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Celik B, Turhan Damar H, Savsar A, Ferraiuolo F, Repustic M, Ogce Aktas F. Investigation of related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy. J Tissue Viability 2024; 33:418-424. [PMID: 38821842 DOI: 10.1016/j.jtv.2024.05.003] [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: 02/18/2024] [Revised: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy. METHODS A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument. RESULTS The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries. CONCLUSIONS While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.
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Affiliation(s)
- Buket Celik
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Hale Turhan Damar
- Izmir Democracy University, Vocational School of Health Services, Elderly Care Program, Izmir, Turkey.
| | - Adile Savsar
- Izmir University of Economics, Faculty of Health Science, Department of Nursing, Izmir, Turkey.
| | | | | | - Filiz Ogce Aktas
- Izmir University of Economics, Faculty of Health Science, Department of Nursing, Izmir, Turkey.
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İşeri Ö, Ursavaş FE. The influence of the online education provided using the six thinking hat method on the knowledge and attitudes of nursing students regarding pressure injury prevention; a pilot study. J Tissue Viability 2024; 33:465-471. [PMID: 38679544 DOI: 10.1016/j.jtv.2024.04.009] [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: 10/23/2023] [Revised: 03/08/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
AIM The study aims to investigate the influence of the online education given to nursing undergraduate students using the Six Thinking Hat Method (STHM) on their knowledge and attitudes related to pressure injury (PI) prevention. METHODS This pilot study was conducted between March-June 2023. The research sample consists of 25 participants in the intervention group and 25 in the control group. The intervention group received an online education carried out utilizing the STHM. Data were collected using the Student Demographic Information Form, the Turkish version of the Pressure Injury Knowledge Assessment Tool 2.0 (PIKAT 2.0-Tr), and the Attitude Towards the Pressure Ulcer Prevention Instrument (APuP). RESULTS While there was no significant difference between the PIKAT 2.0-Tr and APuP mean scores of the groups at the pre-test measurements (p > 0.05), a difference was observed in favor of the intervention group in the first month (post-test 1) and third month (post-test 2) measurements (p < 0.05). The education provided through the STHM resulted in a meaningful and moderate effect, with an 11.7% increase in the PIKAT 2.0-Tr scores (η2 = 0.117; p = 0.003) and a substantial 29.5% increase in the APuP scores (η2 = 0.295; p = 0.000) for the students in the intervention group. CONCLUSION It has been determined that the STHM, as an active teaching method, increases students' knowledge levels on PI prevention, supports the retention of knowledge, and enhances their attitudes. The STHM can be incorporated into nursing education as one of the innovative teaching methods.
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MESH Headings
- Humans
- Pilot Projects
- Pressure Ulcer/prevention & control
- Students, Nursing/statistics & numerical data
- Students, Nursing/psychology
- Female
- Male
- Health Knowledge, Attitudes, Practice
- Adult
- Turkey
- Education, Distance/methods
- Education, Distance/standards
- Education, Nursing, Baccalaureate/methods
- Education, Nursing, Baccalaureate/standards
- Surveys and Questionnaires
- Young Adult
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Affiliation(s)
- Özge İşeri
- Faculty of Health Sciences, Surgical Nursing Department, Ondokuz Mayıs University, Samsun, Turkey.
| | - Figen Erol Ursavaş
- Faculty of Health Sciences, Surgical Nursing Department, Çankırı Karatekin University, Çankırı, Turkey.
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Ma Y, He X, Yang T, Yang Y, Yang Z, Gao T, Yan F, Yan B, Wang J, Han L. Evaluation of the risk prediction model of pressure injuries in hospitalized patient: A systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 39073235 DOI: 10.1111/jocn.17367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 04/13/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024]
Abstract
AIMS AND OBJECTIVES The main aim of this study is to synthesize the prevalent predictive models for pressure injuries in hospitalized patients, with the goal of identifying common predictive factors linked to pressure injuries in hospitalized patients. This endeavour holds the potential to provide clinical nurses with a valuable reference for providing targeted care to high-risk patients. BACKGROUND Pressure injuries (PIs) are a frequently occurring health problem throughout the world. There are mounting studies about risk prediction model of PIs reported and published. However, the prediction performance of the models is still unclear. DESIGN Systematic review and meta-analysis: The Cochrane Library, PubMed, Embase, CINAHL, Web of Science and Chinese databases including CNKI (China National Knowledge Infrastructure), Wanfang Database, Weipu Database and CBM (China Biology Medicine). METHODS This systematic review was conducted following PRISMA recommendations. The databases of Cochrane Library, PubMed, Embase, CINAHL, Web of Science, and CNKI, Weipu Database, Wanfang Database and CBM were searched for all studies published before September 2023. We included studies with cohort, case-control designs, reporting the development of risk model and have been validated externally and internally among the hospitalized patients. Two researchers selected the retrieved studies according to the inclusion and exclusion criteria, and critically evaluated the quality of studies based on the CHARMS checklist. The PRISMA guideline was used to report the systematic review and meta-analysis. RESULTS Sixty-two studies were included, which contained 99 pressure injuries risk prediction models. The AUC (area under ROC curve) of modelling in 32 prediction models were reported ranged from .70 to .99, while the AUC of verification in 38 models were reported ranged from .70 to .98. Gender (OR = 1.41, CI: .99 ~ 1.31), age (WMD = 8.81, CI: 8.11 ~ 9.57), diabetes mellitus (OR = 1.64, CI: 1.36 ~ 1.99), mechanical ventilation (OR = 2.71, CI: 2.05 ~ 3.57), length of hospital stay (WMD = 7.65, CI: 7.24 ~ 8.05) were the most common predictors of pressure injuries. CONCLUSION Studies of PIs risk prediction model in hospitalized patients had high research quality, and the risk prediction models also had good predictive performance. However, some of the included studies lacked of internal or external validation in modelling, which affected the stability and extendibility. The aged, male patient in ICU, albumin, haematocrit, low haemoglobin level, diabetes, mechanical ventilation and length of stay in hospital were high-risk factors for pressure injuries in hospitalized patients. In the future, it is recommended that clinical nurses, in practice, select predictive models with better performance to identify high-risk patients based on the actual situation and provide care targeting the high-risk factors to prevent the occurrence of diseases. RELEVANCE TO CLINICAL PRACTICE The risk prediction model is an effective tool for identifying patients at the risk of developing PIs. With the help of risk prediction tool, nurses can identify the high-risk patients and common predictive factors, predict the probability of developing PIs, then provide specific preventive measures to improve the outcomes of these patients. REGISTRATION NUMBER (PROSPERO) CRD42023445258.
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Affiliation(s)
- Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiang He
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Tingting Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yifang Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Ziyan Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Tian Gao
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fanghong Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Boling Yan
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Juan Wang
- Department of Nursing, Second Hospital of Lanzhou University, Lanzhou, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- The First Hospital of Lanzhou University, Lanzhou, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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Bahar A, Özgürbüz NE, Akın E. Student nurses' knowledge levels and attitudes regarding pressure injury prevention. J Tissue Viability 2024:S0965-206X(24)00123-2. [PMID: 39068086 DOI: 10.1016/j.jtv.2024.07.018] [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: 07/10/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The research was conducted to examine the relationship between student nurses' knowledge levels and attitudes regarding pressure ulcer prevention. METHOD The research was registered between 01.05.2022 and 01.12.2022, and the certification studies of the health sciences faculty of a state and a foundation university in Turkey are carried out on a multi-center basis. The lists of the research were created by 426 student pictures. "Nurse Introduction Form", "Pressure Sore Prevention Information Survey" and "Attitude Scale towards Preventing Pressure Ulcers" were used as data collection tools. Data was collected online via Google Forms and the SPPS 24.0 program was evaluated in detail. RESULTS It was determined that the PIPK total score of Student Certificates was 18.29 ± 5.98, and the total score of APUP was 33.96 + 4.66. The change analysis results revealed positive aspects and a low-level significant relationship between the average nutrition total knowledge scores and the pressure prevention attitude total scores (p < 0.05). CONCLUSION In our study results, it was determined that the pressure values of the certificates and the knowledge scores of the students were insufficient and the attitudes were positive. The values of knowledge and attitudes regarding the nurturing of the values of certificates, starting from student life, states where the necessary knowledge and skills must be acquired in educational programs.
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Affiliation(s)
- Arzu Bahar
- Yuksek Ihtisas University, Faculty of Health Sciences, Fundamentals of Nursing, Ankara, Turkey.
| | - Nilüfer Emir Özgürbüz
- İzmir Tinaz Tepe University, Faculty of Health Sciences, Nursing Department, İzmir, Turkey.
| | - Esra Akın
- İzmir Katip Çelebi University, Faculty of Health Sciences, Fundamentals of Nursing, İzmir, Ankara, Turkey.
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Kumar S, Chu A, Theis T, Rastogi S, Costea DM, Banerjee R, Das BC, Yarmush ML, Hsia H, Cohen R, Schachner M, Berthiaume F. Self-Assembled Fibroblast Growth Factor Nanoparticles as a Therapeutic for Oxidant-Induced Neuronal and Skin Cell Injury. ACS APPLIED BIO MATERIALS 2024. [PMID: 39038169 DOI: 10.1021/acsabm.4c00135] [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: 07/24/2024]
Abstract
Traumatic brain injury (TBI) and spinal cord injury (SCI) are neurological conditions that result from immediate mechanical injury, as well as delayed injury caused by local inflammation. Furthermore, TBI and SCI often lead to secondary complications, including pressure wounds of the skin, which can heal slowly and are prone to infection. Pressure wounds are localized areas of damaged tissue caused by prolonged pressure on the skin due to immobility and loss of neurological sensation. With the aim to ameliorate these symptoms, we investigated whether fibroblast growth factors 2 (FGF-2) could contribute to recovery. FGF-2 plays a significant role in both neurogenesis and skin wound healing. We developed a recombinant fusion protein containing FGF-2 linked to elastin-like polypeptides (FGF-ELP) that spontaneously self-assembles into nanoparticles at around 33 °C. The nanoparticle's size was ranging between 220 and 250 nm in diameter at 2 μM. We tested this construct for its ability to address neuronal and skin cell injuries. Hydrogen peroxide was used to induce oxidant-mediated injury on cultured neuronal cells to mimic the impact of reactive oxidants released during the inflammatory response in vivo. We found that FGF-ELP nanoparticles protected against hydrogen peroxide-mediated injury and promoted neurite outgrowth. In the skin cell models, cells were depleted from serum to mimic the reduced levels of nutrients and growth factors in chronic skin wounds. FGF-ELP increased the proliferation and migration of human keratinocytes, fibroblasts, and endothelial cells. FGF-ELP is, therefore, a potentially useful agent to provide both neuroprotection and promotion of cellular processes involved in skin wound healing.
