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Is it feasible to use incontinence-associated dermatitis assessment tools in routine clinical practice in the long-term care setting?

Is it feasible to use incontinence-associated dermatitis assessment tools in routine clinical practice in the long-term care setting?
Is it feasible to use incontinence-associated dermatitis assessment tools in routine clinical practice in the long-term care setting?
PURPOSE: To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients.

DESIGN: Feasibility study.

SUBJECTS AND SETTING: Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses.

METHODS: Weekly high-quality photographs were taken of the skin beneath absorptive pads of nursing home residents for 8 weeks yielding a library of 78 photographs. A subset of 10 representative photographs was chosen. The 16 nursing home staff and 10 TVS nurses were then asked to describe and grade the IAD in the 10 photographs using 3 IAD instruments and simple severity scoring system (SSS) developed for this study. Particular attention was paid to identifying any practical challenges staff encountered in conducting their task.

RESULTS: The TVS nurses were able to use all 3 IAD instruments and the SSS and reported that they could incorporate them into their clinical practice with relative ease. Although the RNs were able to use the 3 instruments adequately with some initial assistance, they generally felt that they were too busy to complete them. By contrast, they reported that they found the SSS simple and quick enough to incorporate into their routine practice. The caregivers had difficulty with the text-based instruments, especially if English was not their first language, and they were only able to use the SSS. The caregivers' SSS scores for a given photograph varied more than TVS nurse scores, but the correlation between the mean TVS scores, which were operationally defined as the gold standard for purposes of this study, and the mean RN and caregiver scores (R = 0.811) were fairly high.

CONCLUSIONS: Existing IAD instruments are too time-consuming and linguistically complex for use in routine clinical practice in nursing homes. We found that staff generally found the SSS easy to judge IAD severity based on pictures used in the study. This finding suggests that the SSS could be improved by adding reference photographs of skin illustrating each of the 4 points on the scale. Such an instrument could be designed and validated with an emphasis on integration into current clinical practice pathways.
absorbent pads, IAD, long-term care, skin health
1071-5754
379-388
Clarke-OʼNeill, Sinead
cd2b6b81-411b-4c3b-8625-9bb9b2d6ec38
Farbrot, Anne
6b87a112-541a-4199-a4df-dd0006dd1f9a
Lagerstedt Eidrup, Marie-Louise
df6229d7-c1d7-4935-8a96-6f7800072473
Cottenden, Alan
2e71598a-de0c-45e2-8321-aa6f5780e284
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277
Clarke-OʼNeill, Sinead
cd2b6b81-411b-4c3b-8625-9bb9b2d6ec38
Farbrot, Anne
6b87a112-541a-4199-a4df-dd0006dd1f9a
Lagerstedt Eidrup, Marie-Louise
df6229d7-c1d7-4935-8a96-6f7800072473
Cottenden, Alan
2e71598a-de0c-45e2-8321-aa6f5780e284
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277

Clarke-OʼNeill, Sinead, Farbrot, Anne, Lagerstedt Eidrup, Marie-Louise, Cottenden, Alan and Fader, Mandy (2015) Is it feasible to use incontinence-associated dermatitis assessment tools in routine clinical practice in the long-term care setting? Journal of Wound, Ostomy and Continence Nursing, 42 (4), 379-388. (doi:10.1097/WON.0000000000000129).

Record type: Article

Abstract

PURPOSE: To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients.

DESIGN: Feasibility study.

SUBJECTS AND SETTING: Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses.

METHODS: Weekly high-quality photographs were taken of the skin beneath absorptive pads of nursing home residents for 8 weeks yielding a library of 78 photographs. A subset of 10 representative photographs was chosen. The 16 nursing home staff and 10 TVS nurses were then asked to describe and grade the IAD in the 10 photographs using 3 IAD instruments and simple severity scoring system (SSS) developed for this study. Particular attention was paid to identifying any practical challenges staff encountered in conducting their task.

RESULTS: The TVS nurses were able to use all 3 IAD instruments and the SSS and reported that they could incorporate them into their clinical practice with relative ease. Although the RNs were able to use the 3 instruments adequately with some initial assistance, they generally felt that they were too busy to complete them. By contrast, they reported that they found the SSS simple and quick enough to incorporate into their routine practice. The caregivers had difficulty with the text-based instruments, especially if English was not their first language, and they were only able to use the SSS. The caregivers' SSS scores for a given photograph varied more than TVS nurse scores, but the correlation between the mean TVS scores, which were operationally defined as the gold standard for purposes of this study, and the mean RN and caregiver scores (R = 0.811) were fairly high.

CONCLUSIONS: Existing IAD instruments are too time-consuming and linguistically complex for use in routine clinical practice in nursing homes. We found that staff generally found the SSS easy to judge IAD severity based on pictures used in the study. This finding suggests that the SSS could be improved by adding reference photographs of skin illustrating each of the 4 points on the scale. Such an instrument could be designed and validated with an emphasis on integration into current clinical practice pathways.

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More information

Published date: July 2015
Keywords: absorbent pads, IAD, long-term care, skin health
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 385739
URI: http://eprints.soton.ac.uk/id/eprint/385739
ISSN: 1071-5754
PURE UUID: d8a146fd-0eee-46c0-985b-3e9d0473aaa1

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Date deposited: 21 Jan 2016 15:00
Last modified: 14 Mar 2024 22:22

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Contributors

Author: Sinead Clarke-OʼNeill
Author: Anne Farbrot
Author: Marie-Louise Lagerstedt Eidrup
Author: Alan Cottenden
Author: Mandy Fader

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