Compare methods used in each article

Compare methods used in each article

Compare methods used in each Qualitative articles relating to pressure ulcer and write a summary of comparison in around 500-600 words See attached of 3 articles to be used. plagiarism free

J Wound Ostomy Continence Nurs. 2014;41(6):528-534.
Published by Lippincott Williams & Wilkins
WOUND CARE
528 J WOCN ■ November/December 2014 Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™
Patient Perceptions of the Role
of Nutrition for Pressure Ulcer
Prevention in Hospital
An Interpretive Study
Shelley Roberts ■ Ben Desbrow ■ Wendy Chaboyer
■ ABSTRACT
PURPOSE: The aims of this study were to explore (a) patients’
perceptions of the role of nutrition in pressure ulcer
prevention; and (b) patients’ experiences with dieticians
in the hospital setting.
DESIGN: Interpretive qualitative study.
SUBJECTS AND SETTING: The sample comprised 13 females
and 7 males. Their mean age was 61.3 ± 12.6 years
(mean ± SD), and their average hospital length of stay
was 7.4 ± 13.0 days. The research setting was a public
health hospital in Australia.
METHODS: In this interpretive study, adult medical patients
at risk of pressure ulcers due to restricted mobility
participated in a 20 to 30 minute interview using a
semi-structured interview guide. Interview questions
were grouped into 2 domains; perceptions on the role of
nutrition for pressure ulcer prevention; and experiences
with dieticians. Recorded interviews were transcribed
and analyzed using content analysis.
RESULTS: Within the fi rst domain, ‘patient knowledge
of nutrition in pressure ulcer prevention,’ there were
varying patient understandings of the role of nutrition
for prevention of pressure ulcers. This is refl ected in
5 themes: (1) recognizing the role of diet in pressure
ulcer prevention; (2) promoting skin health with good
nutrition; (3) understanding the relationship between
nutrition and health; (4) lacking insight into the role of
nutrition in pressure ulcer prevention; and (5) acknowledging
other risk factors for pressure ulcers. Within
the second domain, patients described their experiences
with and perceptions on dieticians. Two themes
emerged, which expressed differing opinions around
the role and reputation of dieticians; they were receptive
of dietician input; and displaying ambivalence
towards dieticians’ advice.
CONCLUSIONS: Hospital patients at risk for pressure ulcer
development have variable knowledge of the preventive
role of nutrition. Patients had differing perceptions
■ Introduction
Pressure ulcers (PUs) are associated with signifi cant costs
to both patients and the health care system. 1,2 Issues such
as pain, discomfort, decreased mobility and independence,
wound exudate, odor, social isolation, and poor
body image have been described by individuals who have
experienced PUs. 3 In the hospital setting, PUs are associated
with an increased risk of complications and lengthy
healing times, resulting in longer length of stay (LOS) and
higher hospital costs. 1-7 In the Australian public hospital
setting, PUs increase LOS of acute admissions by a median
of 4.3 days, 8 and a recent study estimated the total cost of
PU in Australian public and private hospitals in 2010–11
was US$1.64 billion ( ±US$1.05 billion). 9 In the United
Kingdom, the estimated annual cost of treating PU to
healing time in hospital and long-term care settings was
£1.4 billion to 2.1 billion in 1999 to 2000. 10 Clearly, the
Shelley Roberts, MNutrDiet, PhD candidate, Centre for Health
Practice Innovation, and School of Public Health, Griffi th University,
Gold Coast, Queensland, Australia.
Ben Desbrow, PhD, Associate Professor, Centre for Health
Practice Innovation, Griffi th Health Institute, and School of Public
Health, Griffi th University, Gold Coast, Queensland, Australia.
Wendy Chaboyer, PhD, Director, NHMRC Centre for Research
Excellence in Nursing, Griffi th Health Institute and Centre for Health
Practice Innovation, Griffi th University, Gold Coast, Queensland,
Australia.
The authors declare no confl icts of interest.
Correspondence: Shelley Roberts, MNutrDiet, School of Public
Health, Gold Coast Campus, Griffi th University, QLD 4222, Australia
( s.roberts@griffi th.edu.au ).
DOI: 10.1097/WON.0000000000000072
of the importance and value of information provided by
dieticians.
