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Chen M, Wang F, Xie X, Yang X, Luo Y, Zhuang C, Xie B. Application of bundled process control in the prevention of pressure injury in patients with head and neck cancer. PLoS One 2024; 19:e0305190. [PMID: 38857240 PMCID: PMC11164361 DOI: 10.1371/journal.pone.0305190] [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: 12/15/2023] [Accepted: 05/25/2024] [Indexed: 06/12/2024] Open
Abstract
This study aimed to explore the application effects of cluster process control and routine nursing on the prevention of pressure injury (PI) in patients undergoing head and neck cancer surgery and to provide a basis for reducing the occurrence of PI, thereby promoting the safety of the patients. This was a retrospective study. Patients with head and neck cancers who underwent surgical treatment in the Department of Otolaryngology at the Second Affiliated Hospital of Fujian Medical University from July 2022 to June 2023 were selected as the research participants. Participants were classified into experimental and control groups using a convenience sampling method. In the experimental group, cluster process control was implemented, while routine nursing management was applied in the control group. The incidence of PI (p = 0.028) and healing time (p = 0.035) in the experimental group were lower than those in the control group. The process management ability of nurses in the experimental group was significantly improved, with the results for the Braden scale (p = 0.023), effective decompression (p = 0.002), floating heel (p = 0.002), nutrition monitoring (p = 0.005), and patient satisfaction in the experimental group being higher than those in the control group (p = 0.007). This study effectively demonstrated the effect of cluster process control in reducing the incidence of PI in patients undergoing head and neck cancer surgery, thereby determining that cluster process control is suitable for clinical application.
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Affiliation(s)
- Mianmian Chen
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Fenfen Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Xueying Xie
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Xiaohong Yang
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yaling Luo
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Chaoman Zhuang
- Department of Otolaryngology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Baoyuan Xie
- Department of Nursing, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
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Reese TJ, Domenico HJ, Hernandez A, Byrne DW, Moore RP, Williams JB, Douthit BJ, Russo E, McCoy AB, Ivory CH, Steitz BD, Wright A. Implementable Prediction of Pressure Injuries in Hospitalized Adults: Model Development and Validation. JMIR Med Inform 2024; 12:e51842. [PMID: 38722209 PMCID: PMC11094428 DOI: 10.2196/51842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Numerous pressure injury prediction models have been developed using electronic health record data, yet hospital-acquired pressure injuries (HAPIs) are increasing, which demonstrates the critical challenge of implementing these models in routine care. Objective To help bridge the gap between development and implementation, we sought to create a model that was feasible, broadly applicable, dynamic, actionable, and rigorously validated and then compare its performance to usual care (ie, the Braden scale). Methods We extracted electronic health record data from 197,991 adult hospital admissions with 51 candidate features. For risk prediction and feature selection, we used logistic regression with a least absolute shrinkage and selection operator (LASSO) approach. To compare the model with usual care, we used the area under the receiver operating curve (AUC), Brier score, slope, intercept, and integrated calibration index. The model was validated using a temporally staggered cohort. Results A total of 5458 HAPIs were identified between January 2018 and July 2022. We determined 22 features were necessary to achieve a parsimonious and highly accurate model. The top 5 features included tracheostomy, edema, central line, first albumin measure, and age. Our model achieved higher discrimination than the Braden scale (AUC 0.897, 95% CI 0.893-0.901 vs AUC 0.798, 95% CI 0.791-0.803). Conclusions We developed and validated an accurate prediction model for HAPIs that surpassed the standard-of-care risk assessment and fulfilled necessary elements for implementation. Future work includes a pragmatic randomized trial to assess whether our model improves patient outcomes.
