Pressure injury prevention in Aotearoa New Zealand aged care facilities: A case study

Abstract
High dependency levels and complex care needs increase pressure injury risk for older adults in aged residential care, with devastating consequences for their health and well-being. The prevention of pressure injuries requires comprehensive and skilled care mainly provided by registered nurses and health care assistants. Despite high prevalence of pressure injuries, there is a lack of evidence on their prevention in aged residential care settings in Aotearoa New Zealand. This single case study aimed to identify factors affecting pressure injury prevention in aged residential care. The perceptions of 10 staff from two aged care facilities in Aotearoa New Zealand were obtained from individual interviews along with relevant policy and practice documents. Data were analysed using triangulation and pattern matching. Three themes were identified: 1) staffing; 2) leadership, teamwork, and communication; and 3) assessment and early intervention. Participants were committed to preventing pressure injuries despite the complex, high care needs of residents and challenging contextual factors. The findings contest the notion that pressure injuries occur solely from poor quality care. The association between increasingly difficult work conditions and pressure injury prevalence should be addressed by policy makers. Support and empowerment of health care assistants to take a proactive role in pressure injury prevention could improve outcomes for residents in aged residential care settings. Nurse leaders should continue to advocate for a skilled and knowledgeable nursing workforce and mandated safe staffing levels.

Ngā ariā matua
Nā ngā hiahia pūputu me ngā hiahia taurimatanga matatini ka piki ake te mōrea māuiui takotoranga tinana i waenga i ngā pakeke i ngā kāinga noho manaaki kaumātua, me te puta mai o ētahi hua tino taumaha mō tō rātou hauora, toiora hoki i muri. Ko te ara matua hei ārai i ngā māuiui takotoranga tinana ko te taurimatanga mutunga mai o te matatau, mā ngā tapuhi rēhita me ngā kaiāwhina hauora hei kawe. Ahakoa te pūputu o te panga o ngā māuiui takotoranga tinana, he iti tonu ngā taunakitanga me pēhea e āraia ai i ngā whare kāinga noho manaaki kaumātua i Aotearoa. Tā tēnei rangahau tū āhua kotahi he whai kia tautohutia ngā pūtake mō te ārai i ngā māuiui takotoranga tinana i ngā kāinga noho manaaki kaumātua. I whāia ngā whakaaro mai i ētahi kaimahi 10 i ētahi kāinga noho manaaki kaumātua e rua i Aotearoa, me ētahi uiuinga takitahi, i te taha hoki o ngā tuhinga kaupapa here, tikanga mahi e hāngai ana. I tātaritia ngā raraunga nā te whakamahi pou tuatoru, me te rapu putanga ōrite. E toru ngā tāhuhu i tautohutia: 1) ko ngā kaimahi tōtika; 2) ko te hautū, ko te mahi ā-tira kotahi, me te whakawhiti kōrero; mee 3) te aromatawai me te kōkiri wawe i ngā āwhina e tika ana. I te ū katoa ngā whakaaro o te hunga whai wāhi mai ki te ārai māuiui takotoranga tinana ahakoa ngā hiahia matatini, pūputu hoki o te hunga noho i ō rātou kāinga, me ngā horopaki taumaha i te taha. Nā ngā kitenga nei ka kitea te hē o te kī i takea mai ngā māuiui takotoranga tinana i te taurimatanga ngoikore anake. Me mātua whakatika te pānga tata o ngā āhuatanga mahi uaua me te rahi o ngā māuiui takotoranga tinana, e ngā kaitārei kaupapa here. Mā te tautoko me te whakamana i ngā kaiāwhina hauora kia whakauru wawe ki ngā mahi ārai māuiui takotoranga tinana, ka pai ake ai pea ngā putanga mō ngā tāngata i ngā whare kāinga noho manaaki kaumātua. Kia kaha tonu ngā kaihautū tapuhi ki te kauwhau mō te whakapakaritanga pūkenga mō te kāhui tapuhi, me ngā taumata tokomaha kaimahi haumaru kia whakahautia.

Keywords / Ngā kupu matua
aged residential care/kāinga noho manaaaki kaumātua; case study/mātai tūāhua; gerontology/te taurima tūroro kaumātua; pressure injury/te ārai māuiui takotoranga tinana; safe staffing/ngā taumata tokomaha kaimahi haumaru