October 2017 April 2016

Te Puawai This definition acknowledges two important aspects in providing optimal care in the prevention of pressure injuries. 1. Nursing has a responsibility in the prevention of pressure injuries 2. Nursing is not exclusively responsible for the prevention and / or development of pressure injuries The definition acknowledges that nursing is working within a wider healthcare system that influences the quality of care of the nursing profession produces. This theory connects with the model for delivery quality of care which was first developed by Donabedian in 1966 (Structure process and outcomes) (Donabedian, 1966). The model describes “structure” as how we organise care, “process” what we do and “outcomes” are what we achieve (Makary et al., 2006) In a concept analysis “Nursing sensitive Indicators” Hislop and Lu (2014) conclude that there is support in the literature to use the prevalence of pressure injuries (among other clinical topics: falls, falls with injury, nosocomial elective infection and patient / family satisfaction with nursing care) as an outcome measure (Heslop & Lu, 2014). Here the structural attributes of the concept were deemed to be hours of nursing care per patient day and nursing staffing (staff & skill mix and staff ratio). No particular process attributes could be identified which is not surprising considering the variety of clinical topics affected. All this suggests that when measuring a nurse sensitive indicator such as pressure injuries it must include measuring structural, process and outcome components. Structural indicators Making sure the structural indicators of pressure injuries are in place is a managerial responsibility. Those who work at the bedside should be provided with the tools that enable them to provide optimal care in the prevention of pressure injuries. These structural indicators first need to be supported by the MoH, then disseminated throughout the different DHB, hospitals, aged care facilities and private hospitals arriving ultimately at department level. Examples of structural best practice indicators are: ◆ The presence of a multidisciplinary pressure injury prevention committee in the facility ◆ The presence of approved protocols for the prevention and treatment of pressure injuries ◆ Conducting regular audits to ensure compliance with protocols and guidelines ◆ A pressure injury prevention information brochure for family / care givers ◆ A standard handover policy during admission and discharge of a client with pressure injuries Within the New Zealand healthcare context there is evidence some of these structural indicators are not in place at DHB level. A 2012 survey across all DHB’s showed that 15 of the 20 DHB’s had a pressure injury prevention committee in place and eleven never carried out pressure injury prevalence audits (Blake, 2012). The 2014 edition of the National Survey Care Indicators (NSCINZ) carried out in the six DHB’s of the lower North Island showed that 5 of the six DHB had a © Te Puawai College of Nurses Aotearoa (NZ) Inc 4

October 2017 April 2016 | Page 6