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Affiliation(s)
- Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antonio Hernandez
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel W Byrne
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan P Moore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jessica B Williams
- Department of Nursing, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brian J Douthit
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elise Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine H Ivory
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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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; 33:254-261. [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] [MESH Headings] [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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Zhou Y, Liu L, Rong R, Guo L, Pei Y, Lu X. Constructing nursing quality indicators for intraoperative acquired pressure injury in cancer patients based on guidelines. Int J Qual Health Care 2024; 36:mzae001. [PMID: 38183267 DOI: 10.1093/intqhc/mzae001] [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: 05/05/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
Cancer patients have a high incidence of intraoperative acquired pressure injury (IAPI). Constructing IAPI quality indicators can reduce the incidence of pressure injury, but there are a lack of these indicators targeting cancer patients. Based on this, this study develops a system of quality indicators for IAPI. Thirty-four potential indicators were included based on the literature review. The 26 experts were asked to rate the importance and feasibility of each indicator using three rounds of email survey. The authoritative coefficient ranged from 0.92 to 0.94. After three rounds of Delphi expert consultation, nine nursing quality indicators were identified for IAPI in cancer patients. The mean importance or feasibility ratings ranged from 4.77 to 5.81 on a six-point scale, with variation coefficients ranging from 0.07 to 0.26. The percentage of full score for potential indicators ranged from 23.10% to 80.80%. Over three rounds, the Kendall's W coefficients ranged from 0.157 to 0.354 (P < .01). The absolute and relative importance and feasibility of the nine indicators were identified as potentially valid measures of nursing quality indicators for IAPI in cancer patients. This instrument is the first set of IAPI quality indicators developed specifically for cancer patients, and it should be useful for evaluating and improving the quality of IAPI in this population.
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Affiliation(s)
- Yu Zhou
- Nursing department, Chengdu Fifth People's Hospital, No. 33 Mashi Road,Wenjiang District, Chengdu 611130, China
| | - Lu Liu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Rong Rong
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Li Guo
- Department of Development Management, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing 100191, China
| | - Yuquan Pei
- Operating Room, Beijing Cancer Hospital, No. 52 Fucheng Road, Haidian District, Beijing 100048, China
| | - Xiuying Lu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
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Hsu MY, Chen YS, Chen YC, Wu YL. Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial. Tzu Chi Med J 2023; 35:260-266. [PMID: 37545793 PMCID: PMC10399837 DOI: 10.4103/tcmj.tcmj_256_22] [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: 09/14/2022] [Revised: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment. Materials and Methods We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management. Results The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant. Conclusion We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.
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Affiliation(s)
- Mei-Yu Hsu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Sin Chen
- Department of Nursing, Kuang Tien General Hospital, Taichung, Taiwan
| | - Ying-Chun Chen
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Lin Wu
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Efteli E. Frequency of Minor Shifts in Body Position and Pressure Injury Development: A Comparative Descriptive Study. J Wound Ostomy Continence Nurs 2023; 50:285-288. [PMID: 37144877 DOI: 10.1097/won.0000000000000982] [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: 05/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of minor shifts in body position on the development of pressure injuries. DESIGN A prospective, comparative, descriptive study. SUBJECTS AND SETTING The sample comprised 78 bedridden patients aged 18 years or older, free of pressure injuries, and hospitalized in the Neurology and Internal Medicine clinics and intensive care units. The study setting was a state hospital in Burdur Province, Southwest Turkey; data were collected between March and September 2018. METHODS Patients were monitored once weekly until the end of their stay or until pressure injury development. Data were collected using a researcher-designed data collection form. Patients' ability to make minor shifts in body position was categorized between 0 and 3 per movement group. RESULTS Twenty-one (26.9%) of 78 participants developed a pressure injury; 90.4% (n = 19) were stage 1 pressure injuries. Pressure injuries occurred in 94.1% of the patients who did not make shifts in body position versus 80% of the patients who performed shifts every 4 hours. No pressure injuries developed in those patients who moved every hour ( P = .00). CONCLUSIONS Study findings support the importance of making minor shifts in body position for prevention of pressure injury in bedridden patients.
