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Yang LF, Mu JX, Zhang J, Zang S, Zhang L, Qi JH, Ni CP, Liu Y. Interventions to promote the implementation of pressure injury prevention measures in nursing homes: A scoping review. J Clin Nurs 2024; 33:1709-1723. [PMID: 38156732 DOI: 10.1111/jocn.16983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
AIMS To identify studies and the content of the interventions that have facilitated the implementation of pressure injury (PI) prevention measures in nursing home settings. DESIGN AND METHOD A scoping review methodology was employed. The author has carried out the following steps successively: Identified this scoping review's questions, retrieved potentially relevant studies, selected relevant studies, charted the data, summarised the results, and consulted with stakeholders from nursing homes in China. DATA SOURCES Six electronic databases and three resources of grey literature-PubMed, CINAHL, Web of Science Core Collection, Embase, Cochrane Central Register of Controlled Trials, Psych INFO, Open Grey, MedNar, ProQuest Dissertations, and Theses Full Texts were searched from January 2002 through May 2022. RESULTS Forty articles were included, among which the primary interventions were quality improvement, training and education, evidence-based practice, device-assisted PI prophylaxis, nursing protocols, and clinical decision support systems. Twenty-three outcome indicators were summarised in 40 articles, which included 10 outcome indicators, seven process indicators, and six structural indicators. Furthermore, only five articles reported barriers in the process of implementing interventions. CONCLUSION The common interventions to promote the implementation of PI prevention measures in nursing homes are quality improvement, training, and education. Relatively limited research has been conducted on evidence-based practice, clinical decision support systems, device-assisted PI prophylaxis, and nursing protocols. In addition, there is a paucity of studies examining the impediments to implementing these measures and devising targeted solutions. Therefore, it is recommended that future studies include analysis and reporting of barriers and facilitators as part of the article to improve the sustainability of the intervention. IMPACT This article reminds nursing home managers that they should realise the importance of implementation strategies between the best evidence of PI prevention and clinical practice. Also, this review provides the types, contents, and outcome indicators of these strategies for managers of nursing homes to consider what types of interventions to implement in their organisations. TRIAL AND PROTOCOL REGISTRATION The protocol of this scoping review was published as an open-access article in June 2022 (Yang et al., 2022).
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Affiliation(s)
- L F Yang
- Department of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - J X Mu
- Department of Nursing, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - J Zhang
- The Operating Room, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - S Zang
- Department of Nursing, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - L Zhang
- Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - J H Qi
- Department of Pharmacy and Health Management, Hebei Chemical & Pharmaceutical College, Shijiazhuang, Hebei Province, China
| | - C P Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Y Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
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Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Furtado K, Voorham J, Infante P, Afonso A, Morais C, Lucas P, Lopes M. The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units. Healthcare (Basel) 2023; 11:1751. [PMID: 37372869 DOI: 10.3390/healthcare11121751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. METHODS A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. RESULTS A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time. CONCLUSION A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.
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Affiliation(s)
- Katia Furtado
- Out Patient Department, Hospital of Portalegre, Unidade Local de Saúde do Norte Alentejano, 7300-312 Portalegre, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
| | - Jaco Voorham
- DTIRS-Data to Insights Research Solutions, 1750-307 Lisboa, Portugal
| | - Paulo Infante
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Anabela Afonso
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Clara Morais
- Administração Regional de Saúde do Alentejo, Largo do Jardim do Paraíso, nº 1, 7000-864 Évora, Portugal
| | - Pedro Lucas
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
| | - Manuel Lopes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
- São João de Deus School of Nursing, Universidade de Évora, 7000-671 Évora, Portugal
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Mäki-Turja-Rostedt S, Leino-Kilpi H, Koivunen M, Vahlberg T, Haavisto E. Consistent pressure ulcer prevention practice: The effect on PU prevalence and PU stages, and impact on PU prevention-A quasi-experimental intervention study. Int Wound J 2022. [PMID: 36584884 DOI: 10.1111/iwj.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.
