Post the title of the article, authors, purpose, and type of study: Quantitative article I will post it below
Wound Care
J Wound Ostomy Continence Nurs. 2019;46(3):207-213.
Published by Lippincott Williams & Wilkins
Pressure Injury Prevention: Outcomes and Challenges
to Use of Resident Monitoring Technology in a Nursing
Home
Tracey L. Yap ¿ Susan M. Kennerly ¿ Kao Ly
ABSTRACT
PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction
of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in
the nursing home setting.
DESIGN: Mixed methods, pre-/posttest design.
SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in
the Southeast United States.
METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident’s
anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were
activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits
and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing
staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables,
and inferential statistics were applied to categorical variables (χ2 test or Fisher exact test) and continuous variables (analyses of
variance or equivalent nonparametric tests), respectively, where a 2-sided P value of 120 minutes
since last turn), yellow (105-120 minutes since last turn), or
green (0-105 minutes since last turn); the LCD screen also
displays positional status (left, back, right, upright, prone);
compliance score by resident, wing, and shift; and presence of
an unattached sensor. Nursing staff may “pause” the cue in the
monitoring system for up to 2 hours and document the reason
(eg, clinical circumstances, resident refusal, resident off unit,
procedure in progress). Self-repositioning by residents automatically resets the system to begin the countdown until the
next 2-hour turn is due. Sensors detect position changes based
on degrees of roll angle across specified thresholds.
Turn alert hours was calculated as the (sum of red/overdue minutes >120)/60 for whatever set of hours was specified. Options included red/overdue minutes for a resident
during an 8-hour shift, for an NH wing during a 24-hour
day, or for all residents during the 18-day intervention period. Total monitoring time was operationally defined as the
sum of minutes the sensor(s) were active for the time specified. Compliance was calculated as (1 – [Turn alert hours for
the time specified]/[Total monitoring time in hours for the
time specified]).
Following PM system installation and 2 days prior to system activation, each resident and/or family member was provided a letter on NH letterhead describing use of the PM as
standard of care. The LCD screens at each nurse’s station were
not activated during the 3-day baseline period. On day 1 of
the 3-day baseline period, all resident participants were fitted
with a sensor affixed to the mid-sternum, thus activating wireless data reception. At that time, researchers employed a “justin-time” training technique comprising a 5-minute demonstration of attachment and a handout, which was reinforced at
shift changeovers. On day 3 of the baseline period and day 1 of
the intervention period, the research team trained nursing staff
in 10 sessions across all shifts on PrI etiology and prevention,
repositioning techniques, and digital measures of compliance
captured by the PM system. Unit based champions were recruited from training sessions for an additional 30 minutes of
training to provide additional PM system expertise. On day
1 of the 18-day intervention period, the LCD screens at each
nurse’s station were activated, displaying all residents’ repositioning status and providing the first visual cueing to staff.
Rolling admission of resident participants included those
without a PrI and rated as mild, moderate, or high risk of PrI
development. The Braden Scale for Pressure Sore Risk (Braden
Scale) was used to measure PrI risk.17 The Braden Scale measures 6 factors linked to PrI risk, moisture, activity, mobility,
nutrition, friction/sheer, and sensory perception (range: 6-23);
higher scores represent lower risk; and the instrument has
Yap et al
JWOCN ¿ Volume 46 ¿ Number 3
undergone extensive validation.18,19 Residents scoring more
than 18 (no risk) and less than 10 (severe risk) were excluded,
the latter already having individualized repositioning schedules. If eligible, newly admitted residents were included.
Surveys were administered electronically using a tablet
device. Two demographic variables (age and gender) and 2
employment variables (length of time employed in years and
current job category) items were measured, in addition to assessment of the nursing occupational subculture of the study
site, using the Nursing Culture Assessment Tool (NCAT), at
baseline and after the intervention.16
Occupational subculture exerts latent influence on the quality of work produced and the effectiveness of a workforce.20,21
Our previous work supports use of the NCAT as a stable, valid,
and reliable instrument to screen nursing’s occupational subculture in LTC settings.18,19 The NCAT contains 19 declarative statements scored on a 4-point ordinal scale ranging
from strongly disagree (1) to strongly agree (4) that load on
6 factors: expectations, behavior, satisfaction, teamwork, communication, and professional commitment related to nursing
practice.18 Raw scores range from 19 to 76; they are converted
to normative ranking percentages (0%-100%) for purposes of
data analysis.19 High cumulative NCAT scores potentially represent a beneficial influence of the nursing occupational subculture on the planned change in resident monitoring technology, on the advancement of best practices of repositioning, and
on the improvement in outcomes such as prevention of PrIs.
Challenges and adaptation strategies were measured via
semistructured questions designed for focus groups. The
questions were based on Diffusion of Innovation22 and
Adaptive Leadership23 models, using a standardized topical
guide. Probes focused on expectations prior to implementation; burden; perceived outcomes; changes required in attitudes, behaviors, or skills; technical problems; and proposed
improvements to PM system. Two 1-hour focus group sessions led by the 3 authors were held during, each, first and
second shifts and audiotaped for verbatim transcription.
Participants received a $30 department store gift card for
participation.
DATA ANALYSIS
Descriptive statistics were used to summarize resident positions, changes in position, repositioning frequency, on time
compliance percentages, overall staff on time mean repositioning compliance by wing and shift, and NCAT subscale and
total scores before and during the intervention. For categorical
variables, we used χ2 test or Fisher exact tests to determine the
significance of univariate differences. For continuous variables,
we used analyses of variance or equivalent nonparametric tests,
depending on variable distributions. A 2-sided P value of
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