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To determine the predictors of pressure injuries among residents living in Sri Lankan nursing homes.
A prospective multi-site longitudinal cohort study design.
Semi-structured observations and chart audits were used to gather data on 17 predictors of pressure injury from a consecutive sample of 210 residents (aged ≥ 60 years old) from nine nursing homes in Sri Lanka. Data were collected at baseline and followed up every week until the study endpoint: a new pressure injury or reaching the maximum 12 weeks of data collection, from July to October 2023. Validated semi-structured data collection forms and chart audits were utilised. Binary logistic regression was used to identify the predictors of pressure injuries. Generalised linear mixed models were used to assess the association between predictors and the development of new pressure injuries.
The cumulative incidence of pressure injuries was 17.1% (36/210) during the 12 weeks. The number of medical devices and baseline pressure injuries predicted the development of new pressure injuries. Each additional medical device increased the likelihood of developing a pressure injury by 2.3-fold, and individuals with a baseline pressure injury were 2.1 times more likely to develop a new pressure injury.
Multiple medical devices and baseline pressure injuries are predictors of pressure injury in older residents living in nursing homes.
This study provides evidence of pressure injury predictors among older residents living in nursing homes. Early identification of high-risk residents with an existing pressure injury and those with multiple medical devices is important for nurses and managers at nursing homes. Accurately assessing residents' risk of a pressure injury may result in implementing various preventive strategies that may ultimately help prevent future pressure injuries.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cohort studies guidelines.
No patient or public contribution.
Preventing pressure injuries among nursing home residents is a significant challenge that necessitates understanding the barriers and facilitators from the perspective of staff. This qualitative study aimed to describe these factors within Sri Lankan nursing homes. Semi-structured interviews were conducted with 15 nursing home staff members from nine nursing homes in and near the Colombo district, Sri Lanka. The study was informed by the capability, opportunity, motivation, and behaviour model that guided both data collection and analysis. Data were analysed using content analysis. Using deductive coding based on capability, opportunity, and motivation, followed by inductive analysis, four primary categories emerged: focusing on skincare is foundational for pressure injury prevention, pressure injury knowledge is critical for prevention, pressure injury prevention is a low organisational priority, and overcoming challenges to enact pressure injury prevention. Key facilitators included access to skincare products, maintaining clean and dry skin, recognising risk factors, proactively managing risks, and understanding the broader implications of pressure injuries on residents and their families. Conversely, barriers encompassed limited training, varying staff support, inadequate resources, and the complexities of managing multiple tasks. This research highlights that enhancing knowledge and allocating resources effectively can improve the implementation of pressure injury prevention strategies in Sri Lankan nursing homes.
Patient participation improves patient outcomes, but factors that predict participation in pressure injury prevention (PIP) are relatively unknown. This study aimed to identify patient-related factors predictive of patient participation in pressure injury prevention (PPPIP) in hospitalised medical and surgical patients and to assess the psychometric properties of the PPPIP scale. This observational substudy recruited consenting adults at risk of pressure who participated in a parent trial. The seven-item PPPIP scale was administered within 48 h of recruitment, with higher scores reflecting more participation. Multiple regression was used to identify patient-related factors predictive of patient participation. The scale's psychometric properties were assessed using confirmatory factor analysis and Cronbach's alpha. In total, usable data were obtained from 856 patients. Mean PPPIP scale scores were relatively high, with 571 (66.7%) scores reflecting agreement or strong agreement. The Cronbach's alpha was 0.81, and most confirmatory factor analysis criteria for construct validity were met. Only the use of mobility aids was statistically significant in the model, but it predicted a small amount of variability in PPPIP score (adjusted R 2 = 0.017; p < 0.001). Targeting patients with limited mobility may be a useful strategy when trying to engage patients in PIP if resources are limited.
This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.
A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.
Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.
Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.
These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.
Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.
No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.
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