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Affiliation(s)
- Sirpa Mäki-Turja-Rostedt
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Marita Koivunen
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | - Tero Vahlberg
- Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland
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Min D, Cho E, Kim GS, Lee KH, Yoon JY, Kim HJ, Choi MH. Factors associated with retention intention of Registered Nurses in Korean nursing homes. Int Nurs Rev 2022; 69:459-469. [PMID: 35413132 PMCID: PMC9790496 DOI: 10.1111/inr.12754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
AIM To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes. BACKGROUND Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses. INTRODUCTION Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care. METHODS This mixed-methods study employed a sequential explanatory design. A self-reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In-depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study. RESULTS The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise." DISCUSSION A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor. CONCLUSION This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes. IMPLICATIONS FOR NURSING AND NURSING POLICY A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity.
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Affiliation(s)
- Deulle Min
- Department of NursingCollege of MedicineWonkwang UniversityIksanRepublic of Korea
| | - Eunhee Cho
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Gwang Suk Kim
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Kyung Hee Lee
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing ScienceSeoul National UniversitySeoulRepublic of Korea
| | - Hyun Joo Kim
- Yonhee Seniors Nursing HomeSeoulRepublic of Korea
| | - Moon Hee Choi
- Korea Social Science Data Archive at Asia Center Seoul National UniversitySeoulRepublic of Korea
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Mathias DV, Stellenberg| PEL, van der Heever DM. Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania. Gerontol Geriatr Med 2022; 8:23337214221141272. [PMCID: PMC9716609 DOI: 10.1177/23337214221141272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.
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Affiliation(s)
- Dr Victor Mathias
- Aga Khan University, Dar es Salaam, Tanzania,Victor Mathias, Aga Khan University, Dar es Salaam Campus, P. O. Box 38129, Tanzania. Emails: ;
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Jiang Q, Chen K, Liu Y, Zhou J, Bai Y, Zhao J, Weng Y, Zhu Y, Feng H, Wang J, Cai Y, Ou Y. Relationship between dry skin and pressure injury in older patients: A multicentre cross‐sectional survey in China. Int Wound J 2022; 20:1402-1417. [PMID: 36307094 PMCID: PMC10088826 DOI: 10.1111/iwj.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022] Open
Abstract
Dry skin and pressure injuries in older persons have become global health care problems. This was a multicentre, prospective cross-sectional study in 44 hospitals and 8 long term care institutions from 20 provinces, autonomous regions and municipalities in China and aimed to explore the relationship between the two skin problems in older patients. We mainly found 11 602 cases with dry skin and 1076 cases with pressure injuries in a total of 33 769 valid participants. The overall prevalence of dry skin and pressure injuries was 34.4% (95% confidence interval [CI] 33.9-34.9) and 3.1% (95% CI 2.9-3.3). Stage 2+ pressure injuries were the most (32.9%), followed by stage 1 (32.4%). The patients with dry skin had more pressure injuries than ones without dry skin (50.0% vs 33.9%). The patients with very severe and severe dry skin had more pressure injury risk (OR 2.22 and 1.90) and more stage 2+ pressure injury risk (OR 2.83 and 1.63). Other nine predictors associated with overall pressure injuries and stage 2+ pressure injuries. The area under receiver operating characteristic (ROC) curve of the predictive models of overall pressure injuries and stage 2+ pressure injuries were 0.89 (95% CI 0.88-0.90) and 0.91 (95% CI 0.90-0.92), respectively.
