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Lartigau M, Barateau M, Rosé M, Petricã N, Salles N. Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study. J Wound Care 2023; 32:clxxi-clxxx. [PMID: 37703220 DOI: 10.12968/jowc.2023.32.sup9a.clxxi] [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: 09/15/2023]
Abstract
OBJECTIVE Our aim was to measure the effectiveness of home healthcare pressure ulcer (PU) prevention devices (PUPDs) for at-risk patients after hospital discharge in France. METHOD We conducted a retrospective analysis of PU-associated hospitalisations based on the French medico-administrative database (Système National des Données de Santé, SNDS), which covers the entire French population. All adults >70 years of age, hospitalised from 1 July to 31 December 2015, and equipped with a medical bed at home, were included. Follow-up was for a maximum of 18 months. Propensity score matching allowed the comparison of PUPD equipped and non-equipped groups (No-PUPD), considering sociodemographic characteristics and other factors. RESULTS The study included 43,078 patients. Of this population, 54% were PUPD patients and 46% No-PUPD. After matching, PUPD patients had significantly fewer PUs than No-PUPD patients (5.5% versus 8.9%, respectively; p<0.001). The adoption of PUPD reduced by 39% the risk of a PU in hospital. Patients equipped within the first 30 days at home after hospitalisation had fewer PUs than those equipped later (4.8% versus 5.9%, respectively). The estimated PUPD use costs represented 1% of total healthcare expenditure per patient during the study period. CONCLUSION The study results demonstrated the effectiveness of the adoption of mattress toppers or prevention mattresses in reducing PU occurrence in patients aged >70 years of age. A short delay in PUPD delivery appeared to have a real impact in the medical setting. Future research on a larger population might provide more evidence on the appropriate support and timeframe to choose based on risk assessment.
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Affiliation(s)
- Marion Lartigau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
| | - Martine Barateau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
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2
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Yokoyama H, Deguchi M, Hongu N. The Role of Diets and Dietitians for Para-Athletes: A Pilot Study Based on Interviews. Nutrients 2022; 14:nu14183720. [PMID: 36145095 PMCID: PMC9505573 DOI: 10.3390/nu14183720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Efforts to provide nutrition support to para-athletes have not been established to date, and are far behind those established for athletes without disabilities. In the present study, we attempted to clarify the actual situation regarding dietary challenges of para-athletes. The aim of this study was to obtain clues to effective intervention methods that encourage the practice of sports nutrition. Six active elite para-athletes (30–70 years, four males) and a female physical therapist without physical disability participated in semi-structured interviews. All para-athletes had lower-limb disabilities and participated in the international wheelchair sports competitions (tennis, softball, and table tennis, with 2–26 years of player history). The interview items were on the ideal diet for improving competitive performance, evaluation of their typical diets, and the role of the dietitian as support. Responses obtained from participants were analyzed using quantitative content analysis by language analysis software. There are differences in the ideal diet based on the characteristics of the sport, but most participants believed that a nutritionally well-balanced diet with abundant vegetables was ideal for improving competitive performance. Para-athletes who use a wheelchair daily pay attention to their total calorie intake, because gaining weight is a critical issue for operating their wheelchairs and transferring themselves to and from their wheelchairs. Despite their world-class competition levels, none of them received routine dietary advice from dietitians. Some para-athletes did not even feel the need to engage with dietitians. Even for these para-athletes at a high level of competition, the “ideal diet” they considered was not always the optimal diet for improving their competitive performance. In addition, there are various barriers to practicing their optimal diet due to disability characteristics. Dietitians need to understand these barriers, their concerns and conflicts, and how to help them plan the optimal diet to improve their performance and maintain overall health.
