title: Pressure ulcers among terminally ill nursing home residents.
abstract: The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs.
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, Box 0610, San Francisco, CA 94143-0610, USA. jeanie.kayser-jones@nursing.ucsf.edu
authors.forename: Jeanie
authors.initials: J
authors.lastname: Kayser-Jones
authors.forename: Alison E
authors.initials: AE
authors.lastname: Kris
authors.forename: Kyung-Choon
authors.initials: KC
authors.lastname: Lim
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Walent
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Halifax
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000884:Anthropology, Cultural; D001294:Attitude to Health; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration; D015404:Nursing Methodology Research; D010344:Patient Advocacy; D010561:Personnel Staffing and Scheduling; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology*; D011446:Prospective Studies; D036301:Qualitative Research; D011787:Quality of Health Care; D012307:Risk Factors; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data