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Affiliation(s)
- Qixia Jiang
- Department of Burn and Plastic Surgery Jinling Hospital, Medical School of Nanjing University Nanjing China
| | - Kesu Chen
- Medical School Nanjing University Nanjing China
| | - Yuxiu Liu
- Data and Statistics Division of Department of Critical Care Medicine Jinling Hospital, Nanjing Medical University Nanjing China
- Department of Biostatistics School of Public Health, Nanjing Medical University Nanjing China
| | - Jihong Zhou
- Department of Cosmetology Nanjing Hospital of Traditional Chinese Medicine Nanjing China
| | - Yuxuan Bai
- Clinical Academic Department Zhejiang Top‐Medical Dressing Co., Ltd. Wenzhou China
| | - Jing Zhao
- Department of Outpatient Treatment the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Yajuan Weng
- Nursing Department the First People's Hospital of Changzhou Changzhou China
| | - Yuling Zhu
- Department of Burn and Plastic Surgery Jinling Hospital, Medical School of Nanjing University Nanjing China
| | - Haixia Feng
- Nursing Department Zhongda Hospital Affiliated Southeast University Nanjing China
| | - Jing Wang
- Nursing Department Yangpu Hospital, School of Medicine, Tongji University Shanghai China
| | - Yunmin Cai
- Wound Diagnosis and Treatment Center JinShan Hospital Affiliated to Fudan University Shanghai China
| | - Yulan Ou
- Nursing Department the First Affiliated Hospital of University of South China Hengyang China
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Abstract
Chronic wounds are characterized by their inability to heal within an expected time frame and have emerged as an increasingly important clinical problem over the past several decades, owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. Even up to a few years ago, the management of chronic wounds relied on standards of care that were outdated. However, the approach to these chronic conditions has improved, with better prevention, diagnosis and treatment. Such improvements are due to major advances in understanding of cellular and molecular aspects of basic science, in innovative and technological breakthroughs in treatment modalities from biomedical engineering, and in our ability to conduct well-controlled and reliable clinical research. The evidence-based approaches resulting from these advances have become the new standard of care. At the same time, these improvements are tempered by the recognition that persistent gaps exist in scientific knowledge of impaired healing and the ability of clinicians to reduce morbidity, loss of limb and mortality. Therefore, taking stock of what is known and what is needed to improve understanding of chronic wounds and their associated failure to heal is crucial to ensuring better treatments and outcomes.
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Yang LF, Liu YL, Wu CT, Ni CP, Liu Y. Interventions to promote the implementation of pressure injuries prevention measures in nursing homes: a scoping review protocol. BMJ Open 2022; 12:e052469. [PMID: 36691232 PMCID: PMC9171172 DOI: 10.1136/bmjopen-2021-052469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/17/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Currently, various guidelines and documents on the prevention of pressure injuries have been published, but there are many serious lags in the actual practice in nursing homes. So some interventions are required to promote the implementation of normative practices. There was a review of preventive interventions for pressure injuries in long-term care facilities, but there is no systematic review of how to promote the implementation of preventive measures. This review aims to summarise interventions that promote the implementation of pressure injuries prevention measures in nursing homes, explore the research scope and gaps in this field and provide evidence and striving direction for global nursing homes to improve existing preventive behaviours. METHODS AND ANALYSIS This scoping review will combine the Arksey and O'Malley framework with further clarification and advice of the scoping review by Levac et al as methodological guidance. Systematic retrieval of relevant literature databases, grey literature and references included studies will be conducted. Two reviewers will screen titles and abstracts independently, and then screen the full text of potentially relevant articles to determine final inclusion. After that, two reviewers will extract data based on a predesigned data extraction table independently. Inductive analysis and narrative analysis will be used to collate, summarise and report the results. Finally, managers of nursing homes in China will be consulted for additional information and their viewpoints on the research findings. ETHICS AND DISSEMINATION Since the scoping review is a secondary analysis of the literature, there is no need to apply for ethical approval. Our goal is to share the results with key stakeholders to help them find the direction of effort and improve clinical practice. Therefore, dissemination plans include publication in international journals and sharing it at conferences to inform more healthcare workers about the scope and gaps of the studies.
