1
|
Latimer S, Walker RM, Chaboyer W, Thalib L, Coyer F, Deakin JL, Gillespie BM. Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial. Intensive Crit Care Nurs 2024; 84:103746. [PMID: 38896962 DOI: 10.1016/j.iccn.2024.103746] [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: 02/11/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Pressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from. OBJECTIVES Assess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients. METHODS Using a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data. RESULTS From May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing. CONCLUSIONS A larger trial is feasible with minor refinement to the length of stay eligibility criterion. IMPLICATIONS FOR PRACTICE Prophylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.
Collapse
Affiliation(s)
- Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia, QLD, Australia.
| | - Jodie L Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
| |
Collapse
|
2
|
Lovegrove J, Fulbrook P, Yuan C, Lin F, Liu XL. The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study. Aust Crit Care 2024:S1036-7314(24)00203-0. [PMID: 39129066 DOI: 10.1016/j.aucc.2024.05.015] [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: 04/01/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use. OBJECTIVES This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale. METHODS The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales. RESULTS Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949-0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values >0.6, whereas two Braden Scale subscales (Mobility, Activity) were below this threshold. Instrument sum scores were strongly correlated (Pearson's r = -0.76 [r2 = 0.58]; p < 0.001), as were three subscale item pairs (mobility rs= -0.56 [r2 = 0.32]; nutrition rs= -0.63 [r2 = 0.39]; level of consciousness/sensory perception rs= -0.67 [r2 = 0.45] p < 0.001). CONCLUSION Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.
Collapse
Affiliation(s)
- Josephine Lovegrove
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Southport, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioral Sciences, The University of Queensland & UQCCR, Herston, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cui Yuan
- Peking University First Hospital, Beijing, China
| | - Frances Lin
- Peking University First Hospital, Beijing, China; Flinders University, Adelaide, Australia
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong SAR, China
| |
Collapse
|
3
|
Coyer F, Delaney L, Ingleman J. Preventing pressure injuries in intensive care unit patients compared to non-intensive care unit patients: Is it any different? Intensive Crit Care Nurs 2024; 81:103586. [PMID: 38016400 DOI: 10.1016/j.iccn.2023.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Fiona Coyer
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Lori Delaney
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jessica Ingleman
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| |
Collapse
|
4
|
Li J, Li Z, Wu X. The practice and facilitators of, and barriers to, implementing individualized repositioning frequency: A national cross-sectional survey of critical care nurses. J Tissue Viability 2024; 33:89-95. [PMID: 38245399 DOI: 10.1016/j.jtv.2024.01.002] [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: 05/04/2023] [Revised: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
AIMS To understand the clinical status of implementing individualized repositioning frequency-and its barriers and facilitators-among critical care nurses in China, in view of developing targeted intervention strategies and improving guideline implementation. DESIGN A cross-sectional survey. METHODS A self-report questionnaire was developed with reference to the Theoretical Domains Framework and administered to critical care nurses in 15 hospitals across eastern, southern, western, northern, and central geographical areas of China from 20 February 2023 to 16 March 2023. Data were collected for personal demographics, clinical practice status, and from Likert-type responses about barriers to and facilitators of implementing individualized repositioning frequency. RESULTS In total, 574 effective questionnaires were collected. Only 3.8 % of respondents reported that their hospital/ward uses an individualized repositioning frequency rule. Six facilitator domains identified were: social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; and intentions. Seven barrier domains were: knowledge; skills; goals; memory, attention and decision processes; environmental context and resources; social influences; and behavioral regulation. Inferential analysis showed that critical care nurses who had higher degrees, more years of work, more environmental support, and more nursing experience were prone to being more positive in response to the implementation of individualized repositioning frequency. CONCLUSION The clinical practice status of implementing individualized repositioning frequency among critical care nurses in China is unsatisfactory. Implementation is essential but complex and is influenced by several factors. Theory-based suggestions for improving this situation are provided on the basis of identified barriers.
Collapse
Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, No. 10 Xitoutiao, Youan Men Wai, Fengtai District, Beijing, 100069, China.
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
5
|
dos Reis JD, Sa-Couto P, Mateus J, Simões CJ, Rodrigues A, Sardo P, Simões JL. Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5284. [PMID: 37047900 PMCID: PMC10094196 DOI: 10.3390/ijerph20075284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.
Collapse
Affiliation(s)
- Juliana Dias dos Reis
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - Pedro Sa-Couto
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - José Mateus
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
| | - Carlos Jorge Simões
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
| | - Alexandre Rodrigues
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Centre for Innovative Biomedicine and Biotechnology (CIBB)—Center for Health Studies and Research, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Pedro Sardo
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - João Lindo Simões
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| |
Collapse
|