Skip to main content Accessibility help
×
Home

Care planning for pressure ulcers in hospice: The team effect

  • ANDREW EISENBERGER (a1) and JOMARIE ZELEZNIK (a2)

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.

Copyright

Corresponding author

Corresponding author: Jomarie Zeleznik, M.D., 3224 Grand Concourse, #BA, Bronx, NY 10356. E-mail: zeleznikjo@aol.com

References

Hide All

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, 879882.
Baharestani, M.M. (1994). The lived experience of wives caring for their frail, homebound, elderly husbands with pressure ulcers. Advanced Wound Care, 7, 4052.
Bale, S., Finlay, I., & Harding, K.G. (1995). Pressure sore prevention in a hospice. Journal of Wound Care, 4, 465468.
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, 8588.
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, 7381.
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, 205210.
Brandt, K. (2001). The physician–hospice partnership: Expanding opportunities to improve end-of-life care. Journal of Medical Practice Management, 16(5), 232236.
Chaplin, J. (2000). Pressure sore risk assessment in palliative care. Journal of Tissue Viability, 10, 2731.
Clarke, M. & Kadhom, H.M. (1988). The nursing prevention of pressure sores in hospital and community patients. Journal of Advanced Nursing, 13, 365373.
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, 18391844.
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, 211218.
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, 914.
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, 451459.
Ferrell, B., Josephson, K., Norvid, & P., et al. (2000). Pressure ulcers among patients admitted to home care. Journal of the American Geriatric Society, 48, 10421047.
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, 2529.
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, 1822.
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, 1419.
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. 143154. 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, 1924.
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), 7684.
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, 853860.
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, 225235.
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, 943948.
Levine, C. & Zuckerman, C. (1999). The trouble with families: Toward an ethic of accommodation. Annals of Internal Medicine, 130, 148152.
Maklebust, J. & Magnan, M.A. (1992). Approaches to patient and family education for pressure ulcer management. Decubitus, 5, 18–20, 24, 26 passim.
Miles, M.M. & Huberman, A.M. (1994). Codes and Coding, Qualitative Data Analysis, 2nd ed., pp. 5569. 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, 22412243.
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, 906908.
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), 96106.
Raudonis, B.M. & Kirschling, J.M. (1996). Family caregivers' perspective on hospice nursing care. Journal of Palliative Medicine, 12, 1419.
Regnard, C.F.B. & Tempest, S. (1998). Skin pressure damage. In A Guide to Symptom Relief in Advanced Disease 4th ed., pp. 4445. 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. 513529. Philadelphia: W.B. Saunders Company.
Sachs, G. (2003). Research at the interface of palliative care and geriatrics. Journal of Palliative Care, 19, 56.
Sergi-Swinehart, P. (1985). Hospice home care: How to get patients home and help them stay there. Seminars in Oncology, 12, 461465.
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, 825832.
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, 115120.
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), 9495.
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), 56S67S.
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, 3541.
Walding, M. & Andrews, C. (1995). Preventing and managing pressure sores in palliative care. Journal of Professional Nursing, 11, 3338.
Waller, A. & Caroline, N.L. (2000). Pressure sores. In Handbook of Palliative Care in Cancer, pp. 9198. Boston: Butterworth Heinemann.
Wright, P. (2001). A critical pathway for interdisciplinary hospice care. American Journal of Hospice and Palliative Care, 18, 3134.

Keywords

Care planning for pressure ulcers in hospice: The team effect

  • ANDREW EISENBERGER (a1) and JOMARIE ZELEZNIK (a2)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed