Pressure ulcer prevention and management strategies in Turkey

Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment

The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline.

Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study

BACKGROUND

Pressure ulcers are common conditions among hospitalized patients and impose substantial burden on patients and their caregivers. To assess the knowledge and attitudes of health professionals towards PUs prevention.

METHODS

A cross-sectional study was performed in the rehabilitation hospital at King Fahad Medical City, Riyadh, Saudi Arabia in 2014. The study population consisted of nurses, physical therapists, occupational therapists, and physical medicine rehabilitation physicians who have a minimum of at least one year of clinical practice. The survey that was created for use in this study consisted of demographic characteristics, Pressure Ulcers Knowledge Test and Staff Attitude Scale.

RESULTS

The survey was completed by 105 participants of the 120 total eligible staff. The mean knowledge score of correct answers from all participants was 34.1 ± 4.8 (71.5 %). Only 77(73.3 %) participants had a mean knowledge score of ≥ 70 %. The mean attitude score was 30.5 (56.5 %). The study revealed that age and profession factors had a significant relationship with participants' mean knowledge of PUs prevention (P < 0.001), (P < 0.001) respectively. Moreover, 101 (98.1 %) participants are concerned about PUs prevention in their practices. While, 11 (10.7 %) of participants believe that PUs prevention is a time consuming procedure.

CONCLUSIONS

The present study assessed the current knowledge and attitudes of health professionals regarding PUs prevention in an acute rehabilitation hospital. The majority of participants had an average level of knowledge and exhibited unsatisfactory attitudes towards PUs prevention. Increased health professionals awareness may improve their attitudes towards PUs prevention.

Massage therapy for preventing pressure ulcers

BACKGROUND

Pressure ulcers affect approximately 10% of patients in hospitals and the elderly are at highest risk. Several studies have suggested that massage therapy may help to prevent the development of pressure ulcers, but these results are inconsistent.

OBJECTIVES

To assess the evidence for the effects of massage compared with placebo, standard care or other interventions for prevention of pressure ulcers in at-risk populations.The review sought to answer the following questions:Does massage reduce the incidence of pressure ulcers of any grade?Is massage safe in the short- and long-term? If not, what are the adverse events associated with massage?

SEARCH METHODS

We searched the Cochrane Wounds Group Specialised Register (8 January 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 1), Ovid MEDLINE (1946 to 8 January 2015), Ovid MEDLINE (In-Process Other Non-Indexed Citations 8 January 2015), Ovid EMBASE (1974 to 8 January 2015), and EBSCO CINAHL (1982 to 8 January 2015). We did not apply date or language restrictions.

SELECTION CRITERIA

We planned to include all randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that evaluated the effects of massage therapy for the prevention of pressure ulcers. Our primary outcome was the proportion of people developing a new pressure ulcer of any grade.

DATA COLLECTION AND ANALYSIS

Two review authors independently carried out trial selection. Disagreements were resolved by discussion.

MAIN RESULTS

No studies (RCTs or Q-RCTs) met the inclusion criteria. Therefore, neither a meta-analysis nor a narrative description of studies was possible.

AUTHORS' CONCLUSIONS

There are currently no studies eligible for inclusion in this review. It is, therefore, unclear whether massage therapy can prevent pressure ulcers.

Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia

Background

Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose significant burden on patients, their relatives and caregivers. Pressure ulcers have been described as one of the most costly and physically debilitating complications since the 20^th century. The pain and discomfort due to pressure ulcer prolongs illness, rehabilitation, time of discharge and even contribute to disability and death. This study was aimed to assess knowledge, practice and factors associated with pressure ulcer prevention among nurses in Gondar University Hospital, North-west Ethiopia.

Method

An institution-based cross-sectional survey was conducted from March 15 - April 10, 2014 among 248 nurses in Gondar University hospital. A pretested and structured self-administered questionnaire was used for data collection. Data were entered using EPI info version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. Descriptive statistics was used to describe the study population in relation to relevant variables. Bivariate and multivariate logistic regression was also carried out to see the effect of each independent variable on the dependent variable.

Result

Nearly half (54.4 %) of the nurses had good knowledge; similarly 48.4 % of them had good practice on prevention of pressure ulcer. Educational status [Adjusted Odds Ratio (AOR) = 2.4, 95 % CI (1.39-4.15)], work experience [AOR = 4.8, 95 % CI (1.31-10.62)] and having formal training [AOR = 4.1, 95 % CI (1.29-9.92)] were significantly associated with knowledge on prevention of pressure ulcer. While, satisfaction with nursing leadership [AOR = 1.9, 95 % CI (1.04-3.82)], staff shortage [AOR = 0.07, 95 % CI (0.03-0.13)] and inadequate facilities and equipment [AOR = 0.4, 95 % CI (0.19-0.83)] were found to be significantly associated with the practice on prevention of pressure ulcer.

