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Vera-Salmerón E, Domínguez-Nogueira C, Sáez JA, Romero-Béjar JL, Mota-Romero E. Differentiating Pressure Ulcer Risk Levels through Interpretable Classification Models Based on Readily Measurable Indicators. Healthcare (Basel) 2024; 12:913. [PMID: 38727470 PMCID: PMC11083727 DOI: 10.3390/healthcare12090913] [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: 03/13/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve the data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity, and skin moisture. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. Thus, the primary aim of this approach is to provide nursing professionals with valuable insights for assessing the potential risk levels of pressure ulcers, which could support their decision-making and allow, for example, the application of suitable preventive measures tailored to each patient's requirements. The interpretability of the models proposed and their performance, evaluated through stratified cross-validation, make them a helpful tool for nursing care in estimating the pressure ulcer risk level.
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Affiliation(s)
- Eugenio Vera-Salmerón
- Servicio Andaluz de Salud, Distrito Sanitario Granada-Metropolitano, Centro de Salud Dr. Salvador Caballero de Granada, 18012 Granada, Spain; (E.V.-S.); (E.M.-R.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Carmen Domínguez-Nogueira
- Inspección Provincial de Servicios Sanitarios, Delegación Territorial de Granada, Consejería de Salud y Familias de la Junta de Andalucía, 41071 Sevilla, Spain;
| | - José A. Sáez
- Department of Statistics and Operations Research, University of Granada, Fuente Nueva s/n, 18071 Granada, Spain;
| | - José L. Romero-Béjar
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, Fuente Nueva s/n, 18071 Granada, Spain;
- Institute of Mathematics, University of Granada (IMAG), Ventanilla 11, 18001 Granada, Spain
| | - Emilio Mota-Romero
- Servicio Andaluz de Salud, Distrito Sanitario Granada-Metropolitano, Centro de Salud Dr. Salvador Caballero de Granada, 18012 Granada, Spain; (E.V.-S.); (E.M.-R.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Nursing, University of Granada, Avda. Ilustración 60, 18071 Granada, Spain
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Quiñoz Gallardo MD, Barrientos-Trigo S, Porcel-Gálvez AM. Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study. Worldviews Evid Based Nurs 2023; 20:306-314. [PMID: 36894521 DOI: 10.1111/wvn.12631] [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] [Received: 11/10/2022] [Revised: 12/29/2022] [Accepted: 01/21/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.
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Affiliation(s)
- María Dolores Quiñoz Gallardo
- Virgen de las Nieves Hospital, Granada, Spain
- Research Group Ee-12 Hygia linked to Health Research Institute (ibs.Granada), Granada, Spain
- Research Chair in Health Care and Results (INVESCARE) Virgen de las Nieves Hospital and Department of Nursing Universidad de Sevilla (Code 4477/1155), Seville, Spain
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Seville, Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, Seville, Spain
| | - Ana María Porcel-Gálvez
- Research Chair in Health Care and Results (INVESCARE) Virgen de las Nieves Hospital and Department of Nursing Universidad de Sevilla (Code 4477/1155), Seville, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Seville, Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, Seville, Spain
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Hu L, Sae-Sia W, Kitrungrote L. Predictors of Pressure Injury Prevention Practices Among ICU Nurses in China. Adv Skin Wound Care 2021; 34:582-587. [PMID: 34483257 DOI: 10.1097/01.asw.0000790480.24846.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the predictors of knowledge of pressure injury (PI) prevention, attitudes on PI prevention, organization support for PI prevention, and the influence of a healthy work environment (HWE) on PI prevention practices among ICU nurses in China. METHODS A descriptive, predictive, online survey was conducted among 510 ICU nurses in Guizhou province, China. A PI prevention knowledge questionnaire, PI prevention attitude questionnaire, organizational support for PI prevention questionnaire, HWE assessment tool, and PI prevention practice questionnaire were used for data collection. A hierarchical regression analysis was used to determine the influence of certain predictive factors. RESULTS An HWE, organizational support for PI prevention, and positive attitudes toward PI prevention were significant predictors of good practice regarding PI prevention. However, knowledge of PI prevention was not a significant predictor. CONCLUSIONS To achieve optimal nursing quality in terms of PI prevention, hospital and nursing administrators should develop strategies or interventions to create and sustain an HWE and supportive organizational culture for ICU nurses and enhance positive attitudes toward PI prevention.