KEY WORDS: nutrition , patient knowledge , pressure ulcer ,
prevention
Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
JWOCN-D-13-00098_LR 528 WOCN-D-13-00098_LR 528 10/31/14 12:29 AM 0/31/14 12:29 AM
J WOCN ■ Volume 41/Number 6 Roberts et al 529
strong predictor of PU in the clinical setting. 4,6,20
Participants were eligible for inclusion if they could provide
consent (aged ≥ 18 years, cognitively intact), had a
hospital LOS of 3 or more days, and met the criteria for
reduced mobility. The study sample was selected using a
maximum variation purposive sampling technique (ie, a
mix of men and women, younger and older patients, patients
with and without experience with PU). 21
Data Collection
Individual patient interviews were conducted on the ward,
in a quiet area, and at a time convenient for the patient.
The interviews lasted 15 to 30 minutes. Using a semistructured
interview guide, patients were asked about their perceptions
of the role nutrition played in PUP and their
experiences with and opinions about the role of dieticians.
Three nutrition-related questions were asked. They were
based on literature review and current clinical practice
guidelines, which suggest that nutritional intervention
and education are important components of PUP. Prompts
were used to gain additional information as required.
Individual interviews were conducted by a research assistant
with experience in qualitative data collection.
Interviews were recorded with a handheld digital recording
device and transcribed for analysis.
Data Analysis
Interview transcripts were analyzed using inductive content
analysis, which provides a systematic and objective
means to make valid inferences from verbal data to describe
and quantify phenomena. 22-24 This technique takes
into account meanings, intentions, consequences, and
the context in which data were collected. 20 Because the
interview questions encompassed 2 domains (knowledge
of nutrition in PUP and experience with dieticians), data
from each interview were analyzed in relation to these domains.
To become familiar with the data, transcripts were
read and reread, and notes were taken by 2 of the authors.
For each domain, codes were developed from the verbatim
statements of participants, which were then grouped into
subthemes identifi ed from the data. Subthemes were then
classifi ed into themes within each domain. Frequent discussion
among the research team was undertaken to ensure
that the codes accurately refl ected the data, and that
the themes and subthemes adequately encompassed the
data.
Trustworthiness of fi ndings in qualitative data analysis
is often considered in relation to credibility, dependability,
and transferability. 25 We used purposive sampling
which ensured a broad representation of patients, and
regular meetings with the research team ensured codes,
subthemes and themes accurately refl ected the data for
transferability and credibility. A code book and memos
were written to document the analytic process, including
decisions about emerging subthemes and themes, providing
an audit trail of the analysis.
patient burden and hospital costs associated with PU in
the clinical setting are signifi cant, and preferably avoided
through effective pressure ulcer prevention (PUP).
Historically, risk factors such as pressure, moisture,
shearing forces, and friction have been a primary focus for
PUP. 11-13 In addition, research suggests that malnutrition is
an important risk factor for PU development. Malnutrition
is associated with an odds ratio of 2.6 (95% confi dence
interval: 1.8-3.5; P < .001) of developing a PU in the public hospital setting in Australia. 14 Current evidence suggests that oral nutrition support for patients at risk of PU is effective in reducing the incidence of PU development by approximately 26%, resulting in substantial cost savings. 15 However, there is no evidence to date that a dietician consultation is associated with a reduction in PU risk. Hospitalized patients often fail to eat enough to meet their estimated energy and protein requirements. 16-18 It is crucial, therefore, to improve the nutritional intake of patients at risk for PU, in order to reduce their risk of PU development. Patients may play a more active role in their nutritional care in hospitals if they understand the link between nutrition and PUP. Evidence suggests that patient education around PUP is lacking. A study of patients in 89 institutions in the Netherlands reported that only 14.7% of high-risk patients were educated about PU causes and prevention strategies. 19 To our knowledge, research focusing on patients’ understandings around nutrition of PUP or their experiences with and opinions of dieticians is lacking. Therefore, the aims of this study were to explore (1) patients’ perceptions on the role of nutrition in PUP and (2) patients’ experiences with dieticians. Understanding patients’ perceptions around nutrition for PUP and dietician input in the clinical setting may provide a foundation for targeted interventions to promote good nutrition and prevent PUs. ■ Methods This interpretive qualitative interview study is part of a larger, multisite, mixed-methods study conducted across 4 medical wards in 2 metropolitan hospitals in Southeast Queensland, Australia. Both hospitals have established PUP programs, and preventive strategies have been implemented into regular clinical practice. Ethical approval for study procedures was obtained through Queensland Health (reference number HREC/11/QTHS/111) and