the evidence of the interventions of patients' and informal caregivers' engagement in managing chronic wounds at home. The research team used a systematic review methodology based on an updated guideline for reporting systematic reviews (PRISMA) and recommendations from the Synthesis Without Meta-analysis. Cochrane Central Register of Controlled Trial of the Cochrane Library, Pubmed, Embase, CINAHL, Wanfang (Chinese), and CNKI database (Chinese) were searched from inception to May 2022. The following MESH terms were used: wound healing, pressure ulcer, leg ulcer, diabetic foot, skin ulcer, surgical wound, educational, patient education, counselling, self-care, self-management, social support, and family caregiver. Experimental studies involving participants with chronic wounds (not at risk of wounds) and their informal caregivers were screened. Data were extracted and the narrative was synthesised from the findings of included studies. By screening the above databases, 790 studies were retrieved, and 16 met the inclusion and exclusion criteria. Studies were 6 RCTs and ten non-RCTs. Outcomes of chronic wound management included patient indicators, wound indicators, and family/caregiver indicators. Home-based interventions of patients or informal caregivers' engagement in managing chronic wounds at home may effectively improve patient outcomes and change wound care behaviour. What's more, educational/behavioural interventions were the primary type of intervention. Multiform integration of education and skills training on wound care and aetiology-based treatment was delivered to patients and caregivers. Besides, there are no studies entirely targeting elderly patients. Home-based chronic wound care training was important to patients with chronic wounds and their family caregivers, which may advance wound management outcomes. However, the findings of this systematic review were based on relatively small studies. We need more exploration of self and family-oriented interventions in the future, especially for older people affected by chronic wounds.

Determinants of the success in flap reconstruction-Outcome analysis of 120 flaps in 484 procedures for pressure injury

Pressure injury (PI) mainly occurs in bedridden older adults or those with physical limitations. Here, we aimed to determine the appropriate timing to conduct flap reconstruction in patients with PIs and identify factors affecting surgical outcomes. We retrospectively reviewed the data of all patients who received debridement or flap reconstruction surgery for PIs in our hospital from January 2016 to December 2021. The extracted data included patient demographics, surgical records, blood test results, vital signs, and flap outcomes. In total, 484 surgical procedures (364 debridements and 120 flaps) were performed on 216 patients. Serum albumin level of ≥2.5 g/dL remarkably increased the likelihood of complete wound healing (odds ratio [OR] = 4.12, P = .032) and reduced the risk of postoperative complications (OR = 0.26, P = .040). In contrast, advanced age (OR = 1.04, P = .045) and serum creatinine level ≥2 mg/dL (OR = 5.07, P = .016) increased the risk of postoperative complications. Thus, patients with a favourable nutrition status have a higher likelihood of achieving complete wound healing. By contrast, patients who are older and have serum creatinine ≥2 mg/dL and serum albumin <2.5 g/dL tend to develop more postoperative complications. Overall, thorough correction for patient inflammation, infection, anaemia, and malnutrition status can provide optimal flap surgery outcomes.

Prevalence of Pressure Injury among Stroke Patients In and Out of Healthcare Settings: A Systematic Review and Meta-Analysis

Pressure injury is a recognized problem for patients with stroke. Knowing the prevalence of pressure injury post stroke can guide clinical professionals and researchers to take appropriate actions for patient care and education. The aim of this study was to systematically review the literature regarding prevalence of pressure injury among patients with stroke in the hospital, and in the home with no home healthcare services and nursing homes. Original articles available in Scopus, Web of Science, PubMed, ProQuest, and Google Scholar databases were searched separately by two researchers using the following keywords: stroke, cerebrovascular attack, pressure injury, pressure ulcer, bedsore, decubitus ulcer, and prevalence. The search was performed according to the PRISMA flow diagram from 2000 to 2020. After the initial review, 14 articles conducted between 2008 and 2019 were included in the final analysis. Eight studies were conducted in healthcare settings, and six studies were conducted out of hospitals. The estimated pooled prevalence for pressure injury in all studies was 3.9%. The estimated pooled prevalence for pressure injury in studies conducted in hospitals and in patients' homes with no home healthcare services and nursing homes were 3.06 and 17.25, respectively. The prevalence of pressure injury among stroke patients after hospital discharge was significantly higher than when they were hospitalized. This could indicate that this group of patients do not receive adequate care and attention for pressure injury after hospital discharge. Given the limitations of the available studies, it is recommended that further studies be conducted on pressure injury among stroke patients both at the time of hospitalization and after hospital discharge.