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Affiliation(s)
- Hisayo Yokoyama
- Research Center for Urban Health and Sports, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
- Department of Environmental Physiology for Exercise, Graduate School of Medicine, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
- Correspondence: ; Tel.: +81-06-6605-2947
| | - Miwako Deguchi
- Department of Environmental Physiology for Exercise, Graduate School of Medicine, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
| | - Nobuko Hongu
- Research Center for Urban Health and Sports, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi 558-8585, Osaka, Japan
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3
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Yilmazer T, Tuzer H. Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units. J Wound Ostomy Continence Nurs 2022; 49:226-232. [PMID: 35523237 DOI: 10.1097/won.0000000000000875] [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: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of a pressure injury prevention care bundle. DESIGN Prospective interventional study. SUBJECTS AND SETTING Participants were 13 nurses and 104 patients cared for in the intensive care unit for at least 24 hours in a university hospital in Ankara, Turkey. METHODS The study was conducted in 2 stages: the pre-care and post-care bundle stages. In the pre-care bundle stage, the pressure injury incidence of the patients was followed by the nurses. At the end of the third month, the researcher held a 1-day training program for the nurses about the care bundle use to promote correct implementation. In the post-care bundle stage, the nurses provided care according to the bundle. Compliance with the care bundle was assessed. Pressure injury incidence rates in the pre- and post-care bundle stages were compared. RESULTS The incidence of stage 1 pressure injury was 15.11 (1000 patient-days) in the pre-care bundle stage and 6.79 (1000 patient-days) in the post-care bundle stage; this reduction was not statistically significant. CONCLUSIONS A pressure injury prevention bundle was implemented in an intensive care unit, resulting in a decline in stage 1 pressure injuries.
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Affiliation(s)
- Tuba Yilmazer
- Tuba Yilmazer, PhD, RN , Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
- Hilal Tuzer, PhD, RN, Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hilal Tuzer
- Tuba Yilmazer, PhD, RN , Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
- Hilal Tuzer, PhD, RN, Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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4
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Morri M, Ambrosi E, Raffa D, Raimondi R, Evangelista A, Mingazzini A, Forni C. The impact of first wave of COVID-19 on the nursing-sensitive and rehabilitation outcomes of patients undergoing hip fracture surgery: a single centre retrospective cohort study. BMC Nurs 2022; 21:68. [PMID: 35337324 PMCID: PMC8949825 DOI: 10.1186/s12912-022-00848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the care of hip fracture patients remains a clinical priority. To date, there is limited empirical knowledge about the impact of pandemic on the care of patients surgically treated for hip fracture, affected or not by COVID-19. OBJECTIVE To investigate the effects of the COVID-19 pandemic on the nursing-sensitive and rehabilitation outcomes of frail patients undergoing hip fracture surgery. METHODS A retrospective cohort study was conducted in an Italian Orthopaedic Research Institute. All patients aged ≥ 65 years admitted with fragility hip fractures between 1st March and 30th June in 2019 (group PP: pre-pandemic) and in the same period in 2020 (group P: pandemic), were compared. In the P group, COVID-19 positive patients were excluded due to the presence of a specific treatment pathway. Data on patient demographics and baseline characteristics, and peri-operative care factors were obtained from the Institute's computer-based patient-record system. The primary outcome was the incidence of any stage hospital-acquired pressure ulcers (PUs). The secondary outcome was time to first static verticalization and to first ambulation. RESULTS Three-hundred and sixty patients were included in the study, which comprised 108 patients in PP group and 252 patients in P group. Overall PUs incidence was significantly higher in the P-group (21.8%) than in the PP-group (10.2%) (p = 0.009). Specifically, the incidence of sacral PUs was significantly lower in P-group (38.1%) vs PP-group (91%) (p = 0.004); on the contrary, the incidence of PUs localized to the heels or other body sites were significantly higher in P-group (30.9% and 30.9%, respectively) vs PP-group (0% and 9%, respectively) (p = 0.004). No significant between groups differences were found for all the secondary outcomes. CONCLUSION In the pandemic period, nursing and rehabilitation care provided to patients with fragility hip fracture maintained high standards comparable to the pre-pandemic period. The increase in PUs incidence in the pandemic period was probably due to the older age of the patients admitted to hospital. The qualitative evaluation of the care administered and the emotional impact of the pandemic on the patients are very interesting topic which would deserve further investigation.