Griffi th University (reference number NRS/40/11/HREC). All participants signed a consent form prior to data collection. The sample comprised adult medical patients who received care in 4 inpatient medical units who had reduced mobility (ie, bed-bound, wheelchair-bound, or requiring a mobility aid or physical assistance) and were therefore deemed at risk for PU development. Reduced mobility was chosen as an inclusion criterion to identify patients at risk of PU because it is a widely recognized risk factor and Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited. JWOCN-D-13-00098_LR 529 WOCN-D-13-00098_LR 529 10/31/14 12:29 AM 0/31/14 12:29 AM 530 Roberts et al J WOCN ■ November/December 2014 ■ Results The sample comprised 13 women and 7 men. Participants mean age was 61.3 ± 12.6 years (mean ± SD, range 24-80 years), and their mean hospital LOS was 7.4 ± 13.0 days (range 3-62 days). After 16 interviews, no new information was emerging; however, 4 more interviews were completed to ensure data saturation. Within each domain, a number of themes emerged. A summary of the domains, themes, and subthemes is provided in Table 1 . Domain 1: Patient Knowledge of Nutrition in PUP The fi rst domain had 5 themes that expressed respondents’ perceptions of the role of nutrition for preventing PUs. Consistent with inductive approaches to qualitative analysis, we did not identify an overarching theme, nor was any theme prioritized over the others as each provided a unique perspective. In addition, we refrained from counting frequencies of emerging themes. The fi rst theme was “recognizing the role of diet for PUP.” Participants acknowledged that nutrition as important for prevention of PUs. Nevertheless, while most patients thought that nutrition played a role in prevention, they were unsure exactly what that role was. As respondent 1 stated, “I’m not a dietician and I’m not a medical expert, but I would suggest that nutrition is very, very important.” Some patients stated that consuming a poor diet will result in a higher likelihood of developing a PU. Other patients described a good diet as being a protective factor for PU, and weight loss (in the buttocks area) was described as a factor that may increase the risk of PU. “The good food is building you up all the time, and you may even be putting on weight. And it’s usually when someone loses a lot of weight in their bottom area that these things happen quicker. The skin comes apart quicker. Whereas with well-padded bottoms, it takes a while to happen.” Losing weight if overweight or obese was also described as a measure for PUP and healing. One participant postulated that consuming “heavy foods” in hospital would lead to patients feeling full and heavy, encouraging them to stay in bed rather than resuming mobility. Another participant, unsure of the role that nutrition played in PUP, supposed that nutrition affects your blood, and if your “blood’s out” (ie, blood test results abnormal), you may be more likely to develop PU. On the whole, this theme refl ects patients’ recognition that nutrition plays a role in PUP, but the description of that role was ambiguous. The second theme, “promoting skin health with good nutrition,” portrays how patients linked skin health and nutrition, even if they did not fully understand the mechanisms behind this relationship. Some participants made general statements that nutrition was related to skin health, while others said that poor nutrition would cause skin to break down more easily. Several participants mentioned dietary protein as an important factor for skin integrity. Protein was also mentioned as important for wound healing and prevention of infection. One patient thought that fl uid intake would play a role in PUP; however, they were unsure of its exact role. Although respondents did not articulate the exact relationship between nutrition and skin health, they appeared to have a broad understanding of this notion. One respondent noted, “I should assume that if you weren’t eating properly, and aren’t getting the right nutrition, of course your skin’s going to break down twice as much.” Another observed, “You need vitamins and minerals and proteins in the right ratio so that your skin, your body tissue maintain its intactness, because if it doesn’t maintain intactness, then you’re prone to infection.” The third theme, “understanding the relationship between nutrition and health” describes the perception that nutrition was important for health in general and would be expected to play a role in PUP. As one respondent articulated, “I know nutrition is important for all areas of health, and so it would have a part to play with pressure sore prevention.” The fourth theme “lacking insight into the role of nutrition and PUP” depicts the lack of understanding or knowledge of a relationship between nutrition and PUP expressed by some participants. Some respondents stated that they had “no idea” how nutrition and PUP may be related, and others reported that they had not given this potential connection much thought before. One respondent related, “I’ve got no idea, really. No, none whatsoever.” Another observed, “I don’t think nutrition plays a role in bed sores…. I don’t think it’s to do with nutrition. I wouldn’t have thought so anyway.” The fi nal theme in the knowledge of nutrition and PUP domain was “acknowledging other risk factors for PU.” Within this theme, patients described other risk factors they

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