Hospital acquired pressure ulcers in oncology units: risk, prevalence, and nurse variables

Hospitals acquired pressure ulcers (HAPUs), a nationally recognized indicator of hospital and nursing quality, pose a notable risk to hospitalized patients for pain, debility and death. Oncology patients represent a large portion of hospitalized patients. Numerous common cancer symptoms and complications are known risk factors for HAPUs. HAPU prevalence in oncology units is unknown. Previous research has demonstrated that nurse education and practice environments are significantly related to patient outcomes. The relationship between these variables and HAPUs is unknown. The purpose of this research was to examine the risk for and prevalence of HAPUs on oncology units and evaluate the relationship between them and nursing variables by comparing oncology units to nononcology units. The sample included 145 oncology and 212 nononcology units. Mean unit HAPU prevalence rates for all stage ulcers was not significantly different between unit types (2.9% and 2.6%; p > .05). Total ulcer rates likewise failed to demonstrate significance (10.9% and 11.2%; p > .05). Unit mean Braden Scale scores measuring risk for HAPU on admission were different with the oncology unit mean significantly higher, demonstrating less patient risk for breakdown, than nononcology units (19.0 and 18.6; p > .05). This difference was lost over time, as the unit mean for nononcology units improved between admission and the last recorded to score to 18.9, while the oncology unit mean remained stable at 19.0. No difference was found in mean percent of nurses with a BSN by unit (55.3% and 54.1%). Nurse practice environment, measured with the Practice Environment Scale of the Nurse Work Index (PES-NWI), failed to demonstrated significant differences on any of the five subscales or the total score (p > .05) between unit types. A moderated mediation analysis, utilized to evaluate the relationship of the nurse variables to HAPUs, failed to reach significance on either unit type. The lack of difference by unit type for risk, prevalence, and nursing variables reduces the need to examine oncology units individually from other units. Continued efforts to understand the development of HAPUs needs to incorporate changing rates over time and evolve the relationship to nurse variables.