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Affiliation(s)
- M Morri
- IRCCS Istituto Ortopedico Rizzoli, Servizio Di Assistenza Infermieristico Tecnico E Riabilitativo Bologna, Bologna, Italia.
| | - E Ambrosi
- Dipartimento Di Diagnostica E Sanità Pubblica, Università Degli Studi Di Verona, Verona, Italia
| | - D Raffa
- IRCCS Istituto Ortopedico Rizzoli, Servizio Di Assistenza Infermieristico Tecnico E Riabilitativo Bologna, Bologna, Italia
| | - R Raimondi
- Laboratorio Di Emodinamica, Ospedale Maggiore, Bologna, Italia
| | - A Evangelista
- IRCCS Istituto Ortopedico Rizzoli, Servizio Di Assistenza Infermieristico Tecnico E Riabilitativo Bologna, Bologna, Italia
| | - A Mingazzini
- IRCCS Istituto Ortopedico Rizzoli, Servizio Di Assistenza Infermieristico Tecnico E Riabilitativo Bologna, Bologna, Italia
| | - C Forni
- IRCCS Istituto Ortopedico Rizzoli, Servizio Di Assistenza Infermieristico Tecnico E Riabilitativo Bologna, Bologna, Italia
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5
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Gour-Provencal G, Mac-Thiong JM, Feldman DE, Bégin J, Richard-Denis A. Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury. J Spinal Cord Med 2021; 44:949-957. [PMID: 32045340 PMCID: PMC8725680 DOI: 10.1080/10790268.2020.1718265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team. DESIGN Prospective cohort study. SETTING A single Level-1 trauma center specialized in SCI care. PARTICIPANTS A cohort of 301 patients with acute TSCI was studied. OUTCOME MEASURES The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors. RESULTS When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1-4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001). CONCLUSIONS Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.
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Affiliation(s)
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montréal, Quebec, Canada
| | - Debbie E. Feldman
- École de réadaptation, Pavillon du Parc, Université de Montréal, Québec, Canada
| | - Jean Bégin
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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6
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Öğülmüş Demircan F, Yücedağ İ, Toz M. A novel mathematical model including the wetness parameter as a variable for prevention of pressure ulcers. Proc Inst Mech Eng H 2021; 236:427-437. [PMID: 34696655 DOI: 10.1177/09544119211048557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pressure ulcers are injuries caused by external conditions such as pressure, friction, shear, and humidity resulting from staying in the same position for a long time in bedridden patients. It is a serious problem worldwide when assessed in terms of hospital capacity, nursing staff employment and treatment costs. In this study, we developed a novel mathematical model based on one of our previous models to prevent pressure ulcers or delay injuries. The proposed model uses a human thermal model that includes skin temperature, hypothalamus temperature, regional perspiration coefficient, and unconsciously loss of water amount. Moreover, in our model, we defined a variable wetness parameter in addition to the parameters, pressure, temperature, and humidity. The proposed model is mathematically defined in detail and tested for a wide range of parameters to show the model's effectiveness in determining the pressure ulcer formation risk. The model is also compared with a model from the literature that based on only the general parameters, pressure, temperature, and humidity. The obtained results showed that the model determines the risk of the occurrence of the pressure ulcer more precisely than the compared one.
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Affiliation(s)
| | - İbrahim Yücedağ
- Department of Computer Engineering, Faculty of Engineering, Duzce University, Duzce, Turkey
| | - Metin Toz
- Department of Computer Engineering, Faculty of Engineering, Karamanoglu Mehmetbey University, Karaman, Turkey
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7
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Faucher N, Barateau M, Hentz F, Michel P, Meaume S, Rousseaux C, Marty M, Le Fort M, Nicolas B. Use of multilayer silicone foam dressings as adjuvant therapy to prevent pressure injuries. J Wound Care 2021; 30:712-721. [PMID: 34554838 DOI: 10.12968/jowc.2021.30.9.712] [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
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
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Affiliation(s)
- Nathalie Faucher
- Service de Gériatrie Hôpital Bichat Claude Bernard, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | - Martine Barateau
- Consultation Plaies, Service de Gériatrie, CHU, Bordeaux, France.,Société Française de l'Escarre
| | - Franck Hentz
- Direction des soins CHU, Clermont Ferrand, France
| | - Philippe Michel
- Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France.,Société Française de l'Escarre
| | - Sylvie Meaume
- Service Plaie et Cicatrisation, Hôpital Rothschild, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | | | - Marc Marty
- Nukléus, Research department, Paris, France
| | - Marc Le Fort
- Service de MPR neurologique, Hôpital Saint Jacques, CHU Nantes, France
| | - Benoit Nicolas
- Pôle MPR St Hélier, Rennes, France.,Société Française de l'Escarre
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8