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Affiliation(s)
- Elçin Efteli
- Elçin Efteli, PhD, RN, Faculty of Health Sciences, Mehmet Akif Ersoy University, Burdur, Turkey
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Hou P, Xue H, Chang S, Xie P, Chen Y, Wang Y, Miura D, Fan J, Liang J, Kitayama A, Fang F, Yuan H, Wu X, Zhang X, Wang J, Ding N, Zhang C, Sun X, Takashi E. Thermal preconditioning can reduce the incidence of intraoperatively acquired pressure injuries. J Therm Biol 2023; 115:103617. [PMID: 37352595 DOI: 10.1016/j.jtherbio.2023.103617] [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: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
Intraoperatively acquired pressure injuries (IAPIs) occur frequently among patients who undergo surgical procedures that last longer than 3 h. Several studies indicated that heat shock proteins (HSPs) play an important role in the protection of stress-induced damages in skin tissues. Hence, the aim of this study was to investigate the potential preventive effect of thermal preconditioning (TPC) on IAPIs in surgical patients and rats and to identify the differentially expressed HSP genes in response to the above treatment. TPC was performed on one group of hairless rats before the model of pressure injuries was established. Subsequently, the size of skin lesions was measured and the expression levels of mRNA and protein of HSPs of the pressured skin were detected by real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into the TPC group (n = 59) and the control group (n = 59), respectively. The temperature and pressure of sacral skin, as well as the incidence of pressure injury (PI) were detected and compared. In animal studies, TPC significantly reduced both the size and incidence of PI in rats on the second, third and fourth days post treatment. In addition, the expression levels of both mRNA and protein of HSP27 were increased in the TPC group, compared with the control group. Immunohistochemical staining showed that HSP27 was distributed in various types of dermal cells and increased in basal cells. In human studies, a significant reduction (75%) of IAPIs was observed among the patients in the TPC group. TPC can reduce the incidence of PI in rats and humans, and the upregulation of HSP27 may play an important role in this biological progress. Further studies are warranted to explore the molecular mechanism of the preventive effect in PI mediated by HSP27.
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Affiliation(s)
- Ping Hou
- Nagano College of Nursing, 399-4117, Nagano, Japan; School of Nursing and School of Public Health, Yangzhou University, 225000, Yangzhou, China
| | - Huiping Xue
- Nagano College of Nursing, 399-4117, Nagano, Japan; Emergency Intensive Care Unit, Affiliated Hospital of Nantong University, 226000, Nantong, China
| | - Shuwen Chang
- Nagano College of Nursing, 399-4117, Nagano, Japan; Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ping Xie
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China.
| | - Yajie Chen
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Yanwei Wang
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Daiji Miura
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Jianglin Fan
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Jingyan Liang
- Health Science Center, Yangzhou University, 225000, Yangzhou, China.
| | | | - Fang Fang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Haijuan Yuan
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaoling Wu
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaolin Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Jing Wang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ning Ding
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Can Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiuyun Sun
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - En Takashi
- Nagano College of Nursing, 399-4117, Nagano, Japan.
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Tran DL, Huang RW, Chiu ES, Rajhathy EM, Gregory JH, Ayello EA, Sibbald RG. Debridement: Technical Considerations and Treatment Options for the Interprofessional Team. Adv Skin Wound Care 2023; 36:180-187. [PMID: 36940374 DOI: 10.1097/01.asw.0000920660.07232.f7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
GENERAL PURPOSE To enhance the learner's chronic wound debridement competence as an interprofessional team member. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Differentiate healable, maintenance, and nonhealable wounds to create a holistic debridement treatment plan using the Wound Bed Preparation paradigm.2. Evaluate active debridement options including the potential need for an interprofessional referral or specialized investigations.3. Assess chronic wound debridement options.4. Analyze case studies for appropriate clinical application of debridement modalities.
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Fischbein AB. Improving Skin Care Protocol Use in the Intensive Care Unit to Reduce Hospital-Acquired Pressure Injuries. AACN Adv Crit Care 2023; 34:16-23. [PMID: 36877652 DOI: 10.4037/aacnacc2023806] [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: 03/07/2023]
Abstract
BACKGROUND Patients in the intensive care unit have the highest rate of hospital-acquired pressure injuries (HAPIs). In the United States, treatment of HAPIs costs an estimated $9.1 to $11.6 billion annually, with each occurrence adding an average of $10 708 to a patient's total hospital cost. In addition to their financial impact, pressure injuries negatively affect patients physically, socially, and psychologically and are associated with increased morbidity and mortality. OBJECTIVE An intensive care unit had 42 HAPIs during a single fiscal year, with 45% of them related to lack of adherence to the institution's established evidence-based skin care protocol. This project was conducted to increase adherence to the protocol and thus reduce the incidence of HAPIs in the unit. METHODS This quality improvement initiative featured an evidence-based multifaceted intervention to increase adherence to the skin care protocol. A review of medical records was used to determine general skin care protocol adherence and to measure the monthly incidence of HAPIs in the unit. RESULTS The number of HAPIs in the unit decreased from 33 in the preintervention period to 11 in the postintervention period, a reduction of 67%. The rate of general skin care protocol adherence improved to as high as 76% by the end of the postintervention period. CONCLUSION Use of an evidence-based multifaceted intervention can improve adherence to a skin care protocol in the intensive care unit, resulting in a reduced incidence of HAPIs and improved patient outcomes.
