Hartmann Christine W, Solomon Jeffrey, Palmer Jennifer A, Lukas Carol VanDeusen
Christine W. Hartmann, PhD • Research Health Scientist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts • Research Associate Professsor • Health Law, Policy, and Management • Boston University School of Public Health • Boston, Massachusetts Jeffrey Solomon, PhD • Research Health Scientist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts Jennifer A. Palmer, PhD • Health Science Specialist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts Carol VanDeusen Lukas, EdD • Clinical Associate Professor • Department of Health Law, Policy, and Management • Boston University School of Public Health • Boston, Massachusetts.
Adv Skin Wound Care. 2016 May;29(5):226-38; quiz E1. doi: 10.1097/01.ASW.0000482113.18800.1c.
To present findings of a study of institutional factors related to pressure ulcer (PrU) prevention in Veterans Health Administration nursing homes.
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
After participating in this educational activity, the participant should be better able to:1. Identify the study's design, process, and purpose.2. List the factors pertaining to sites with improving performance.
Important gaps exist in the knowledge of how to achieve successful, sustained prevention of pressure ulcers (PrUs) in nursing homes. This study aimed to address those gaps by comparing nursing leadership and indirect care staff members' impressions about the context of PrU prevention in facilities with improving and declining PrU rates.
The study was conducted in a sample of 6 Veterans Health Administration nursing homes (known as community living centers) purposively selected to represent a range of PrU care performance.
One-time 30-minute semistructured interviews with 23 community living center staff were conducted. Qualitative interview data were analyzed using an analytic framework containing (a) a priori analytic constructs based on the study's conceptual framework and (b) sections for emerging constructs.
Analysis revealed 6 key concepts differentiating sites with improving and declining PrU care performance. These concepts were (1) structures through which the change effort is initiated; (2) organizational prioritization, alignment, and support; (3) improvement culture; (4) clarity of roles and responsibilities; (5) communication strategies; and (6) staffing and clinical practices. Results also pointed to potential contextual facilitators of and barriers to successful PrU prevention.
Leadership's visible prioritization of and support for PrU prevention and the initiation of PrU prevention activities through formal structures were the most striking components represented at sites with improving performance, but not at ones where performance declined. Sites with improving performance were more likely to align frontline staff and leadership goals for PrU prevention.
介绍一项关于退伍军人健康管理局疗养院中与压疮预防相关的机构因素的研究结果。
本次继续教育活动面向对皮肤和伤口护理感兴趣的医生和护士。
参与本次教育活动后，参与者应能更好地：1. 识别该研究的设计、过程和目的。2. 列出与绩效改善场所相关的因素。
在如何在疗养院成功、持续预防压疮方面，知识上存在重要差距。本研究旨在通过比较护理领导层和间接护理工作人员对压疮预防情况的看法，来填补这些差距，这些疗养院的压疮发生率有上升和下降之分。
该研究在6家退伍军人健康管理局疗养院（称为社区生活中心）的样本中进行，这些疗养院是有目的地挑选出来的，以代表一系列压疮护理绩效情况。
对23名社区生活中心工作人员进行了一次时长30分钟的半结构化访谈。定性访谈数据采用一个分析框架进行分析，该框架包含（a）基于研究概念框架的先验分析结构，以及（b）用于新出现结构的部分。
分析揭示了6个区分压疮护理绩效上升和下降场所的关键概念。这些概念是：（1）发起变革努力的结构；（2）组织的优先级、一致性和支持；（3）改进文化；（4）角色和职责的明确性；（5）沟通策略；（6）人员配备和临床实践。结果还指出了成功预防压疮的潜在背景促进因素和障碍。
领导层对压疮预防的明显重视和支持，以及通过正式结构启动压疮预防活动，是绩效改善场所最显著的组成部分，但绩效下降的场所则没有。绩效改善的场所更有可能使一线工作人员和领导层在压疮预防目标上保持一致。
