Role of Staff Education in Pressure Ulcer Incidence in Long-Term Care Residents
Pressure ulcers (PUs), also known as bed sores, decubitus ulcers, or pressure sores, are formed where skin and tissue are squeezed between bone and an outside surface for long periods of time, often due to immobility ("Pressure Ulcer," 2002). The development of PUs is a common problem in long-term care of the elderly. A recent report by a national pressure ulcer organization estimates the prevalence of PUs in acute care at about 15%, with about a 7% incidence after admission (National Pressure Ulcer Advisory Panel, 2001).
Because PUs are so common, cause distress to the patient and their family, and can form the basis for litigation, it is important for the long-term medical care community to find ways to reduce their prevalence and incidence. Two commonly suggested solutions to the PU problem include identifying patients at risk using risk assessment methods and initiating preventive measures (Ayello & Braden, 2002). In order for long-term care staff to identify patients at risk they must be educated in assessment of the risk for developing PUs. One risk assessment method used in this area is the Braden Scale, developed in 1987 by Drs. Barbara Braden and Nancy Bergstrom. The scale attempts to identify risk factors that increase the chance that patients will develop PUs in the future and assigns a numeric value to the risk for any particular patient (Bergstrom, Braden, Laguzza, & Holman, 1987).
Rationale for the Study
This study will attempt to evaluate the effect of training staff in a long-term care facility in the use of the Braden Scale on ulcer incidence. It will do this by examining three factors before and after training in the use of the Braden Scale: (1) the overall incidence of ulcers, (2) the average ulcer development time, and (3) the average ulcer healing time.
Definition of Terms
Braden Scale -- a risk assessment method for the development of pressure ulcers that examines various factors and assigns a numeric value of the potential risk.
Retrospective Data -- data concerning events occurring before a subject is enrolled in a study.
Prospective Data -- data concerning events occurring after a subject is enrolled in a study.
Quasi-Experimental -- a method of quantitative research design that examines causality; it does not include random selection of subjects or control groups.
REVIEW OF THE LITERATURE
Chronological presentation of the theoretical and research basis for the study
The Braden Scale is a risk assessment method for the development of pressure ulcers that was formulated in 1987 (Bergstrom et al.). Since that time, a large number of studies have been done to try to determine if the scale is reliable (consistent) and valid (accurate) in predicting those patients that will develop pressure ulcers. Work by Braden herself indicates that the scale does have clinical utility, predictive utility, and extends to various healthcare settings (Braden & Bergstrom, 1989; Bergstrom, Braden, Kemp, Champagne, & Ruby, 1998; and Bergstrom, Braden, Kemp, Champagne, & Ruby, 1996). This has been supported by research done by other groups, including studies examining patients of African-American, Hispanic, and Asian decent (Lyder, Yu, Emerling, Mangat, Stevenson, Empleo-Frazier & McKay, 1999 and Pang & Wong, 1998). However, a very recent paper calls into question the predictive value of the Braden Scale in hospitalized patients (Schoonhoven, Haalboom, Bousema, Algre, Grobbee, Grypdonck, & Buskens, 2002). Overall, though, it appears proper to evaluate an education plan including the Braden Scale and recommended preventative measures based on this analysis to determine if it could affect the incidence of ulcer occurrence, the time before ulcer development, and/or the time of ulcer healing.
Conceptual Framework
The literature review of this study shows that there is significant controversy about the predictive validity of the Braden Scale in particular settings and with particular patient populations. But there is still a need for studies that examine the relationship between education about risk assessment such as the Braden Scale and a reduced number of ulcers. Also, where ulcers do occur, studies are needed to determine whether education in this area can result in an increased time from admission to ulcer development and a decreased time for the ulcer to heal. The present study attempts to find a correlation between staff education and use of the Braden Scale with changes in ulcer incidence, time for ulcer development, and time for ulcer healing for the long-term resident.
METHODOLOGY
Research Design
This study will utilize both retrospective and prospective data in a quasi-experimental design. Before staff education, overall ulcer incidence will be followed until a total of thirty residents develop ulcers. Staff education on the Braden Scale...
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