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Affiliation(s)
- Amanda B Fischbein
- Amanda B. Fischbein is Nurse Practitioner, Electrophysiology Group, Lexington Cardiology, 2728 Sunset Blvd #300, West Columbia, SC 29169
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Francis KF. Assessment and Identification of Skin Disorders in Skin of Color: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:107-114. [PMID: 36867032 DOI: 10.1097/won.0000000000000960] [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: 03/04/2023]
Abstract
Skin assessment in patients with dark skin tones (DST) continues to be a challenge for many healthcare providers (HCP) because the visual cues are not always readily identified. For example, identification of early signs of pressure injury when subtle skin color changes are missed has the potential to cause harm and contribute to healthcare disparities. Appropriate wound management can begin only when the wound is correctly identified. For HCPs to identify early signs of skin conditions in DST patients, they must be provided education and effective tools enabling them to identify clinically relevant signs of skin damage in all patients. This article reviews basic anatomy of the skin; it focuses on differences seen in DST and reviews assessment strategies to assist the HCP to identify skin changes and conditions.
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Affiliation(s)
- Kathleen F Francis
- Kathleen F. Francis, DNP, RN, FNP-BC, CWOCN, Wound Ostomy Service, NYU Langone Hospital Brooklyn, Brooklyn, New York
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12
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Ma L, Chen H, Gu H, Hua L, Gao X. Analysis of the clinical features and risk factors of device-related pressure injuries in the operating room. Int Wound J 2023; 20:706-715. [PMID: 36787265 PMCID: PMC9927895 DOI: 10.1111/iwj.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022] Open
Abstract
To describe the clinical features and risk factors of device-related pressure injuries (DRPIs) in the operating room. The clinical features of the DRPIs in patients undergoing elective surgery in a tertiary hospital in 2020 were investigated through prospective data collection. A DRPI-related questionnaire was designed for the patients, and those who did not experience any DRPI were selected according to a ratio of 1:2. Logistic regression analysis was performed in terms of the independent risk factors of operating-room DRPIs. A P-value of <.05 indicated a statistically significant difference. The incidence of operating-room DRPIs was 0.56%, and the proportion of stage I injuries was 73.53%. The injury-related devices included vital monitoring devices (31.62%), auxiliary therapy devices (27.94%), therapy devices (19.12%), and dressings (3.67%). Non-bone protuberances, such as the upper arms and thighs, were common injury sites. The patients' body mass index, mean arterial pressure, and instrument action time were independent risk factors for the operating-room DRPIs. To reduce the incidence of operating-room DRPIs, it is of great clinical significance to focus on the characteristics of the surgical patients and the types of surgery-related devices used and to take personalised preventive measures based on the relevant risk factors.
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Affiliation(s)
- Ling‐Yu Ma
- Department of Operating RoomSecond Affiliated Hospital of Nantong UniversityNantongChina
| | - Hong‐Lin Chen
- School of Public HealthNantong UniversityNantongChina
| | - Hai‐Yan Gu
- Department of Operating RoomSecond Affiliated Hospital of Nantong UniversityNantongChina
| | - Li Hua
- Department of Operating RoomSecond Affiliated Hospital of Nantong UniversityNantongChina
| | - Xiao‐Mei Gao
- Department of Operating RoomSecond Affiliated Hospital of Nantong UniversityNantongChina
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Kim MJ, Jeong YS, Kim HJ, Hahn HM, Thai DQ, Lee IJ. Effect of a Team Approach to Pressure Injury Management over 5 Years in a Tertiary Hospital. Adv Skin Wound Care 2023; 36:1-7. [PMID: 36537777 DOI: 10.1097/01.asw.0000902488.10296.9b] [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: 06/17/2023]
Abstract
OBJECTIVE The authors' facility established a novel integrated wound care team (IWCT), which included the implementation of a strict treatment algorithm by the patients' attending providers and a specialized wound care team led by a plastic surgeon. Investigators then retrospectively analyzed clinical outcomes of pressure injury (PI) management by the IWCT over 5 years. METHODS The authors performed a retrospective chart review and periodic statistical analysis of the data for all patients with PI referred to the IWCT in the authors' center from May 2015 to April 2019. Data including patients' demographic information, first and last consultation dates, referring department, PI stage, site of PI, and Braden Scale scores were collected and analyzed. RESULTS Patients (N = 15,556) did not differ significantly in age, sex, or Braden Scale score. A preimplementation/postimplementation analysis of PI data before and after establishing the IWCT showed that the incidence of stage 3 or 4 PIs had significantly decreased during the study period (19.1% vs 15.2%, P < .05). Conversely, the incidence of stage 1 PIs significantly increased in the same period (38.0% vs 57.4%, P < .05). The proportion of completely healed PIs also increased, and the median treatment period was significantly shortened (P < .05). CONCLUSIONS Implementation of the IWCT in a tertiary hospital setting led to a significant increase in early-stage PI detection and a decrease in severe PIs.
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Affiliation(s)
- Min Ji Kim
- In the Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea, Min Ji Kim, MD, PhD, is Clinical Assistant Professor; Yon Soo Jeong, MD, is Resident; Hee Joung Kim, RN, is Wound Care Nurse; Hyung Min Hahn, MD, is Assistant Professor; Duy Quang Thai, MD, is Graduate Resident; and Il Jae Lee, MD, PhD, is Full Professor
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A Prospective Study of Pressure Injury Healing Rate and Time and Influencing Factors in an Acute Care Setting. Adv Skin Wound Care 2022; 35:1-9. [PMID: 36409189 DOI: 10.1097/01.asw.0000892488.90282.a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine pressure injury (PI) healing rate and time and identify influencing factors. METHODS A prospective cohort research design was used. Data collection was performed between May 2015 and August 2018. The study participants were 77 inpatients who developed at least one PI during their stay in a university hospital. Researchers assessed participants' demographic (age, sex); physical (incontinence, activity of daily living, and nutrition status); physiologic (serum total protein, albumin, and creatinine, blood glucose, and hemoglobin levels); and disease- (diagnosis, number of comorbidities, and cardiovascular comorbidity), wound- (PI stage and size at first detection, and Pressure Ulcer Scale for Healing score), and treatment-related (IV nutrition supply and albumin infusion) factors. RESULTS Across the 77 patients, 91 PIs developed. Of these, 54 (59.3%) healed with a mean healing time of 17.63 days. The healing rate was better, and the healing time was shorter for stage 2 PIs compared with unstageable or deep-tissue PIs. Factors influencing PI healing rate were number of comorbidities, cardiovascular comorbidity, incontinence, PI stage at first detection, IV nutrition supply, and mean serum creatinine level. Factors influencing PI healing time were number of comorbidities, cardiovascular comorbidity, and PI stage at first detection. CONCLUSIONS To reduce hospital stays, PI-related complications, and mortality, evidence-based management strategies for PIs are needed. The findings of the present study may contribute to the development of such strategies.
