Use of Pressure-Redistributing Support Surfaces Among Elderly

According to Baumgarten et al. (2010), the study’s purpose was to “estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS” (p. 253). The study also aimed to test the validity of the positivist approach to explaining the actual factors that predetermine the increased rates of PRSS usage in hospital settings.

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The study contains several references to the discursively similar research-projects that have taken place in the past, such as the 1998 study by Perneger, Heliot, Rae, Borst, and Gaspoz, or the 2008 study by Tannen, Dassen and Halfens. The analysis of these studies made it possible for the authors to conclude that there is an apparent lack of consistency in how different healthcare practitioners perceive the correlation between the risk factors of pressure ulcer, on one hand, and the likelihood for the concerned patients to decide in favor of using PRSS, on the other.

The study fits into the methodological framework of an ‘analytical deductive inquiry’ – the authors strived to find empirical evidence, in support of the study’s initial hypotheses. This explains why the concerned study placed a heavy emphasis on the quantification of the empirically obtained data.

Before conducting the empirical/analytical phases of their study, the authors came up with two major hypotheses: a) patients with higher chances to develop pressure ulcer should be more likely to consider requesting PRSS, b) there should be more instances of patients using PRSS in the acute care settings because these settings presuppose the prolonged immobility of the former.

Among the study’s main independent variables can be named the severity of pressure ulcer risk factors, patients’ age, and the type of the affiliated hospital-settings (acute hospital, nursing home, rehabilitation center). The dependent variables include the actual type of PRSS (such as wheelchair cushions, heel protectors, etc.) and the rate of hip fracture patients’ affiliation with PRSS in each hospital, as well as the overall (combined) rate of PRSS usage by the study’s participants.

The study’s foremost assumption (the actual premise behind the mentioned hypotheses) was that the distributional characteristics of elderly hip fracture patients’ affiliation with PRSS in both: acute and rehabilitation hospital settings, corresponding to the essentially intuitive rules of logic.

The study’s limitations have to do with: a) the factor of observational biases/inaccuracy, on the part of the research nurses, b) the fact that no consideration was given to the possibility for the varying rate of PRSS use in every individual facility to be spatially incidental, c) the fact that even though, throughout the study’s entirety, the authors continued to make references to ‘high-pressure ulcer risk’, there is no universally accepted definition to the notion in question.

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The study’s sampled participants consisted of 658 patients (aged > 65 years), who at the time of having been approached by the research nurses, were recovering from hip fracture surgery. The average age of participants is estimated to account for 83.2 years. About one-quarter of the participants were male. The studied sample featured a high degree of racial homogeneity (98% of participants were Caucasian).

In essence, the authors’ methodological approach to conducting their study involved assigning every individual participant with the Braden Scale score (the lower the score, the higher is the probability for him or her to develop pressure ulcer), and relating it to the varying measure of his or her association with PRSS. The participating patients were also ranked within the methodological framework of the Rand Sickness at Admission Scale and the Charlson comorbidity index.

The data-collection process was concerned with the research nurses observing the sampled participants (in regards to the presence/absence of PRSS in the affiliated care-settings) on alternating days for 21 days and taking note of their observations.

The received data analysis was conducted by the mean of constructing the generalized estimating equations, with the independent variables of pressure ulcer risk factor/the qualitative specifics of the affiliated care settings, on one hand, and the dependent variable of the binominal distribution of PRSS, on the other.

The study’s main finding was that there is “the lack of association between pressure ulcer risk factors and use of PRSS, both in the analysis that included all settings and in the analysis limited to the initial acute hospital stay” (Baumgarten et al., 2010, p. 256). Contrary to what was the study’s initial hypothesis, the authors came to conclude that the Braden score of every individual participant does not define the concerned person’s likelihood to end up requesting PRSS. In its turn, this prompted the authors to suggest the rate of PRSS use by patients with high-pressure ulcer risk, is not the subject of the applicable rules and regulations, in this respect, but rather the subject of what happened to be the financial situation in a particular healthcare institution that provides treatment for patients with hip fracture.

References

Baumgarten, M. et al. (2010). Use of pressure-redistributing support surfaces among elderly hip fracture patients across the continuum of care: Adherence to pressure ulcer prevention guidelines. Gerontologist, 50 (2), 253-262.

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