Burden of informal caregivers of patients with pressure ulcers in a primary care setting

Objective:

The aim of this study was to assess the burden experienced by the caregivers of patients with pressure ulcers (PUs) and the variables that might contribute to its manifestation.

Method:

This cross-sectional study enrolled primary care patients and their informal caregivers. To assess the burden experienced by the caregivers, the Zarit Burden Interview, short-form version (ZBI) was used. This instrument was self-applied by the caregiver. We assessed PU status, demographic and clinical variables. The Kolmogorov–Smirnov test was used to test for normality, the Spearman's rank correlation coefficient (rs) test to assess the correlation between variables, and paired Student's t-test to compare the difference between the groups, with and without burden.

Results:

Patients (n=54) were older, mean age 82±9.92 years, mainly female (64.8%), with an average of 1.47±0.73 PUs. The informal caregivers (n=46) were: primarily female (84.8%); mean age 57.13±11.87 years; 20.8% were unemployed; 14.6% were retired; 60.4% were the patient's offspring and 14.8% were spouses. Informal caregivers reported that they spent on average 10.20±8.10 hours each day taking care of their patient. The caregivers' (n=46) ZBI score was, on average, 14.63±9.60, and 37.0% reported a high burden. We did not find any correlation between caregiver burden and number of PUs (p=0.148), number of hours spent taking care of the patient (p=0.364) and age of the caregiver (p=0.259).

Conclusion:

Over one-third of the informal caregivers of the PU patients in this study reported a high burden. We did not find any correlation with the variables analysed, probably due to the small sample size.

Acceptability and Impact of an Educational App (iCare) for Informal Carers Looking After People at Risk of Pressure Ulceration: Mixed Methods Pilot Study

Background

Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden.

Objective

This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role.

Methods

In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a “think aloud” interview in week 1 and semistructured interviews at the end of weeks 2 and 6.

Results

Of the 32 participants, 23 (72%) participants completed the week 2 and 16 (50%) completed the week 6 questionnaires; 66% (21/32) of carers participated in qualitative “think aloud” interviews, and 18 (56%) also participated in semistructured interviews at week 2, and 13 (41%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme “I’m more careful now and would react to signs of redness” captured participants’ reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: “When you’re not used to these things, they take time to get the hang of” and “It’s not a fun app but it is informative.” All participants (n=32, 100%) liked the microlearning approach.

Conclusions

The iCare app offers a promising way to improve informal carers’ pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences.

Home health care for mechanical ventilation-dependent patients: A grounded theory study

The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.

Evidence-Based Prevention and Management of Pressure Injuries in Home Care: A Scoping Review

OBJECTIVE

To determine the presence of evidence-based practice protocols for the prevention and management of pressure injuries (PIs) in home care settings, whether the contents of existing protocols were based on current evidence, and adherence to these protocols.

DATA SOURCES

Comprehensive and structured literature searches were conducted using PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Ovid, Scopus, Web of Science, and Joanna Briggs Institute Evidence-Based Practice Database.

STUDY SELECTION

A literature search retrieved 2,929 articles. Investigators evaluated the titles, abstracts, and full texts of the articles retrieved from the literature search in accordance with the review questions and eligibility criteria. The authors included four studies in this scoping review.