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Li J, Zhu C, Liu Y, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Critical Care Nurses’ Knowledge, Attitudes, and Practices Regarding Pressure Injury Treatment: A Nationwide Cross-Sectional Survey. Healthc Policy 2022; 15:2125-2134. [PMID: 36415220 PMCID: PMC9675999 DOI: 10.2147/rmhp.s389706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pressure injury is a common problem in intensive care units. Critical care nurses play an important role in multidisciplinary teams performing pressure injury treatment. Identifying the clinical status of pressure injury treatment may contribute to improving care quality. Aim To identify the knowledge, attitudes, and practices regarding pressure injury treatment in critical care nurses. Design A cross-sectional survey. Methods Secondary data were extracted from a multicenter clinical trial. Knowledge and attitudes toward pressure injury treatment were assessed through a self-administered eight-item questionnaire. The observed practices were recorded using a case report form. The report was in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. Results A total of 950 critical care nurses in 15 hospitals from six provinces/municipalities of China were investigated. The mean knowledge score was 2.89 ± 1.16 (95% confidence interval: 2.82–2.97) out of a possible total of 5 points. The correct rates of selecting wound dressings and pain management were 34.4% and 45.6%, respectively. The mean attitude score was 9.07 ± 1.09 (95% confidence interval: 9.00–9.13) out of a possible total of 12 points. A total of 2092 patient days of pressure injury treatment practices were observed and recorded. Repositioning was the most commonly employed treatment measure (98.8%). Foam dressing was the common dressing for stage I (53.6%), stage II (47.5%), and more severe pressure injury (67.9%), including stage III, IV, unstageable, and suspected deep tissue injury. Conclusion Critical care nurses exhibited a generally low level of knowledge and moderate attitudes regarding pressure injury treatment. Practices of pressure injury treatment were generally acceptable.
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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, Beijing, People’s Republic of China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Ying Liu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Jingfen Jin
- Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, People’s Republic of China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Jianghan District, Wuhan, People’s Republic of China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan People’s Hospital, Chengdu, People’s Republic of China
| | - Shouzhen Cheng
- Department of Nursing, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People’s Republic of China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Xinjuan Wu, Email
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Factors Associated with Pressure Injury Among Critically Ill Patients in a Coronary Care Unit. Adv Skin Wound Care 2022; 35:1-10. [PMID: 36125458 DOI: 10.1097/01.asw.0000872172.83299.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To ascertain the incidence of pressure injuries (PIs) in patients in the coronary care unit (CCU), identify PI characteristics, and determine associated risk factors. METHODS Researchers conducted a retrospective investigational study of patients' medical records. A total of 820 patients who were admitted to the CCU between January 2018 and December 2020 met the study criteria. Of these, 200 patients who developed PIs after admission to the CCU were included in this study. This study examined the clinical features of PIs, as well as five PI risk factors: patient characteristics; length of stay; intrinsic factors; care factors, including medical devices; and vasopressor agents. RESULTS The incidence of PIs among patients in the CCU was 24.4%. At initial detection, 79.5% of these injuries were already at stage 2 or higher. The results indicated a significant correlation between PI stage and hemoglobin level. Moreover, the authors also found relationships between the use of medical devices (eg, arterial catheters, oxygen tubes, and Levin tubes) and PI onset. CONCLUSIONS Critically ill patients in the CCU use various medical devices for an extended period with severe consequences. The risk factors affecting PI are multifactorial. Therefore, the implementation of PI prevention and early detection strategies for patients in the CCU are crucial.
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Interactive Evidence-Based Pressure Injury Education Program for Hospice Nursing: A Quality Improvement Approach. J Wound Ostomy Continence Nurs 2022; 49:428-435. [PMID: 36108226 PMCID: PMC9481287 DOI: 10.1097/won.0000000000000911] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this quality improvement (QI) project was to develop and implement an interactive, evidence-based pressure injury (PI) education program and evaluate the impact on frontline hospice nursing staff knowledge and practice. PARTICIPANTS AND SETTING The QI setting was a 12-bed inpatient hospice unit in a tertiary care Veterans Affairs (VA) Medical Center in Cleveland, Ohio. Nineteen licensed and unlicensed hospice nursing staff participated in this pre-/postworkshop project. APPROACH Chart audit determined baseline PI incidence and prevalence on the inpatient hospice unit. Interviews with key leaders informed the need to develop and implement innovative PI education opportunities. A literature review determined existing standards regarding the benefits of PI education for nursing staff but did not reveal measurable targets in hospice settings. We developed a PI education intervention based on Kolcaba's Theory of Comfort framework and a Plan-Do-Study-Act (PDSA) performance improvement model. Education was delivered in 7 workshops, lasting 2 hours each. Knowledge, practice, and comfort for inpatient hospice nursing staff were evaluated at baseline and 8 weeks following the final refresher visit. Workshop satisfaction was collected once using standard program evaluation forms after final workshop delivery. OUTCOMES We observed a significant improvement in staff PI knowledge (P = .001) and practice (P = .001) after initial workshop attendance and repeat engagement (P = .001). There was a large magnitude of effect for overall knowledge change (d = 1.04); similarly PI care planning and practice showed a large magnitude of effect and significant improvement (P = .001, d = 2.64). Staff comfort with job duties was stable with low effect size (mean 4.52, d = 0.04), and satisfaction with the workshop education was high (100% agreement with trainer effectiveness). IMPLICATIONS FOR PRACTICE We found that frontline hospice nursing staff knowledge and practice improved after attendance at our evidence-based PI education program. Results of this QI project have stimulated ongoing discussion on how to sustain this program in our hospice setting.
