Title

Research Paper: Preventing Pressure Ulcers: Occupational Challenges Embedded in Everyday Life

Start Time

6-10-2012 3:10 PM

End Time

6-10-2012 3:40 PM

Session Type

Event

Abstract

Chris a 35-year old single man with an active social life, full time job, his own apartment and a long-time time loyal aid noticed a blister on his buttocks. For the next 9 months he lay in a hospital bed struggling to heal from surgery to repair his stage 4- pressure ulcer. He lost his job, apartment and social life but not his sense of humor.

Pressure sores associated with spinal cord injuries can be devastating to individuals, families and the national economy and thus became the problem driving the Pressure Ulcer Prevention Studies (PUPS).1 Using the USC translations research model as a guideline, studies addressing the quality of life of people who have spinal cord injuries and pressure sores have been conducted. The purpose of the first pressure ulcer prevention study, and the topic of this paper, is to gain a participant-derived emic understanding about how lifestyle considerations embedded within occupations affect the risk of attaining a pressure sore.3 2 Although isolated risk factors that enhance the probability that an individual may acquire a pressure sore are identified in existing literature, our intent was to document how a confluence of unanticipated situations, moment-to-moment decision-making and individual circumstances come to bear on acquiring pressure ulcers. To this end, twenty, multi-ethnic, individuals with spinal cord injuries and a history of pressure sores participated in an 18-month qualitative research project including in-depth interviews and participant observations. Using thematic analysis4 eight overarching principle were derived that reflected risk in their real world life context. These principles include: 1) perpetual danger; 2) disruption of routine; 3) decay of prevention behaviors; 4) lifestyle risk ratio; 5) individualization; 6) presence of awareness and motivation; 7) lifestyle trade-offs; and 8) access to needed care, services and supports.

In this paper first, I will present the purpose of the study, methodological design, and analytical approach. Second, I will describe the overarching principles through examples from participants. By focusing on the participants experience I will demonstrate complexity and interwoven nature of the principles. Furthermore, I will argue that the findings call into question some of the typical occupational therapy practices that are used in clinics. Finally, I will propose the need for systemic changes in service delivery for people who incur pressure ulcers.

Objectives for Discussion: The discussion will be audience-driven. However, if silence is an issue, the following will serve as points of discussion.

  1. Discuss, clarify, support, or debate the overarching principles that emerged and how these principles may inform theory in occupational science.
  2. Discuss how the findings can support systemic changes in service delivery.
  3. Explore the ways we can integrate qualitative occupational science research to enhance occupational therapy treatment.

References

Fuhrer MJ, Garber SL, Rintala DH, Clearman R, Hart KA. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil 1993;74:1172–1177.

Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med 1997;13:421–436.

Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks (CA): Sage Publication; 2002. p 692.

Jackson J, Carlson M, Rubayi S, Scott MD, Atkins MS, Blanche EI, Saunders-newton C, Mielke S, Wolfe MK, Clark FK. Qualitative study of principles pertaining to lifestyle and pressure ulcer risk in adults with spinal cord injury. Disabili Rehabil, 2010; 32(7): 567–578. http://dx.doi.org/10.3109/09638280903183829

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Oct 6th, 3:10 PM Oct 6th, 3:40 PM

Research Paper: Preventing Pressure Ulcers: Occupational Challenges Embedded in Everyday Life

Chris a 35-year old single man with an active social life, full time job, his own apartment and a long-time time loyal aid noticed a blister on his buttocks. For the next 9 months he lay in a hospital bed struggling to heal from surgery to repair his stage 4- pressure ulcer. He lost his job, apartment and social life but not his sense of humor.

Pressure sores associated with spinal cord injuries can be devastating to individuals, families and the national economy and thus became the problem driving the Pressure Ulcer Prevention Studies (PUPS).1 Using the USC translations research model as a guideline, studies addressing the quality of life of people who have spinal cord injuries and pressure sores have been conducted. The purpose of the first pressure ulcer prevention study, and the topic of this paper, is to gain a participant-derived emic understanding about how lifestyle considerations embedded within occupations affect the risk of attaining a pressure sore.3 2 Although isolated risk factors that enhance the probability that an individual may acquire a pressure sore are identified in existing literature, our intent was to document how a confluence of unanticipated situations, moment-to-moment decision-making and individual circumstances come to bear on acquiring pressure ulcers. To this end, twenty, multi-ethnic, individuals with spinal cord injuries and a history of pressure sores participated in an 18-month qualitative research project including in-depth interviews and participant observations. Using thematic analysis4 eight overarching principle were derived that reflected risk in their real world life context. These principles include: 1) perpetual danger; 2) disruption of routine; 3) decay of prevention behaviors; 4) lifestyle risk ratio; 5) individualization; 6) presence of awareness and motivation; 7) lifestyle trade-offs; and 8) access to needed care, services and supports.

In this paper first, I will present the purpose of the study, methodological design, and analytical approach. Second, I will describe the overarching principles through examples from participants. By focusing on the participants experience I will demonstrate complexity and interwoven nature of the principles. Furthermore, I will argue that the findings call into question some of the typical occupational therapy practices that are used in clinics. Finally, I will propose the need for systemic changes in service delivery for people who incur pressure ulcers.

Objectives for Discussion: The discussion will be audience-driven. However, if silence is an issue, the following will serve as points of discussion.

  1. Discuss, clarify, support, or debate the overarching principles that emerged and how these principles may inform theory in occupational science.
  2. Discuss how the findings can support systemic changes in service delivery.
  3. Explore the ways we can integrate qualitative occupational science research to enhance occupational therapy treatment.