This study sought to establish if nurses at a community hospital could correctly identify patients at high risk for skin breakdown and determine whether the resources needed to reposition high-risk patients per protocol were available.
The sample comprised 101 registered nurses from 8 acute care units in a 246-bed community-owned district Magnet® hospital. The study facility serves patients from a wide geographic area in the “panhandle” of Idaho with a largely rural population.
Face-to-face interviews were conducted on all shifts for 4 days. The instrument consisted of demographic questions and patient assignment questions including which patients the nurse identified at high risk for skin breakdown, which patients the nurse received information on about skin risks at change of shift, whether the nurse knew the Norton Pressure Ulcer Scale scores for their patients, whether patients were repositioned, who performed the repositioning, and how many times that shift. Surveyors obtained patients' Norton scores from computer records and recorded whether the nurse correctly identified patients at high-risk for skin breakdown.
Most nurses (73%) stated they did not know their patients' Norton scores. About 60% of nurses reported turning their high-risk patients every 2 to 4 hours. The repositioning was completed most often by RNs alone (39%), RN and CNA (36%), and by patients themselves (35%). Reasons for not repositioning included the following: allowed to sleep, off unit, patient refused, not enough time, family refused, pain, not enough help, and patient receiving end-of-life care. Assessment of patient's skin risk status was correct in 232 out of 348 patients (66%). Nurses predicted high risk when the Norton score indicated low risk in 35.9% of patients and low risk when the Norton scale indicated high risk in 35.1%. Nurses reported receiving information about skin risk in 33% of their assigned patients.
Nurses reported adequate resources to reposition patients. Most were not aware of their patients' Norton scores and were found to have poor accuracy when identifying patients' risk status.
Anita Voz, BSN, CWCN, Kootenai Health, Department of Nursing, Coeur d'Alene, Idaho.
Carol Williams, BSN, Kootenai Health, Department of Nursing, Coeur d'Alene, Idaho.
Marian Wilson, MPH, RN-BC, Kootenai Health, Department of Nursing, Coeur d'Alene, Idaho.
Correspondence: Anita Voz, BSN, CWCN, Kootenai Health, 2003 Kootenai Health Way, Coeur d'Alene, ID 83814 (firstname.lastname@example.org).