Is caring for pressure ulcers in the intensive care unit in Spain still a challenge? A qualitative study on nurses' perceptions

Skin tears in older patients in intensive care units: A multicentre point prevalence study

BACKGROUND

With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing-related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs).

AIM

To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.

STUDY DESIGN

The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an "ST chart" to record patient demographic characteristics, clinical variables and skin assessment.

RESULTS

STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST.

CONCLUSIONS

In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified.

RELEVANCE TO CLINICAL PRACTICE

Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

Difficulties and obstacles experienced by intensive care unit nurses during the prevention and care of pressure injuries: A qualitative study

AIM

This study aimed to examine the difficulties and obstacles experienced by nurses working in intensive care units during the prevention and care of pressure injuries (ulcers).

MATERIALS AND METHODS

A descriptive phenomenological study was designed, involving 13 nurses working in the intensive care unit of a hospital in Turkey. The data were collected through face-to-face interviews. The data were analyzed using thematic analysis. The findings were reported according to the Consolidated Criteria for Reporting Qualitative Studies criteria.

RESULTS

Through the data analysis, an overall theme "Prevention and Care of Pressure Injuries" and three main themes, namely "Obstacles Encountered", "Impacts on The Nurses", and "Needs and Recommendations" were identified.

CONCLUSION

This study identified institution-related issues (lack of resources, managers' attitudes, etc.), as well as lack of knowledge and training prevent the effective management of pressure injuries in intensive care units. The development of pressure injuries emotionally and professionally affects nurses. The primary needs of nurses were found to be equipment and material support, personnel training, positive attitudes of institution managers, and the establishment of a wound care unit within the hospital. The following recommendations were made based on the obtained findings: practical training should be given to all intensive care unit teams based on the latest information, modern, practical, diverse, and sufficient amount of equipment for pressure injuries should be provided, personnel shortage should be eliminated, institution managers should exhibit solution-oriented attitudes toward nurses rather than accusatory approaches, and a wound care unit should be established within the hospital. This study was limited to the nurses working in the ICU of a state hospital in Turkey. Since the study was carried out in a single hospital and due to the personal characteristics of the participants, the findings cannot be generalized to all ICU nurses and healthcare institutions.

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study

AIM

The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation.

DESIGN

A qualitative descriptive phenomenological study.

METHODS

The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method.

RESULTS

The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales.

CONCLUSION

The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review

OBJECTIVE

To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.

METHODS

A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.

RESULTS

A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences".

CONCLUSION

The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.