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Jacqueline Lavallee, PhD Student CLAHRC
As a health psychologist I am passionate about behaviour change, whether that is the behaviour of individual patients or members of the public or the professional behaviour of healthcare professionals. My PhD focused on the pressure ulcer prevention behaviours of care home staff and involved collaborating with them and community nurses to develop an intervention to prevent residents developing pressure ulcers. Below I have shared some of the key findings from my PhD.
What are pressure ulcers?
Pressure ulcers occur when there is an area of localised damage to the skin and/or underlying tissue due to prolonged pressure (for example due to sitting or lying without movement). Risk factors for developing a pressure ulcer include reduced mobility, impaired circulation of blood, existing or healed pressure ulcers and increased age.
Why do we need to prevent pressure ulcers?
Pressure ulcers can become serious wounds that affect health-related quality of life, impair recovery and rehabilitation, cause pain, poorer physical functioning and sleep disturbances.
In the UK, the cost of treating a pressure ulcer to healing is estimated to range from £1,214 to £14,108 (depending on the severity of the ulcer). In 2012, the annual cost of treating pressure ulcers in the UK was estimated as £3 million.
Pressure ulcer prevention care bundle for care home settings
Many people living in care homes are at risk of developing a pressure ulcer. I spoke to care home staff and managers, as well as community-based NHS tissue viability nurses and managers about the barriers and facilitators to pressure ulcer prevention. We identified a number of barriers including staff shortages and limited skills and knowledge, but found that good communication and teamwork were helpful.
I worked with care home staff and tissue viability nurses to co-design the first theory- and evidence-informed care bundle designed specifically for the prevention of pressure ulcers in care home settings. Our care bundle consists of three prevention practices (skin inspection, checking support surfaces and repositioning) and a range of behaviour change techniques to promote the use of these practices.
One care home implemented the care bundle and I collected data on how the staff used the care bundle, the number of pressure ulcers that developed during that time and I asked staff about their experiences of using the care bundle. The care home staff explained that they liked using the care bundle and they believed it assisted them in the delivery of comprehensive pressure ulcer prevention care.
“I think we probably checked the pressure areas a little bit more actually. Because you’ve got to tick whether you’ve done it, you have got to physically look. … So yeah it did make me look personally. I did check people more with them, definitely!” [Healthcare assistant].
Our findings have highlighted a number of issues surrounding recruiting and retaining care homes in research, collecting data and monitoring how the care bundle is being used. Currently, we cannot say that the care bundle was effective in preventing pressure ulcers but our work has highlighted the potential for a pressure ulcer prevention care bundle for care home settings and further research is needed to build on these findings and evaluate the bundle fully.
We have disseminated the above findings widely at conferences and in academic journals. The final and most recent publication from my PhD was ‘Preventing pressure ulcers in nursing homes using a care bundle: a feasibility study’. I am really pleased that all four of my PhD studies have been published, as this is such an important area of healthcare.
Finally, there is a lot of exciting wound care research being conducted across Greater Manchester and it is great to be involved in this.