The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs.
As part of an ethnographic study exploring what it means for nursing home residents to "do well," we examined patterns of advocacy on which they relied to have an effective voice. The purposive sample included 17 older, long-stay residents from a for-profit chain nursing home and a large public skilled nursing facility. Data collection included in-depth interviews, participant observation, and document review. Depending on personal history, health status, and facility context, participants relied on family and friends, trusted staff, fellow residents, or themselves as advocates. Although residents varied in their abilities and willingness to express concerns, a program matching staff advocates with residents at the chain nursing home fostered participants' sense that they were heard and their needs addressed. Attending to patterns of advocacy and the effect of the nursing home environment on resident communication are essential for individualizing care and promoting systems to ensure residents have a voice and are heard.
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