Evaluating Nursing Home Resident Monitoring Technology Use in Pressure Ulcer Prevention: A Mixed-Methods Approach

Purpose:  Standard practice for pressure ulcer (PrU) prevention care in U.S. nursing homes (NH) is to reposition residents every 2 hours to minimize pressure exposure; however, on-time repositioning compliance is low (~30%). This study examined the adaptive and technical challenges nursing staff face in using new technology to facilitate on-time repositioning of NH residents.

Methods:  A 21-day trial with a convergent mixed methods pre/post-test design compared resident and staff outcomes at a southeastern U.S. NH. The Leaf Patient Monitoring System is a wireless movement tracking system that monitors resident position and movement 24-hours a day, cues staff when repositioning is required; captures position and repositioning frequency, and enables calculation of the percentage of on-time compliance. Web-based surveys completed by staff (RNs, LPNs, CNAs) pre/post intervention were the Nursing Culture Assessment Tool (NCAT), Perceived Organizational Support (POS), and Affective Organizational Commitment (AOC). During post-intervention staff focus groups (2, n=13), perspectives of adaptive and technical challenges were gathered via semi-structured questions. Quantitative analyses were performed for NH staff data and Leaf monitoring data. Qualitative analyses using transcribed focus group sessions identified core concepts, applied satisfaction-based apriori codes, and allowed emergence of new themes.

Results:  Staff on-time repositioning compliance improved from 59.8 to 77.3%. Staff responded positively to repositioning cues and described an enhanced sense of teamwork in order to achieve on-time repositioning, believing that usual care was provided faster. Adaptive and technical challenges focused on accessibility to system monitors, difficulties repositioning residents in reclining chairs, and uniformity in using system pause functions. Nursing culture’s normative ranking percentage increased and communication, satisfaction, and professional commitment item scores positively corresponded with focus groups. Also, POS and AOC scale scores improved.

Conclusions: Triangulated findings support the effectiveness of nursing staff strategies for managing the adaptive and technical challenges experienced in using new technology. Clinical and research insights will be discussed in relation to implications for adaptive leadership to aid translation of findings to PrU prevention practice.