Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-19T07:50:35.702Z Has data issue: false hasContentIssue false
  • English
  • Français

Care planning for pressure ulcers in hospice: The team effect

Published online by Cambridge University Press:  12 May 2005

ANDREW EISENBERGER  and
JOMARIE ZELEZNIK
ANDREW EISENBERGER
Affiliation:
Department of Medicine, Montefiore Medical Center, Bronx, New York
JOMARIE ZELEZNIK
Affiliation:
Division of Geriatrics, Montefiore Medical Center, Bronx, New York
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: The standards of care for patients at risk for or with a pressure ulcer in hospitals and nursing homes focus on prevention and ulcer healing using an interdisciplinary approach. Although not a primary hospice condition, pressure ulcers are not uncommon in dying patients. Their management in hospices, particularly the involvement of family caregivers, has not been studied. The objective of this study is to identify the factors that influence care planning for the prevention and treatment of pressure ulcers in hospice patients and develop a taxonomy to use for further study.

Methods: A telephone survey was conducted with 18 hospice directors of clinical services and 10 direct-care nurses. Descriptive qualitative data analysis using grounded theory was utilized.

Results: The following three themes were identified: (1) the primary role of the hospice nurse is an educator rather than a wound care provider; (2) hospice providers perceive the barriers and burdens of family caregiver involvement in pressure ulcer care to be bodily location of the pressure ulcer, unpleasant wound characteristics, fear of causing pain, guilt, and having to acknowledge the dying process when a new pressure ulcer develops; and (3) the “team effect” describes the collaboration between family caregivers and the health care providers to establish individualized achievable goals of care ranging from pressure ulcer prevention to acceptance of a pressure ulcer and symptom palliation.

Significance of results: Pressure ulcer care planning is a model of collaborative decision making between family caregivers and hospice providers for a condition that occurs as a secondary condition in hospice. A pressure ulcer places significant burdens on family caregivers distinct from common end-of-life symptoms whose treatment is directed at the patient. Because the goals of pressure ulcer care appear to be individualized for a dying patient and their caregivers, the basis of quality-of-care evaluations should be the process of care rather than the outcome of an incident pressure ulcer.