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Affiliation(s)
- Suneel Kumar
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Alexa Chu
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Thomas Theis
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Shikhar Rastogi
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
- School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Denisa M Costea
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
- School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Roshni Banerjee
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Biraja C Das
- Department of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut 06519, United States
| | - Martin L Yarmush
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Henry Hsia
- Department of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut 06519, United States
| | - Rick Cohen
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Melitta Schachner
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
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Secher Cailleteau P, Cadon L, Paille C, Olivier E, Rulleau T. Assessment of perceived patient comfort and ease of bedpan handling by caregivers, a cross-sectional survey. PLoS One 2024; 19:e0306773. [PMID: 38990820 PMCID: PMC11239000 DOI: 10.1371/journal.pone.0306773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Since its creation in the 18th century, bedpan has remained more or less the same. Its unique material composition varies from one model to another, but its shape remains relatively similar. The environment is one of the four pillars of the nursing paradigm. It is therefore essential to question this device in the nursing discipline. AIM To assess perceived patient comfort and ease of bedpan handling by nurses and their assistants. METHOD A cross-sectional survey via an online questionnaire was conducted among nurses and nursing assistants, nursing students, and health executives using the bedpan for their patients to assess their feelings and their level of satisfaction. The questionnaire asks professionals about the ease of handling the bedpan and the patient's perceived comfort. RESULTS 431 responses were obtained out of 3007 persons interviewed (14.3%). 83.0% believe that the cause of poor elimination by the patient is often or very often due to physical discomfort on the bedpan. 62.6% find the installation of the bedpan rather tough or very difficult. 59.2% find the removal of the bedpan rather tough or very difficult. DISCUSSION Our study confirms our hypothesis and highlights a lack of comfort in the bedpan as perceived by professionals. This analysis is the first step in enabling the nurse researcher to support change in the transformation paradigm.
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Affiliation(s)
- Pia Secher Cailleteau
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, Nantes, France
| | - Lucie Cadon
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, Nantes, France
| | - Cécile Paille
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, Nantes, France
| | - Elise Olivier
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, Nantes, France
| | - Thomas Rulleau
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, Nantes, France
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Fabrizio G, Sivori F, Cavallo I, Truglio M, Toma L, Sperati F, Francalancia M, Obregon F, Pamparau L, Kovacs D, Pimpinelli F, Di Domenico EG. Efficacy of sodium hypochlorite in overcoming antimicrobial resistance and eradicating biofilms in clinical pathogens from pressure ulcers. Front Microbiol 2024; 15:1432883. [PMID: 39050624 PMCID: PMC11266179 DOI: 10.3389/fmicb.2024.1432883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Sodium hypochlorite (NaOCl) is widely recognized for its broad-spectrum antimicrobial efficacy in skin wound care. This study investigates the effectiveness of NaOCl against a range of bacterial and fungal isolates from pressure ulcer (PU) patients. We analyzed 20 bacterial isolates from PU patients, comprising carbapenem-resistant Klebsiella pneumoniae (CRKP), multidrug-resistant Acinetobacter baumannii (MDRAB), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible Staphylococcus aureus (MSSA), along with 5 Candida albicans isolates. Antibiotic resistance profiles were determined using standard susceptibility testing. Whole-genome sequencing (WGS) was employed to identify antimicrobial resistance genes (ARGs) and disinfectant resistance genes (DRGs). Genetic determinants of biofilm formation were also assessed. The antimicrobial activity of NaOCl was evaluated by determining the minimum inhibitory concentration (MIC) and the minimal biofilm eradication concentration (MBEC) for both planktonic and biofilm-associated cells. CRKP and MDRAB showed resistance to fluoroquinolones and carbapenems, while MRSA exhibited resistance to β-lactams and levofloxacin. MSSA displayed a comparatively lower resistance profile. WGS identified significant numbers of ARGs in CRKP and MDRAB, with fewer DRGs compared to MRSA and MSSA. All isolates possessed genes associated with fimbriae production and adhesion, correlating with pronounced biofilm biomass production. NaOCl demonstrated substantial antimicrobial activity against both planktonic cells and biofilms. The MIC90 for planktonic bacterial cells was 0.125 mg/mL, and the MBEC90 ranged from 0.225 to 0.5 mg/mL. For planktonic C. albicans, the MIC90 was 0.150 mg/mL, and the MBEC90 was 0.250 mg/mL. These results highlight the challenge in treating biofilm-associated infections and underscore the potential of NaOCl as a robust antimicrobial agent against difficult-to-treat biofilm infections at concentrations lower than those typically found in commercial disinfectants.
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Affiliation(s)
- Giorgia Fabrizio
- Department of Biology and Biotechnology "C. Darwin", Sapienza University of Rome, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Truglio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Luigi Toma
- Medical Directorate, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Massimo Francalancia
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Francisco Obregon
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Luisa Pamparau
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Enea Gino Di Domenico
- Department of Biology and Biotechnology "C. Darwin", Sapienza University of Rome, Rome, Italy
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Zhou C, Jiao L, Qiao X, Zhang W, Chen S, Yang C, Meng M. Combined treatment of umbilical cord Wharton's jelly-derived mesenchymal stem cells and platelet-rich plasma for a surgical patient with hospital-acquired pressure ulcer: a case report and literature review. Front Bioeng Biotechnol 2024; 12:1424941. [PMID: 39045540 PMCID: PMC11263083 DOI: 10.3389/fbioe.2024.1424941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/10/2024] [Indexed: 07/25/2024] Open
Abstract
Hospital-acquired pressure ulcers (HAPUs) are still an important worldwide issue related to the safety and quality of patient care, which are among the top five adverse events reported. Patients who develop HAPUs have longer stays in the hospital than necessary, are at a greater risk of infections, and are more likely to die. Surgical patients are prone to developing PUs because they often remain immobile for extended periods of time, and their surgical procedures may limit the flow of blood oxygen and nutrition and lead to a decrease in muscle tone. Mesenchymal stem cells (MSCs) represent an attractive stem cell source for tissue regeneration in clinical applications, which have been demonstrated to improve wound healing through re-epithelialization, increased angiogenesis, and granulation tissue formation. Here, we present the case of an emergency surgical patient who developed an ulcer on the right heel during hospitalization. The human umbilical cord Wharton's jelly-derived MSCs (WJ-MSCs) re-suspended in platelet-rich plasma (PRP) were injected into ulcer margins. Four days after the WJ-MSC application, the patient showed progressive healing of the PU. From days 4 to 33, granulation tissue formation and re-epithelialization were clearly observed. The ulcer was almost healed completely on day 47, and the pain in the patient's wound area also decreased. Thus, intradermal transplantation of WJ-MSCs and PRP was safe and effective for treatment in patients with pressure ulcers. WJ-MSCs, together with PRP, may offer a promising treatment option for wound healing.
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Affiliation(s)
- Changhui Zhou
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Linlin Jiao
- Nursing Department, Liaocheng People’s Hospital, Liaocheng, China
| | - Xiaoping Qiao
- Department of Traditional Chinese Medicine, Liaocheng People’s Hospital, Liaocheng, China
| | - Weiwei Zhang
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Shuangfeng Chen
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Chunling Yang
- Nursing Department, Liaocheng People’s Hospital, Liaocheng, China
| | - Min Meng
- Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, China
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Fulbrook P, Lovegrove J, Ven S, Schnaak S, Nowicki T. Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study. J Adv Nurs 2024. [PMID: 38969344 DOI: 10.1111/jan.16309] [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: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk-stratified intervention bundle. DESIGN Single-centre, cross-sectional, observational, prospective. METHODS The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation. RESULTS Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient-/carer-focused interventions was particularly poor, with evidence indicating they had been implemented for 3%-10% of patients. Also, nutritional screening-related interventions were implemented poorly. Clinically indicated implementation of heel-elevation devices and bariatric equipment was low for at-risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such. CONCLUSION While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them. IMPLICATIONS FOR PATIENT CARE Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation. IMPACT The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals. REPORTING METHOD The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Schnaak
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tracy Nowicki
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, Moore Z, Deakin J, Carlini J, Lovegrove J, Jahandideh S, Gillespie BM. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104768. [PMID: 38642429 DOI: 10.1016/j.ijnurstu.2024.104768] [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: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42023423058. TWEETABLE ABSTRACT Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/SharonLLatimer
| | - Udeshika Priyadarshani
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Emma Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jenny Sim
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney Australia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/jodie_deakin3
| | - Joan Carlini
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Health Consumer and Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Josephine Lovegrove
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Sepideh Jahandideh
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. https://twitter.com/bgillespie6
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11
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Kottner J, Amin R, Tomova‐Simitchieva T, Hillmann K, Blume‐Peytavi U. Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial. Int Wound J 2024; 21:e14957. [PMID: 38994923 PMCID: PMC11240536 DOI: 10.1111/iwj.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.
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Affiliation(s)
- Jan Kottner
- Institute for Clinical Nursing ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Tsenka Tomova‐Simitchieva
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
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12
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Choragudi S, Andrade LF, Maskan Bermudez N, Burke O, Sa BC, Kirsner RS. Trends in inpatient burden from pressure injuries in the United States: Cross-sectional study National Inpatient Sample 2009-2019. Wound Repair Regen 2024; 32:487-499. [PMID: 38845416 DOI: 10.1111/wrr.13182] [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: 07/24/2023] [Revised: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 07/11/2024]
Abstract
Pressure injuries are a significant comorbidity and lead to increased overall healthcare costs. Several European and global studies have assessed the burden of pressure injuries; however, no comprehensive analysis has been completed in the United States. In this study, we investigated the trends in the burden of pressure injuries among hospitalised adults in the United States from 2009 to 2019, stratified by sociodemographic subgroups. The length of admission, total cost of hospitalisation, and sociodemographic data was extracted from the National Inpatient Sample provided by the Healthcare Cost and Utilisation Project, Agency for Healthcare Research and Quality. Overall, the annual prevalence of pressure injuries and annual mean hospitalisation cost increased ($69,499.29 to $102,939.14), while annual mean length of stay decreased (11.14-9.90 days). Among all races, minority groups had higher average cost and length of hospitalisation. Our findings suggest that while the length of hospitalisation is decreasing, hospital costs and prevalence are rising. In addition, differing trends among racial groups exist with decreasing prevalence in White patients. Further studies and targeted interventions are needed to address these differences, as well as discrepancies in racial groups.
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Affiliation(s)
- Siri Choragudi
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis F Andrade
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Narges Maskan Bermudez
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olivia Burke
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brianna Christina Sa
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert S Kirsner
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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13
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Silverstein LA, Moser DK, Rayens MK. Nurse-Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition. J Trauma Nurs 2024; 31:189-195. [PMID: 38990874 DOI: 10.1097/jtn.0000000000000797] [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: 07/13/2024]
Abstract
BACKGROUND About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. OBJECTIVE The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. METHODS This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. RESULTS A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. CONCLUSIONS Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes.
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Affiliation(s)
- Lily A Silverstein
- Author Affiliations: College of Nursing, University of Kentucky, Lexington, Kentucky (Ms. Silverstein and Drs. Moser and Rayens)
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14
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Arıburnu Ö, Korkmaz F. Nursing students' perceptions and experiences in pressure injury risk assessment: A qualitative study. Nurse Educ Pract 2024; 79:104039. [PMID: 38996581 DOI: 10.1016/j.nepr.2024.104039] [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: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024]
Abstract
AIM This study aims to capture the perspectives of senior undergraduate nursing students concerning pressure injury risk assessment, shedding light on their practical experiences and insights. BACKGROUND Pressure injuries pose a significant challenge in healthcare, demanding vigilant attention from healthcare professionals. Central to mitigating this challenge is the imperative role of risk assessment, placing nurses at the forefront of prevention strategies. Given the critical nature of this responsibility, the need for a robust and well-structured integration of risk assessment teaching within undergraduate nursing education becomes increasingly apparent. DESIGN This study was conducted as a descriptive qualitative study. METHOD This research was conducted at the Nursing Faculty of a State University in Ankara/Turkey, involving 19 senior students enrolled in the nursing program. Data was collected online using in-depth interviews with semi-structured interview questions between November and December 2022. After data collection, transcripts were generated and subjected to thematic analysis. The study was reported following the COREQ Checklist. RESULTS The study revealed two overarching themes: Opinions and Experiences. Within the Opinions theme, subthemes emerged, including "Features of Teaching," "Pressure Injury Definition," and "Improving Teaching Methods." The Experiences theme encompassed sub-themes such as the "Limited Relationship between Theoretical Teaching and Clinical Practice" and "Assessing the Risk of Pressure Injury in Practice." CONCLUSION Participants affirmed that theoretical instruction sufficiently addressed pressure injury risk assessment yet expressed concerns about the inadequacy of clinical teaching. Additionally, they underscored the need for innovative teaching methods in the theoretical instructional process.
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Affiliation(s)
- Özlem Arıburnu
- Hacettepe University, Faculty of Nursing, Ankara, Turkey.
| | - Fatoş Korkmaz
- Hacettepe University, Faculty of Nursing, Ankara, Turkey
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15
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Bayram A, Şara Y, Uzgör F, Öztürk H. Exploring the relationship between pressure ulcer knowledge and self-efficiency among nursing students: A multicenter study. J Tissue Viability 2024:S0965-206X(24)00092-5. [PMID: 38951049 DOI: 10.1016/j.jtv.2024.06.017] [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: 11/27/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
AIM To determine the relationship between the knowledge and self-efficiency regarding pressure ulcers of nursing students. METHODS This descriptive and correlational study was conducted with 775 nursing students from three different universities in various regions of Turkey. The "Pressure Ulcer Knowledge Assessment Tool-Updated Version" and "Pressure Ulcer Management Self-Efficiency Scale for Nurses" tool were used to collect data between May and September 2023. The Strengthening the Reporting of Observational Studies checklist was followed to report this study. RESULTS The mean knowledge score was 7.27 ± 3.09, and the mean self-efficiency on pressure ulcer management score was 35.5 ± 18.3. A statistically significant positive correlation was found between nursing students' knowledge and self-efficiency mean scores regarding pressure ulcers (p < 0.05). A significant difference was also found between the students' academic levels and gender and their knowledge and self-efficiency scores regarding pressure ulcers. CONCLUSION In this study, where the data covers these three institutions, students' pressure ulcer knowledge and self-efficiency scores were lower compared to all academic years. Accordingly, it was also determined that students with more nursing practice experience showed higher knowledge and self-efficacy scores than students with less nursing practice experience. Additionally, the students' self-efficacy increased along with their knowledge level. Training courses may be suggested to improve students' knowledge and self-efficiency regarding pressure ulcers.
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Affiliation(s)
- Aysun Bayram
- Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkiye.
| | - Yasemin Şara
- Nursing Department, Faculty of Nursing, Konya Selçuk University, Konya, Turkiye
| | - Füsun Uzgör
- Nursing Department, Faculty of Fethiye Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkiye
| | - Havva Öztürk
- Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkiye
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16
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Alkhazali MAN, Totur Dikmen B, Bayraktar N. The Effectiveness of Mobile Applications in Improving Nursing Students' Knowledge Related to Pressure Injury Prevention. Healthcare (Basel) 2024; 12:1264. [PMID: 38998799 PMCID: PMC11241487 DOI: 10.3390/healthcare12131264] [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: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024] Open
Abstract
The study's main goal was to compare the effects of a mobile application versus traditional methods of teaching on nursing students' acquisition of knowledge about pressure injury prevention. In addition, a secondary aim was to discover nursing students' viewpoints related to the advantages and disadvantages of using mobile applications as an educational method. A randomized controlled study design was implemented during November and December of 2023 in a nursing faculty with 60 undergraduate students in their second nursing year. A total of 30 students were assigned to the mobile application group, while the other 30 students were assigned to the traditional lecture group. The study was executed in three stages: pre-test, educational intervention, and post-test. The results of the study during the pre-test showed that there were no statistically significant differences in the mean scores of pressure injury themes between the two groups. However, the post-test scores for all PI themes were higher in the mobile application group compared to the traditional lecture group. Furthermore, five advantages of the mobile application were highlighted by students: "improvement of students' knowledge and skills", "self-confidence", "stress reduction", "enhancement of competence", and "stimulation of learning motivation". This study demonstrated the effectiveness of the mobile application method in enhancing nursing students' knowledge and prophylaxis of pressure injury. Therefore, the mobile application method is recommended as an innovative approach to teaching.
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Affiliation(s)
- Mo Ath Nayef Alkhazali
- Department of Surgical Nursing, Faculty of Nursing, Near East University, TRNC, Mersin 10, Nicosia 99138, Turkey
- School of Nursing, European University of Lefke, TRNC, Mersin 10, Lefke 99010, Turkey
| | - Burcu Totur Dikmen
- Department of Surgical Nursing, Faculty of Nursing, Near East University, TRNC, Mersin 10, Nicosia 99138, Turkey
| | - Nurhan Bayraktar
- Department of Nursing, Faculty of Health Sciences, Atlılım University, Ankara 06830, Turkey
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17
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Luo L, Wen X, Wang J, Xiao Q, Su L, Zhou M. Analysis of the Current Status of Nurses' Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1451-1462. [PMID: 38841316 PMCID: PMC11151280 DOI: 10.2147/rmhp.s458522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Background Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries. Aim To understand the current status of nurses' knowledge of pressure injuries in Shaanxi Province and the factors influencing it. Design A cross-sectional survey. Methods In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform. Results 16,599 nurses had a pressure injury knowledge score of (44.32±10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province. Conclusion Clinical nurses' awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff's awareness through continuing education, tiered training, and other measures.
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Affiliation(s)
- Liqun Luo
- Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiulin Wen
- Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jingrong Wang
- Department of Surgical, The Second Affiliated Hospital of the Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Qian Xiao
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Liuju Su
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Min Zhou
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
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Hübner UH, Hüsers J. Differential effects of electronic patient record systems for wound care on hospital-acquired pressure injuries: Findings from a secondary analysis of German hospital data. Int J Med Inform 2024; 185:105394. [PMID: 38460463 DOI: 10.1016/j.ijmedinf.2024.105394] [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: 08/21/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied. MATERIAL AND METHODS A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment. RESULTS The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios. DISCUSSION These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.
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Affiliation(s)
- Ursula H Hübner
- Health Informatics Research Group, Department of Business Management and Social Sciences, Osnabrück University of Applied Sciences, P.O. Box 1944, D-49009 Osnabrück, Germany.
| | - Jens Hüsers
- Health Informatics Research Group, Department of Business Management and Social Sciences, Osnabrück University of Applied Sciences, P.O. Box 1944, D-49009 Osnabrück, Germany.
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Zuniga J, Mungai M, Chism L, Frost L, Kakkar R, Kyololo O. Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review. Nurs Outlook 2024; 72:102151. [PMID: 38490058 DOI: 10.1016/j.outlook.2024.102151] [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: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PURPOSE Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. METHODS This systematic review of the literature used, PRISMA to guide the search. FINDINGS The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DISCUSSION There were gaps in the interventions that have been proven successful in other global settings. CONCLUSION In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
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Affiliation(s)
- Julie Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX.
| | | | - Lucy Chism
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Livia Frost
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Reha Kakkar
- College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - O'Brien Kyololo
- School of Nursing and Midwifery, Moi University, Eldoret, Kenya
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Eberhardt TD, Lima SBD, Pozzebon BR, Santos KPD, Silveira LBD, Soares RSDÁ, Alves PJ. Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial. J Tissue Viability 2024; 33:305-311. [PMID: 38553355 DOI: 10.1016/j.jtv.2024.03.006] [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: 06/29/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. METHOD the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. RESULTS significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF. CONCLUSIONS The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.
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Pei J, Zhang H, Ma Y, Wei Y, Tao H, Yang Q, Yang Z, Han L. Dose-response relationships between body-mass index and pressure injuries occurrence in hospitalized patients: A multi-center prospective study. J Tissue Viability 2024; 33:179-184. [PMID: 38553354 DOI: 10.1016/j.jtv.2024.03.012] [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: 01/01/2024] [Revised: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Pressure injuries (PIs) are one of the leading potentially preventable hospital-acquired complications associated with prolonged hospital length, poor quality of life and financial burden. The relationship between body mass index (BMI) and PIs occurrence is controversial. OBJECTIVE The aim of this study was to further examine relationships between BMI and PIs occurrence in hospitalized patients. DESIGN A multi-center prospective study. SETTING 39 hospitals located in northwest China from April 2021 to July 2023. PARTICIPANTS 175,960 hospitalized patients aged over 18 years were enrolled, and 170,800 patients were included in the final analysis. METHODS BMI and clinical characteristics were assessed at baseline. PIs assessment were performed by trained nurses, with data recorded for the presence, the location and stage of each PI. For staging PIs, the National Pressure Ulcer Advisory Panel(NPUAP) staging system were used. The multivariate logistic regressions analysis and restricted cubic splines (RCS) models were used to explore associations between BMI and PIs, adjusting for potential confounders. RESULTS Of 175,960 participants, 5160 were excluded from analyses. The multivariate logistic regression model identified a positive relationship between under-weight BMI and risk of PIs occurrence (OR = 1.60, 95% CI:1.18-2.17). We also found U shaped association between BMI and PIs occurrence (non-linear P < 0.001). BMI less than 23 kg/m2 significantly increased risk of PIs, and there was a tendency to increase risk of PIs at BMI higher than 30 kg/m2. We stratified participants by sex to further investigate their association and found the risk of PIs increases substantially in women at BMI below 17 kg/m2 and in men at BMI below 23 kg/m2. CONCLUSIONS The present study indicated that there was an approximate U shaped relationship between BMI and PIs occurrence, and this association was potentially different between men and women.
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Affiliation(s)
- Juhong Pei
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuting Wei
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Hongxia Tao
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Qiuxia Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zhuang Yang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; School of Nursing, Lanzhou University, Lanzhou, Gansu, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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Sahay A, Willis E, Yu S. Pressure injury education for older adults and carers living in community settings: A scoping review. Int Wound J 2024; 21:e14894. [PMID: 38772749 PMCID: PMC11108764 DOI: 10.1111/iwj.14894] [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: 03/02/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and residential aged care facilities, however, there remains a critical gap in understanding how PI knowledge on prevention and management is shared with older adults and their carers living in the community. We aimed to describe the nature and characteristics of structured and unstructured PI education programs available to community-dwelling older adults and their carers. As coping review was undertaken. We searched five databases: CINAHL, Medline, Scopus, Cochrane Library and ProQuest from 2009 to August 2023. The review was guided by Arksey and O'Malley's six-step framework and adhered to the PRISMA-ScR guidelines. It included primary peer-reviewed papers published in English, which focus on PI education for older adults and/or their carers living in community settings. Data extraction was organised in a table, and findings presented as a narrative summary. One-hundred and thirty-six papers were screened and four included in the review. Results indicate that consideration was placed on literacy levels and cognitive status of older adults and their carers when designing PI education materials. Educational materials such as leaflets/brochures, in-person training sessions or a combination of both were used. However, duration of these interventions varied, lasting for 1-4 weeks while others were completed over 12 months. Some improvements in PI knowledge such as how to treat PI, dietary requirements and importance of mobility were noted. However, information retention and its translation into effective long-term behaviour change remained unclear. In conclusion, adopting a multifaceted educational approach increases the effectiveness of PI knowledge translation. Continuous education, support and reinforcement on PIs over time are necessary when interacting with older adults and caregivers to ensure long-term management and prevention success. Conversations on PIs should start at the primary care levels when older adults and carers are visiting their GP clinics and accessing support services for other healthcare needs. Understanding older adults' and carers' literacy levels, cognitive status and cultural background can assist clinicians in designing and delivering fit-for-purpose PI educational interventions that are accessible, relatable and effective in promoting knowledge transfer and behaviour change. Carers are vital conduits in the care continuum. These factors will lead to a more informed, collaborative and person-centred approaches to PI management and prevention.
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Affiliation(s)
- Ashlyn Sahay
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
| | - Eileen Willis
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
| | - Stephen Yu
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
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Tao H, Zhang H, Ma Y, Lv L, Pei J, Jiao Y, Han L. Comparison of the predictive validity of the Braden and Waterlow scales in intensive care unit patients: A multicentre study. J Clin Nurs 2024; 33:1809-1819. [PMID: 38031387 DOI: 10.1111/jocn.16946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The first step in preventing pressure injuries (PIs), which represent a significant burden on intensive care unit (ICU) patients and the health care system, is to assess the risk for developing PIs. A valid risk assessment scale is essential to evaluate the risk and avoid PIs. OBJECTIVES To compare the predictive validity of the Braden scale and Waterlow scale in ICUs. DESIGN A multicentre, prospective and cross-sectional study. METHODS We conducted this study among 6416 patients admitted to ICUs in Gansu province of China from April 2021 to October 2022. The incidence and characteristics of PIs were collected. The risk assessment of PIs was determined using the Braden and Waterlow scale. The sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve of the two scales were compared. RESULTS Out of 5903 patients, 72 (1.2%) developed PIs. The sensitivity, specificity, positive and negative predictive, and the area under the curve of the Braden scale were 77.8%, 50.9%, 0.014 and 0.996, and 0.689, respectively. These values for the Waterlow scale were 54.2%, 71.1%, 0.017, 0.994 and 0.651. CONCLUSIONS Both scales could be used for risk assessment of PIs in ICU patients. However, the accuracy of visual inspection for assessment of skin colour, nursing preventive measures for patients and scales inter-rater inconsistency may limited the predictive validity statistics. RELEVANCE TO CLINICAL PRACTICE Both scales could be used for PIs risk assessment. The low specificity of the Braden scale and low sensitivity of the Waterlow scale remind medical staff to use them in combination with clinical judgement and other objective indicators. PATIENT OR PUBLIC CONTRIBUTION This study was designed to enhance the management of PIs. Patients and the general public were not involved in the study design, analysis, and interpretation of the data or manuscript preparation.
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Affiliation(s)
- Hongxia Tao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Gansu Medical College, Pingliang, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Juhong Pei
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Yanxia Jiao
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
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24
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Ni TF, Wang JL, Chen CK, Shih DF, Wang J. Can a prolonged healing pressure injury be benefited by using an AI mattress? A case study. BMC Geriatr 2024; 24:307. [PMID: 38566023 PMCID: PMC10986049 DOI: 10.1186/s12877-024-04900-x] [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: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Pressure injuries are a common and serious issue for bedridden residents in long-term-care facilities. Areas of bony prominences, such as the scapula, sacrum, and heels, are more likely to develop pressure injuries. The management of pressure injury wounds include dressing changes, repositioning, away from moisture, decreasing the occurrence of friction and shear, and more. Some supportive surfaces are also used for pressure injury cases such as gel pads, alternating pressure air mattresses, and air-fluidized beds. The aim of this case study was to determine whether the use of an artificial intelligent mattress can improve a nursing home resident with prolonged pressure injury. CASE PRESENTATION A retrospective study design was conducted for this case study. A 79-year-old male developed a pressure injury in the sacrum. His pressure injury was initially at stage 4, with a score of 12 by the Braden scale. The PUSH score was 16. During 5.5 months of routine care plus the use of the traditional alternative air mattress, in the nursing home, the wound stayed in stage 3 but the PUSH score increased up to 11. An artificial intelligence mattress utilizing 3D InterSoft was used to detect the bony prominences and redistribute the external pressure of the skin. It implements a color guided schematic of 26 colors to indicate the amount of pressure of the skin. RESULTS The wound size was decreased and all eczema on the resident's back diminished. The PUSH score was down to 6, as the artificial intelligent mattress was added into the routine care. The staff also reported that the resident's quality of sleep improved and moaning decreased. The hemiplegic side is at greater risk of developing pressure injury. CONCLUSIONS This novice device appeared to accelerate wound healing in this case. In the future, more cases should be tested, and different care models or mattress can be explored.
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Affiliation(s)
- Tung Fang Ni
- Chang Gung Memorial Hospital, Nursing home, Taoyuan, Taiwan
| | - Jyh-Liang Wang
- Department of Electronic Engineering, Ming Chi University of Technology, New Taipei city, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - De Fen Shih
- eBio Technology Inc, New Taipei city, Taiwan
| | - Jeng Wang
- Geriatric & Long-term Care Research Center, Chang Gung University of Science and Technology, 261 Wen-Hwa 1 Rd, Kwei-Shan, Tao-Yuau, Taoyuan, 333, Taiwan.
- Chang Gung Memorial Hospital, Keelung, Taiwan.
