Prevention of pressure sores in hospital and community with special reference to the time spent for care
The main purpose of this study was to evaluate the amount of time which was spent in giving preventive pressure area care in both a sample of hospital patients and a sample of community patients. A pilot study was carried out to test the methodology, which was subsequently used with only minor modifications, for the main study. Bedfast or chairfast patients were studied from admission to the selected hospital wards or community nursing areas for a period of six weeks or until they were discharged from care, developed pressure sores, died, or became mobile. Data was collected by means of interviews and observations made of patients, nurses and relatives. A diary sheet was designed for use by nurses in hospital and by nurses and relatives in the community, on which they were asked to record pressure area care as it was given. Information collected by this means included the time spent in care, the method used and observation of the skin areas. The researcher also collected data about the patient's appetite, Norton Score, age, sex and diagnosis. The outcome measure used was whether or not the patient developed a pressure sore which was defined for this study as a break in the skin due to pressure. Due to geographical dispersion of patients within the community in the health district used for that part of the study, fewer community patients (n = 30) were included in the study than the number of hospital patients studied (n = 88). Discriminant analysis was used on the results to distinguish between groups of patients. Results of this study showed that a higher percentage (29%) of the hospital patients developed pressure sores than among the community patients studied (20%). The average total time spent on pressure area care daily was higher for the community patients than for the hospital patients. Interestingly, of the six community patients who developed pressure sores, five were dependent entirely upon the nursing service for pressure area care, whilst the usual pattern at home was that relatives and nurses shared the care. Frequency of pressure area care given showed a significant relationship with outcome for both hospital and community patients. It should be noted that whilst the number of patients who developed sores is reported here, and this is related to the total number of patients studied, this study is not an incidence or a prevalence study, and should not be considered as such. The study appears to show that nursing care devoted to the prevention of pressure sores in terms of time and frequency is significantly related to outcome and thus to effectiveness.