Patient satisfaction and comfort assessed

At the Newcastle Upon Tyne Hospitals NHS Foundation Trust (NUTH), an innovative approach to the strategy for the prevention and treatment of pressure ulcers has seen a near total shift towards a complete static approach (98.4%), with high quality foam mattresses (Softform Premier, Invacare) as standard (85.1.%) and fluid-filled mattress (13.3%) (RIK, KCI). Only 0.4% usage is low air loss (KCI rental) and 1% alternating technology (Nimbus III, Huntleigh). This article reports on the findings of a satisfaction survey, which canvassed two hundred patients on their perception of comfort when nursed on the fluid-filled mattress.

Literature review

It is difficult to comprehend that on any given day, an estimated 7% of all hospitalised patients have pressure ulcers somewhere on their body (Whitney 2007). It is generally accepted that highquality pressure ulcer prevention requires the integration of several aspects of care such as patient re-positioning and appropriate nutritional intake (Clark 2002). A pressure ulcer is defined as a localised area of tissue necrosis that tends to develop when soft tissue is compressed between a bony prominence and an external surface for prolonged periods (Piper 2007). Whitney (2007) further suggests that low-intensity pressure over a long period can create tissue damage, just as high-intensity pressure can over a short period. Pressure ulcers develop due to morphological and biochemical changes triggered by the combined effects of mechanical deformation, ischaemia and reperfusion that occur during extended periods of immobility (Solis et al 2007). There is, in fact, an increasing consensus that pressure ulcers are a sign of acute illness and that particular intrinsic and extrinsic factors affect the tolerance of skin to pressure. The overall cost implication associated with the provision of pressure relieving devices for this population is considerable. Most establishments in the NHS have a very finite budget for therapy beds. Whitfield et al (2000), in a review of the available literature, state that the prevalence of pressure ulcers in the acute setting has remained constant at about 7%, even though considerable time and money has been invested in various prevention strategies, the most costly of all being therapy beds. There is little doubt that the drive towards early discharge, coupled with day care and the range of new technologies which have done much to extend the survival of patients, has resulted in a population of hospital patients who are extremely sick (Gould 2000) and it seems, therefore, inevitable that certain patients will develop pressure ulcers (Niezgoda and Mendez- Eastman 2006). Therapy beds have been evaluated mainly for cost-efficiency. Comparisons have been made between dynamic and standard hospital mattresses (Vanderwee et al 2007), visco-elastic foam and standard mattresses (Hampton and Collins 2005); different types of dynamic mattresses (Nixon 2006); and dynamic and air-fluidised (Finnegan et al 2008). However, very few studies have taken into consideration patients’ perceptions of comfort when nursed on these surfaces. Gray et al (2001) recruited forty-four patients during a six-months period when evaluating pressure-reducing foam mattresses used in conjunction with bed frames. Two outcome measures were used: pressure ulcer incidence and the patient’s perception of comfort, using a visual score ranging from “very uncomfortable to very comfortable”. Only twenty patients were well enough to comment on their perceptions of comfort while on the mattress. Ninety per cent (18 patients) scored the foam mattress as comfortable to very comfortable, and the remaining two (10%) stated that it was adequate. The fluid-filled mattress (RIK – KCI) is a static product containing jellified water. This fluid, combined with patient anti-shear layers, helps minimise patient sliding, reduces the problem of “bottoming out” and therefore reduces pressure ulcers due to shear forces. One of its main benefits is that patients can be sat upright for chest management without the problem of continually slipping down the bed, reducing shearing forces responsible for pressure damage (Doughty and Sparks-DeFriese 2007). Fluid-filled mattress technology offers some clear advantages: it is simple technology which means no electronic components that may fail. There is no need for maintenance, therefore, which also has financial benefits. The main disadvantage of fluid-filled mattress technology is its weight: at 7stone, it can be a health and safely disadvantage to staff who have to move and handle the product. However, the product can be dismantled into three sections, which becomes easily transportable. Wells and Karr (1998) evaluated RIK mattress in terms of interface pressure, wound healing and patient/practitioner satisfaction. The study was divided in two parts. Twenty-two volunteers placed on the mattress were used to evaluate interface pressure, while thirty-three patients were recruited in order to establish wound healing rates. Only twenty-six patients were able to complete the user satisfaction questionnaire, however. Most patients (81.3%) said they would select the fluid-filled mattress for a hospital stay; 37% of patients felt it was more difficult to move on the fluid mattress than on a regular bed, while patients commented positively on the bed’s lack of noise and its comfortable temperature. Some patients (18.7%) did not like the fluid-filled mattress and, unfortunately, the study does not disclose the reasons. The average ranking was 4.3 on a five-point scale. Wells and Karr’s study (1998) is the only paper found in the literature that discusses patient satisfaction with this type of fluid-filled mattress. In our experience, very emaciated patients can find fluid-filled mattress uncomfortable at times, as they fail to “sink” in the mattress. However, it is unknown how other users would rate the comfort of this product. Our regional cancer unit uses fluid-filled mattress technology extensively, as terminally ill patients find the mattress extremely comfortable and they tend to find alternating pressure relieving mattresses painful with the continual moving of the cells. Within the healthcare industry, patient satisfaction has emerged as an important component and measure of the quality of care (Aarony and Strasser 1993). Patients’ perceptions of the care they receive has increased in importance, especially with recent emphasis on quality of care and outcome measurement, where patient satisfaction is a key element of quality assurance and expected outcome of care. Patient satisfaction or dissatisfaction is a complicated phenomenon that is linked to patient expectations, health status and personal characteristics, as well as health system characteristics (Hseik and Kagle 1991). All healthcare organisations are currently operating in extremely competitive markets. In order to maintain or increase market share, they need to satisfy all key stakeholders including patients. The foundation for any system for maintaining or improving patient satisfaction is a good system for measuring patient service quality (Ford et al 1997). Measuring patient satisfaction offers real benefit to an organisation, such as greater profitability, increased market share, improved patient retention, greater efficiently and productivity, reduced hospitalisation and length of stay – to cite but a few. There are many ways to measure patient satisfaction, including both qualitative and quantitative approaches. They vary in costs, accuracy and the degree to which they inconvenience the patient. Selecting the best method or combination of methods should represent and ideal balance between the organisation’s strategic goals and the cost of achieving these goals.