Prevention of pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury: An observational study.

AIMS AND OBJECTIVES: To uncover efforts made by healthcare professionals to prevent pressure ulcers in patients with severe brain injury undergoing treatment at a subacute rehabilitation department.

BACKGROUND: Pressure ulcers are a major burden for patients and also generate considerable healthcare costs. Pressure ulcers are, nevertheless, prevalent in both secondary care and primary care.

DESIGN: In this qualitative study, we performed 24-hour observation on four patients undergoing rehabilitation for severe brain injury. An observation guide was developed inspired by the Braden Scale and Spradley's theory and methods. Observations were analysed using content analysis. Patricia Benner's aspects of clinical grasp were employed in the interpretation of the observations.

FINDINGS: One overarching theme was identified: "Professionalism expressed by preventing intervention, involving the patient, employing clinical grasp and professional pride." Seven subcategories were summed up into the following three categories: organisation of clinical practice, professional assessment and interactions with the patient.

CONCLUSION: The healthcare professionals' actions to prevent pressure ulcers consisted of attaining the necessary knowledge about pressure ulcer care and performing the activities. However, our observations revealed one important additional aspect: a very distinct impression that the healthcare professionals were committed to learning about the patients' former life and actively used this knowledge in their planning and provision of daily patient care. We believe this commitment has a very positive effect on prevention of pressure ulcers.

RELEVANCE TO CLINICAL PRACTICE: Professional knowledge about prevention of pressure ulcer is a necessary requisite, but is not sufficient to ensure effective treatment. To transfer knowledge into practice, we recommend that patients' rehabilitation days be planned in such a manner that activities, mobilisation and training are conducted throughout the day and evening. We also recommend that professional staff are encouraged to seek information about the former life of patients with severe brain injury.