Keywords

Caregiver educationPressure ulcerPalliative careHospice
Type
Research Article
Information
Palliative & Supportive Care , Volume 2 , Issue 3 , September 2004 , pp. 283 - 289
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Hospice Foundation. Available at: http://www.americanhospice.org. Accessed March 17, 2004.
Baer, W.M. & Hanson, L.C. (2000). Families' perception of the added value of hospice in the nursing home. Journal of the American Geriatric Society, 48, 879–882.Google Scholar
Baharestani, M.M. (1994). The lived experience of wives caring for their frail, homebound, elderly husbands with pressure ulcers. Advanced Wound Care, 7, 40–52.Google Scholar
Bale, S., Finlay, I., & Harding, K.G. (1995). Pressure sore prevention in a hospice. Journal of Wound Care, 4, 465–468.Google Scholar
Baranoski, S., Salzberg, C., Stanley, & M., et al. (1998). Obstacles and opportunities for the multidisciplinary wound care team. A report from the clinical symposium of wound management. Advanced Wound Care, 11, 85–88.Google Scholar
Bennett, R.G., O'Sullivan, J., DeVito, & E.M., et al. (2000). The increasing medical malpractice risk related to pressure ulcers in the United States. Journal of the American Geriatric Society, 48, 73–81.Google Scholar
Bergstrom, N., Allman, R.M., Carlson, & C.E., et al. (1992). Pressure ulcers in adults: Prediction and prevention. Clinical practice guidelines. Number 3. AHCPR Publication No. 92-0047. Rockville MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
Bergstrom, N., Bennett, M.A., Carlson, & C.E., et al. (1994). Treatment of Pressure Ulcers. Clinical Practice Guideline, No. 15. Rockville, MD: Public Health Service, Agency for Health Care Policy and Research. U.S. Department of Health and Human Services.
Bergstrom, N., Braden, B., Laguzza, & A., et al. (1987). The Braden scale for predicting pressure sore risk. Nursing Research, 36, 205–210.Google Scholar
Brandt, K. (2001). The physician–hospice partnership: Expanding opportunities to improve end-of-life care. Journal of Medical Practice Management, 16(5), 232–236.Google Scholar
Chaplin, J. (2000). Pressure sore risk assessment in palliative care. Journal of Tissue Viability, 10, 27–31.Google Scholar
Clarke, M. & Kadhom, H.M. (1988). The nursing prevention of pressure sores in hospital and community patients. Journal of Advanced Nursing, 13, 365–373.Google Scholar
Covinsky, K.E., Goldman, L., Cook, & E.F., et al. (1994). The impact of serious illness on patient's families. Journal of the American Medical Association, 272, 1839–1844.Google Scholar
Dallam, L., Smyth, C., Jackson, & B.S., et al. (1995). Pressure ulcer and pain: Assessment and quantification. Journal of Wound, Ostomy, and Continence Nursing, 22, 211–218.Google Scholar
Decanay, A. (2000). Pressure ulcers. In Skin Care Triad. Continence Management, Wound Care, and Therapeutic Positioning, J.L. Rook & L.D. Weiss, D.D. Hagler (eds.), pp. 366. Boston: Butterworth Heinemann.
Eisenberger, A. & Zeleznik, J. (2003). Pressure ulcer prevention and treatment in hospices: A qualitative analysis. Journal of Palliative Care, 19, 9–14.Google Scholar
Emanuel, E.J., Fairclough, D.L., Slutsman, & J., et al. (2000). Understanding economic and other burdens of terminal illness: The experience of patients and their care givers. Annals of Internal Medicine, 132, 451–459.Google Scholar
Ferrell, B., Josephson, K., Norvid, & P., et al. (2000). Pressure ulcers among patients admitted to home care. Journal of the American Geriatric Society, 48, 1042–1047.Google Scholar
Fried, T.R., Pollack, D.M., Drickamer, & M.A., et al. (1999). Who dies at home? Determinants of site of death for community-based long-term care patients. Journal of the American Geriatric Society, 47, 25–29.Google Scholar
Hanson, D.S., Langemo, D., Olson, & B., et al. (1991). The prevalence and incidence of pressure ulcers in the hospice setting: Analysis of two methodologies. American Journal of Hospice and Palliative Care, September/October, 18–22.Google Scholar
Hanson, D.S., Langemo, D., Olson, & B., et al. (1994). Evaluation of pressure ulcer prevalence rates for hospice patients post-implementation of pressure ulcer protocols. American Journal of Hospice and Palliative Care, November/December, 14–19.Google Scholar
Hayley, D.C., Cassel, C.K., Snyder, & L., et al. (1996). Ethical and legal issues. In Medical Care of the Nursing Home Resident. What Physicians Need to Know, R.W. Besdine, L.Z. Rubenstien, & L. Synder (eds.), pp. 143–154. Philadelphia: America College of Physicians.