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Fulbrook P, Mbuzi V, Miles S. Incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care: A systematic review and meta-analysis. Int J Nurs Stud 2021; 114:103826. [PMID: 33352437 DOI: 10.1016/j.ijnurstu.2020.103826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. OBJECTIVES To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care. DESIGN Systematic review and meta-analysis of incidence and prevalence REVIEW METHODS: Articles published in English between 2009 and 2018, reporting pressure injury as a primary outcome were selected based on inclusion criteria. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted. Sub-group meta-analyses were conducted to investigate potential causes of heterogeneity. RESULTS Fifteen studies met the criteria for inclusion in the systematic review, of which 14 were incidence studies. Heterogeneity was significant and there was large observed variance between studies. The 95% confidence interval of cumulative incidence across all 14 studies, with an overall sample size of 6371, was 9.8-25.6%. In 11 studies that included all-stage pressure injury the 95% confidence interval was 8.3-28.3%. In seven studies in which Stage 1 pressure injury was excluded, the 95% confidence interval was 5.8-22.7%. In the single prevalence study included, which excluded Stage 1 pressure injury, prevalence was 8.8%. CONCLUSIONS The incidence of pressure injury in cardiac intensive care patients was similar to that found in general intensive care patients. However, our results suggest that the incidence may be significantly higher in cardiac surgical patients admitted to intensive care. There were significant differences across the various studies in the ways in which data were collected and reported. Further well-designed studies are required to better understand incidence in this population, using standardised methods of data collection and reporting.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Vainess Mbuzi
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.
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9
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Olivo S, Canova C, Peghetti A, Rossi M, Zanotti R. Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study. J Wound Care 2020; 29:S20-S28. [PMID: 32160127 DOI: 10.12968/jowc.2020.29.sup3.s20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU). METHODS A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP). RESULTS The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU). CONCLUSION Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.
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Affiliation(s)
- Stella Olivo
- 1 Department of Maternity. Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Cristina Canova
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, University of Padua, Padua, Italy
| | - Angela Peghetti
- 3 Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Maurilio Rossi
- 4 Azienda Ospedaliero-Universitaria Careggi di Firenze, Florence, Italy
| | - Renzo Zanotti
- 5 Laboratory of Nursing Studies, Public Health Section, Department of Medicine, University of Padova, Padua, Italy
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10
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Tschannen D, Anderson C. The pressure injury predictive model: A framework for hospital-acquired pressure injuries. J Clin Nurs 2020; 29:1398-1421. [PMID: 31889342 DOI: 10.1111/jocn.15171] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/19/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite decades of research, pressure injuries continue to be a source of significant pain and delayed recovery for patients and substantial quality and cost issues for hospitals. Consideration of the current thinking around pressure injury risk must be evaluated to improve risk assessments and subsequent nursing interventions aimed at reducing hospital-acquired pressure injuries. DESIGN This is a discursive paper using Walker and Avant's (2005) theory synthesis framework to examine the relevance of existing pressure injury models as they align with the current literature. METHODS PubMed and CINAHL indexes were searched, first for conceptual models and then for pressure injury research conducted on hospitalised patients for the years 2006-2016. A synthesis of the searches culminated into a new pressure injury risk model. CONCLUSIONS Gaps in previous models include lack of attention to the environment, contributing episode-of-care factors and the dynamic nature of injury risk for patients. Through theory synthesis, the need for a new model representing the full risk for pressure injury was identified. The Pressure Injury Predictive Model is a representation of the complex and dynamic nature of pressure injury risk that builds on previous models and addresses new patient, contextual and episode-of-care process influences. The Pressure Injury Predictive Model (PIPM) provides a more accurate picture of the complexity of contextual and process factors associated with pressure injury development. RELEVANCE TO CLINICAL PRACTICE Using the PIPM to determine risk can result in improved risk identification. This information can be used to implement targeted, evidence-based pressure injury prevention interventions specific to the patient risk profile, thus limiting unwarranted and unnecessary care.
