Problem Statement
When people choose nursing home services, they expect high-quality care, support, and treatment at all levels. Older adults who do not have spouses and are seriously ill decide to move to such facilities for physical and mental well-being maintenance. There are more than 15,600 nursing homes with about 1.3 million residents (Harris-Kojetin et al., 2019). However, despite the offered professionalism and medical knowledge, there are many types of abuse and neglect, and the growth of bedsores is one of them. Poor nutrition, a lack of attention to repositioning, the patient’s weight, and uncontrolled friction may contribute to the progress of this problem. Bedsores, also known as pressure sores, pressure ulcers, or decubitus ulcers, are physiological injuries that emerge due to prolonged pressure on the skin and local interference with circulation (Anthony et al., 2019). In most cases, nursing home residents live a sedentary lifestyle, and it is hard for the staff to examine every patient thoroughly and regularly to predict bedsores. Some risk factors remain neglected, while preventive strategies are poorly implemented in relation to all patients in a timely manner.
There are four stages of bedsores characterized by different signs, symptoms, and outcomes, starting with redness without skin breaks and ending with bone or muscle damage. More than 2.5 million hospitalizations are related to pressure ulcers: in about 90% of cases, the first two stages are reported (Borojeny et al., 2020). The task is to notice skin damage as soon as possible and offer the necessary treatment to prevent complications in other body systems. However, increased statistics prove that bedsores introduce a serious concern in older adults’ health care. Therefore, in nursing homes, the problem of common pressure ulcers in older patients cannot be ignored, with special attention to analyzing nursing home staff knowledge about the impact of risk factors and current preventive strategies.
Purpose Statement
This study will examine the current findings about bedsores’ risk factors and strategies that nursing homes should apply to predict the growth of the problem. The main intention is to improve pressure ulcer statistics in the chosen healthcare setting and the overall quality of care offered to older adults. It is not enough to learn what healthcare practitioners know and do right or wrong. It is more important to identify which steps can be more effective for their implementation in all nursing homes in the country. According to Anthony et al. (2019), pressure ulcers are caused by poor quality nursing care, patient immobility, and the absence of a particular care model. In their studies, researchers underline the worth of the Pressure Ulcer Daily Risk Assessment, the SSKIN (surface, skin inspection, keep moving, incontinence and moisture, nutrition and hydration), or the Behavior Change Wheel framework (Anthony et al., 2019; Lavallée et al., 2019a). The purpose of this project is to clarify what nursing home workers know about bedsore risk factors and define which preventive strategies are most effective for preventing this health condition among older adults.
A qualitative description will allow to summarize the main concepts in the chosen context and define which preventive steps are critical for patients with bedsores. Data generation helps to answer “who,” “what,” “where,” and “how” questions. Other researchers demonstrated successful results using similar approaches within their preferred environments. For example, Li et al. (2022) examined the activities of registered nurses in China in preventing pressure ulcers with the help of qualitative descriptive interviews. Naderi et al. (2019) used an exploratory qualitative study to examine elder abuse in Iranian hospitals by interviewing patients and their families. The target population will be nursing home employees who will share their knowledge and assess the effectiveness of the preferred pressure sores strategies.
At this moment, it is hard to implement new interventions within nursing homes due to the inability to predict COVID-19 outcomes and the desire of older adults to cooperate with other people. Therefore, face-to-face collaboration is restricted, and descriptive and explanatory approaches are preferred. Bedsores can become a serious health problem in older patients if it remains poorly recognized or untreated. Therefore, the initial stage of further improvement should include the background knowledge and essential skills for nurses to develop while working with the residents of nursing homes. This study aims at creating an informative basis about bedsores from the point of view of healthcare providers, addressing two particular issues – risk factors and preventive strategies. When enough descriptive information is obtained, it will be possible to implement these findings from new perspectives, like patients’ opinions, real-life interventions, and policy-making. It is expected to describe the risks of developing a particular health condition and examine the steps for nurses to take and predict bedsores in older residents of nursing homes.
Research Question
A new question should be formulated regarding the problem of increased pressure ulcers among nursing home residents and the purpose of evaluating the level of nurses’ knowledge about this health condition’s risk factors and strategies. Preventing such serious physiological injuries as bedsores is a complex process that requires high-level knowledge, cooperation, and resources. Modern nursing homes are usually equipped with appropriate materials, and the staff has access to various possibilities. Researchers continue developing new strategies and approaches to stabilize care delivery and support residents. For example, Lavallée et al. (2019b) introduce the pressure ulcer prevention care bundle consisting of three elements, namely skin inspection, support surface, and repositioning. Boyko et al. (2018) describe gauze/foam/alginate dressings and other treatment modalities depending on wound size, depth, and location. However, the promotion of information does not define the level of knowledge among nurses. Therefore, a new study should examine what care providers actually knowledge about bedsores and what steps they are programmed to take to reduce pressure injuries.
