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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
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-8169-853X
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 [en]
prevention, pressure ulcers, malnutrition, poor oral helath, falls, older persons, nursing homes, educational intervention
National Category
Nursing
Research subject
Care science
Identifiers
URN: urn:nbn:se:mau:diva-67403DOI: 10.24834/isbn.9789178774043ISBN: 978-91-7877-403-6 (print)ISBN: 978-91-7877-404-3 (electronic)OAI: oai:DiVA.org:mau-67403DiVA, id: diva2:1860364
Public defence
2024-05-17, Hälsa och samhälle aulan, Jan Walderströmsgata 25, Malmö, 09:00 (Swedish)
Opponent
Supervisors
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
List of papers
1. Prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls: a register study among older persons receiving municipal health care in southern Sweden
Open this publication in new window or tab >>Prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls: a register study among older persons receiving municipal health care in southern Sweden
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2021 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 265Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although pressure ulcers, malnutrition, poor oral health and falls are common among older persons, causing deteriorated health status, they have not been studied altogether among older persons receiving different types of municipal health care. The aim of this study was to determine the prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls among older persons aged ≥65 years receiving municipal health care in southern Sweden.

METHODS: A retrospective cross-sectional study (n = 12,518 persons aged ≥65 years) using data from the national quality registry Senior Alert was conducted. The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was calculated based on categorical data from the instruments available in Senior Alert. T-tests, chi-square test, the Mantel- Haenszel test and logistic regression models were performed.

RESULTS: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was 27.9, 56.3, 34.2 and 74.5% respectively. Almost 90% of the older persons had at least one health risk. The prevalence of risk for pressure ulcers, poor oral health and falls was significantly higher in dementia care units compared to short term nursing care, home health care and nursing homes. The prevalence of risk for malnutrition was significantly higher among older persons staying in short term nursing care compared to other types of housing. The odds of having a risk for malnutrition were higher in short term nursing care compared to other types of housing. The oldest age group of 95-106 years had the highest odds of having a risk for falls. The presence of multiple health risks in one subject were more common in dementia homes compared to nursing homes and home health care but not compared to short term nursing care.

CONCLUSION: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was high, implying that these health risks are a great concern for older persons receiving municipal health care. A comprehensive supporting preventive process to prevent all the investigated health risks among older persons receiving municipal health care is recommended.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Falls, Malnutrition, Municipal health care, Older persons, Poor oral health, Pressure ulcers, Prevention, Register study, Risk assessment, Senior alert
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-42192 (URN)10.1186/s12877-021-02205-x (DOI)000642627800003 ()33882869 (PubMedID)2-s2.0-85104596413 (Scopus ID)
Available from: 2021-05-12 Created: 2021-05-12 Last updated: 2024-05-24Bibliographically approved
2. Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers
Open this publication in new window or tab >>Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers
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2021 (English)In: International Journal of Nursing Studies Advances, 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
Keywords
Elderly, Falls, Focus group, Health care staff, Malnutrition, Managers, Poor oral health, Pressure ulcers, Prevention, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-48429 (URN)10.1016/j.ijnsa.2021.100056 (DOI)001026269700003 ()2-s2.0-85120753134 (Scopus ID)
Available from: 2021-12-29 Created: 2021-12-29 Last updated: 2024-05-24Bibliographically approved
3. The STAIR OF KNOWLEDGE-a codesigned intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes in Sweden: development of a complex intervention
Open this publication in new window or tab >>The STAIR OF KNOWLEDGE-a codesigned intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes in Sweden: development of a complex intervention
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 8, article id e072453Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To describe the development of a codesigned complex intervention intended to prevent the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes.

DESIGN: : Nursing homes in the municipality in southern Sweden.

PARTICIPANTS: End users (n=16) in nursing homes (n=4) codesigned the intervention together with the research group in workshops (n=4) in March-April 2022. Additionally, stakeholders (n=17) who were considered to play an important role in developing the intervention participated throughout this process. Data were analysed using reflexive thematic analysis.

RESULTS: Four workshops were conducted with end users (n=16) and 13 meetings with stakeholders (n=12) were held during the development process. The intervention aims to bridge the evidence-practice gap regarding the preventive care process of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The intervention is aimed at end users, lasts for 3 weeks and is divided into two parts. First, end users obtain knowledge on their own by following written instructions. Second, they meet, interact and discuss the knowledge acquired during part 1.

CONCLUSION: The intervention is robustly developed and thoroughly described. The study highlights the extensive process that is necessary for developing tailored complex interventions. The description of the entire development process may enhance the replicability of this intervention. The intervention needs to be tested and evaluated in an upcoming feasibility study.

TRIAL REGISTRATION NUMBER: NCT05308862.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Aging, Nursing Care, PREVENTIVE MEDICINE
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-62077 (URN)10.1136/bmjopen-2023-072453 (DOI)001046594600007 ()37562934 (PubMedID)2-s2.0-85167737537 (Scopus ID)
Available from: 2023-08-23 Created: 2023-08-23 Last updated: 2024-05-24Bibliographically approved
4. The codesigned STAIR OF KNOWLEDGE intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes: a feasibility study for a pragmatic cluster randomized controlled trial
Open this publication in new window or tab >>The codesigned STAIR OF KNOWLEDGE intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes: a feasibility study for a pragmatic cluster randomized controlled trial
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Care science
Identifiers
urn:nbn:se:mau:diva-67402 (URN)
Available from: 2024-05-24 Created: 2024-05-24 Last updated: 2024-05-31Bibliographically approved

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Neziraj, Merita

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