Publication Date

2013-12-18

Availability

Embargoed

Embargo Period

2015-12-18

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2013-12-16

First Committee Member

Karina Gattamorta

Second Committee Member

Mary A. Hooshmand

Third Committee Member

Carl I. Schulman

Fourth Committee Member

Joseph De Santis

Abstract

Pressure ulcer prevention requires consistent assessments and documentation. Documentation of pressure ulcers among providers is often inconsistent and can lead to a delay in proper treatment of pressure ulcers. Purpose: The purpose of this study was to explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between nursing documentation and incidence of pressure ulcers in Intensive Care Units (ICUs). Sample: A convenience sample of ICU patients at the selected medical center comprised the study’s sample. All patients’ medical records of patients admitted to ICUs between the time periods of September 01, 2011 through September 30, 2012 were audited for the proposed study. Data used in the analysis were from 98 pressure ulcer patients and 98 non-pressure ulcer patients from four ICUs at the selected medical center. Method: This study used a retrospective, comparative, descriptive, correlational design to examine the relationship between nursing documentation and incidence of pressure ulcers in ICUs. Instruments: The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. Analyses: The analysis of data was conducted using the PASW version 19.0. Descriptive statistics were used to describe the study sample and to calculate the frequencies of categorical variables, which are the aspects of pressure ulcer documentation. One-way ANOVA was used to compare the scores of comprehensiveness of nursing documentation in four ICUs. Kruskal-Wallis H test was used to compare the quality score of pressure ulcer documentation in the four ICU settings. Pearson’s r Correlation was used to explore the relationships between the quality and comprehensiveness of documentation of pressure ulcers as well as the incidence of pressure ulcers. A Chi square test was used to test differences between the pressure ulcer patients and non-pressure ulcer patients in terms of categorical variables (gender, nutritional status, and primary diagnosis). Patients with and without pressure ulcers were compared by age and length of stay. An independent sample t test was also used to examine the differences in quality/comprehensiveness scores between dayshift and nightshift. Results: The results of this study showed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. There were no significant differences in pressure ulcer incidence across four ICUs. The MICU had the highest quality/comprehensiveness score among the four ICU settings. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers differ from patients without pressure ulcers in length of stay and nutritional status. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. Conclusions: The findings of this study have shown that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Nursing documentation of pressure ulcers did not provide a complete picture of patients’ care needs that require nursing interventions. The findings of this study can be used to design educational interventions for both student and staff nurses and has implications for nursing practice, policy and future research.

Keywords

pressure ulcers; nursing informatics, electronic health record; nursing documentation; patient safety; quality and comprehensiveness of nursing documentation

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