Heel Pressure Ulcers: Contributory factors and their impact on quality of life and role at the end of life in the adult population

Dube, Alisen Zandilintombi (2024) Heel Pressure Ulcers: Contributory factors and their impact on quality of life and role at the end of life in the adult population. Doctoral thesis, Birmingham City University.

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Abstract

Pressure ulcer prevention remains a persistent challenge in healthcare, affecting patients across all age groups, from neonates to the elderly. Pressure ulcers occur as damage to the skin and/or underlying tissue over bony prominence areas because of sustained pressure and/or shear. Heel pressure ulcers (HPUs) are the second most common type of pressure ulcer, following those at the sacrum, in most healthcare settings. There is limited evidence to support the prevention of heel pressure ulcers in the adult population. Furthermore, emerging evidence suggests differences in risk factors associated with pressure ulcers based on the specific anatomical site affected. This study therefore aims to identify and quantify the relationship between risk factors and HPUs presence and to investigate their impact on health-related quality of life (HRQoL) and prognostic significance at the end of life (EoL).

This research employed an exploratory single-centre observational study design, grounded in a pragmatic philosophy and utilising three distinct methodologies, as outlined below.

Phase 1: Risk factors for developing heel pressure ulcers in the adult population: a systematic literature review.

Phase 2: Factors associated with the presence of heel pressure ulcers in the adult population: a matched case-control study.

Phase 3: the impact of heel pressure ulcers on HRQoL and their prognostic
significance in EoL.

This thesis is the first to conduct a systematic literature review on risk factors associated with HPUs in the adult population. The review identified a significant lack of evidence, with 76.9% of the studies rated as moderate to poor quality, highlighting the need for further research. A total of 103 participants took part in Phases 2 and 3, compromising 53 patients with heel pressure ulcer(s) and 50 without. A conceptual framework for risk factors is proposed to aid in identifying those at risk and support the timely implementation of preventive strategies. HPUs negatively impact the quality of life and significantly increase healthcare resource use in acute settings. Applying evidence-based risk assessment tools (RATs) can help improve patient outcomes.

Individuals of ethnic minority backgrounds and those lacking capacity remain underrepresented in HPU research, which denies them evidence-based care and further perpetuates health inequalities. Engaging patients and the public can be essential for ensuring research is inclusive and reflects the needs of those it aims to serve. Future research needs to prioritise ethnic minority backgrounds and those lacking capacity to make HPU risk assessment and prevention processes relevant to their care.

Item Type:	Thesis (Doctoral)
Dates:	Date Event 19 November 2024 Accepted
Uncontrolled Keywords:	Adults, bedsores, ethnic minority, end of life, heel, mental capacity, nursing, patient and public involvement, predictors, pressure ulcers, quality of life, risk factors
Subjects:	CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-02 - adult nursing
Divisions:	Doctoral Research College > Doctoral Theses Collection Faculty of Health, Education and Life Sciences > College of Nursing and Midwifery
Depositing User:	Louise Muldowney
Date Deposited:	17 Jan 2025 11:15
Last Modified:	17 Jan 2025 11:15
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16084