Outpatient and community care for preventing pressure injuries in spinal cord injury. A qualitative study of service users’ and providers’ experience

Abstract

Study design

Qualitative exploratory study.

Objectives

Pressure injuries (PIs) are a major secondary condition occurring after spinal cord injuries (SCI). Optimization of outpatient and community care may be a promising approach to better support community-dwelling individuals with SCI in preventing PIs. The aim of this study was to examine the experiences of individuals with SCI, family caregivers and health professionals (HPs) in using or providing outpatient and community services for early treatment and prevention of PIs in SCI.

Setting

Switzerland.

Methods

Semi-structured interviews with a sample of Swiss residents community-dwelling individuals with SCI (n = 20), family caregivers (n= 5) and HPs (n = 22) were analysed using thematic analysis.

Results

General practitioners (GPs), home care providers, SCI-specialized outpatient clinics and an SCI-specialized nursing service are involved in the prevention and early treatment of PIs. Our findings show that the needs of individuals with SCI are not fully met: outpatient and community care is often fragmented, mono-professional and non-specialized, while persons with SCI and HPs prefer coordinated, inter-professional and specialized services for preventing and treating PIs. Our findings also highlight the challenges faced by HPs in providing care to individuals with SCI in the community.

Conclusions

Although there seems to be a gap in service provision, there is the potential for improvement by better integrating the different providers in a network and structuring their collaborations. Concrete suggestions are: systematizing knowledge transfer to home care providers and GPs; redefining the role of involved HPs and individuals with SCI and reinforcing the role of the SCI-specialized nursing service.

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Data availability

The transcripts of the interviews analysed in the current study are available from the corresponding author on request. Transcripts will be provided in the original language (mostly German).

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Acknowledgements

The authors would like to express their gratitude to the participants for their time and engagement. We also thank Nadja Münzel for her comments on an earlier version of the paper, and Hans Georg Koch for his assistance in the recruitment of study participants. Thank you also to Lisa Adey, who carefully checked the translation of all quotes from the interviews.

Funding

This project was supported by the Suva, the Swiss National Accident Insurance Fund.

Author information

Affiliations

Authors

Contributions

NL contributed to the preparation of the protocol for the Ethics Committee, recruited the participants, conducted and transcribed the interviews. She also contributed to data analysis and publication drafting. CZ was involved in the design of the study, supervised data collection, mainly contributed to data analysis and interpretation of the findings, as well as to drafting, revising and finalizing the manuscript for submission. SE was involved in interpreting the findings, drawing implications for practice as well as in drafting, revising and finalizing the paper for submission. ASS was involved in developing the study protocol, interpreting the findings, drawing implications for practice as well as drafting the paper. GS, SR and MB developed the study protocol, provided feedback and approved the manuscript draft. AG provided feedback on the manuscript draft. GS, MB, AG, ASS and SE were also part of the Expert Advisory Group for this project.

Corresponding author

Correspondence to Claudia Zanini.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

We certify that all applicable institutional and governmental regulations concerning the ethical treatment of human volunteers were followed throughout the study. The study obtained ethical approval from the regional committee of north-western and central Switzerland (Ethikkommission Nordwest- und Zentralschweiz, reference number EKNZ 2015-311).

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Zanini, C., Lustenberger, N., Essig, S. et al. Outpatient and community care for preventing pressure injuries in spinal cord injury. A qualitative study of service users’ and providers’ experience. Spinal Cord 58, 882–891 (2020). https://doi.org/10.1038/s41393-020-0444-4

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