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Affiliation(s)
- Dana Tschannen
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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11
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Shi C, Bonnett L, Dumville J, Cullum N. Nonblanchable erythema for predicting pressure ulcer development: a systematic review with an individual participant data meta‐analysis. Br J Dermatol 2019; 182:278-286. [DOI: 10.1111/bjd.18154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C. Shi
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
| | - L.J. Bonnett
- Department of Biostatistics University of Liverpool Waterhouse Building, Block F, 1–5 Brownlow Street Liverpool L69 3GL U.K
| | - J.C. Dumville
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
| | - N. Cullum
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
- Research and Innovation Division Manchester University NHS Foundation Trust Manchester Academic Health Science Centre 1st Floor, Nowgen Building, 29 Grafton Street Manchester M13 9WU U.K
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12
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Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. Int J Nurs Stud 2018; 87:14-25. [DOI: 10.1016/j.ijnurstu.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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13
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Samaniego-Ruiz MJ, Llatas FP, Jiménez OS. Assessment of chronic wounds in adults: an integrative review. Rev Esc Enferm USP 2018; 52:e03315. [PMID: 29947700 DOI: 10.1590/s1980-220x2016050903315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/27/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the main aspects that should be assessed in adults with chronic wounds. METHOD This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases. RESULTS Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution). CONCLUSION The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.
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Affiliation(s)
| | - Federico Palomar Llatas
- Universidad Católica de Valencia San Vicente Mártir, Valencia, España.,Consorcio Hospital General Universitario de Valencia, Área de Gestión Clínica de la Piel, Valencia, España
| | - Onofre Sanmartín Jiménez
- Universidad Católica de Valencia San Vicente Mártir, Valencia, España.,Instituto Valenciano de Oncología, Servicio de Dermatología Médico Quirúrgica, Valencia, España
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Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk. Nurs Res 2018; 67:314-323. [PMID: 29870519 DOI: 10.1097/nnr.0000000000000287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research investigating risk factors for hospital-acquired pressure injury (HAPI) has primarily focused on the characteristics of patients and nursing staff. Limited data are available on the association of hospital characteristics with HAPI. OBJECTIVE We aimed to quantify the association of hospital characteristics with HAPI and their effect on residual hospital variation in HAPI risk. METHODS We employed a retrospective cohort study design with split validation using hierarchical survival analysis. This study extends the analysis "Hospital-Acquired Pressure Injury (HAPI): Risk Adjusted Comparisons in an Integrated Healthcare Delivery System" by Rondinelli et al. (2018) to include hospital-level factors. We analyzed 1,661 HAPI episodes among 728,266 adult hospitalization episodes across 35 California Kaiser Permanente hospitals, an integrated healthcare delivery system between January 1, 2013, and June 30, 2015. RESULTS After adjusting for patient-level and hospital-level variables, 2 out of 12 candidate hospital variables were statistically significant predictors of HAPI. The hazard for HAPI decreased by 4.8% for every 0.1% increase in a hospital's mean mortality ([6.3%, 2.6%], p < .001), whereas every 1% increase in a hospital's proportion of patients with a history of diabetes increased HAPI hazard by 5% ([-0.04%, 10.0%], p = .072). Addition of these hierarchical variables decreased unexplained hospital variation of HAPI risk by 35%. DISCUSSION We found hospitals with higher patient mortality had lower HAPI risk. Higher patient mortality may decrease the pool of patients who live to HAPI occurrence. Such hospitals may also provide more resources (specialty staff) to care for frail patient populations. Future research should aim to combine hospital data sets to overcome power limitations at the hospital level and should investigate additional measures of structure and process related to HAPI care.
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Li C, DiPiro ND, Krause J. A latent structural equation model of risk behaviors and pressure ulcer outcomes among people with spinal cord injury. Spinal Cord 2017; 55:553-558. [DOI: 10.1038/sc.2017.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/06/2017] [Indexed: 12/12/2022]
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A latent structural equation model of protective behaviors and pressure ulcer outcomes among people living with spinal cord injury. Spinal Cord 2016; 55:135-140. [DOI: 10.1038/sc.2016.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/16/2016] [Accepted: 10/06/2016] [Indexed: 11/08/2022]
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18
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Kirsner R, Vivas A. Lower‐extremity ulcers: diagnosis and management. Br J Dermatol 2015; 173:379-90. [DOI: 10.1111/bjd.13953] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 01/30/2023]
Affiliation(s)
- R.S. Kirsner
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
| | - A.C. Vivas
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
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Nosocomial Pressure Ulcer Risk Factors in a Relatively Young Adult Population. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2014. [DOI: 10.1097/jdn.0000000000000073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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