DATA EXTRACTION

The researchers extracted details of the full-text articles, including author(s)/year of publication/country, aim(s), study population and sample size, study design, intervention type, outcomes, and key findings.

DATA SYNTHESIS

The four articles included in this scoping review are descriptive cross-sectional studies published between 2005 and 2010. Although the articles provided significant data on the quality of practices for the prevention and management of PIs in home care, no studies reported on the achievement of objective results.

CONCLUSIONS

The use of protocols for the prevention and management of PIs, including evidence-based interventions in home care, and adherence to existing protocols were low. Comprehensive observational and randomized controlled studies are necessary to improve evidence-based prevention and management of PIs in home care settings.

An exploration of the perspectives of individuals and their caregivers on pressure ulcer/injury prevention and management to inform the development of a clinical guideline

BACKGROUND

Consumer engagement is a requirement of high quality clinical guidelines. Developing strategies to engage consumers and incorporate the perspectives of individuals with or at risk of pressure ulcers/injuries and their informal caregivers was one priority in the recent update of the EPUAP/NPIAP/PPPIA's Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline.

AIMS

The aims were to determine the goals of individuals and caregivers for pressure ulcer/injury care, priorities for pressure ulcer/injury education and biggest problems related to pressure ulcers/injuries.

METHODS

An online, anonymous, international 10-item survey, accessible in nine languages was provided to individuals and their caregivers from April to October 2018. Descriptive statistics were used for quantitative data and a thematic analysis approach was used to analyse qualitative data.

RESULTS

There were 1233 individuals from 27 countries who completed the survey. Overall, individuals and caregivers had similar goals of care. Reducing the size of pressure ulcer/injury was selected more often as a care goal than complete healing. Individuals, compared to caregivers, considered managing pain more important. Qualitative data analysis identified five themes including knowledge, attitudes, and skills; risk factors for pressure ulcer/injury; accessing pressure ulcer/injury care; quality of life for patients and caregivers; and the pressure ulcer/injury.

CONCLUSIONS

The consumer survey provided consumer engagement and perspective that was incorporated into guideline development, including consideration during evaluation of the relevance and acceptability of recommendations, and assignment of recommendation strength ratings.

Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework

Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners' perceived barriers and enablers to the implementation of evidence-based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi-structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five-step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence-based practice included high levels of self-reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self-reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.

The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study

Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.

The comparison of the effects of local cooling and heating on apoptosis and pyroptosis of early-stage pressure ulcers in rats

The exploration of an effective method for preventing and treating pressure ulcers (PUs) is a hot topic in medical research. Recently, disputes about the choice of heat and cold therapies have emerged for the prevention and treatment of clinical PUs. The present study was designed to compare the effect of cool and heat therapies on pyroptosis and apoptosis of early-stage PUs in rats. Sixty SD rats of SPF grade were randomly divided into the sham group, model group, heating group, and cooling group. We established a rat model of early-stage PUs by using an ischemia-reperfusion method. At the end of the experiment, the tissue underneath the compressed region was collected for hematoxylin and eosin staining, transmission electron microscopy, immunohistochemistry, immunofluorescence staining, a TdT-mediated dUTP nick-end labeling assay, a Western blot analysis, and a mitochondrial swelling experiment. Our results suggested that the mitochondrial apoptotic pathway and pyroptosis were involved in the formation of early-stage PUs, and local heating increased the PU injury in rats, while local cooling reduced the PU injury in rats. This study showed that heat therapy might not be suitable for the clinical treatment and care of early-stage PUs, while cold therapy may be more appropriate.

Effectiveness of high frequency ultrasound on pressure ulcer: A systematic review protocol of randomized controlled trial

BACKGROUND

This study aims to systematically assess the effectiveness of high frequency ultrasound (HFUS) on pressure ulcer (PU).

