Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study

OBJECTIVE

To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers.

DESIGN

Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis.

SETTING

The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts.

PARTICIPANTS

Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10).

RESULTS

Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment).

CONCLUSIONS

There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.

How consistent and effective are current repositioning strategies for pressure ulcer prevention?

AIM

To examine the inter-practitioner variability of repositioning for pressure ulcer prevention, the effectiveness of the intervention, and whether the provision of written guidance influenced the repositioning technique.

METHODS

A pre-test post-test study design was utilised. Descriptive data regarding the work history of participants was collected. Participants were invited to reposition a healthy volunteer before and after reviewing guidance detailing the 30° side-lying technique. The researchers measured the resulting turn angles and assessed offloading of bony prominences.

RESULTS

The repositioning technique varied considerably in the sample of nurse participants. Turn angles decreased following the guidance, but offloading of body sites vulnerable to pressure damage remained sporadic.

CONCLUSION

Pressure ulcer prevention training should include practical demonstrations of repositioning. Clear guidance regarding the optimal repositioning technique for pressure ulcer prevention is needed.

The physiological response of soft tissue to periodic repositioning as a strategy for pressure ulcer prevention

BACKGROUND

Individuals who have reduced mobility are at risk of developing pressure ulcers if they are subjected to sustained static postures. To reduce this risk, clinical guidelines advocate healthcare professionals reposition patients regularly. Automated tilting mechanisms have recently been introduced to provide periodic repositioning. This study compared the performance of such a prototype mattress to conventional manual repositioning.

METHODS

Ten healthy participants (7 male and 3 female, aged 23-66 years) were recruited to compare the effects of an automated tilting mattress to standard manual repositioning, using the 30° tilt. Measures during the tilting protocols (supine, right and left tilt) included comfort and safety scores, interface pressures, inclinometer angles and transcutaneous gas tensions (sacrum and shoulder). Data from these outcomes were compared between each protocol.

FINDINGS

Results indicated no significant differences for either interface pressures or transcutaneous gas responses between the two protocols (P>0.05 in both cases). Indeed a small proportion of participants (~30%) exhibited changes in transcutaneous oxygen and carbon dioxide values in the shoulder during a right tilt for both protocols. The tilt angles at the sternum and the pelvis were significantly less in the automated tilt compared to the manual tilt (mean difference=9.4-11.5°, P<0.001). Participants reported similar comfort scores for both protocols, although perceived safety was reduced on the prototype mattress.

INTERPRETATION

Although further studies are required to assess its performance in maintaining tissue viability, an automated tilting mattress offers the ability to periodically reposition vulnerable individuals, with potential economic savings to health services.

Apparent monosomy 21 owing to a ring 21 chromosome: parental origin revealed by DNA analysis

A three and a half year old mildly retarded boy is presented. Karyotyping showed monosomy 21 (45,XY,-21) in all 50 metaphase spreads examined from two lymphocyte cultures, and in 20% of cells examined from cultured fibroblasts; the remaining 80% of cells showed a ring 21 chromosome (46,XY,r(21)(p1q22]. Molecular studies using chromosome 21 specific DNA probes confirmed the monosomy in blood and showed that the ring 21 chromosome was paternal in origin. Parental karyotypes were normal.

The effect of ultraviolet, visible and infrared radiation on the rabbit blood-aqueous barrier

We studied the effects of visible (400-750 nm), infrared (750-1100 nm), and ultraviolet (300-400 nm) radiation on the breakdown of the blood-aqueous barrier (BAB) in albino rabbit eyes using fluorophotometry and fluorescein-bound albumin. There was no evidence of BAB breakdown following exposure to visible (158 J cm-2) or infrared (106 J cm-2) radiation. Fluorescence was detected in the anterior chamber 15 min following ultraviolet (UV) (300-400 nm; 37 J cm-2 and 73 J cm-2) and ultraviolet-A (UV-A) (320-400 nm; 45 J cm-2 and 90 J cm-2) irradiation. This fluorescence peaked at 2 hr after irradiation. Reestablishment of the BAB, indicated by no detectable fluorescence, occurred in all animals after 24 hr. There was a significant increase in fluorescence with increasing UV-irradiation dosage in all groups (P less than 0.05). Comparison of BAB breakdown following exposure to ultraviolet 320-400 nm and 300-400 nm in the same dosage (45 J cm-2) indicated that the inclusion of shorter wavelength UV exposure produced a significantly higher degree of BAB breakdown (P less than 0.001).

Effects of selected repeated intravitreal chemotherapeutic agents

The toxic effects of repeated intravitreal injections of selected chemotherapeutic agents were studied in female albino rabbits. Three groups of eyes participated in each therapeutic regimen. Agents studied were doxorubicin (dox), 3 and 5 micrograms; 5-fluorouracil (5-FU), 0.375 and 1.0 mg; bleomycin (bleo), 15 micrograms; thiotepa (thio), 12 micrograms; etoposide (VP-16), 150 micrograms; and methotrexate (MTX), 600 mic. Toxicity was evaluated using electroretinography (ERG) in 66% and histopathology in 100% of eyes 5 weeks following the initial injection and at least 2 weeks after the final injection of each series. Eyes receiving 2 doses of dox 3 micrograms showed no toxicity. Eyes receiving 3 or more doses of dox 3 micrograms and those treated with 2 or more doses of dox 5 demonstrated toxicity proportional to the number of doses received. Eyes treated with 5-FU 0.375 or 1.0 mg showed no toxic reaction. Successive intravitreal injections of 5-FU, 0.375 mg and dox 5 micrograms, and 5-FU, dox, and bleo produced no toxicity. Eyes treated with successive intravitreal injections of 5-FU, dox, bleo, and thio displayed decreased ERG response. The addition of VP-16 and MTX resulted in further loss of ERG response and more severe histologic retinal changes.

Alterations in the blood-aqueous barrier of the rabbit eye after neodymium: YAG photodisruption

We studied the effects of the Nd:YAG laser on the blood-aqueous barrier following photodisruption of the anterior capsule, posterior capsule, and mid-vitreous of the albino rabbit eye with fluorophotometric techniques using albumin-bound fluorescein. After photo-disruption of the anterior capsule, fluorescence appeared in the anterior chamber at 30 minutes, peaked at two hours, and decreased almost to baseline values by 24 hours. No fluorescence was noted at any time in contralateral control eyes or in eyes receiving photo-disruption of the posterior capsule or mid-vitreous.