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Affiliation(s)
- Long-Fei Yang
- Nursing Department, Peking Union Medical College Hospital, Beijing, China
| | - Yan-Ling Liu
- Nursing Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Tao Wu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Cui-Ping Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
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Yap TL, Horn SD, Sharkey PD, Zheng T, Bergstrom N, Colon-Emeric C, Sabol VK, Alderden J, Yap W, Kennerly SM. Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: TEAM-UP Trial Results. Adv Skin Wound Care 2022; 35:315-325. [PMID: 35051978 PMCID: PMC9119401 DOI: 10.1097/01.asw.0000817840.68588.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the clinical effectiveness of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence in 4 weeks. METHODS An embedded pragmatic cluster randomized controlled trial was conducted in nine nursing homes (NHs) that were randomly assigned to one of three repositioning intervals. Baseline (12 months) and 4-week intervention data were provided during the TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study. Intervention residents were without current PrIs, had PrI risk (Braden Scale score) ≥10 (not severe risk), and used viable 7-inch high-density foam mattresses. Each arm includes three NHs with an assigned single repositioning interval (2-, 3-, or 4-hour) as standard care during the intervention. A wireless patient monitoring system, using wearable single-use patient sensors, cued nursing staff by displaying resident repositioning needs on conveniently placed monitors. The primary outcome was PrI incidence; the secondary outcome was staff repositioning compliance fidelity. RESULTS From May 2017 to October 2019, 1,100 residents from nine NHs were fitted with sensors; 108 of these were ineligible for some analyses because of missing baseline data. The effective sample size included 992 residents (mean age, 78 ± 13 years; 63% women). The PrI incidence during the intervention was 0.0% compared with 5.24% at baseline, even though intervention resident clinical risk scores were significantly higher (P < .001). Repositioning compliance for the 4-hour repositioning interval (95%) was significantly better than for the 2-hour (80%) or 3-hour (90%) intervals (P < .001). CONCLUSIONS Findings suggest that current 2-hour protocols can be relaxed for many NH residents without compromising PrI prevention. A causal link was not established between repositioning interval treatments and PrI outcome; however, no new PrIs developed. Compliance improved as repositioning interval lengthened.
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Affiliation(s)
- Tracey L Yap
- Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina, United States. Susan D. Horn, PhD, is Adjunct Professor, University of Utah School of Medicine, Salt Lake City. Phoebe D. Sharkey, PhD, is Professor Emeritus, Loyola University Maryland, Baltimore. Tianyu Zheng, MS, is Research Assistant, University of Utah Department of Population Health Sciences. Nancy Bergstrom, PhD, RN, FAAN, is Professor Emeritus, University of Texas Health Science Center at Houston School of Nursing. Cathleen Colon-Emeric, MD, is Professor, Duke University School of Medicine. Valerie K. Sabol, PhD, MBA, ACNP, GNP, FAANP, FAAN, is Professor, Duke University School of Nursing. Jenny Alderden, PhD, APRN, is Associate Professor, Boise State University School of Nursing, Idaho. Winston Yap, MD, Carroll County Memorial Hospital, Carrollton, Kentucky. Susan M. Kennerly, PhD, RN, CNE, WCC, FAAN, is Professor, East Carolina University College of Nursing, Greenville, North Carolina. Acknowledgments: The authors thank Judith Hayes, PhD, RN, and Elizabeth Flint, PhD, for editorial assistance. This project was funded by the National Institutes of Health, National Institute of Nursing Research (R01NR016001; Yap, principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have disclosed no other financial relationships related to this article. Submitted December 5, 2021; accepted December 23, 2021; published online ahead of print January 19, 2022
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Yakupu A, Wang H, Huang L, Zhou J, Wu F, Lu Y, Lu S. Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease 2019. INT J LOW EXTR WOUND 2022:15347346221092265. [PMID: 35379022 DOI: 10.1177/15347346221092265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.
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Affiliation(s)
- Aobuliaximu Yakupu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Hanqi Wang
- Department of Radiology, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Lifang Huang
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Jingqi Zhou
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Fangyi Wu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
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Bliss DZ, Becker AJ, Gurvich OV, Bradley C, Olson ET, Steffes MT, Flaten C, Jameson S, Condon JP. Projected Augmented Reality (P-AR) for Enhancing Nursing Education About Pressure Injury: A Pilot Evaluation Study. J Wound Ostomy Continence Nurs 2022; 49:128-136. [PMID: 35255063 PMCID: PMC8908808 DOI: 10.1097/won.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To describe results of a study evaluating a Projected Augmented Reality (P-AR) system for its potential to enhance nursing education about pressure injuries. DESIGN Pilot evaluation survey. SUBJECTS AND SETTING The sample comprised nursing students and faculty at a school of nursing in a large, Midwestern public university. A total of 32 participants, which included 27 students (30% BSN, 44% MN, and 26% DNP students; 81% female) and 5 faculty members (80% female) participated. METHODS The P-AR system was prototyped using commercial-off-the-shelf components and software algorithms, applied to pressure injury nursing education content. After interaction with the P-AR system, participants completed a survey evaluating the following features of the P-AR system for potential: engagement, effectiveness, usefulness, user-friendliness, and realism, and users' overall impression and satisfaction with system features. Evaluation statements used a 5-level Likert-scale; open-ended questions about what was liked, disliked, or anything else offered opportunity for comments. RESULTS Student and faculty median evaluation scores were 5 (strongly agree or very satisfied) and 4 (agree or satisfied) for nearly all evaluation and satisfaction statements. Students' satisfaction with "realism" received a median score of 3 (neutral). The P-AR system was refined to include realistic still and animated images. CONCLUSION The P-AR system, an innovative technology using 3-dimensional dynamic images, was applied to nursing education content about pressure injury and was evaluated as having potential to enhance pressure injury teaching and learning. Education about complex processes of pressure injury development and management may benefit from using cutting-edge simulation technologies such as P-AR.
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Affiliation(s)
- Donna Z. Bliss
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Adam J. Becker
- Innovative Design Labs, Inc., Minneapolis, Minnesota, USA
| | - Olga V. Gurvich
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Cynthia Bradley
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Erica Timko Olson
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Mary T. Steffes
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Carol Flaten
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - John P. Condon
- Innovative Design Labs, Inc., Minneapolis, Minnesota, USA
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Haavisto E, Kielo-Viljamaa E, Hjerppe A, Puukka P, Stolt M. Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities. Adv Skin Wound Care 2022; 35:1-10. [PMID: 35188487 DOI: 10.1097/01.asw.0000818576.93870.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland. METHODS A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument. RESULTS According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices. CONCLUSIONS Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.
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Affiliation(s)
- Elina Haavisto
- At the University of Turku, Finland, Elina Haavisto, PhD, RN, is Professor, Department of Nursing Science; Emilia Kielo-Viljamaa, PhD, RN, is Researcher, Department of Nursing Science; Anna Hjerppe, MD, is Chief Physician and Clinical Teacher, Department of Medicine; Pauli Puukka, MSocSci, is Statistician, Department of Nursing Science; and Minna Stolt, PhD, is University Lecturer, Department of Nursing Science. Acknowledgments: The authors thank all the contact persons who participated in this study by assessing the skin condition of all patients at their own long-term care facilities and completing the questionnaires. Study materials and salaries were funded by State Research Funding, Satakunta Hospital District, Finland. The authors have disclosed no other financial relationships related to this article. Submitted February 16, 2021; accepted in revised form April 7, 2021
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Wynn M. Patient expectations of pressure ulcer prevention in the NHS, healthcare demands and national policy: a critical commentary. ACTA ACUST UNITED AC 2021; 29:S26-S31. [PMID: 33180603 DOI: 10.12968/bjon.2020.29.20.s26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Preventive care was recently identified as a Government priority, which is likely to affect pressure ulcer (PU) preventive care in the NHS. Contemporary economic analyses of PU prevention interventions are undermined by factors including methodological challenges and poor inter-rater reliability of PU risk assessment tools. Healthcare demands on the NHS created by PU prevention remain unclear, although the burden is high, with litigation costs rising continuously. The poorly understood economics of PU prevention may create variation in practice. Patient expectations of PU prevention may be influenced by mainstream media, national awareness campaigns and the varied information and advice offered by professionals. Patient expectations and low levels of functional health literacy may create confusion and unrealistic expectations. This article critically examines the impact of recent changes in Government priorities related to PU prevention, considering the effects of healthcare demand, economics and patient expectations.
