Investigating Older Adult Self-Advocacy Through Pressure Injury Care in Skilled Nursing Facilities 公开

Abstract

Background: Self-advocacy in healthcare settings is associated with better health outcomes like decreased fall risk, increased screening for chronic conditions, and greater satisfaction with care. However, past research has indicated that healthcare professionals are less receptive to instances of self-advocacy in older adults and that older adults tend to be more passive in healthcare settings than their younger counterparts. Pressure injury (PrI) is a preventable skin wound caused by consistent pressure or pressure and shear. 70% of all PrIs occur in adults over 65 and 15% of older adults transferred from acute care hospitals to skilled nursing facilities have at least one PrI.

 

Methods: This qualitative study investigated clinician and caregiver perspectives on barriers to self-advocacy during PrI prevention and management in skilled nursing facilities. Thematic content analysis with deductive and inductive coding phases was performed on transcripts from ten semi-structured interview recordings with clinicians. Preliminary analysis was performed for one caregiver interview. Participants were clinicians who cared for older adult residents with PrI in skilled nursing facilities and an informal caregiver, recruited through convenience sampling. 

 

Results: Resident-level barriers such as cognitive impairment were identified as barriers to self-advocacy. Even in instances when older adults were motivated and cognitively able to self-advocate, systemic barriers complicated self-advocacy and appropriate PrI care. SNF residents and their caregivers were consistently ranked least responsible for PrI management by clinicians. Education to residents and families about PrI prevention and management was usually given verbally and by variable members of the care team. 

 

Conclusion: Previous studies have identified intrinsic qualities that promote older adult self-advocacy including knowledge, communication ability, and willingness to challenge the healthcare team. However, the results of this study indicate that older adult residents in SNFs also face extrinsic barriers that impede their participation in PrI care. The implementation of structured resident education and alternative models of geriatric treatment are promising future directions for improving the quality of care in SNFs.

Table of Contents

Abstract............................................................................................................................................1

Introduction......................................................................................................................................3 Methods............................................................................................................................................7 Results.............................................................................................................................................10 Discussion........................................................................................................................................15

Tables and Figures.............................................................................................................................23

  Table 1: Clinician Characteristics                                                                                          23

 Table 2: Subset of semi-structured interview questions                                                    24

 Table 3: Resident-Level Barriers to PrI Management                                                          25

 Table 4: Negative Workplace Culture                                                                                      26

 Figure 1: Staged Images of PrI                                                                                                  29

 Figure 2: Graphic of clinician responses                                                                                 30

References........................................................................................................................................31

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Aging Health Sciences, Health Care Management Health Sciences, Rehabilitation and Therapy
关键词	pressure ulcer skilled nursing facility pressure injury self-advocacy
Committee Chair / Thesis Advisor	Shilpa Krishnan, Emory University
Committee Members	Keith Easterling, Emory University Theodore Johnson, Emory University

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