Pressure ulcers are a significant healthcare problem confronting practitioners across all healthcare settings. Prevalence and incidence studies with a high methodological rigour are needed to provide concise estimations of the scope of the problem. This will inform healthcare organisations and influence decision making regarding effective strategies, and guidelines for the prevention and treatment of pressure ulcers. In addition, these epidemiological studies will allow healthcare workers access to resource allocation and staff training requirements in order to effectively confront the problem. Currently, there is variance noted throughout the literature regarding methodological approaches, with a dearth of epidemiological studies conducted in the community. Healthcare delivery is becoming more complex and exists beyond acute care settings. Primary care is recognised internationally as the most effective way to provide high quality easily accessible services. Therefore, internationally, consensus is required in regard to methodological approaches for rigorous and reliable strategies to tackle the problem.
There is a limited amount of research available on the true human and financial cost of pressure ulcers. That said, judging by the available literature, the cost is substantial. As the forecast growth in numbers of elderly is realised, the strain on the healthcare budget will increase. It is evident that prevention is less costly than treatment, however economic analysis state that treatment costs continue to
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escalate. Many economic analysis-based studies exist, with the majority conducted in the acute and long term care setting. As with prevalence and incidence studies, there is variation in the methodological approaches used. This causes problems comparing studies across settings, and hinders the ability to identify and implement accurate outcome from a cost effectiveness perspective. Nurses are responsible for ensuring that care is evidence-based, therefore it is necessary to obtain an insight into the personal costs of living with a pressure ulcer. Exploring the experience of living with a pressure ulcer allows the researcher to understand how the patient feels. This can allow the healthcare practitioner to develop patient-focused approaches to care delivery. The impact of health and social gain is becoming increasingly influential in strategies to reduce the cost of pressure ulcer occurrence.
Primary care at present is experiencing challenges: a change in demographic structure, evolving legislation, quicker discharges and increase in case complexity. This has occurred at a much faster pace than the growth in the community nursing staffing levels. As a result, there is an increased reliance on HSWs to extend their role. Nonetheless, pressure ulcers remain a problem in the community setting, and primary care have embraced the innovative model of care to prevent pressure ulcers, known as the SSKIN bundle. The first ‘S’ in this acronym stands for skin assessment, and research has confirmed that within primary care skin observation is currently undertaken by the HSWs. A key factor in pressure ulcer prevention is skin observation and accurate classification. The lack of clarity and role confusion regarding the HSW role in general remains a consistent factor throughout the literature. A dearth of evidence and research into skin assessment and the knowledge needed to fulfil this role is apparent. Insufficient awareness of HSW competency levels means that nursing professionals are unable to determine which duties can and cannot be delegated. This can have detrimental effects on decision making for planning and delivery of quality and efficient care to prevent and manage pressure ulcers to all patients in primary care.
There is an abundance of transformative teaching methods for HSWs in other clinical areas. It is clear that further effort is required to improve knowledge regarding skin observation and classification among nurses and HSWs alike to ensure patient safety. There is also a lack of recognised training programmes specific to skin
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observation and classification for HSWs, which puts patients’ quality and safety at risk. Healthcare organisations expect educators to meet expanded training needs regardless of financial and time restraints.
HSWs require education to provide them with the skills to fulfil the role of skin observation and classification, therefore it is fundamental that research into HSWs knowledge is carried out. This can be accomplished by ensuring any rigorous educational intervention tackles all deficits in relation to inaccurate skin detection. The PUCLAS e-learning tool is one such validated innovative approach for improving knowledge and skills regarding skin observation and classification of pressure ulcers. An assurance is urgently needed as to whether this e-learning program results in an increase in knowledge regarding early skin detection.
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Chapter 3
Methods
3.1 Introduction
This chapter aims to examine the quantitative approach suitable for the study. The research question and aims are also explored. The rationale for the choice of quantitative methodology is provided. Sample selection and negotiation of access plus ethical consideration are discussed. Finally, this chapter will address the issue of establishing rigour in a quantitative study.
Nursing research can be achieved within two theoretical approaches: quantitative and qualitative (Gerrish and Lacey, 2010). Qualitative research allows researchers to explore human experiences in personal and social environments, to obtain a detailed understanding of the factors influencing these experiences within a scientific process (Miller, 2010). Quantitative researchers support the scientific truth The cause and effect of phenomena is tested by gathering evidence directly or indirectly through the senses rather than through meaning or experience (Watson, 2015). This deductive approach captures reasoning and logic, and gives assurance regarding unequivocal knowledge of the world.Therefore, the quantitative approach lends itself to this study where testing the cause and effect of an educational intervention was required.
It is proposed that quantitative methodology was most suited for the study enquiry. This methodology is extrapolated from the literature with the application of Gerrish and Lacey (2010) guidance to collect and analyse the quantitative data obtained. Quantitative design studies can be described in two main categories: experimental and non-experimental (Watson, 2015). Experimental research enables the researcher to manipulate some aspect of the phenomenon under study and observe the effect (Claydon, 2015).
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The simplest form of experiment used in healthcare is a before and after study design. (Kwong et al, 2011). This study design is also known as pre-/post-test design. As the researcher is testing an educational intervention and observing the effect, a repeated measure design was employed. This method allowed the researcher to test the study subjects’ knowledge before, and monitor the outcomes at two measuring points post intervention. The pre-test aimed to gain insight into the HSWs’ ability to detect early pressure ulcer damage. The first post-test tested the effectiveness of the educational intervention as an instruction method. The final post-test evaluated the effectiveness of the educational intervention over time.