Entrevistas realizadas en la FELCC de la ciudad de La Paz

As this inquiry adopts a quantitative approach, the study concepts are referred to as variables, which are “concepts at various level of abstraction that are measured, manipulated, or controlled in a study”(Burns and Grove, 1999, p.34). According to this simple definition, a concept that can take more than one value is considered variable. In the current context, there is more than one concept that can take more than one value. The study hypotheses state three variables: PU status, preventive interventions and risk factors. For instance, PU status can take two values: affected with PU or free of PU.

90

Preventive measure and risk factors can vary between patients and take more than one value.

Based on the literature, both interventions and risk factors can play an important role in PU incidence and prevalence rates. Effective interventions are supposed to be associated with decreasing these rates. Likewise, some risk factors were associated with higher incidence and prevalence rates of PUs.

Variables under investigation in this study have been classified into dependent and independent variables.

- PU status is the dependent or outcome variable. This is because it is the main focus of the study and the outcome variable. In addition, the study aims to understand what interventions are associated with PU prevention and which are not. This also applies to risk factors.

- Independent variables are nursing interventions and risk factors. These can contribute to changes in the dependent variable under investigation.

Although it is mainly the experimental studies that refer to variables as dependent and independent in order to indicate a direct causal relationship. These terms are used in this descriptive study for a practical reason; in order to indicate direction of influence rather a causal relation.

Details of different variables and their categories will be discussed in further detail in the results chapter.

91 3.4.1 Setting criteria for variables selection

This section was used to guide the selection of different study variables. The aim of setting criteria for variables selection will assure that all variables were selected under the same conditions. This can facilitate statistical analysis and ensure that the research questions are answered more accurately.

The most important use of these criteria was to set operational definitions for the study variables. Operational definitions and exact details for categories and grouping of different study variables will be discussed thoroughly in results chapter (section 4.3).

In this section, criteria for selecting independent variables (preventive interventions and risk factors) will be discussed. The dependant or outcome variable (PU) will be discussed with the subjects’ inclusion criteria (section 3.10.1), because this variable is the base variable upon which subjects were selected.

 Preventive intervention selection criteria

Different nursing interventions that have a theoretical relation with PUs prevention will be included. Other activities of the nursing care process will be also included, because some aspects of the nursing care process may affect susceptibility to PUs.

Apart from dedicated PU preventive interventions, other activities of care or therapy from other healthcare providers (e.g. dieticians) will also be included and analysed. These activities may have an effect on the general condition of the patient, and in turn on susceptibility to PUs. Including other aspects of patients’ care processes aimed to discover any covert interventions that could prevent PUs.

92

For any nursing intervention or aspect of care or therapy to be recorded included in this study, two conditions must be fulfilled:

- All nursing interventions or other aspects of care must be recorded for a particular patient, and must be continuously implemented (or implemented at regular intervals). Occasionally implemented interventions or interventions recorded at irregular intervals are not included in the analysis for a particular patient. Occasionally applied preventions may be effective, but due to their short duration there is no way to judge their effectiveness.

- Any interventions or aspect of the caring process to be included in this study comprise those implemented before PU developed in PU group. There is no utility in including newly implemented interventions, because the PU is already developed. For the free of PU group, all interventions implemented are included.

 Risk factors selection criteria

- Risk factors: related factors that were reported in literature to be associated with the development of PUs were recorded. Risk factors that represent Waterlow sub-scores that were matched between the two study groups were not recorded.

- The findings of patient assessment are also recorded as potential risk factors, to help in discovering new factors that might be related to developing PUs.

- Risk factors included are those on admission to hospital for both of the study groups. Baseline assessment is the key factor that can lead nurses to adopt preventive interventions against PUs. Discovering which factors on admission that are related to developing PUs is of great clinical importance because this

93

can help nurses at aiming preventive intervention as early as possible and prevent PU more effectively. Furthermore, early screening for the risk of PUs is important due to the high incidence of PUs immediately after admission (Perneger et al., 2002).

To sum up, the criteria for selecting variables in this study were expanded to cover all aspects of the care process and assessment data. Including all possible information about the care and assessment process aids in increasing the chance to find covert interventions, which might prevent PUs and/or new risk factors that might increase susceptibility to ulceration.