A prospective cohort study on influencing factors of pressure ulcer development in Hong Kong private nursing homes

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A prospective cohort study on influencing factors of pressure ulcer development in Hong Kong private nursing homes

 

Author: Aboo, Gloria Halima
Title: A prospective cohort study on influencing factors of pressure ulcer development in Hong Kong private nursing homes
Degree: D.H.Sc.
Year: 2010
Subject: Bedsores
Nursing homes -- China -- Hong Kong
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: 236 leaves : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2417678
URI: http://theses.lib.polyu.edu.hk/handle/200/6127
Abstract: Aims: Shortened hospital stays in order to save healthcare costs lead to earlier discharge of patients who require assistive care in long-term care settings. Consequently, nursing homes have to accommodate residents at severe levels of infirmity and with greater dependency, which are known risk factors for pressure ulcer development. As part of the quality enhancement agenda, this study aims to understand the factors that influence pressure ulcer development in private nursing homes in Hong Kong. The information will be delineated to design pressure ulcer prevention strategies that are tailored to nursing home settings. Background: Previous studies have shown that demographic, poor clinical condition and adverse health factors affect pressure ulcer development among old people in various healthcare setting. The quality of care provided by private nursing homes in Hong Kong has been a concern. No previous study has investigated the pressure ulcer incidence, and the factors that influence the pressure ulcer development in the private nursing homes in Hong Kong.
Methods: This was a prospective cohort study of 368 residents in four private nursing homes. Data were collected by using a Personal Characteristics Form (PCF), the Cumulative Illness Rating Scale (CIRS), the Bedford Alzheimer Nursing Severity Subscale (BANS-S), the Personal Daily Life Activities Scale (P-ADL), the Modified Braden Scale (MBS), the Skin Assessment Chart (SAC) and the Resident Observation Sheet (ROS). Each resident was observed over a period of 28 days upon obtaining voluntary consent. A final assessment was conducted and cases were closed when (1) no pressure ulcers developed after 28 days of observation or (2) the residents left the homes either temporarily (e.g. hospitalization) or permanently (e.g. death). The chi-square and the independent t-test were used to compare residents who had and had not developed pressure ulcers. Logistic regression was used to identify the patient-related factors. Content analysis of resident observations was conducted to identifY the care-and environment-related factors that influence the development of pressure ulcer. Results: The study contfirmed that occurrence of pressure ulcer is indeed a problem in private nursing homes. The pressure ulcer prevalence and incidence were 7.6% and 28% in the four nursing homes. 21 residents (75%) who already had pressure ulcers developed new ones, and 82 residents developed their first pressure ulcer (24.1 %) within the observation period. Residents of specific nursing homes, who required oral hand feeding by others, needed tube feeding, were less active, and had impairment induced by neurological and psychiatric disease were more likely to develop pressure ulcers. Some care practices prevalent in the nursing homes and certain enviromental conditions could increase pressure ulcer risk. Discussion: Pressure ulcer prevention strategies will be proposed based on the observations of pressure ulcer occurrence in nursing homes and the patient-, care-and environment-related factors.

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