Innovative Outcomes

It is suggested that the HSW function, like the nursing profession, is gender isolated, not reflecting the population needs in present-day Ireland. It is also clear that there are several issues relating to HSW ability to detect early pressure ulcer damage, caused by issues relating to competency to complete a comprehensive skin assessment. The findings point towards deficiencies in HSW ability to accurately detect skin damage, irrespective of the training provided. However, the low health literacy finding is worrying, and as shown previously, does not only lie in the field of HSW inability to accurately detect skin changes alone. Low health literacy can prevent HSWs from obtaining vital information needed to prevent harmful ritualistic practices. This can not only lead to HSW isolation from the rest of the caring workforce, but can inhibit measures designed to counteract harmful ritualistic approaches. Variations in learning abilities are of concern and low health literacy adds confusion to the debate surrounding training requirements. It is difficult for

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educators to determine the most valid training options for HSWs when research has shown that training is not measured in a consistent way, and clinical supervision is haphazard or non-existent, especially in the community setting. This current research adds to knowledge regarding the inconsistencies and inadequacies in existing training for HSWs, and their lack of career progression. Most existing literature recommends a shift from the current teacher-centred method towards transformative style training, including structured education to ensure HSWs of different ability and ethnic background benefit from the training provided.

HSWs provide most daily patient care and have the greatest opportunity to complete a comprehensive skin assessment in the community. Skin assessment is one vital preventative measure which must be undertaken in order to reduce risk and avoid pressure ulcer development. However, to date in Ireland no writer has investigated the effects of existing HSW training has on their competency to fulfil this role. Any positive impact arising from an educational intervention requires measurement if a true representation of the validity or reliability of the training received is to be obtained. Most significantly, two studies assessing the validity of the PUCLAS tool noted their predictive validity and advocated their use (Beeckman et al, 2008, Beeckman et al, 2010). The prevailing point to note in this writer’s study is the negative effect of the educational intervention. This was reflected in the post-test 1 scores. If the PUCLAS tool were a suitable educational method for HSWs to accurately detect early pressure ulcer damage, an increase in scores from pre-test to post-test 1 and post-test 2 should be observed. The negative impact of this educational intervention shows that the PUCLAS tool may not be a reliable teaching method for HSWs. However, the small sample size does not enable the researcher to generalise the findings. Nonetheless, this negative finding is disconcerting for registered nurses in the community, as they must now be mindful of deficits in HSW ability to competently complete skin assessment. Thus delegation of such tasks must be undertaken with caution, and structured accredited education for HSWs in skin assessment vital. A more appropriate method of teaching approaches must be found if HSWs are to detect early pressure ulcer damage, with consideration given to the associated findings of low health literacy among participants.

The fear of being ‘found out’ cannot be overlooked, which could call into question the values held by HSWs, e.g. compassion. care and commitment. This must be

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considered when querying why some HSWs chose not to participate in the study. The research design for this study directly tested HSW knowledge, prohibiting conferring and techniques of memorising knowledge, which reduce results validity. The writer underestimated the complexity of the phenomenon under investigation and this was influential in the low response rate.

The research question was:

What is the impact of an educational intervention on community Home Support Workers’ ability to detect early pressure ulcer damage?

This study showed that there was a small negative correlation between the pre-test scores and post-test 2 scores, but this was not statistically significant. There was a small positive correlation between the post-test 1 scores and post-test 2, this also was not statistically significant. This is surprising, considering the fact that previous studies demonstrated statistical significant results for the PUCLAS tool. However, the study population differed, which makes meaningful comparison difficult

Although the writer’s study did not show statistical significant variations following the educational intervention, the writer believes this is not due to the PUCLAS tool as an instruction method. Firstly, the writer believes this is in part a factor of the small sample size. The writer also believes that the lack of statistical significance arises from the moderate negative relationship between pre-training and post-test 2 scores and can be principally explained by low health literacy among the participants. Previous research regarding this method of improving skills and knowledge in detecting various stage of skin damage showed promising results. Further research is needed in this area in order to conclusively measure the benefits of this educational intervention method for HSWs, and to further explore the issue of low health literacy among HSWs in all areas of clinical practice. Overall, the findings of this study point to unacceptable variations in the competence of this workforce. These findings have indicated that presently HSWs are being sent into homes with inadequate or no training, and that currently there is minimal supervision to monitor if current practices for care delivery are safe.

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5.9 Summary

Skin assessment is an essential component in preventing pressure ulcers, and therefore reducing the incidence of pressure ulcer damage. Most pressure ulcers are believed to be preventable (O’Brien and Cowman, 2011). However, pressure ulcers are an ongoing economic and social burden. They can also cause considerable suffering for the individual and significantly impair quality of life. The financial cost of treating pressure damage creates a heavy burden on healthcare systems. Bennett et al (2004) estimated that 2-4% of annual global healthcare expenditure is used to treat pressure ulcer. This indicates that many preventable pressure ulcers occur, despite the widespread use of visual skin assessment methods.

Presently, in the community setting, visual skin assessment remains a key trigger for the initiation of preventative measures. The inconsistencies in visual skin assessment have been outlined in the research and in this study. The inconsistencies are a worry for nurses working in the community and create risk for the delivery of effective strategies which involve the delegation of care. A more efficient and reliable method of training is urgently if HSWs are to competently complete a comprehensive skin assessment. If prompt and accurate skin assessment were completed by HSWs, nurses in the community could more effectively initiate preventative measures which would therefore significantly reduce pressure ulcer occurrence. Pressure ulcers are a growing problem in the healthcare sector, and all healthcare workers must make every effort to tackle this problem. However, HSWs need a method of training appropriate to their learning needs. The finding of low health literacy adds a layer of complexity to the task of achieving educational attainment for this workforce and thus requires further research. This will support nurses in the community and further the goal of improving safe delegation of care provision and maintain patient safety. The writer believes that health educators could benefit from combining transformative style learning with clinical supervision (Hayes, 2014 and Thomas et al, 2014). Therefore, the educators involved in health and social care education need to adapt to the growing needs of the HSW in terms of how and what they learn and what they need to know.

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Chapter 6

Conclusion

The aim of this study was to investigate the impact of an educational intervention on community HSW ability to detect early pressure ulcer damage. The educational intervention employed was the PUCLAS e-learning tool. Two previous studies have been conducted regarding the its impact, however neither of these related to HSWs. The writer’s findings will therefore add to the body of knowledge concerning limitations in current training and the future educational needs of HSWs. In this chapter, a brief summary of the writer’s findings will be outlined. The study strengths and limitations will be discussed. Furthermore, the implications arising from the study findings and recommendations for future research will be discussed in detail. Finally, the writer will reflect on the study, and discuss the lessons learned from the research process.