Preventing pressure ulcers in long-term care

The purposes of this research project are the following:

– to develop the knowledge test for pressure ulcer prevention
– to develop the instrument of Pressure Ulcer Prevention Practice (PUPreP)
– to develop and implement an intervention based on the guidelines of pressure ulcer prevention
– to evaluate knowledge, attitudes and consistent practices of pressure ulcer prevention

The research consists of three sub studies:
I. Preventing pressure ulcers in long-term care facilities (2015 – 2019)
II. Knowledge, attitude and consistent practice of pressure ulcer prevention in specialized and primary health care (2018 – 2019)
III. Knowledge and attitude of pressure ulcer prevention in an out-hospital emergency care (2016 – 2019)

Sub studies

Sub Study I: Preventing pressure ulcers in long-term care facilities (2015 - 2019)

Part I (2015 – 2017)  
The purpose of the first part is to study prevalence as well as pressure ulcer prevention practices and care among older people in long-term care facilities.

Sample and method
Three structured questionnaires related to pressure ulcer patients, health professionals’ knowledge and practices of pressure ulcer prevention and treatment. Data consists of 62 organizations in public and private health care who provide older people in long-term care facilities and pressure ulcer patients (n=112 patients with 158 PUs).
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Part II (2016 – 2019) 
The second part of the study is based on the first part. The purpose of the second part is to develop and implement an intervention based on international guidelines for pressure ulcer prevention, which focuses on older people in long-term care facilities and evaluate its effectiveness.

Sample and method
The sample of this study is of older people and staff in long-term care units (two intervention wards and two control wards: 260 patients, 141 nurses).
Data was collected with three structured questionnaires and from the patients’ records before, after (both in intervention and control wards) and during intervention (follow-up data only in intervention wards).
Development and implementation of pressure ulcer intervention in the four phases Operational Model for Evidence-Based Practices (OMEBP)

The four phases of development include:  
1. Assess the development needs of current practice;
2. Plan that the practice is consistent in accordance with the evidence;
3. Describe the consistent EBP and implement of the new practice during decision-making;
4. Evaluate continuous practices

The intervention was developed together during four development days with staff, researchers and experts in pressure ulcer. Before and during the implementation of intervention, staff members were trained in pressure ulcer prevention and documentation.
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Part III (2016-2019)
The purpose of the third part is to describe the roles of ward nurses and nurses in the management of EBP in four long-term-care units according to four phases of OMEBP.

Sample and method
Nine focus group interviews were conducted with the staff members who participated in the development days (practical nurses, registered nurses and four ward nurses).

Research team
Elina Haavisto, Professor, PhD, RN, Principal investigator 1
Helena Leino-Kilpi, Professor, Head of the Department, PhD, RN, FEANS 1 Nurse director (part time) 4
Anna Hjerppe, MD, MD, Chief Physician, Clinical Teacher, Special Competence in Wound Healing, Clinic of Dermatology, Satakunta Hospital District, Department of Medicine, University of Turku, Finnish Medial Association 2
Marita Koivunen, Docent, PhD, RN, Head Nurse of the development 1, 2
Eija Luotoja, RN,  Wound nurse 2
Arja Holopainen, PhD, RN, Research Director 3
Teija Korhonen, PhD, RN, Researcher 3
Anne-Maria Kanerva, PhD, Senior Lecturer, Team Leader, Health 5

1 University of Turku, Department on Nursing Science
2 Hospital District of Satakunta
3 Nursing Research Foundation
4 Hospital District of Southwest Finland
5 Satakunta University of Applied Sciences

PhD-research related to topic
Sirpa Mäki-Turja-Rostedt, “Preventing pressure ulcers in long-term care -development and evaluation of an intervention”

Sub-study II : Knowledge, attitude and consistent practice of pressure ulcer prevention in specialized care and in primary health care (2018-2020)

The purpose of the study is to examine knowledge, attitude and consistent practices of nursing staff in pressure ulcer prevention as well as to evaluate validity and reliability of instruments used in the study.

Sample and method
Data was collected with three structured instruments in two hospital districts.

Research team
Elina Haavisto, Professor, PhD, RN, Principal investigator 1
Marita Koivunen, Docent, PhD, RN, Head Nurse of the development 1, 2
Anne Kuusisto, Post doc – researcher, PhD 1, 2

1 University of Turku, Department on Nursing Science
2 Hospital District of Satakunta

Partner
Hospital District of Etelä-Pohjanmaa

Sub-study III: Knowledge and attitude of pressure ulcer prevention in an out-hospital emergency care (2016-2019)

The purpose of the sub-study is to examine knowledge and attitude of pressure ulcer prevention among staff working in emergency nursing care and to compare these between Finnish and Swedish staff.

Sample and method
The research material consists of 250 emergency medical service personnel in Finland and 200 personnel in Sweden. Data was collected using two structured instruments.

Research team 
Castrén Maaret, professor,PhD, Emergency medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Haavisto Elina, professor, PhD, University of Turku, Department of Nursing, Hospital District of Satakunta.
Marja Mäkinen, PhD, Emergency medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Brolin Karin, Department of Emergency Medicine at Södersjukhuset and Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Sweden.
Lindström Veronica, PhD, Department of Emergency Medicine at Södersjukhuset and Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Sweden.

Publications

Selected publications

Mäki-Turja-Rostedt S, Leino-Kilpi H, Stolt M, Haavisto E. Preventive interventions for pressure ulcer in long-term older people care facilities: A systematic review. 2018. Journal of Clinical Nursing DOI: 10.1111/jocn.14767.

Stolt M, Hjerppe A, Hietanen H, Puukka P, Haavisto E. Local treatment of pressure ulcers in long-term care. Accepted for publication in Journal of Wound Care.

Korhonen T, Holopinen A, Kanerva A-M, Petman S, Haavisto E. The role of ward managers when developing consistent evidence-based practises in long-term care facility: A qualitative study . Submitted.

Haavisto E, Kielo E, Hjerppe A, Puukka P, Stolt M. Consistent practices in PU prevention based on guidelines at long-term care facilities. Submitted.

Stolt M, Kielo E, Haavisto E. Näyttöön perustuva haavojen hoito (Evidence based treatment of pressure ulcer). In Juutilainen V, Hietanen H (eds.). 2018. Haavanhoidon periaatteet. Sanoma Pro Oy, Helsinki.

Conference presentations

Mäki-Turja-Rostedt S, Leino-Kilpi H, Hupli M, Haavisto E. Painehaavojen ehkäisemisen käytänteet ympärivuorokautisisssa vanhuspalveluyksiköissä. XIV Kansallinen hoitotieteellinen konferenssi. Hoitotiede – Vahva ja Vapaa, 28.- 29.9.2016, Turku.

Mäki-Turja- Rostedt S, Leino-Kilpi H, Haavisto E. Consistent practices in prevent of pressure ulcers. One Voice for Pressure Ulcer Prevention and Treatment. Challenges and Opportunities for Practice, Research and Education. The 19th Annual meeting of the European Pressure Ulcer Advisory Panel 21-22.9.2017, Belfast, Northern Ireland.

Principal Investigator

Elina Haavisto Professorelina.haavisto@utu.fi