Design Features to Enhance External Hip Protector Adherence in the Nursing Home Setting

Abstract

To determine the preferences for external hip protector (EHP) design features of both certified nursing assistants (CNAs) and nursing home laundry personnel, and to test the durability of favored model features. Cross-sectional descriptive study of CNAs' and laundry personnels' preferences and a prospective experimental study of EHP fastener durability under institutional laundry conditions. Three urban nursing homes and a hospital-based laundry service. Twenty-seven CNAs, 4 laundry service supervisors. Five focus groups with CNAs and a survey of laundry supervisors were conducted to elicit preferences of EHP design features with an emphasis on convenience and durability. A laundry test of 20 EHPs was conducted to compare these design features. There was wide agreement among CNAs and laundry personnel that EHPs with soft pads in garments of light neutral colors, and cotton-blend fabrics were most preferred. CNAs preferred sewn-in pads to removeable ones, but laundry personnel had no consensus on this issue. For dependent residents, wraparound (front opening) garments using Velcro were preferred by CNAs, whereas laundry supervisors preferred snap closures. When EHP underwent repeated washing in the laundry test, Velcro and snaps were functionally comparable at 52 cycles. Garments constructed of heavyweight cotton blends, polyester, or cotton with spandex maintained elasticity at 52 weeks, whereas the lightweight cotton blend stretched significantly. Based on CNAs' preferences, laundry personnels' input, and a laundry test, EHP design features that could enhance both caregiver efficiency and resident comfort include soft pads sewn into a light-colored (but non-white) heavier weight cotton-blend garment, with the availability of both a pull-up style and a wraparound style using Velcro fasteners. Snaps did not demonstrate superior durability in the laundry test, but further comparison with Velcro under clinical conditions is indicated. Education and inclusion of CNAs in EHP decision making are important ways to improve EHP adherence.