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Abstract
OBJECTIVE To explore the population of patients with a community-acquired pressure injury (CAPI) admitted to an acute care facility from December 2018 to December 2019. The specific aims of the study were to identify the (1) number of patients admitted with a CAPI, (2) type and frequency of pressure injury (PI), (3) location of residence prior to admission, (4) general demographics of the patient, and (5) condition of the PI at discharge. METHODS In this retrospective descriptive study, participants were identified and pulled from the hospital database at a 260-bed level 2 trauma center. Patients' charts were identified by searching for nursing documentation of CAPIs. The exclusion criterion was charts that did not include verification of PI by a certified wound nurse. Data were pulled from the electronic medical record, verified by the certified wound nurse, and reviewed for participant demographics and implementation of PI prevention and treatment. RESULTS Over the course of the year, 88 patients had a CAPI. The majority lived at home (86.4%), were male (68.2%), and had stage 2 PIs (37%) on the sacrum (30.7%) or coccyx (51.1%). All participants had multiple comorbidities. Few PIs were from postacute care settings (11%) or another acute care hospital (1.1%). On average, patients had more than one PI. All patients had decreased or impaired mobility and mean body mass index of 26.38 ± 7.23 kg/m2. No one developed a new PI while in the acute care setting, and many of the CAPIs either healed (69.3%) or stabilized (22.7%). CONCLUSIONS Providers have an opportunity to make a difference in the prevalence of PIs occurring outside of acute and postacute care settings.
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Affiliation(s)
- Charleen Singh
- Charleen Singh, PhD, FNP-BC, CWOCN, is Director of Wound Care Services, Regional Medical Center, San Jose, California; Faculty, Betty Irene Moore School of Nursing, University of California Davis; and Nurse Practitioner, Cottage Hospital, Santa Barbara. Noordeen Shoqirat, PhD, RN, is Professor and Dean of Nursing Faculty, Mutah University, Karak, Jordan. Acknowledgments: The authors thank the San Jose Valley Foundation School of Nursing Master's in Nursing Education students and the nurses at Regional Medical Center San Jose for their continued educational and clinical support. The authors have disclosed no financial relationships related to this article. Submitted May 15, 2020; accepted in revised form September 21, 2020
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Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. J Tissue Viability 2021; 30:108-115. [PMID: 33485786 DOI: 10.1016/j.jtv.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce. AIM The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics. METHODS This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed. RESULTS The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account. CONCLUSIONS Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study.
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Trends in Decubitus Ulcer Disease Burden in European Union 15+ Countries, from 1990 to 2017. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3252. [PMID: 33299715 PMCID: PMC7722593 DOI: 10.1097/gox.0000000000003252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Decubitus ulcers (DU) are a common pathology with significant morbidity and financial implications for health services globally. This study aimed to compare the burden of DU across European Union (EU) 15+ countries between 1990 and 2017. Methods: Age-standardized incidence, mortality, and disability-adjusted life-years (DALYs) rates per 100,000 were extracted from the Global Burden of Disease Study online data repository for EU15+ countries (a group of 19 countries with comparable health expenditure, including the United States, Canada, the United Kingdom, and Australia). A joinpoint regression analysis was used to describe trends. Results: The incidence of DU increased between 1990 and 2017 in 15 of 19 EU15+ countries for both men and women. Mortality from DU decreased over the time period analyzed in the majority of EU15+ countries: only in Denmark, Finland, and Germany were increasing mortality rates observed. Decreasing DALY rates were generally observed, with the largest decreases observed in Ireland for men and women. Denmark and Germany were the only countries to demonstrate unfavorable trends in mortality, incidence, and DALYs between 1990 and 2017 for men and women. The United States, the Netherlands, and France were the only EU15+ countries in which improving disease burden was identified between 1990 and 2017 for all parameters assessed. Conclusions: Incidence of DU is increasing in EU15+ countries, whereas mortality rates and DALYs are improving. The trends in disease burden in Denmark and Germany have followed contrasting and unfavorable trends. Investigation into these trends is called for.