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25
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Rippon MG, Fleming L, Chen T, Rogers AA, Ousey K. Artificial intelligence in wound care: diagnosis, assessment and treatment of hard-to-heal wounds: a narrative review. J Wound Care 2024; 33:229-242. [PMID: 38573907 DOI: 10.12968/jowc.2024.33.4.229] [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] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The effective assessment of wounds, both acute and hard-to-heal, is an important component in the delivery by wound care practitioners of efficacious wound care for patients. Improved wound diagnosis, optimising wound treatment regimens, and enhanced prevention of wounds aid in providing patients with a better quality of life (QoL). There is significant potential for the use of artificial intelligence (AI) in health-related areas such as wound care. However, AI-based systems remain to be developed to a point where they can be used clinically to deliver high-quality wound care. We have carried out a narrative review of the development and use of AI in the diagnosis, assessment and treatment of hard-to-heal wounds. We retrieved 145 articles from several online databases and other online resources, and 81 of them were included in this narrative review. Our review shows that AI application in wound care offers benefits in the assessment/diagnosis, monitoring and treatment of acute and hard-to-heal wounds. As well as offering patients the potential of improved QoL, AI may also enable better use of healthcare resources.
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Affiliation(s)
- Mark G Rippon
- University of Huddersfield, Huddersfield, UK
- Daneriver Consultancy Ltd, Holmes Chapel, UK
| | - Leigh Fleming
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Tianhua Chen
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | | | - Karen Ousey
- University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Ireland
- Chair, International Wound Infection Institute
- President Elect, International Skin Tear Advisory Panel
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Zhetmekova Z, Kassym L, Kussainova A, Akhmetova A, Everink I, Orazalina A, Zhanaspayeva G, Botabayeva A, Kozhakhmetova D, Olzhayeva R, Semenova Y. The prevalence and risk factors of pressure ulcers among residents of long-term care institutions: a case study of Kazakhstan. Sci Rep 2024; 14:7105. [PMID: 38531944 DOI: 10.1038/s41598-024-57721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Limited information is available regarding the prevalence of pressure ulcers (PUs) in residential homes in Central Asia. Therefore, the aim of this study was to identify the prevalence rates and risk factors associated with PUs among residents of long-term care medical institutions in the Republic of Kazakhstan. This cross-sectional study was conducted in four long-term care institutions in Kazakhstan. The study sample consisted of 640 patients who were assessed for the presence of PUs and associated risk factors. The evaluation was performed using the International Prevalence Measurement of Care Quality (Landelijke Prevalentiemeting Zorgkwaliteit, LPZ), the Braden scale, and the Care Dependency Score (CDS). The overall prevalence of PUs, classified as categories I-IV, was found to be 37%. When excluding category I PUs, the prevalence decreased to 35.6%. The odds ratios (ORs) for presenting with PUs were as follows: history of stroke (OR 5.22), diseases of the digestive system (OR 10.01), presence of spinal cord lesions/paraplegia (OR 20.50), recent reported confusion within the last 7 days (OR 184.00), and limited extent dependency according to the CDS (OR 4.44; 95%CI 1.31-16.1). It is imperative to establish specialized training programs aimed at equipping medical personnel, relatives, and patients themselves with the necessary skills to provide optimal care for individuals affected by PUs.
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Affiliation(s)
| | - Laura Kassym
- Department of General Medical Practice with a Course of Evidence-Based Medicine, Astana Medical University, Astana, Kazakhstan.
| | - Assiya Kussainova
- Department of Infectious Diseases, Dermatovenereology and Immunology, Semey Medical University, Semey, Kazakhstan
| | - Almira Akhmetova
- Department of Infectious Diseases, Dermatovenereology and Immunology, Semey Medical University, Semey, Kazakhstan
| | - Irma Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ainash Orazalina
- Department of Molecular Biology and Medical Genetics Named After the Academician of National Academy of Sciences Republic of Kazakhstan Raissov T. K., Semey Medical University, Semey, Kazakhstan
| | - Galiya Zhanaspayeva
- National Scientific Center of Traumatology and Orthopedics Named After Academician Batpenov N.D., Astana, Kazakhstan
| | - Ainur Botabayeva
- Department of Internal Diseases and Rheumatology, Semey Medical University, Semey, Kazakhstan
| | - Dana Kozhakhmetova
- Department of Internal Diseases and Rheumatology, Semey Medical University, Semey, Kazakhstan
| | - Rauza Olzhayeva
- Department of Biochemistry and Chemical Disciplines Named D.M.S., Professor Tapbergenov S.O., Semey Medical University, Semey, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
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27
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de Almeida RMF, Tura LFR, Queiroz ABA, Ferreira MDA, da Silva RC. Beliefs and practices of the nursing team related to pressure injury preventive measures: A analysis of social representations. J Adv Nurs 2024. [PMID: 38523566 DOI: 10.1111/jan.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
AIMS AND OBJECTIVES To analyse the process of elaborating social representations about pressure injury preventive measures by the nursing team (nurses and nurse technicians) and how this process relates to preventive practices for hospitalized patients. DESIGN Qualitative study, with the application of the theory of social representations in its procedural methodological approach. METHODS The study was carried out in an inpatient clinic of a public hospital in the state of Rondônia, Brazil. Totally, 28 nursing professionals in the medical clinic sectors who had worked directly with patient care for more than 6 months participated. The data were collected between July and September 2021 via in-depth interviews with the application of a semi-structured instrument. Analysis was carried out with the help of ALCESTE software, which performed a lexicographic analysis, and also via thematic analysis. The COREQ guided the presentation of the research report. RESULTS The social representations were developed based on the professionals' symbolic beliefs about the visibility/invisibility of the results of applying preventive care. These symbolic constructions mobilized positive and negative feelings among the nursing team, which guided the classification of prevention practices as being of greater or lesser priority among other care activities. There were favourable attitudes among professionals, which included applying prevention measures in their daily routines, and unfavourable attitudes of non-adherence to the institution's protocol for preventing pressure injuries. CONCLUSIONS The nursing team's perception of pressure injury prevention is influenced by symbolic, affective, values, and social dimensions. Non-adherence behaviours are attributed to the belief in the invisibility of prevention outcomes, resulting in a reluctance to implement preventive measures. RELEVANCE TO CLINICAL PRACTICE Understanding the subjective logic that explains the thinking and actions of the nursing team suggests the need to incorporate discussions on beliefs, values, sentiments, and attitudes of nursing professionals into educational programs on pressure injury prevention. PATIENT OR PUBLIC CONTRIBUTION No public contribution.
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Affiliation(s)
| | - Luiz Fernando Rangel Tura
- Institute of Studies and Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Rafael Celestino da Silva
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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28
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Hammad BM, Eqtait FA, Ayed AJ, Salameh BS, Fashafsheh IH, Saleh MYN. Insights into pressure injury prevention: Assessing the knowledge, attitudes, and practices of Palestinian nursing students. J Tissue Viability 2024:S0965-206X(24)00036-6. [PMID: 38521681 DOI: 10.1016/j.jtv.2024.03.011] [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: 01/30/2024] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
AIM To assess the knowledge, attitudes, and practices of Palestinian nursing students towards pressure injury prevention. MATERIALS AND METHODS A descriptive cross-sectional study was conducted with 455 nursing students recruited from Arab American University-Palestine, employing a total population sample. Data collection forms include socio-demographic information, the Pressure Ulcer Knowledge Assessment Tool, Attitude towards Pressure Ulcer Prevention Instrument and Pressure Injury Preventive Practices scale. RESULTS The study found that students had a mean knowledge score of 54% (14.04/26), a positive attitude score of 75.8% (39.42/52), and demonstrated a fair level of practice 75.3% (30.12/40). Significant differences were observed in the Knowledge, Attitude, and Practice total scores, linked to academic year, clinical experience, and the number of attended departments during clinical training (p < 0.001). Additionally, weak but significant positive relationships were found between practice and attitude scores (r = 0.303, p < 0.001), practice and knowledge score (r = 0.211, p < 0.001), and a moderate positive significant relationship between knowledge and attitude scores (r = 0.567, p < 0.001). CONCLUSION The study revealed insufficient knowledge, positive attitudes, and somewhat unsafe practices among nursing students regarding pressure injury prevention. It highlights the need for specific revisions in the nursing curriculum. Improvements can be achieved through detailed coverage in classrooms and laboratories, integrating simulation methods. Additionally, ensuring that students gain adequate experiences in clinical units, with a specific emphasis on pressure injury prevention, is crucial for improving students' capability and contribute to better pressure injury management.
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Affiliation(s)
- Bahaaeddin M Hammad
- Faculty of Nursing, Arab American University Palestine, Jenin City, 240, Palestine.
| | - Faeda A Eqtait
- Faculty of Nursing, Arab American University Palestine, Jenin City, 240, Palestine.
| | - Ahmad J Ayed
- Faculty of Nursing, Arab American University Palestine, Jenin City, 240, Palestine.
| | - Basma S Salameh
- Faculty of Nursing, Arab American University Palestine, Jenin City, 240, Palestine.
| | - Imad H Fashafsheh
- Faculty of Nursing, Arab American University Palestine, Jenin City, 240, Palestine.
| | - Mohammad Y N Saleh
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan.
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Roddis J, Dyson J, Woodhouse M, Devrell A, Oakley K, Cowdell F. Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study. BMJ Open 2024; 14:e080398. [PMID: 38503413 PMCID: PMC10953097 DOI: 10.1136/bmjopen-2023-080398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers. DESIGN Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis. SETTING The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts. PARTICIPANTS Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10). RESULTS Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment). CONCLUSIONS There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.
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Affiliation(s)
- Jennifer Roddis
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Judith Dyson
- C-SCHaRR, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Marjolein Woodhouse
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Anne Devrell
- Patient and Public Involvement representative, Birmingham, UK
| | | | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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Dimanopoulos T, Chaboyer W, Campbell J, Ullman AJ, Battley C, Ware RS, Patel M, Griffin BR. Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital. J Adv Nurs 2024. [PMID: 38468151 DOI: 10.1111/jan.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. METHODS This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. RESULTS The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. CONCLUSION HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. IMPACT The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. REPORTING METHOD STROBE guidelines. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution to the conduct of this study.