Hoffman, R., Lile, J.L., Mace, & K., et al. (1991). Standards of care for hospice patients with pressure ulcers. Decubitus, 4, 19–24.Google Scholar
Kayser-Jones, J., Schell, E., Lyons, & W., et al. (2003). Factors that influence end-of-life care in nursing homes: The physical environment, inadequate staffing, and lack of supervision. The Gerontologist, 43 (special issue II), 76–84.Google Scholar
Keay, T.J., Fredman, L., Taler, & G.A., et al. (1994). Indicators of quality medical care for the terminally ill in nursing homes. Journal of the American Geriatric Society, 42, 853–860.Google Scholar
Langemo, D.K., Melland, H., Hanson, & D., et al. (2000). The lived experience of having a pressure ulcer. A qualitative analysis. Advanced Skin Wound Care, 13, 225–235.Google Scholar
Leff, B., Kaffenbarger, K.P., & Remsberg, R. (2000). Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care. Journal of the American Geriatric Society, 48, 943–948.Google Scholar
Levine, C. & Zuckerman, C. (1999). The trouble with families: Toward an ethic of accommodation. Annals of Internal Medicine, 130, 148–152.Google Scholar
Maklebust, J. & Magnan, M.A. (1992). Approaches to patient and family education for pressure ulcer management. Decubitus, 5, 18–20, 24, 26 passim.Google Scholar
Miles, M.M. & Huberman, A.M. (1994). Codes and Coding, Qualitative Data Analysis, 2nd ed., pp. 55–69. Thousand Oaks, CA: Sage Publications.
Moody, B.L., Fanale, J.E., Thompson, & M., et al. (1988). Impact of staff education on pressure sore development in elderly hospitalized patients. Archives of Internal Medicine, 148, 2241–2243.Google Scholar
Moss, R.J. & La Puma, J. (1991). The ethics of pressure sore prevention and treatment in the elderly: A practical approach. Journal of the American Geriatric Society, 39, 906–908.Google Scholar
Pillemer, K., Suitor, J.J., Henderson, & C.R., et al. (2003). A cooperative communication intervention for nursing home staff and family members of residents. The Gerontologist, 43 (special issue II), 96–106.Google Scholar
Raudonis, B.M. & Kirschling, J.M. (1996). Family caregivers' perspective on hospice nursing care. Journal of Palliative Medicine, 12, 14–19.Google Scholar
Regnard, C.F.B. & Tempest, S. (1998). Skin pressure damage. In A Guide to Symptom Relief in Advanced Disease 4th ed., pp. 44–45. Cheshire, UK: Hochland and Hochland.
Remsburg, R. & Bennett, R.G. (1997). Pressure-relieving strategies for preventing and treating pressure sores. In Pressure Ulcers. Clinics of Geriatric Medicine, Vol. 13 D.R. Thomas, & R.M. Allman (eds.), pp. 513–529. Philadelphia: W.B. Saunders Company.
Sachs, G. (2003). Research at the interface of palliative care and geriatrics. Journal of Palliative Care, 19, 5–6.Google Scholar
Sergi-Swinehart, P. (1985). Hospice home care: How to get patients home and help them stay there. Seminars in Oncology, 12, 461–465.Google Scholar
Steinhauser, K.E., Clipp, E.C., McNeilly, & M., et al. (2000). In search of a good death: Observations of patients, families, and providers. Annals of Internal Medicine, 132, 825–832.Google Scholar
Strauss, A. & Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 2nd ed. Thousand Oaks, CA: Sage Publications.
Szor, J.K. & Bourguignon, C. (1999). Description of pressure ulcer pain at rest and at dressing change. Journal of Wound, Ostomy, and Continence Nursing, 26, 115–120.Google Scholar
Tuch, H. (2003). Commentary on “Lower respiratory infections in nursing home residents with dementia: A tale of two countries”. The Gerontologist, 43 (special issue II), 94–95.Google Scholar
van Rijswijk, L. & Braden, B.J. (1999). Pressure ulcer patient and wound assessment: An AHCPR clinical practice guideline update. Ostomy/Wound Management, 45(suppl. 1A), 56S–67S.Google Scholar
von Gunten, C., Ferris, F., D'Antuono, & R., et al. (2002). Recommendations to improve end-of-life care through regulatory change in U.S. health care financing. Journal of Palliative Medicine, 5, 35–41.Google Scholar
Walding, M. & Andrews, C. (1995). Preventing and managing pressure sores in palliative care. Journal of Professional Nursing, 11, 33–38.Google Scholar
Waller, A. & Caroline, N.L. (2000). Pressure sores. In Handbook of Palliative Care in Cancer, pp. 91–98. Boston: Butterworth Heinemann.
Wright, P. (2001). A critical pathway for interdisciplinary hospice care. American Journal of Hospice and Palliative Care, 18, 31–34.Google Scholar