UCLA

Background: Pressure injuries (PIs) impose significant human and financial costs on patients and their families and the health care system. Most are considered preventable and therefore are deemed medical errors. Among medical errors, PIs are the costliest. Results from extensive etiology-related and interventional research have been translated into evidence-based clinical guidelines which have been widely disseminated. Yet, hospital acquired pressure injuries (HAPI) have been increasing in recent years while HAPI prevalence rates in intensive care units (ICU) continue being the highest among hospitalized patients. Considering that the majority of PIs are medical errors, researchers and health care organizations have to explore human factors, such as

attitudes of main stakeholders, to inform approaches to decreasing HAPIs in ICU patients who are among the most vulnerable of hospitalized patients.

Methods: A multi-site, focused ethnographic study was conducted with four major stakeholders in the ICU. Critical care nurses (CCRN), physician and nurse practitioner providers, ICU leaders, and patients and their families from two community hospitals and two academic hospitals participated in interviews or focus groups. Semi-structured interview guides were used to elicit implicit and explicit attitudes of each stakeholder group towards PIP.

Results: Findings of three stakeholder groups, CCRNs, providers, and patients and families, are reported here. All participants held preconceptions and misconceptions about PIs and PIP which informed the degree to which they were engaged with PIP processes. Preconceptions and misconceptions affected how they interpreted transition points in the ICU which in turn impacted how they prioritized PIP. Major misconceptions held by both CCRNs and providers were that PIP could not be undertaken with very critical patients, that PIP mostly consisted of side to side turning at various intervals, and that PIs took longer than scientific evidence suggests. Patients’ and families’ incomplete preconception that affected their attitude toward PIP in the ICU was that PIs only befell frail, bedbound, and debilitated patients in skilled nursing facilities.