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Mäki-Turja-Rostedt S, Leino-Kilpi H, Korhonen T, Vahlberg T, Haavisto E. Consistent practice for pressure ulcer prevention in long-term older people care: A quasi-experimental intervention study. Scand J Caring Sci 2020; 35:962-978. [PMID: 33164226 DOI: 10.1111/scs.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long-term older people care. AIM To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long-term older people care. DESIGN A quasi-experimental intervention study. METHODS Two long-term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence-Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument. RESULTS In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure-relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices. CONCLUSIONS The results of this study support the implementation of PU prevention guidelines in long-term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care.
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Affiliation(s)
- Sirpa Mäki-Turja-Rostedt
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | | | - Tero Vahlberg
- Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
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Wei M, Yang D, Chen L, Wu L, Jiang Q, Niu N, Yang T. The prevalence and prevention of pressure ulcers: A multicenter study of nine nursing homes in eastern China. J Tissue Viability 2020; 30:133-136. [PMID: 33139158 DOI: 10.1016/j.jtv.2020.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022]
Abstract
AIM To assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China. MATERIALS AND METHODS In this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019. RESULTS Of the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes. CONCLUSIONS The prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.
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Affiliation(s)
- Min Wei
- Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | | | - Lu Chen
- Nursing Department Office, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Qixia Jiang
- Wound Care Center of Outpatient Department, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Niu Niu
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ting Yang
- Jiangsu College of Nursing, Huaian, Jiangsu, China
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Righi L, Ourahmoune A, Béné N, Rae AC, Courvoisier DS, Chopard P. Effects of a pressure-ulcer audit and feedback regional programme at 1 and 2 years in nursing homes: A prospective longitudinal study. PLoS One 2020; 15:e0233471. [PMID: 32469916 PMCID: PMC7259581 DOI: 10.1371/journal.pone.0233471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/05/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
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Affiliation(s)
- Lorenzo Righi
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
- Quality of Care and Clinical Networks, Tuscany Region, Italy
| | - Aimad Ourahmoune
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Nadine Béné
- Geneva Nursing Homes Association, Geneva, Switzerland
| | - Anne-Claire Rae
- Health Care Research and Quality, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S. Courvoisier
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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Moore Z, Avsar P, Conaty L, Moore DH, Patton D, O'Connor T. The prevalence of pressure ulcers in Europe, what does the European data tell us: a systematic review. J Wound Care 2020; 28:710-719. [PMID: 31721669 DOI: 10.12968/jowc.2019.28.11.710] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The main aim of this systematic review was to establish the prevalence of pressure ulcers (PU) within published studies from Europe. METHOD Using systematic review methodology, quantitative design studies which explored prevalence data and/or the epidemiology of PUs in Europe were considered. The primary outcome was PU prevalence. The search, conducted in April 2019, using Cochrane, Medline, Embase, CINAHL, PubMed, Scopus and Web of Science databases, returned 3065 records, of which 79 met the inclusion criteria. Data were extracted using a pre-designed extraction tool, and validity analysis was undertaken using the Evidence-Based Librarianship (EBL) Critical Appraisal Checklist. RESULTS We included 79 articles in this review. Across the studies, the median prevalence was 10.8% (standard deviation: 7%; range: 4.6-27.2%). The highest PU prevalence reported was from the Netherlands (27.2%; n=17,494 participants), and the lowest was reported from Finland (4.6%; n=629 participants). Almost 32.4% (n=151,195) of the PUs were category I and the most common site for PUs was the sacrum. CONCLUSION The prevalence data is consistently high. These data indicate the continued need for further resource allocation into PU prevention and management.
