103907449.pdf - Research for Practice Attitudes of Nurses Toward Pressure Ulcer Prevention A Literature Review Shirley M Waugh hile most pressure

103907449.pdf - Research for Practice Attitudes of Nurses...

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September-October 2014 • Vol. 23/No. 5 350 Shirley M. Waugh, MSN, RN, is Doctoral Nursing Student, Kansas University Medical Center, Kansas City, KS, and Adjunct Instructor, Washburn University, School of Nursing, Topeka, KS. Acknowledgment: The author would like to acknowledge Kansas University faculty member Dr. Phoebe Williams for her instruction and guidance in writing this manuscript. Attitudes of Nurses Toward Pressure Ulcer Prevention: A Literature Review W hile most pressure ulcers (PUs) are considered avoidable, these wounds remain a significant problem in acute and long-term care settings (Black et al., 2011; Shahin, Dassen, & Halfens, 2008; U.S. Department of Health & Human Services [HHS], 2012). HealthGrades, Inc. (2011) reported occurrence of 368,261 PUs in nearly 14 million Medicare patients hospitalized from 2007 through 2009 (2.7% incidence). These ulcers contributed to nearly $2 billion in health care costs. By 2009, PU incidence among nursing home residents was 7.6% (HHS, 2012). Well-known and commonly ac- cepted PU prevention guidelines are available (National Guideline Clear inghouse, 2011), yet these prevention strategies are not per- formed consistently (Beeckman, Defloor, Schoonhoven, & Vander - wee, 2011; Compas & Brown, 2009; Dunleavy, 2008; Källman & Suserud, 2009; O’Brien, 2009; Rapp et al., 2010; Rich et al., 2011; Sving, Gunningberg, Högman, & Mamhidir, 2012). Although suc- cessful PU prevention requires a multidisciplinary approach, re - sponsibility for assessment and intervention generally lie with direct-care nurses (Institute for Healthcare Im provement [IHI], 2011; Walker, Van Sell, & Kindred, 2010). Nurses first must identify patients at risk for PU development and then provide appropriate pre- vention interventions (Compas & Brown, 2009; Duncan, 2007; IHI, 2011; National Pressure Ulcer Advisory Panel [NPUAP]/European Pressure Ulcer Advisory Panel [EPUAP], 2009; Young, Ernsting, Kehoe, & Holmes, 2010). Any re- search concerning PU prevention thus should consider variables related to nurses (Moore, 2010). Research on preventing PUs has focused primarily on patient vari- ables, such as risk assessment, mobility, pressure-reducing equip- ment, friction and shear, and nutri- tion (Athlin, Idvall, Jernfält, & Johansson, 2009; Langer, Knerr, Kuss, Behrens, & Schlömer, 2008; McInnes, Jammali-Blasi, Bell-Syer, Dumville, & Cullum, 2011; Moore & Cowman, 2008; Spencer, 2008). Additional research has focused on nurses’ education and knowledge of PU prevention, but improved knowledge has not been linked con- sistently with improved care (Armstrong et al., 2008; Athlin et al., 2009; Beeckman et al., 2011; Dunleavy, 2008; Moore, 2010; Young et al., 2010). Examining nurses’ attitudes toward PU preven- tion may help explain nurses’ per- formance of preventive measures. The purpose of this article is to dis- cuss the current evidence on nurses’ attitudes toward PU prevention. Background The NPUAP/EPUAP (2009) de - fined pressure ulcers as “localized injury to the skin and/or underlying tissue usually over a bony promi- nence, as a result of pressure, or pres- sure in combination with shear” (p. 19). A pressure ulcer is classified by stages that correspond with the degree of tissue damage as follows: Stage I, intact nonblanchable red or pink skin
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