The major research question to answer is based on the evaluation of nurses’ knowledge about the chosen hospital-acquired conditions. What do nurses know about bedsores’ risk factors and preventive strategies to improve care quality at nursing homes and reduce the incidence of this hospital-acquired condition among older adults? As soon as participants share their ideas and facts about bedsores, they will be able to analyze their contributions to care delivery quality. It might happen that governments and other funding organizations spend different resources and offer solid financial support to create safe and favorable conditions for nursing home residents. However, no or a few positive results are obtained, and pressure ulcer prevalence is hard to control (Anthony et al., 2019). A variety of alternatives are usually offered and described in sources, covering the basics of patient optimization and contamination control (Boyko et al., 2018). Nurses can have some general awareness of these ideas and their obligations but fail to apply their knowledge properly in real settings.
The formulation of the question helps align the problem (increased bedsore cases at nursing homes) and the purpose (to clarify nurses’ theoretical and practical knowledge). The offered qualitative research question seeks to describe the responses of participants and focuses on a single phenomenon, which is pressure ulcers. The participants are clearly identified and free to give different answers that must be reviewed and systematically analyzed.
Data Collection, Reliability, and Validity
Choosing an appropriate research method is a final step in this plan to achieve the defined goal and answer the research question based on the offered problem. In this study, qualitative data should be gathered, and several ways can be applied. The main idea of collecting qualitative information is to obtain people’s perceptions, analyze experiences, and describe problematic areas (Denzin & Lincoln, as cited in Johnson et al., 2020). This method helps better understand a situation or problem and develop a background for further studies in the same field. Phenomenology is a research methodology that concentrates on human experiences with some particular phenomenon. Instead of generalizing information and addressing random sampling design, it is important to identify a specific context and select individuals with appropriate practical skills (Johnson et al., 2020). Bedsore-related problems have been investigated for a long period, and the inability to predict damage proves that more analysis and descriptions are required. This phenomenon needs more assumptions to be developed, and communication with real people is one of the best ways to find answers and contribute to the current discussion.
In this case, qualitative data will be collected from interviews (oral form) or open-ended questionnaires (written form) with nurses who work at nursing homes and face bedsores in their practice. It is planned to cooperate with 15-20 nurses from several nursing homes in the United States. This choice of participants meets a general requirement of validity and reliability. Qualitative interviews are usually in-depth and semi-structured because the task is to gather different opinions on a particular topic and achieve saturation. There will be three main questions for interviews and questionnaires. The first question is, “What are the risk factors for bedsores among nursing home residents?”. The second question is, “What are the strategies to prevent pressure ulcers in older adults?”. The last question is, “What steps do nurses take to reduce bedsores in patients?”. This formulation allows clarifying what nurses know at the moment of the study and how they apply their knowledge in practice. All interviews are voluntary, and informed content is offered to cover the details of the project, the roles of participants, and the guarantees that the researcher offers.
Reliability and validity of measurement aim at reducing errors in a research process. Validity shows the extent to which the chosen data collection instrument is valid. Reliability is assessed to define if measuring the same phenomenon gives similar results. The number of participants from the same nursing field ensures validity or the accuracy of the study. The choice of clear questions within the chosen hospital-acquired condition ensures reliability or the consistency of the measure. The responses are stable and detailed, which allows using several codes and themes. One of the validity measure steps is to ask such questions if the whole project makes sense and if it is possible to trust the results. Reliability measures depend on participants because their answers should be honest and thorough. Therefore, the researcher should think over practical aspects and remove biases if possible. In general, the chosen data collection methods, questions, goals, and problems are critical for improving nursing home care processes and reducing bedsores in patients.
References
Anthony, D., Alosoumi, D., & Safari, R. (2019). Prevalence of pressure ulcers in long-term care: A global review. Journal of Wound Care, 28(11), 702–709.
Borojeny, L. A., Albatineh, A. N., Dehkordi, A. H., & Gheshlagh, R. G. (2020). The incidence of pressure ulcers and its associations in different wards of the hospital: A systematic review and meta-analysis. International Journal of Preventive Medicine, 11. Web.
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57–67.
Johnson, J. L., Adkins, D., & Chauvin, S. (2020). A review of the quality indicators of rigor in qualitative research. American Journal of Pharmaceutical Education, 84(1).
Harris-Kojetin, L., Sengupta, M., Lendon, J. P., Rome, V., Valverde, R., & Caffrey, C. (2019). Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics.
Lavallée, J. F., Gray, T. A., Dumville, J. C., & Cullum, N. (2019a). Preventing pressure injury in nursing homes: Developing a care bundle using the behaviour change wheel. BMJ Open, 9(6).
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019b). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & Social Care in the Community, 27(4), 417-427.
Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Registered nurses’ approach to pressure injury prevention: A descriptive qualitative study. Journal of Advanced Nursing, 78, 2575-2585.
Naderi, Z., Gholamzadeh, S., Zarshenas, L., & Ebadi, A. (2019). Hospitalized elder abuse in Iran: A qualitative study. BMC Geriatrics, 19(1).