Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
School of Medicine, University of Leeds, Leeds, UK.
Int J Older People Nurs. 2023 Jul;18(4):e12550. doi: 10.1111/opn.12550. Epub 2023 May 29.
The older person care home population is increasing. As skin ages, it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is suboptimal.
(i) develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and (ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care.
Instrument development and survey. Barriers and facilitators identified from the literature and pilot study were categorised in a Delphi survey of experts (n = 8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n = 38), construct validity (n = 235) and test-retest reliability (n = 11). Barriers and facilitators were surveyed in Round 2 and reported in accordance with TRIPOD.
A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator.
This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.
老年人护理院的人口正在增加。随着皮肤老化，它变得容易干燥、瘙痒、出现裂缝和裂痕。大多数老年人都会经历这些问题，它们会降低生活质量，并导致皮肤破损、依赖性增加、住院治疗以及更高的经济和人力成本。干燥、瘙痒、裂缝和裂痕是可以预防的，但尽管有最佳实践指南，一致性仍然不理想。
(i) 开发和测试一种基于理论的诊断工具，以准确和前瞻性地评估障碍和促进因素；(ii) 调查护理院工作人员在提供皮肤卫生护理方面的障碍和促进因素。
仪器开发和调查。从文献和试点研究中确定的障碍和促进因素被归类为专家德尔菲调查（n=8）到理论领域框架。该模型在三轮中进行了验证（n=38），以验证其表面有效性、结构有效性和测试-再测试可靠性（n=11）。在第二轮中调查了障碍和促进因素，并按照 TRIPOD 报告。
得出了一个 29 项有效且可靠的工具（SHELL-CH）（χ2/df=1.539，RMSEA=0.047，CFA=0.872）。主要障碍包括为烦躁或困惑的居民提供皮肤卫生护理、来自同事的匆忙或从事其他任务的压力、忙碌和亲属的不切实际期望。皮肤卫生护理知识是一个促进因素。
这项研究具有国际意义，它确定了皮肤卫生护理的障碍和促进因素，包括以前未报道的障碍。
