A qualitative analysis of pressure injury development among medically underserved adults with spinal cord injury.
Lucía I Floríndez, Mike E Carlson, Elizabeth Pyatak and 8 others
PMID 30621460WHAT IT FOUND
25 adults with spinal cord injury developed medically serious pressure injuries during a prevention program, and notes identified themes including basic wound care knowledge gaps, equipment shortfalls, comorbidities, bed rest non-adherence, inactivity, or circumstances beyond the program.
Key findings
01The analysis identified six themes that explained medically serious pressure injury development, and almost all injuries had more than one contributing theme.
02Lack of rudimentary wound care knowledge was reported in 13 injury instances, and equipment or supply deficits were implicated in 17 of the 40 injuries.
03Comorbidity or fragile skin was noted in 19 injuries, with 13 at least partially linked to compromised skin integrity from prior pressure injuries or surgeries, and non-adherence to prescribed bed rest was reported in 11 injuries.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The themes came from treatment notes written by intervention staff, so they reflect staff judgments about what to record, not a neutral factual account. The analysis included only 25 participants whose notes met criteria, all of whom developed a medically serious pressure injury, so it cannot show why others did not. The sample was low-income, medically underserved, and had many prior pressure injuries, so findings may not apply to other spinal cord injury groups. This is a qualitative secondary analysis, not an outcome trial, so it does not test whether the prevention program worked. The parent trial results are described elsewhere, so this paper cannot be read as an outcome study of the prevention program.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not read this as proof that the prevention program failed or that these six themes caused pressure injuries. It analyzed treatment notes from 25 participants who developed injuries. The notes are staff accounts, so they report possible contributing circumstances, not tested causes.