METHODS

In this study, PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched from inception to the present without any language limitations. The primary outcomes include change in ulcer area, and time complete healing. The secondary outcomes consist of proportion of ulcers healed within trial period, quality of life, pain intensity, and adverse events. Cochrane risk of bias tool will be used to assess methodological quality. RevMan 5.3 software (London, UK) will be used to analyze the data.

RESULTS

This study will analyze change in ulcer area, time complete healing, proportion of ulcers healed within study period, quality of life, pain intensity, and adverse events on HFUS in patients with PU.

CONCLUSION

This study will provide most recent evidence for the effectiveness and safety of HFUS for patients with PU.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42019138177.

Investigation on the Status and Determinants of Caregiver Burden on Caring for Patients with Chronic Wound

Objective: To investigate the caring burden and its determinants of primary informal caregiver of patients with chronic wound. Approach: A prospective cross-sectional study of 132 pairs of chronic wound care recipients and their informal caregivers was included. The characteristics of patients and their informal caregivers as well as caregiver burden assessment by the caregiver burden inventory (CBI) were measured. Single factor analysis and multiple regression analysis were carried out to explore the independent determinants of caregiver burden on caring for patients with chronic wound. Results: Most of the caregivers were female with mean age of 54.57 ± 13.35 years, and 58.3% of the caregivers were adult children. The mean CBI score was 34.21 ± 9.69 at a medium level. The following variables increased the CBI scores of caregivers: long caring time per day for patients, powerlessness status of patients, insufficient self-efficacy, and social support of caregivers, the model was able to explain 67.5% of variance in caregiver burden (F = 47.167, p = 0.000, R ² = 0.675, adjusted R ² = 0.660). Innovation: Caring burden of patients with chronic wound as a key consideration of patient-centered wound care has received relatively little attention. In this study we report the status of caring burden and reveal its determinants of primary informal caregiver of patients with chronic wound. Conclusion: Wound professionals are suggested to pay attention to the caregiver burden of patients with chronic wound and develop family-centered intervention support service system according to the determinants of caregiver burden to alleviate the caregiver burden.

Quality of life predictors in informal caregivers of seniors with a functional performance deficit - an example of home care in Poland

Background: There is insufficient research into informal caregivers' quality of life (QoL) in Poland. The purpose of this work is to study predictors that considerably affect QoL of informal caregivers (IC) providing home care for seniors with chronic diseases and a functional performance deficit. Materials and methods: In the cross-sectional research design, ICs were randomly chosen among the geriatric population receiving care in 5 primary health care settings. The WHOQoL-AGE questionnaire was used to assess QoL of ICs (n=138). The Barthel scale and Polish version of the Abbreviated Mental Test Score (AMTS) were applied to assess individuals with chronic diseases and functional and mental performance deficits (n=138). The Geriatric Depression Scale Short Form (GDS-SF) was used to measure the extent of risk of depressive symptoms in care-receivers. A hierarchical regression analysis was carried out to determine predictors of caregivers' QoL. Results: Mean values in the group of seniors provided with home care were as follows: the Barthel scale M=43.20, SD=27.06, the AMTS M=7.78 (SD=1.65), and the GDS-SF M=7.34 (SD=3.10). QoL of ICs (the WHOQoL-AGE) was M=70.14 (SD=15.31). Significant predictors of caregivers' QoL turned out to be support in care given by others β =0.605, p<0.001, experience in care β =-0.220; p<0.001, caregivers' health self-assessment β =0.174, p<0.001, and depressive disorders in care-receivers GDS β = -0.178, p<0.001. Conclusions: The QoL of ICs who provide care for individuals with chronic diseases and a functional performance deficit improves with an increase in the support they receive from others, their higher health self-assessment, and greater experience in care. An increase in depressive symptoms in care-receivers determines a lower level of caregivers' QoL.

"Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study

BACKGROUND

Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers.

METHODS

Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis.

RESULTS

More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies.

CONCLUSION

Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.

