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Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-8169-853X
Department of Health and Social Care, Strategic Development, Unit of Research, Quality and Education, Malmö, Swede.
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0001-5493-8334
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2021 (English)In: International Journal of Nursing Studies Advances, E-ISSN 2666-142X, Vol. 3, article id 100056Article in journal (Refereed) Published
Abstract [en]

Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n = 21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 3, article id 100056
Keywords [en]
Elderly, Falls, Focus group, Health care staff, Malnutrition, Managers, Poor oral health, Pressure ulcers, Prevention, Qualitative
National Category
Nursing
Identifiers
URN: urn:nbn:se:mau:diva-48429DOI: 10.1016/j.ijnsa.2021.100056ISI: 001026269700003Scopus ID: 2-s2.0-85120753134OAI: oai:DiVA.org:mau-48429DiVA, id: diva2:1623481
Available from: 2021-12-29 Created: 2021-12-29 Last updated: 2024-06-20Bibliographically approved
In thesis
1. The stair of knowledge – prevention of pressure ulcers, malnutrition, poor oral healthand falls among older persons in nursing homes: development and evaluation of the feasibility of an educational intervention
Open this publication in new window or tab >>The stair of knowledge – prevention of pressure ulcers, malnutrition, poor oral healthand falls among older persons in nursing homes: development and evaluation of the feasibility of an educational intervention
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Evidence exists on how to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, but these health risks still occur frequently, causing suffering. Aim: The overall aim of the thesis was to develop and evaluate the feasibility of an educational intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. Methods: By combining methods, four studies were conducted to develop and evaluate the feasibility of an educational intervention. The educational intervention was developed in studies I-III, and its feasibility was evaluated in study IV. In study I, a quantitative study was conducted to determine the prevalence of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons receiving municipal healthcare. In study II, a qualitative study was conducted to explore nurse aides’, registered nurses’ and managers’ experiences of preventive work regarding pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. In study III, a qualitativ estudy was conducted to co-design the educational intervention together with nurse aides, registered nurses and managers to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. Additionally, key persons in the municipality participated in co-designing the educational intervention. The development process and the educational intervention itself was also described in study III. In study IV, a mixed methods study was conducted to evaluate the feasibility of the educational intervention. Results: The risks of pressure ulcers, malnutrition, poor oral health and falls was approximately 28%, 56%, 34% and 74%, respectively, and approximately 90% had at least one health risk (study I). Nurse aides, registered nurses and managers experienced prevention of pressure ulcers, malnutrition, poor oral health and falls as important but challenging (study II). The lack of knowledge among them was reported as a major challenge (studies II and III). The educational intervention, the STAIR OF KNOWLEDGE, was co-designed with nurse aides, registered nurses and managers in nursing homes, and stakeholders in the municipality, to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The content, format and delivery of the STAIR OF KNOWLEDGE intervention was co-designed to fit the need for knowledge to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in a local context (study III), and was proven as feasible but with some refinements required for a perfect fit (study IV). Conclusion: The educational intervention, the STAIR OF KNOWLEDGE, was developed together with and for nurse aides, registered nurses and managers to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The STAIR OF KNOWLEDGE intervention is therefore likely to provide end users with the knowledge needed to accomplish preventive work in nursing homes. The STAIR OF KNOWLEDGE intervention was proven to be feasible but with some amendments necessary before continuing to a definitive trial.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2024. p. 106
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383, E-ISSN 2004-9277
Keywords
prevention, pressure ulcers, malnutrition, poor oral helath, falls, older persons, nursing homes, educational intervention
National Category
Nursing
Research subject
Care science
Identifiers
urn:nbn:se:mau:diva-67403 (URN)10.24834/isbn.9789178774043 (DOI)978-91-7877-403-6 (ISBN)978-91-7877-404-3 (ISBN)
Public defence
2024-05-17, Hälsa och samhälle aulan, Jan Walderströmsgata 25, Malmö, 09:00 (Swedish)
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Note

Paper IV in dissertation as manuscript

Paper IV is not included in the fulltext online 

Available from: 2024-05-24 Created: 2024-05-24 Last updated: 2024-05-24Bibliographically approved

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Neziraj, MeritaHellman, PeterAxelsson, MalinKumlien, Christine

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