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Affiliation(s)
- Li Hu
- In the Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand, Li Hu, BSN, RN, is Master's Student, Nursing Science in Adult and Gerontological Nursing (International Program); Wipa Sae-Sia, PhD, RN, is Associate Professor, Department of Adult and Elderly Nursing; and Luppana Kitrungrote, PhD, RN, is Assistant Professor, Department of Adult and Elderly Nursing. Acknowledgment: This study was conducted as partial fulfillment of the requirements of the first author for the master's degree of nursing program and has received financial support from Thailand's Education Hub for Southern Region of ASEAN Countries Scholarship through Prince of Songkla University, Thailand. The authors have disclosed no other financial relationships related to this article. Submitted September 11, 2020; accepted in revised form November 24, 2020; published online ahead of print September 2, 2021
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Hu L, Sae-Sia W, Kitrungrote L. Intensive Care Nurses' Knowledge, Attitude, and Practice of Pressure Injury Prevention in China: A Cross-Sectional Study. Risk Manag Healthc Policy 2021; 14:4257-4267. [PMID: 34703338 PMCID: PMC8524251 DOI: 10.2147/rmhp.s323839] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Pressure injury (PI) remains a critical health issue worldwide. The global incidence of hospital-acquired PI is 8.4%, and among intensive-care unit (ICU) patients, it is even higher, ranging from 6.60% to 36.80%. It is important to investigate ICU nurses’ PI prevention knowledge, attitudes, and practices (KAP). Aim The aim of this study was to describe the level of Chinese ICU nurses’ knowledge, attitudes, and self-reported practices of PI prevention. Materials and Methods From March 31 to April 30, 2019, we recruited a total of 510 ICU nurses into the current study using convenience sampling. The Modified Pressure Ulcer Knowledge Assessment Tool version 2.0, Attitudes toward Pressure Ulcer Prevention instrument, and Questionnaire to evaluate nurses’ Adherence to Recommendations for Preventing Pressure Ulcers were used for data collection. We used one-way analysis of variance, Student’s t-test, and the Mann–Whitney U-test to assess differences in knowledge, attitudes, and self-reported practices of PI prevention among ICU nurses, whom we categorized by their demographic characteristics. Results Mean scores of participants’ knowledge, attitude, and their self-report practice were 65.82 ± 9.29, 76.65 ± 8.62, and 83.35 ± 13.55, respectively. Participants with bachelor’s degrees or higher, who worked in tertiary hospitals, and who had received training on PI prevention over the last year had higher scored on PI prevention knowledge (all P < 0.05). Participants who had received training on PI prevention over the last year scored higher on attitude than those who had not received such training over the last year (P = 0.001). Conclusion ICU nurses surveyed in this study did not demonstrate an acceptable level of knowledge about PI prevention, while their attitudes and self-reported practices were acceptable. Continuing education or in-service training should be provided to enhance ICU nurses’ knowledge of PI prevention.
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Affiliation(s)
- Li Hu
- Breast Surgery Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.,Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Wipa Sae-Sia
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Luppana Kitrungrote
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Floyd NA, Dominguez-Cancino KA, Butler LG, Rivera-Lozada O, Leyva-Moral JM, Palmieri PA. The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background:
Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.
Methods:
This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.
Results:
The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.
Conclusion:
Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33054619 DOI: 10.12968/jowc.2020.29.latam_sup_2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33048017 DOI: 10.12968/jowc.2020.29.sup10.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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Kısacık ÖG, Sönmez M. Pressure ulcers prevention: Turkish nursing students' knowledge and attitudes and influencing factors. J Tissue Viability 2019; 29:24-31. [PMID: 31759832 DOI: 10.1016/j.jtv.2019.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/23/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Öznur Gürlek Kısacık
- Faculty of Health Science, Nursing Department, Afyonkarahisar University of Health Science, 03200, Afyonkarahisar, Turkey.
| | - Münevver Sönmez
- Faculty of Health Science, Nursing Department, Bülent Ecevit University of Health Science, 67000, Zonguldak, Turkey
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