Management of Pressure Injury Prevention in Two New Zealand Residential Aged Care Facilities: A Case Study
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The purpose of this study was to explore how pressure injury prevention is managed in residential aged care in New Zealand. Pressure injuries are costly and have negative physical, social and psychological consequences that impact significantly on quality of life. Residents in aged care are becoming more dependent with more complex needs. Frail older people have increased risk of developing pressure injuries and Registered Nurses and Health Care Assistants, with different and unique roles, are integral to the prevention of these injuries. The prevention of pressure injuries requires a comprehensive and multifactorial approach. Exploratory case study methodology was used in this thesis to answer the question: How are pressure injuries prevented in residential aged care? Data were collected from Clinical Managers, Registered Nurses and Health Care Assistants working in two residential aged care facilities, and who provided pressure injury prevention intervention in their daily practice, using semi-structured interviews. Facility policies and guidelines related to pressure injury prevention and management were also analysed. Two main themes were identified during data analysis and used to structure the presentation of findings. Firstly, “The Context of Residential Aged Care”, which captured the complex cultural dynamics within residential aged care which impact on how nurses and healthcare assistants work together to provide pressure injury prevention. The second theme, “Assessment and Interventions of Daily Practice”, encapsulated the complexity and multidimensional nature of providing care in relation to pressure injury prevention within the residential aged care environment. The study identified barriers and facilitators in the prevention of pressure injuries and illustrate the interplay between provision of pressure injury prevention and organisational culture and structure. Implementation strategies to reduce pressure injuries must reflect organisational infrastructures that impact negatively on quality care while also acknowledging the increasing dependency and complexity involved in caring for frail older adults with the ultimate goal of reducing the incidence of pressure injuries in aged care.