The impact of pressure ulcer prevention education on the knowledge, skills and attitudes of health care assistants working in long term care settings.

AIM The aim of this study was to evaluate the impact of pressure ulcer prevention education for health care assistants on their knowledge, skills, and attitudes towards PU prevention.

MATERIALS AND METHODS A quasi-experimental, one group, pre-test, post-test design was employed. The participants were health care assistants (HCAs) caring for older adults at risk of pressure ulcer development residing in long term care settings. Following ethical approval, the Shanley pressure ulcer prevention programme (SPUPP) (Shanley et al., 2022 May). and the pressure ulcer classification education tool (PUCLAS) (Beeckman, 2017) was delivered to consenting participants. Knowledge was assessed using the knowledge of pressure ulcer prevention tool (KPUP) (Shanley et al., 2020), skills were assessed using images depicting pressure ulcers as per the European Pressure Ulcer Advisory Panel (2019) classification tool, and attitudes were assessed using the Moore and Price attitude tool (APUP) (Moore & Price 2004). Outcomes were assessed at baseline, immediately following the education intervention and again at 4 months. Data were analysed using descriptive and inferential statistics, as appropriate.

RESULTS A total of 129 HCAs completed the education intervention and completed the questionnaires pre (K1) and post intervention (K2), while 52% (n = 67) completed the 4 month (K3) follow up questionnaires. In total, 19% (n = 24) were male and 81% (n = 105) were female, with a mean age of 49 years (SD: 7 years; min 29 years, max 60 years). The average duration of employment was 2.4 (SD:1) years and 33% (n = 42) had received previous education in PU prevention. There was a statistically significant increase in average knowledge scores at K2 compared to K1 (MD: 3.40; 95% CI: 3.10 to 3.70) and K3 compared to K1 (MD: 3.04; 95% CI: 2.65 to 3.42) with large effects (Cohen's d = 1.74 at K2; d = 1.55 at K3), and a decrease in average scores from K2 to K3, but this was not statistically significant (MD: -0.36, 95% CI: -0.75 to 0.02). Similarly, there was a statistically significant increase in average skill scores at S2 compared to S1 (MD: 2.13; 95% CI: 1.95 to 2.30; p < 0.001) and S3 compared to S1 (MD: 1.53; 95% CI: 1.31 to 1.75; p < 0.001) with large effects (Cohen's d = 2.72 at S2; d = 1.95 at S3). Conversely, there was a statistically significant decrease in mean skill scores from S2 to S3 (MD: -0.60; 95% CI: -0.82 to 0.38; p < 0.001). Furthermore, there was a statistically significant MD in attitude scores from A1TS to A2TS and from A1TS to A3TS (MD: 1.81, 95% CI: 1.08 to 2.55, p < 0.001; MD: 2.83, 95% CI: 1.89 to 3.76, p < 0.001, respectively) with a moderate effect at A2TS (Cohen's d = 0.47) and a moderate-to-large effect at A3TS (d = 0.73). There was also a statistically significant difference in attitude scores from A2TS to A3TS (MD: 1.00, 95% CI: 0.77 to 1.95, p = 0.035).

CONCLUSIONS HCAs are an integral component of the health care workforce, and play a very important role in providing direct care to patients within the LTC setting. As such, HCAs need the right knowledge, skills and attitudes to ensure that care delivered is timely and appropriate. Outcomes of this study showed that knowledge, skill and attitude scores improved from baseline and remained higher than baseline at the 4 month follow up. It is evident therefore, that HCAs are a group of health care workers that can be positively impacted by investment in education. Findings also reiterate the need for reinforcement of education at regular intervals, due to the risk of knowledge and skill scores dropping over time.