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Affiliation(s)
- Tanesha Dimanopoulos
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Maharshi Patel
- School of Medicine and Dentistry, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Bronwyn R Griffin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Nathan, Queensland, Australia
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Fulbrook P, Lovegrove J, Ven S, Miles SJ. Pressure injury risk assessment and prescription of preventative interventions using a structured tool versus clinical judgement: An interrater agreement study. J Adv Nurs 2024. [PMID: 38450740 DOI: 10.1111/jan.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
AIM To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. DESIGN Interrater agreement study. METHODS Data were collected from November 2019 to December 2022. Paired nurse-assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence-adjusted and bias-adjusted kappa. RESULTS Ninety-four nurse assessors participated. Absolute agreement of not-at-risk versus at-risk-any-level was substantial, but absolute agreement of risk-level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower-risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher-risk patients. CONCLUSION There were clear differences in pressure injury risk-level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation. IMPACT The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool. REPORTING METHOD This study adhered to the GRRAS reporting guideline. PATIENT/PUBLIC CONTRIBUTION No patient or public involvement in this study. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Sandra J Miles
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
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Lin P, Tang X, Zhong J, Tang F, Liu H, Peng L, Wan B, Wang M, Ye Y, Guo R, Liu X, Deng L. Antibacterial, ROS scavenging and angiogenesis promoting ϵ-Polylysine/gelatin based hydrogel containing CTLP to regulate macrophages for pressure ulcer healing. Biofabrication 2024; 16:025025. [PMID: 38408382 DOI: 10.1088/1758-5090/ad2d2e] [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: 09/25/2023] [Accepted: 02/26/2024] [Indexed: 02/28/2024]
Abstract
Pressure ulcers (PUs) have emerged as a substantial burden on individuals and society. The introduction of innovative dressings that facilitate the healing of pressure ulcer wounds represents a cost-effective alternative for treatment. In this study, the emphasis is on the preparation of Carthamus tinctorius L. polysaccharide (CTLP) as hydrogel microspheres (MPs), which are then encapsulated within a hydrogel matrix crosslinked with phenylboronic acid gelatin (Gelatin-PBA) andϵ-polylysine-grafted catechol (ϵ-PL-Cat) to enable sustained release for promoting pressure ulcer healing. The presented Gelatin-PBA/ϵ-PL-Cat (GPL)/CTLP-MPs hydrogel demonstrated outstanding self-healing properties. In addition,in vitroexperiments revealed that the hydrogel exhibited remarkable antibacterial activity, excellent biocompatibility. And it showed the capacity to promote vascular formation, effectively scavenge reactive oxygen species, and facilitate macrophage polarization from the M1 to M2 phenotype.In vivowound healing of mice PUs indicated that the prepared GPL/CTLP-MPs hydrogel effectively accelerated the formation of granulation tissue and facilitated the healing of the wounds. In summary,in vivoandin vitroexperiments consistently highlight the therapeutic potential of GPL/CTLP-MPs hydrogel in facilitating the healing process of PUs.
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Affiliation(s)
- PinLi Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaona Tang
- Shenzhen Bao'an Traditional Chinese Medicine Hospital Group, Shenzhen, People's Republic of China
| | - Jintao Zhong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Fang Tang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Hanjiao Liu
- Shenzhen Hospital of Integrative Medicine, Shenzhen, People's Republic of China
| | - Lu Peng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Biyu Wan
- School of Nursing Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Mengya Wang
- School of Nursing Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yuling Ye
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Guangdong Provincial Engineering and Technological Research Centre for Drug Carrier Development, Department of Biomedical Engineering, Jinan University, Guangzhou, People's Republic of China
| | - Xusheng Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lili Deng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, 51000, People's Republic of China
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Torsy T, Tency I, Beeckman D, De Vylder F. Effectiveness of glutamine and arginine in wound healing of pressure ulcers: A systematic review protocol. J Tissue Viability 2024:S0965-206X(24)00026-3. [PMID: 38448329 DOI: 10.1016/j.jtv.2024.03.001] [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: 01/30/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Various nutrients play a physiological role in the healing process of pressure ulcers (PUs). Nutritional interventions include the administration of enteral nutritional supplements and formulas containing arginine, glutamine, and micronutrients. The aim of this systematic review is to evaluate the effectiveness of enteral nutritional supplements and formulas containing arginine and glutamine on wound-related outcomes. These include (1) time to healing, (2) changes in wound size, (3) local wound infection, (4) PU recurrence, and (5) PU-related pain. MATERIALS AND METHODS This protocol was developed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A search will be conducted in the Cochrane Library, EMBASE, PubMed (MEDLINE), CINAHL (EBSCOhost interface) and Web of Science. In addition, a manual search will be conducted to identify relevant records. Except for systematic reviews, no restrictions will be placed on the study design, the population studied or the setting. Studies that do not address PUs, in vitro studies and studies that do not report wound-related outcomes will be excluded. Study selection, risk of bias assessment and data extraction will be performed independently by three researchers. Depending on the extent of heterogeneity of interventions, follow-up time and populations, results will be summarised either by meta-analysis or narrative synthesis. CONCLUSIONS This is the first systematic review to identify, evaluate and summarise the current evidence for enteral arginine and glutamine supplementation on wound-related outcomes in PUs. The review will provide a solid basis for deriving valid and clinically relevant conclusions in this area.
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Affiliation(s)
- Tim Torsy
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium.
| | - Inge Tency
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium
| | - Dimitri Beeckman
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium; Örebro University, School of Health Sciences, Sweden
| | - Flore De Vylder
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences, Belgium
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Milliren CE, Ozonoff A, Fournier KA, Welcher J, Landschaft A, Kimia AA. Enhancing Pressure Injury Surveillance Using Natural Language Processing. J Patient Saf 2024; 20:119-124. [PMID: 38147064 PMCID: PMC10922576 DOI: 10.1097/pts.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study assessed the feasibility of nursing handoff notes to identify underreported hospital-acquired pressure injury (HAPI) events. METHODS We have established a natural language processing-assisted manual review process and workflow for data extraction from a corpus of nursing notes across all medical inpatient and intensive care units in a tertiary care pediatric center. This system is trained by 2 domain experts. Our workflow started with keywords around HAPI and treatments, then regular expressions, distributive semantics, and finally a document classifier. We generated 3 models: a tri-gram classifier, binary logistic regression model using the regular expressions as predictors, and a random forest model using both models together. Our final output presented to the event screener was generated using a random forest model validated using derivation and validation sets. RESULTS Our initial corpus involved 70,981 notes during a 1-year period from 5484 unique admissions for 4220 patients. Our interrater human reviewer agreement on identifying HAPI was high ( κ = 0.67; 95% confidence interval [CI], 0.58-0.75). Our random forest model had 95% sensitivity (95% CI, 90.6%-99.3%), 71.2% specificity (95% CI, 65.1%-77.2%), and 78.7% accuracy (95% CI, 74.1%-83.2%). A total of 264 notes from 148 unique admissions (2.7% of all admissions) were identified describing likely HAPI. Sixty-one described new injuries, and 64 describe known yet possibly evolving injuries. Relative to the total patient population during our study period, HAPI incidence was 11.9 per 1000 discharges, and incidence rate was 1.2 per 1000 bed-days. CONCLUSIONS Natural language processing-based surveillance is proven to be feasible and high yield using nursing handoff notes.
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Affiliation(s)
- Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Al Ozonoff
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kerri A. Fournier
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Jennifer Welcher
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
| | - Assaf Landschaft
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
| | - Amir A. Kimia
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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Yeşil M, Toygar İ, Aslan FE. Validity and Reliability of the Pieper-Zulkowski Pressure Ulcer Knowledge Test for Use in Turkey. Adv Skin Wound Care 2024; 37:1-5. [PMID: 38393708 DOI: 10.1097/asw.0000000000000106] [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: 02/25/2024]
Abstract
OBJECTIVE To assess the validity and reliability of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) for use in Turkey. METHODS This methodological study was carried out at a state hospital from June to November 2022. The authors used the PZ-PUKT and nurse identification form for data collection. They assessed the validity and reliability of the PZ-PUKT for Turkish society by evaluating language validity, content validity index, exploratory factor analysis, confirmatory factor analysis, Cronbach α, Spearman-Brown Split-Half analysis, item-scale correlations, and test-retest correlations. RESULTS Item-level content validity indices ranged from .778 to 1.000 and the scale-level content validity index was .960. Factor loadings of the Turkish version of the PZ-PUKT ranged between .297 and .671. Cronbach α coefficients for the scale subsections were .838 for wounds, .851 for prevention, and .844 for staging; the Cronbach α coefficient was .936 for the total scale score. CONCLUSIONS The PZ-PUKT is valid and reliable for use with nurses in Turkey. The authors recommend using the Turkish version of the tool in education and research to assess nurses' pressure injury knowledge.
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Affiliation(s)
- Mine Yeşil
- Mine Yeşil, MSc, RN, is Nurse, Antalya Atatürk State Hospital, Antalya, Turkey. İsmail Toygar, PhD, RN, is Associate Professor, Fethiye Faculty of Health Sciences, Muğla Sitki Koçman University, Muğla, Turkey. Fatma Eti Aslan, PhD, RN, is Full Professor, Faculty of Health Sciences, Bahçeşehir University, İstanbul, Turkey. Acknowledgment: The authors thank all the nurses who participated in the study for their collaboration and thank the experts and translators for their contributions. The authors have disclosed no financial relationships related to this article. Submitted February 1, 2023; accepted in revised form March 16, 2023
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Liu Z, Meng J, Jing N, Liu X. Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis. Int Wound J 2024; 21:e14676. [PMID: 38439163 PMCID: PMC10912392 DOI: 10.1111/iwj.14676] [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: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 03/06/2024] Open
Abstract
To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.
