Preventing pressure ulcers in the home requires creative solutions by nurses
Many patients in hospitals and long-term care facilities are prone to pressure ulcers. However, pressure ulcers can also occur in individuals being cared for at home. A new study found that wound care nurses use many of the preventive interventions recommended for the institutional setting, but also use new approaches and creative solutions to avoid pressure ulcer development during home care.
The researchers conducted a focus group with nine certified wound care nurses, who had 5 or more years of wound care experience and 10 or more years of home health experience. They all practiced their clinical skills in the home care setting at least half of the time. During the 75-minute focus group discussion, the nurses were asked open-ended questions about how they cared for home-bound patients to prevent pressure ulcers.
Participating nurses felt it was important to do a skin assessment and assess for pressure ulcer risk when the patient was admitted for home health care. They provided individualized patient education and emphasized the importance of partnering with family or other caregivers to stop pressure ulcer occurrence. They routinely assessed caregiving resources, as well as the potential of caregivers to effectively manage pressure ulcer prevention care.
Providing appropriate preventive care was often challenging and sometimes frustrating. Medicare does not usually cover pressure redistribution surfaces or other prevention products for patients who are at risk for pressure ulcers. The nurses had to inquire about the patient's economic and insurance status to determine what interventions were feasible. Approaches to improving patient nutrition also required careful consideration of the patient's economic status. When insurance coverage was minimal or lacking and the patient could not afford the out-of-pocket expense, nurses contacted community resources and vendors to try and get materials and supplies needed by the patient. Most of the nurses agreed that knowledge of resources within their community is crucial to pressure ulcer prevention in home health care. The study was supported in part by the Agency for Healthcare Research and Quality (HS17353).
See "Adapting pressure ulcer prevention for use in home health care," by Sandra Bergquist-Beringer, Ph.D., R.N. and Christine Makosky Daley, Ph.D., in the Journal of Wound, Ostomy, and Continence Nursing 38(2), 145-154, 2011.
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