Patient perceptions and understanding of pressure ulcer risk and potential factors affecting adherence to prevention strategies in community settings

Abstract

Background: Pressure ulcers (PUs) are a key priority area for healthcare institutions, representing a patient safety issue, but despite global campaigns around awareness, incidence remains high. PUs are associated with ill health, poor mobility and reduced quality of life. Increasingly, patients are required to be aware of their PU risk and to self-manage their conditions, with a need to increase patient involvement in decision-making to promote adherence. To date, research is limited regarding patients’ own understanding of their PU risk and the factors that affect adherence to prevention techniques and advice given from Health Care Professionals. This is particularly significant in community settings, where patients are increasingly expected to self-manage long-term conditions.

Aims: This study aimed to address the following research questions: 1. What are patient perceptions and understanding of their PU risk? and 2.What factors affect their adherence or non-adherence to prevention strategies in community settings?

Method: This was a qualitative study using a pragmatic research approach. Data gathered included direct observations of nurse-patient interactions during nursing visits, collation of the PU patient information leaflet provided and follow-up in-depth interviews with patients. A total of 15 participants were successfully recruited for the study.
Findings: The study revealed four key overarching themes related to patient understanding of PU risk and potential factors affecting adherence to advice as: Pressure Ulcer Awareness, Risk & Prevention Knowledge, Patient Factors & Adherence, The Nursing Encounter and The Nursing Approach. Novel findings included that whilst patients understood PU risk in a basic sense, this did not necessarily secure adherence due to other patient related factors, such as pain, mood affects, fatigue, fear of falling and carer dependency. The patient information leaflet was not sufficient to secure patient understanding and adherence. The study observed two overall nursing approaches: a closed directive and a more open participatory approach. Use of an open participatory approach was pivotal in securing trust and enabling acknowledgement of dynamic patient related factors as part of shared decision-making.

Conclusion: The study provides important new insights for clinical practice in relation to how PU information and advice is provided and how decision-making occurs between nurse and patient and the effect of this on adherence. The findings were translated into a new conceptual risk model of PU prevention that places the patient perspective alongside the nursing perspective in partnership, with an open participatory nursing approach used to support shared decision-making

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Identifiers

ORCID for Peter Worsley: orcid.org/0000-0003-0145-5042

ORCID for Joanna Hope: orcid.org/0000-0002-8939-7045

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