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Affiliation(s)
- Zhu‐Feng Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Juan Meng
- Department of General MedicinePeople's Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Na Jing
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Xiao‐Yun Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
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Wilson HJE, Patton D, Budri AMV, Boland F, O'Connor T, McDonnell CO, Rai H, Moore ZEH. The correlation between sub-epidermal moisture measurement and other early indicators of pressure ulcer development-A prospective cohort observational study. Part 1. The correlation between sub-epidermal moisture measurement and ultrasound. Int Wound J 2024; 21:e14732. [PMID: 38385834 PMCID: PMC10883243 DOI: 10.1111/iwj.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
The correlation between sub-epidermal moisture (SEM) and other early indicators of pressure ulcer (PU) development is yet to be determined. This three-part series aims to bridge this knowledge gap, through investigating SEM and its correlation with evidence-based technologies and assessments. This article focuses on the correlation between SEM and ultrasound. A prospective cohort observational study was undertaken between February and November 2021. Patients undergoing three surgery types were consecutively enrolled to the study following informed consent. Assessments were performed prior to and following surgery for 3 days at the sacrum, both heels and a control site, using a SEM scanner and high-frequency ultrasound scanner (5-15 MHz). Spearman's rank (rs ) explored the correlation between SEM and ultrasound. A total of 60 participants were included; 50% were male with a mean age of 58 years (±13.46). A statistically significant low to moderately positive correlation was observed between SEM and ultrasound across all anatomical sites (rs range = 0.39-0.54, p < 0.05). The only exception was a correlation between SEM and ultrasound on day 0 at the right heel (rs = 0.23, p = 0.09). These results indicate that SEM and ultrasound agreed in the presence of injury; however, SEM was able to identify abnormalities before ultrasound.
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Affiliation(s)
- Hannah Jane Elizabeth Wilson
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Honorary Senior Fellow, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Aglecia Moda Vitoriano Budri
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Fiona Boland
- Data Science Centre, School of Population HealthRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Department of NursingLida InstituteShanghaiChina
| | | | - Himanshu Rai
- Cardiovascular Research Institute Dublin (CVRI Dublin)Mater Private NetworkDublinIreland
- School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health SciencesDublinIreland
| | - Zena Elizabeth Helen Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Department of NursingLida InstituteShanghaiChina
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- School of Healthcare SciencesUniversity of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandGold CoastQueenslandAustralia
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Riley BH, Pittman J, Otts JAA, Mulekar MS. Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries. J Nurs Scholarsh 2024; 56:291-313. [PMID: 37984994 DOI: 10.1111/jnu.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability. DESIGN A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices. METHODS Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions. RESULTS Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs. CONCLUSION The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally. CLINICAL RELEVANCE The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.
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Zhang A, Li L, Li Y, Sun S, Wang M, Tang X. Effects of cluster nursing interventions on the prevention of pressure ulcers in intensive care units patients: A meta-analysis. Int Wound J 2024; 21:e14776. [PMID: 38494661 PMCID: PMC10945037 DOI: 10.1111/iwj.14776] [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: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 03/19/2024] Open
Abstract
A meta-analysis was conducted to comprehensively evaluate the impact of cluster nursing interventions on the prevention of pressure ulcers (PUs) in intensive care unit (ICU) patients. Computer searches were performed in databases including Embase, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure for randomized controlled trials (RCTs) implementing cluster nursing interventions for PUs prevention in ICU patients, with the search period covering the database inception to November 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1463 ICU patients were included. The analysis showed that compared with conventional nursing, cluster nursing interventions significantly reduced the incidence of PUs (odds ratio: 0.24, 95% confidence intervals [CI]: 0.17-0.34, p < 0.001) and also significantly improved the levels of anxiety (standardized mean difference [SMD]: -1.39, 95% CI: -1.57 to 1.22, p < 0.001) and depression (SMD: -1.64, 95% CI: -2.02 to 1.26, p < 0.001) in ICU patients. This study indicates that the application of cluster nursing interventions in ICU patients can effectively reduce the incidence of PUs, as well as improve patients' anxiety and depression levels, thereby enhancing their quality of life, which is worth clinical promotion and application.
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Affiliation(s)
- Ai‐Guo Zhang
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Ling Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Yuan‐Li Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Shun‐Xia Sun
- Department of OrthopaedicsChongqing General HospitalChongqingChina
| | - Min Wang
- Department of Special MedicalChongqing General HospitalChongqingChina
| | - Xiao‐Ling Tang
- Department of Critical MedicineChongqing General HospitalChongqingChina
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Lahmann N, Mayer MF, Posnett J. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay. Open Med (Wars) 2024; 19:20230839. [PMID: 38463526 PMCID: PMC10921433 DOI: 10.1515/med-2023-0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 03/12/2024] Open
Abstract
Objective Hospital-acquired pressure ulcers are an important indicator of the quality of care. Most pressure ulcers are avoidable with a robust protocol for prevention, but prevention activities often have a low priority for senior management because the true costs to the hospital are not visible. Our aim was to raise awareness of the value of pressure ulcer prevention by estimating the excess length of inpatient stay associated with hospital-acquired pressure ulcers, and by assessing whether additional costs are covered by increased reimbursement. Methods National activity data for hospitals in Germany are available through the InEK Data Browser. Data were extracted covering discharges from German hospitals between January 1 and December 31, 2021. Cases were selected according to the presence of a pressure ulcer diagnosis using ICD-10-GM codes L89.0-L89.3. Information was extracted for the ten most common German Diagnosis-Related Group (G-DRG) codes in patients with a secondary pressure ulcer diagnosis on mean length of stay and average reimbursement. Ulcer-associated excess length of stay was estimated by comparing cases within the same G-DRG with and without a pressure ulcer diagnosis. Results Mean length of stay was higher in patients with a pressure ulcer than in patients with no ulcer by between 1.9 (all ages) and 2.4 days (patients aged ≥65) per case. In patients aged ≥65 years, 22.1% of cases with a pressure ulcer had a length of stay above the norm for the DRG. In the German system length of stay above the norm is not normally reimbursed. Excess length of stay between 1.9 and 2.4 days leads to a potential cost to a hospital of between 1,633€ and 2,074€ per case. Conclusion Hospital-acquired pressure ulcers represent an important source of cost for a hospital which highlights the potential value of effective prevention.
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Affiliation(s)
- Nils Lahmann
- Geriatrics Research Group, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117Berlin, Germany
- Medical School Berlin University, Rüdesheimer Str. 50, 14197Berlin, Germany
| | | | - John Posnett
- Independent Health Economics Consultant, York, UK
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Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
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Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
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ALFadhalah T, Lari M, Al Salem G, Ali S, Al Kharji H, Elamir H. Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study. BMC Health Serv Res 2024; 24:173. [PMID: 38326902 PMCID: PMC10851550 DOI: 10.1186/s12913-024-10615-x] [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: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Marjan Lari
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Shaimaa Ali
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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Durmuş Sarıkahya S. Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis. J Tissue Viability 2024:S0965-206X(24)00005-6. [PMID: 38326162 DOI: 10.1016/j.jtv.2024.02.001] [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: 07/30/2023] [Revised: 12/04/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting. OBJECTIVE The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services. METHOD This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale." FINDINGS In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale. CONCLUSION The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.
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Affiliation(s)
- Selma Durmuş Sarıkahya
- Artvin Coruh University, Faculty of Health Sciences, Department of Public Health Nursing, Artvin, Turkey.
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van Helden TMN, van Neck JW, Versnel SL, Mureau MAM, van Dishoeck AM. The clinical applicability of sensor technology with body position detection to combat pressure ulcers in bedridden patients. Med Eng Phys 2024; 124:104096. [PMID: 38418025 DOI: 10.1016/j.medengphy.2023.104096] [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: 03/06/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Pressure Ulcers (PUs) are a major healthcare issue leading to prolonged hospital stays and decreased quality of life. Monitoring body position changes using sensors could reduce workload, improve turn compliance and decrease PU incidence. METHOD This systematic review assessed the clinical applicability of different sensor types capable of in-bed body position detection. RESULTS We included 39 articles. Inertial sensors were most commonly used (n = 14). This sensor type has high accuracy and is equipped with a 2-4 hour turn-interval warning system increasing turn compliance. The second-largest group were piezoresistive (pressure) sensors (n = 12), followed by load sensors (n = 4), piezoelectric sensors (n = 3), radio wave-based sensors (n = 3) and capacitive sensors (n = 3). All sensor types except inertial sensors showed a large variety in the type and number of detected body positions. However, clinically relevant position changes such as trunk rotation and head of bed elevation were not detected or tested. CONCLUSION Inertial sensors are the benchmark sensor type regarding accuracy and clinical applicability but these sensors have direct patient contact and (re)applying the sensors requires the effort of a nurse. Other sensor types without these disadvantages should be further investigated and developed. We propose the Pressure Ulcer Position System (PUPS) guideline to facilitate this.
