Development of a Social Learning Theory-based Pressure Injury Training Program for Nursing Assistants in Chinese Nursing Homes

Overview

Journal Front Public Health

Specialty Public Health

Date 2025 Feb 24

PMID 39989863

Authors

Yanxia Guo

Shengnan Yang

Plernpit Boonyamalik

Arpaporn Powwattana

Wen Zhu

Lingxia Xu

Affiliations

Soon will be listed here.

Abstract

Introduction: Pressure injury (PI) is a significant concern in Chinese nursing homes, particularly in China, especially due to the rapidly aging population. Nursing assistants play a vital role in PI prevention and management but often lack adequate training. To address this gap, we developed a training program for nursing assistants based on Social Learning Theory (SLT), aimed at improving their competencies in PI prevention and management. The modified Delphi method was used to gather expert consensus on the program's structure and content.

Methods: A two-round Delphi process was performed involving an expert panel in wound care, community nursing, geriatric nursing, and nursing education. The training program was designed based on SLT, emphasizing observational learning, enactive learning, and behavioral reinforcement. Several experts evaluated the training program's content, which was informed by systematic reviews and qualitative interviews with stakeholders. Data analysis included expert's positive coefficient, expert's authority coefficient (Cr), expert's coordination coefficient (Kendall's W), and coefficient of variation (CV) were used to reflect reliability and consensus.

Results: Consensus was reached on 79 key indicators for the training program, which included 4 first-level indicators (training objectives, content, methods, and evaluation), 13 second-level indicators, and 62 third-level indicators. The expert authority coefficient was 0.93, and Kendall's W values of 0.372 ( < 0.001) in the first round and 0.177 ( < 0.001) in the second round indicated strong agreement among experts. The program integrates SLT principles, such as attention, retention, motor reproduction, and motivation, to enhance the training's effectiveness.

Conclusion: The study developed a comprehensive SLT-based PI training program for nursing assistants in Chinese nursing homes using the modified Delphi method. The program addresses the critical need for competency-based training in PI prevention and management. Future research should focus on the implementation and evaluation of this program in real-world settings to determine its effectiveness in improving nursing assistants' skills and reducing PI incidence among older adult residents.

References

Dellefield M, Magnabosco J . Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors. Geriatr Nurs. 2013; 35(2):97-104. DOI: 10.1016/j.gerinurse.2013.10.010. View

Zhi M, He Z, Ji J, Lian J, Guo R, Sun J . Patient satisfaction with non-clinical nursing care provided by the nursing assistant under different management models in Chinese public tertiary hospital. Appl Nurs Res. 2021; 67:151431. DOI: 10.1016/j.apnr.2021.151431. View

Horsburgh J, Ippolito K . A skill to be worked at: using social learning theory to explore the process of learning from role models in clinical settings. BMC Med Educ. 2018; 18(1):156. PMC: 6029173. DOI: 10.1186/s12909-018-1251-x. View

Wogamon C . Exploring the Effect of Educating Certified Nursing Assistants on Pressure Ulcer Knowledge and Incidence in a Nursing Home Setting. Ostomy Wound Manage. 2016; 62(9):42-50. View

Kwong E, Chen L, Kwan R, Lee P . The effectiveness of a pressure injury prevention program for nursing assistants in private for-profit nursing homes: A cluster randomized controlled trial. J Adv Nurs. 2020; 76(7):1780-1793. DOI: 10.1111/jan.14391. View

Kong Y, Xu H, Li C, Yang Y, Zhu X, Zuo Y . Construction of PARI public health education programs for Chinese undergraduates: a Delphi study. Front Public Health. 2024; 12:1390011. PMC: 11215213. DOI: 10.3389/fpubh.2024.1390011. View

Foth T, Efstathiou N, Vanderspank-Wright B, Ufholz L, Dutthorn N, Zimansky M . The use of Delphi and Nominal Group Technique in nursing education: A review. Int J Nurs Stud. 2016; 60:112-20. DOI: 10.1016/j.ijnurstu.2016.04.015. View

Ousey K, Kaye V, McCormick K, Stephenson J . Investigating staff knowledge of safeguarding and pressure ulcers in care homes. J Wound Care. 2016; 25(1):5-6, 8-11. DOI: 10.12968/jowc.2016.25.1.5. View

Hultin L, Olsson E, Carli C, Gunningberg L . Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. J Wound Ostomy Continence Nurs. 2017; 44(2):142-147. DOI: 10.1097/WON.0000000000000301. View

10.

Elli C, Novella A, Nobili A, Ianes A, Pasina L . Factors Associated with a High-Risk Profile for Developing Pressure Injuries in Long-Term Residents of Nursing Homes. Med Princ Pract. 2022; 31(5):433-438. PMC: 9801375. DOI: 10.1159/000527063. View

11.

Rummel E, Evans E, ONeal P . Educating Certified Nursing Assistants to Communicate Skin Changes to Reduce Pressure Injuries. J Gerontol Nurs. 2021; 47(8):21-28. DOI: 10.3928/00989134-20210624-04. View

12.

Hardy D, OBrien A, Gaskin C, OBrien A, Morrison-Ngatai E, Skews G . Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand. J Adv Nurs. 2004; 46(1):95-109. DOI: 10.1111/j.1365-2648.2003.02969.x. View

13.

Lavallee J, Gray T, Dumville J, Cullum N . Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. Int J Nurs Stud. 2018; 82:79-89. DOI: 10.1016/j.ijnurstu.2017.12.015. View

14.

Lee Y, Kwon D, Chang S . Bridging the Knowledge Gap for Pressure Injury Management in Nursing Homes. Int J Environ Res Public Health. 2022; 19(3). PMC: 8834936. DOI: 10.3390/ijerph19031400. View

15.

Niederhauser A, VanDeusen Lukas C, Parker V, Ayello E, Zulkowski K, Berlowitz D . Comprehensive programs for preventing pressure ulcers: a review of the literature. Adv Skin Wound Care. 2012; 25(4):167-88. DOI: 10.1097/01.ASW.0000413598.97566.d7. View

16.

Anthony D, Alosoumi D, Safari R . Prevalence of pressure ulcers in long-term care: a global review. J Wound Care. 2019; 28(11):702-709. DOI: 10.12968/jowc.2019.28.11.702. View

17.

Seo Y, Roh Y . Effects of pressure ulcer prevention training among nurses in long-term care hospitals. Nurse Educ Today. 2019; 84:104225. DOI: 10.1016/j.nedt.2019.104225. View

18.

Howe L . Education and empowerment of the nursing assistant: validating their important role in skin care and pressure ulcer prevention, and demonstrating productivity enhancement and cost savings. Adv Skin Wound Care. 2008; 21(6):275-81. DOI: 10.1097/01.ASW.0000323505.45531.92. View

19.

Bowles N . The Delphi technique. Nurs Stand. 2000; 13(45):32-6. DOI: 10.7748/ns1999.07.13.45.32.c2650. View

20.

Souza D, Santos V . Incidence of pressure ulcers in the institutionalized elderly. J Wound Ostomy Continence Nurs. 2010; 37(3):272-6. DOI: 10.1097/WON.0b013e3181d8c25c. View