Assessment of histopathology of wounds based on protein distribution detected by wound blotting

Background:

Shortening the duration of healing based on an accurate assessment is important in pressure ulcer management. This study focused on the peroxidase and alkaline phosphatase activity detected by wound blotting, a non-invasive method of collecting wound exudate, to establish a non-invasive and point-of-care assessment method for analyzing the histopathology of wounds using an animal model.

Methods:

Wounds were created on the dorsal skin of rats. Peroxidase and alkaline phosphatase activities in the wound exudate were detected by wound blotting on post-wounding days 1, 4, 7, and 10. Wound tissue was collected on the same sampling days. Peroxidase and alkaline phosphatase activity within the tissue and myeloperoxidase were visualized. Two types of peroxidase activities were detected by wound blotting: ring and non-ring signals. The histopathological features were compared between wounds with ring and non-ring signals.

Results:

The wounds with ring signals showed a high level of peroxidase activity, and histological analysis demonstrated that the secreted or deviated peroxidase activity originated from myeloperoxidase, indicating a strong inflammation reaction within the tissue. The histopathology of wounds related to the alkaline phosphatase signals was not identified.

Conclusion:

The results suggested that ring signals indicated a strong inflammatory reaction and that they could be used to assess non-visible inflammation.

Nurses' perceptions of the root causes of community-acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare

AIMS AND OBJECTIVES

To explore how the context of care influences the development of community-acquired pressure ulcers from the perspective of nurses working in home healthcare settings, to identify and categorise the factors perceived as contributing to the development of these ulcers using the Model for Examining Safety and Quality Concerns in Home Healthcare, and to explore how these risks are managed in practice.

BACKGROUND

Pressure ulcer reduction is a priority in both hospital and community settings. Evidence suggests the factors affecting safety and performance in community settings are not the same as in hospital. However, research pertaining to pressure ulcer risk management has predominantly been undertaken in hospital settings.

DESIGN

The study was framed by a qualitative exploratory design.

METHODS

Semistructured interviews were conducted with a purposive sample of 19 registered nurses recruited from an independent regional tissue viability network and five community nursing provider organisations in London.

RESULTS

The experiences and perceptions of participants mapped onto the components of the Model for Examining Safety and Quality Concerns in Home HealthCare: patient characteristics, provider characteristics, nature of home healthcare tasks, social and community environment, medical devices and new technology, physical environment, and external environment. Four strategies to address identified risks were established: behavioural interventions, technical interventions, safeguarding interventions and initiatives to promote better integration between health, local authorities and families.

CONCLUSION

Understanding the complex interplay between people and other elements of the healthcare system is critical to the prevention, management and investigation of pressure ulcers. This study has illuminated these elements from the perspective of nurses working in community settings.

RELEVANCE TO CLINICAL PRACTICE

Further consideration should be given to the importance of place when both developing risk management strategies for pressure ulcer prevention and learning the lessons from failure.

Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances

OBJECTIVE

Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances.

METHODS

A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems.

RESULTS

Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates.

CONCLUSION

Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care.

Longitudinal Outcomes of Home Care in Korea to Manage Pressure Ulcers

Home care provides preventive, support, and treatment services to economically vulnerable community populations. In this study, we examined the outcomes of a home care program for pressure ulcers (PrUs) in an economically vulnerable group. The 184 participants were admitted with PrUs and received services from a home care agency in South Korea during a study window of 5 years. The changes in PrU staging over time were analyzed in relation to the agency's home care data and the participants' health data. At enrollment, approximately 60% had a single ulcer; 40% had two or more. Most patients' ulcers were at stages 3 or 4, and most patients were bedridden. The maximum odds of reduced ulcer size from one measurement point to the next was estimated at 14.3% for ulcers in stages 1 and 2, 33.4% of those in stage 3, and 25.5% of those in stage 4; more than 10% of ulcers healed completely within a year. PrUs were a serious problem in this community-dwelling economically vulnerable group, and home care played a critical role in providing health care to this population. © 2017 Wiley Periodicals, Inc.