Conclusion

Knowledge and practice of the nurses regarding prevention of pressure ulcer was found to be inadequate. Having higher educational status, attending formal training and being experienced were positively associated with knowledge; while shortage of facilities and equipments, dissatisfaction with nursing leadership and inadequate staff number showed negative association with practice of nurse’s pressure ulcer prevention. In-service training and upgrading courses are some of the important steps to improve nurses’ knowledge and practice on prevention of ulcer pressure.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0076-8) contains supplementary material, which is available to authorized users.

Pressure ulcer prevalence in Turkey: a sample from a university hospital

PURPOSE

The purpose of this study was to identify pressure ulcer prevalence among hospitalized patients in a university hospital setting.

SETTING AND SUBJECTS

The study setting was medical and surgical inpatient wards and critical care units in a university hospital in Adana, Turkey. The sample population comprised 404 patients who were aged 18 years or older and admitted to the intensive care units and internal and surgery units at least 24 hours before data collection.

METHODS

Each participating patient's skin was assessed and pressure ulcers were classified according to the National Pressure Ulcers Advisory Panel grading system. Pressure ulcer risk was assessed using the Braden Scale. Data were recorded on a patient observation form designed for this study.

INSTRUMENTS

The following tools were used to collect data: (a) data collection form in identifying sociodemographic and medical characteristics of the patients, (b) the classification developed by the National Pressure Ulcers Advisory Panel in identifying the phases and localization of pressure ulcers, and (c) Braden Risk Assessment Scale in assessing risks.

RESULTS

The average age of patients was 51.22 ± 0.84 years (mean ± SD); 51.7% were male. The mean hospital length of stay was 9.6 ± 0.5 days. Pressure ulcer risk assessment revealed that 34.2% of the patients were at increased risk. The prevalence of pressure ulcers was 10.4%. Pressure ulcers occurred most frequently in the sacral area (43.9%); 45.2% of them were stage (grade) II.

CONCLUSIONS

The pressure ulcer prevalence identified in this study is comparable with studies conducted in other countries.

The relationship among pressure ulcers, oxygenation, and perfusion in mechanically ventilated patients in an intensive care unit

PURPOSE

We examined the relationships among oxygenation, tissue perfusion, and other comorbid conditions not incorporated into the Norton Scale, and pressure ulcer (PU) development in subjects receiving mechanical ventilation.

DESIGN

Descriptive, observational study.

SETTING AND SUBJECTS

The setting was our university hospital's surgical/emergency intensive care unit in Istanbul province, Turkey. The sample comprised 30 patients who were older than 18 years, did not have a PU on admission, and had been mechanically ventilated for more than 24 hours when data collection began.

METHODS

Skin integrity and a PU risk, using the Norton Scale, were administered twice daily. In addition, serum blood testing, vital signs, and data regarding ventilation and oxygenation status were obtained from the patient's electronic medical records.

RESULTS

Slightly less than half of subjects were women (n = 14, 46.7%). Their mean age was 54.36 years (SD = 20.68). Pressure ulcers developed in 5 patients (16.7%); all PUs were located on the heel. All ulcers were initially observed as stage I lesions; 1 progressed to a stage II ulcer and 1 progressed to a stage III ulcer. Patients who developed pressure ulcers have higher serum glucose levels (z = -2.198; P = .028), higher serum pH levels (z = -2.031; P = .028), and lower diastolic blood pressures (z = 0.055; P = .057) than those who remained ulcer free.

CONCLUSION

Our results demonstrate that mechanically ventilated patients who develop PUs were more likely to have significantly higher blood glucose levels, significantly lower diastolic blood pressure values, and significantly higher serum pH values than were patients who remained free of PUs. Nurses who care for mechanically ventilated patients should recognize these factors and initiate preventive interventions as indicated.

Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement

AIMS AND OBJECTIVES

To consider the validity and reliability of risk assessment scales for pressure ulcers.

BACKGROUND

Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful.

DESIGN

A literature review and commentary.

METHODS

Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers.

RESULTS

There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment scales has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care.

CONCLUSIONS

There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced.

RELEVANCE TO CLINICAL PRACTICE

Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.