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

Part I Prevalence, pressure ulcer prevention and local care (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).

Part II Preventing pressure ulcers in long-term care development and evaluation of an intervention (2016 – 2020)

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.

Part III Managing development of evidence-based consistent practices of PU prevention (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) 1,4
Anna Hjerppe, MD, MD, Chief Physician, Clinical Teacher, Special Competence in Wound Healing, Clinic of Dermatology,, University of Turku, Finnish Medial Association 2
Marita Koivunen, Docent, PhD, RN, Head Nurse of the development 1, 2
Arja Holopainen, PhD, RN, Research Director 3
Teija Korhonen, PhD, RN, Researcher 3
Anne-Maria Kanerva, PhD, Senior Lecturer, Team Leader, Health 5
Castrén Maaret, professor,PhD, Emergency medicine 6
Marja Mäkinen, PhD, Emergency medicine 6
Brolin Karin7, 8
Lindström Veronica 9
Anne Kuusisto, Post doc – researcher, PhD 1, 2

  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
  6. University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
  7. Academic EMS, Stockholm, Sweden
  8. The Ambulance Medical Service in Stockholm (AISA), Sweden
  9. Department of Emergency Medicine at Södersjukhuset and Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Sweden

 

PhD-research related to topic

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

Partner

Hospital District of Etelä-Pohjanmaa

Funded by

Betania Foundation
State Research Funding (Hospital District of Satakunta)
The Research Foundation of Nursing Education
the Finnish Cultural Foundation
Government research funding (Satakunta Hospital District and Turku University Hospital) Finnish Wound Care Society
Satakunta Central Hospital
Helsinki University Hospital.

Publications

Selected publications

Mäki-Turja-Rostedt S, Leino-Kilpi H, Korhonen T, Vahlberg T, Haavisto E. 2020. Consistent practice for pressure ulcer prevention in long term older people care: A quasi-experimental intervention study. Scandinavian Journal of Caring Science. https:/doi.org/10.1111/scs.12917.

Mäkinen M, Haavisto E* (first author position*), Lindsrtöm V, Brolin K, Castren M. 2020. Finnish and Swedish prehospital emergency care providers’ knowledge and attitudes towards pressure ulcer prevention. :https: //dx.doi.org/10.1016/j.ienj.2020.100873. International Emergency Nursing.

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.

Korhonen T, Holopainen A, Kanerva A-M, Petman S, Haavisto E. 2020. The role of ward managers when developing consistent evidence-based practices in long-term care facility: A qualitative study. The Malaysian Journal of Nursing 11(4): 52-64. https://doi.org 10.31674/mjn.2020.v11i04.005.

Stolt M, Hjerppe A, Hietanen H, Puukka P, Haavisto E. 2019. Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study. Journal of Wound Care 28 (6) June, 409-415. https://doi.org/10.12968.jowc.2019.28.6.409.

Haavisto E, Kielo E, Hjerppe A, Puukka P, Stolt M. Consistent pressure ulcer (PU) prevention practices based on guidelines for long-term care facilities in Finland. Submitted.

Parisod H, Holopainen A, Koivunen M, Puukka P, Haavisto E. Factors determining nursing knowledge on evidence-based pressure ulcer prevention practices in Finland: A correlational cross-sectional study. Submitted.

Parisod H, Holopainen A, Kielo-Viljanmaa E, Puukka P, Beekman D, Haavisto E. Nursing staff’s attitudes towards pressure ulcer prevention in primary and specialized health care – A correlational cross-sectional study. 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

Hoitotyöntekijöiden osaaminen näyttöön perustuvista painehaavojen ehkäisyn Parisod H, Holopainen A, Koivunen M, Puukka, Haavisto E. XIV Kansallinen hoitotieteellinen konferenssi. Hoitotiede – Vahva ja Vapaa, 28.- 29.9.2016, Turku.

Yhtenäisen näyttöön perustuvan käytännön kehittäminen uniapneapotilaan ohjaukseen. Heino M, Koivunen M, Haavisto E. XVI Kansallinen hoitotieteellinen konferenssi perustutkimuksesta innovaatioihin hoitotieteessä. Kuopio 30.9.-1.10.2020.

Yhtenäisen painehaavojen ehkäisyn käytännön vaikuttavuus painehaavojen esiintyvyyteen vanhuspalveluyksiköissä. Mäki-Turja- Rosted S, Leino-Kilpi H, Haavisto E.XVI Kansallinen hoitotieteellinen konferenssi perustutkimuksesta innovaatioihin hoitotieteessä. Kuopio 30.9.-1.10.2020.

Vaikuttavat painehaavojen ehkäisyn interventiot vanhuspalveluyksiköissä – systemaattinen katsaus. Mäki-Turja-Rostedt S, Leino-Kilpi H, Korhonen T, Haavisto E. Satakunnan sosiaali- terveys- ja hyvinvoinnin tutkimuksen päivä 21.2.2020. Porin yliopistokeskus, Pori.

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

Consistent practices in prevent of pressure ulcers. Mäki-Turja- Rostedt S, Leino-Kilpi H, Haavisto E. 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