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Affiliation(s)
- Tim M N van Helden
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Johan W van Neck
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Sarah L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Marc A M Mureau
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Anne-Margreet van Dishoeck
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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Latimer SL, Bone M, Walker RM, Thalib L, Gillespie BM. Inter-device agreement of sacral subepidermal oedema measurement in healthy adults during prolonged 60° head of bed elevation. Nurs Open 2024; 11:e2103. [PMID: 38391104 PMCID: PMC10830921 DOI: 10.1002/nop2.2103] [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: 02/27/2023] [Revised: 09/13/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To investigate the level of agreement between the SEM 200 and Provisio® subepidermal moisture sacral delta measurements, which may indicate increased pressure injury risk, in healthy adults during 120 min of prolonged 60° head of bed elevation. This position, which requires the elevation of the patient's upper body at a 60° angle above the horizontal plane for an extended period, is used by clinicians to prevent or manage a patient's medical or surgical conditions. DESIGN This prospective exploratory study recruited 20 healthy adults during October 2021 and collected sacral subepidermal moisture delta measurements using the SEM 200 and Provisio® devices. METHODS Delta measurements were taken at 20-min intervals over 120 min resulting in seven data collection timepoints. Descriptive statistics and a Bland Altman plot analysis were conducted. RESULTS A total of 280 sacral subepidermal moisture delta measurements were gathered or 140 per device. There were good levels of agreement between the two devices at baseline (T0) [mean 0.025; SD 0.137] and following 60- (T3) [mean 0.025; SD 0.111], 80- (T4) [mean -0.01; SD 0.177] and 100 min (T5) [mean 0.01; SD 0.129] of prolonged 60° head of bed elevation. Head of bed elevations can increase a patient's risk of sacral pressure injuries. In some countries, nurses have access to the SEM 200 and/or the Provisio® device, so our findings may increase nurses' confidence in the interchangeability of the device measurements, although further research is needed to confirm this. The SEM 200 and Provisio® subepidermal moisture scanners show promise in gathering similar objective pressure injury risk data which could prompt clinicians to implement prevention strategies. IMPACT Current pressure injury risk assessment is largely subjective in nature. This quantitative study on healthy human sacral tissue found a good level of agreement in the SEM 200 and Provisio® subepidermal moisture scanners, which may increase nurses' confidence in the interchangeability of the devices in clinical practice.
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Affiliation(s)
- Sharon L. Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
| | - Madeline Bone
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
| | - Rachel M. Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversityNathanQueenslandAustralia
- Metro South HealthBrisbaneQueenslandAustralia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of MedicineIstanbul Aydin UniversityIstanbulTurkey
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
- Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
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Zeng S, Tian Z, Gong F, Wang F, Xie M, Chen X, Liao S. The comparison of fluidized positioners and traditional gel pads for skin protection in neurosurgical patients undergoing lateral and prone positions: A retrospective analysis with propensity score matching method. Int Wound J 2024; 21:e14662. [PMID: 38402555 PMCID: PMC10830910 DOI: 10.1111/iwj.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 02/26/2024] Open
Abstract
To compare fluidized positioners and gel pads for skin protection in neurosurgery patients placed in lateral and prone positions. It is one of the major challenges that operating room nurses face in protecting the skin during the long duration of neurosurgery. Currently, there are increasing tools available to protect the skin under pressure, and various tools practice well in the clinic. Fluidized positioners are newly emerging protective pads that have been clinically effective in protecting the skin, but no studies have compared them to previous pads. This is a retrospective cohort study. Data from 706 patients who underwent neurosurgery between January 2018 and December 2021 were systemically reviewed. Patients undergoing long-term neurosurgery in the neurosurgical lateral and prone positions were divided into two groups: fluidized positioners or gel pads. Propensity score matching (PSM) was performed for group balance (1:1 ratio) using the following baseline characteristics: age, gender, ASA (American Society of Anesthesiologists) classification, duration of surgery, surgical position and underlying disease. The incidence of decubitus, and length of stay (LOS) in the hospital were compared between the two groups. The results were obtained for 394 patients in the fluidized positioner group with a 3.8% incidence of pressure ulcers and 312 patients in the gel pad group with an 8% incidence of pressure ulcers, which were unbalanced in terms of gender, ASA, hypertension and diabetes data. After a PSM, patients were compared in terms of pressure ulcer incidence (3.7% vs. 7.8%, p = 0.034) and LOS (22.35 vs. 25.65 days, p < 0.001). Fluidized positioners can effectively reduce the incidence of pressure injury in lateral and prone positions of neurosurgery. The results of this study may contribute to the development of policies to prevent the development of pressure ulcers during neurosurgical procedures.
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Affiliation(s)
- Shuyan Zeng
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Ziyang Tian
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Fengqiu Gong
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Fujuan Wang
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Manying Xie
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - XiaoJun Chen
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - ShuFeng Liao
- Operating Theatre, The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Wang I, Walker RM, Gillespie BM, Scott I, Sugathapala RDUP, Chaboyer W. Risk factors predicting hospital-acquired pressure injury in adult patients: An overview of reviews. Int J Nurs Stud 2024; 150:104642. [PMID: 38041937 DOI: 10.1016/j.ijnurstu.2023.104642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries remain a significant patient safety threat. Current well-known pressure injury risk assessment tools have many limitations and therefore do not accurately predict the risk of pressure injury development over diverse populations. A contemporary understanding of the risk factors predicting pressure injury in adult hospitalised patients will inform pressure injury prevention and future researchers considering risk assessment tool development may benefit from our summary and synthesis of risk factors. OBJECTIVE To summarise and synthesise systematic reviews that identify risk factors for hospital-acquired pressure injury development in adult patients. DESIGN An overview of systematic reviews. METHODS Cochrane and the Joanna Briggs Institute methodologies guided this overview. The Cochrane library, CINAHL, MEDLINE, and Embase databases were searched for relevant articles published in English from January 2008 to September 2022. Two researchers independently screened articles against the predefined inclusion and exclusion criteria, extracted data and assessed the quality of the included reviews using "a measurement tool to assess systematic reviews" (AMSTAR version 2). Data were categorised using an inductive approach and synthesised according to the recent pressure injury conceptual frameworks. RESULTS From 11 eligible reviews, 37 risk factors were categorised inductively into 14 groups of risk factors. From these, six groups were classified into two domains: four to mechanical boundary conditions and two to susceptibility and tolerance of the individual. The remaining eight groups were evident across both domains. Four main risk factors, including diabetes, length of surgery or intensive care unit stay, vasopressor use, and low haemoglobin level were synthesised. The overall quality of the included reviews was low in five studies (45 %) and critically low in six studies (55 %). CONCLUSIONS Our findings highlighted the limitations in the methodological quality of the included reviews that may have influenced our results regarding risk factors. Current risk assessment tools and conceptual frameworks do not fully explain the complex and changing interactions amongst risk factors. This may warrant the need for more high-quality research, such as cohort studies, focussing on predicting hospital-acquired pressure injury in adult patients, to reconsider these risk factors we synthesised. REGISTRATION This overview was registered with the PROSPERO (CRD42022362218) on 27 September 2022.
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Affiliation(s)
- Isabel Wang
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.
| | - Rachel M Walker
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; The Princess Alexandra Hospital, Brisbane, Australia. https://twitter.com/rachelmwalker
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast, Australia. https://twitter.com/bgillespie6
| | - Ian Scott
- The Princess Alexandra Hospital, Brisbane, Australia; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. https://twitter.com/WendyChaboyer
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Han L, Wei Y, Pei J, Zhang H, Lv L, Tao H, Yang Q, Su Q, Ma Y. Nomogram model on estimating the risk of pressure injuries for hospitalized patients in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103566. [PMID: 37913713 DOI: 10.1016/j.iccn.2023.103566] [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: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This study aimed to build and validate a nomogram model to estimate the risk of pressure injuries in intensive care unit patients. DESIGN Multicenter prospective cohort study. SETTING 33 tertiary hospitals in the Gansu Province, China. MEASUREMENTS AND MAIN RESULTS This study included 6420 patients between April 2021 to October 2022 from an information platform of pressure injury risk management called the "Long Hu Hui." Univariate and multivariate logistic regression analyses identified pressure injury risk factors to be included in the nomogram. The resulting nomogram was tested for calibration discrimination, and clinical usefulness. Of the included patients, 77 developed pressure injuries, representing an incidence rate of 1.2 %. Analysis of binary logistic regression revealed that the estimation nomogram included weight loss greater than 5 kg in the last three months, pneumotomy cannula, thoracic catheter, isoproterenol, norepinephrine, abnormal skin color, ruptured erythema, stroke, increased body temperature and nonspecific patients (specific patients include paralysis, unconsciousness, dementia, forced body position). The area under the receiver operating characteristic curve for the training cohort was 0.806 (95 % CI 0.755-0.857), and the AUC of the text cohort was 0.737 (95 % CI 0.574-0.901). The model has excellent calibration in both the training cohort (H-L test: χ2 = 6.34, P = 0.61) and the text cohort (H-L test: χ2 = 4.50, P = 0.81). Furthermore, the decision curve analysis revealed the preferred net benefit and the threshold probability in the estimation nomogram. CONCLUSIONS The nomogram model accurately estimated the risk of pressure injuries among intensive care patients, it should be used to inform risk assessment and facilitate early intervention strategies in future practice. IMPLICATIONS FOR CLINICAL PRACTICE The nomogram allows intensive care providers to dynamically assess the patient's risk of pressure injuries and to implement more targeted interventions accordingly.
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Affiliation(s)
- Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Juhong Pei
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China
| | - Lin Lv
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Hongxia Tao
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qiuxia Yang
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qian Su
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Patient Service Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China.
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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.
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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.
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Azizoğlu F, Terzi B. Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer. Intensive Crit Care Nurs 2024; 80:103557. [PMID: 37804817 DOI: 10.1016/j.iccn.2023.103557] [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: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field. RESEARCH METHODOLOGY/DESIGN Descriptive and bibliometric analysis method study. SETTING Data were obtained from the "Web of Science Core Collection" database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords "intensive care unit," "pressure injury," "prevention," "risk assessment tools," and critical care." Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications. MAIN OUTCOME MEASURES Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools. RESULTS As a result of the analysis, the most used keywords were "pressure injury," "pressure ulcer," "critical care," "pressure ulcers," "intensive care unit," and "pressure injuries." The journal with the highest number of publications (n = 55) was "Journal of Wound Ostomy Continence Nursing", the highest number of articles (n = 47) was published in 2022, the most active institution was "Queensland University of Technology Qut" (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the "National Institutes of Health NIH USA" (20 articles), and Cox J. was the author who published the most articles. CONCLUSION This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
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Affiliation(s)
- Fatma Azizoğlu
- Haliç University, Faculty of Health Sciences, 5.Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No: 14/12 34060, Eyüpsultan/İstanbul, Turkey
| | - Banu Terzi
- Akdeniz University, Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz Üniversitesi Dumlupınar Bulvarı, Akdeniz Üniversitesi Yerleşkesi Konyaaltı, 07070 Antalya, Turkey.
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