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Affiliation(s)
- Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI.,Adjunct Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Professor Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University.,Honorary Professor, Lida Institute, Shanghai, China.,Senior Tutor, University of Wales
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
| | | | | | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
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24
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Dellafiore F, Arrigoni C, Ghizzardi G, Baroni I, Conte G, Turrini F, Castiello G, Magon A, Pittella F, Caruso R. Development and validation of the pressure ulcer management self-efficacy scale for nurses. J Clin Nurs 2019; 28:3177-3188. [PMID: 30938908 DOI: 10.1111/jocn.14875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/09/2019] [Accepted: 03/23/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed. OBJECTIVES To develop a valid and reliable scale to assess nurses' self-efficacy in managing PUs, that is, the pressure ulcer management self-efficacy scale for nurses (PUM-SES). METHODS This study had a multi-method and multi-phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items' generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three-step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM-SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM-SES and an established general self-efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency. RESULTS PUM-SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM-SES had four domains, labelled as follows: assessment, planning, supervision and decision-making. These domains were predicted by the same second-order factor, labelled as PU management self-efficacy. CONCLUSION PUM-SES is a 10-item scale to measure nurses' self-efficacy in PU management. A standardised 0-100 scoring is suggested for computing each domain and the overall scale. PUM-SES might be used in clinical and educational research. RELEVANCE TO CLINICAL PRACTICE Optimising nurses' self-efficacy in PU management might enhance clinical assessment, determining better outcomes in patients with PUs.
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Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Greta Ghizzardi
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesca Turrini
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Castiello
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
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25
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Miranda JS, Abbade LPF, Deonizio AP, Abbade JF, Mbuagbaw L, Thabane L. Quality of reporting of outcomes in trials of therapeutic interventions for pressure ulcers in adults: a protocol for a systematic survey. BMJ Open 2019; 9:e024633. [PMID: 30772853 PMCID: PMC6398669 DOI: 10.1136/bmjopen-2018-024633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results to enhance transparency and replicability. OBJECTIVES The primary objective of this study is to assess the completeness of the descriptions of the outcomes of therapeutic interventions in RCTs in adult patients with PU. The secondary objectives are to evaluate the types of reported primary outcomes, measurement methods or tools used to evaluate the outcomes and the results of reported outcomes. METHODS We will conduct a systematic survey of RCTs published from January 2006 to April 2018. The selection process of the studies will be done in two stages of screening: title and abstract, and full text revision, always by two researchers independently. The completeness of the outcome will be assessed according to five criteria: domain (outcome title), specific measurement or technique/instrument used, specific metric or format of the outcome data that will be used for analysis, method of aggregation (how data from each group will be summarised) and time-points that will be used for analysis. The quality of the results of the outcome will be classified as either complete, incomplete or unreported. We will conduct a descriptive analysis of the number, type and degrees of outcome specification in the included RCTs. The frequency of categories in each domain of the outcomes will also be reported. The median and IQR will be estimated for each element of the specified outcome (out of five). ETHICS AND DISSEMINATION This will be the first systematic assessment of the outcomes of therapeutic interventions used for pressure ulcers. After completion, this review will be submitted to a peer-reviewed journals.
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Affiliation(s)
| | | | - Arthur Pollo Deonizio
- Graduate Student Medicine, São Paulo State University Julio de Mesquita Filho, Botucatu, Brazil
| | - Joelcio Francisco Abbade
- Department of Gynecology and Obstetrics, São Paulo State University Julio de Mesquita Filho, Botucatu, Brazil
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
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