Barriers and facilitators to Skin Hygiene and Emollients in Care Homes: Instrument design and survey

Cowdell, Fiona and Heague, Megan and Dyson, Judith (2023) Barriers and facilitators to Skin Hygiene and Emollients in Care Homes: Instrument design and survey. International Journal of Older People Nursing. ISSN 1748-3735

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The older person care home population is increasing. As skin ages it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is sub-optimal. Our aims were to: i) Develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care.

Instrument development and survey. Barriers and facilitators identified from literature and pilot study were categorised in a Delphi survey of experts (n=8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n=38), construct validity (n=235) and test-retest reliability (n=11). Barriers and facilitators were surveyed in round 2 and reported in accordance with TRIPOD

A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df=1.539, RMSEA=0.047, CFA=0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator.

This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.

Item Type: Article
Identification Number:
9 May 2023Accepted
29 May 2023Published Online
Uncontrolled Keywords: Barriers and facilitators, care homes, emollient, hygiene, implementation, skin health
Subjects: CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-02 - adult nursing
Divisions: Faculty of Health, Education and Life Sciences > School of Nursing and Midwifery
Depositing User: Fiona Cowdell
Date Deposited: 09 May 2023 14:02
Last Modified: 12 Jun 2023 13:27

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