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General Skin Issues in the Adult Rehabilitation Population. Phys Med Rehabil Clin N Am 2022; 33:745-758. [DOI: 10.1016/j.pmr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Desenvolvimento de aplicativo móvel para avaliar, tratar e prevenir lesão por pressão. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao0329345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Su P, Lun Q, Lu D, Wu Q, Liu T, Zhang L. Biomechanical Changes on the Typical Sites of Pressure Ulcers in the Process of Turning Over from Supine Position: Theoretical Analysis, Simulation, and Experiment. Ann Biomed Eng 2022; 50:654-665. [PMID: 35394601 DOI: 10.1007/s10439-022-02938-9] [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: 11/30/2021] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
Pressure ulcers are mainly caused by prolonged pressure on local tissues. The current method of preventing pressure ulcers is mainly to change the patient's position by turning, so it is significant to study the biomechanics of the typical site of pressure ulcers. Based on anatomical theory, a three-dimensional model of the shoulder and hip was established, and the theoretical contact pressure between the body and the bed was calculated by force analysis. Then, finite element models of typical parts of pressure ulcers were established, and the maximum stresses under different boundary conditions were obtained by finite element analysis. Finally, a human body turning experiment was conducted using a pressure distribution sensor, and the pressure distribution clouds and maximum contact pressure curves under different turning angles were obtained. The results show that the extreme point of maximum stress occurs at [Formula: see text], producing a stress concentration phenomenon; the peak stresses at the shoulder and hip are more balanced in the angular threshold range of [Formula: see text] to [Formula: see text], the stresses are more dispersed, and there exists an angular threshold for optimal integrated pressure, which can improve the efficiency of the use of assisted turning equipment. The relevant results help to explain the causes of pressure ulcer disease and can provide clinical references to improve the effectiveness of care.
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Affiliation(s)
- Peng Su
- School of Electromechanical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Qinglong Lun
- School of Electromechanical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Da Lu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Qiulong Wu
- School of Electromechanical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Tian Liu
- School of Electromechanical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Leiyu Zhang
- Beijing Key Laboratory of Advanced Manufacturing Technology, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, 100124, China.
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Guo Y, Pattavana F, Siangco C, Ngo-Huang A, Fu J, Hui D, Bruera E. Overall Survival among Patients with Cancer and Pressure Injury and Its Association with Braden Scale Score. J Palliat Med 2022; 25:1254-1257. [PMID: 35394852 DOI: 10.1089/jpm.2021.0645] [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: 11/12/2022] Open
Abstract
Background: The overall survival (OS) of hospitalized cancer patients with pressure injury (PI) has not been studied in a large cohort. Objective: To assess risk factors associated with OS of hospitalized cancer patients with PI. Methods: After IRB approval, charts of 445 hospitalized cancer patients with PI were reviewed. Kaplan-Meier method was used to estimate the OS time and log-rank test was used to assess the association between OS and other variables. Results: Stage 1, 2, 3, 4, deep tissue injury, unstageable, and unknown stage were 79 (17.8%), 91 (20.4%), 24 (5.4%), 3 (0.7%), 144 (32.4%), 36 (8.1%), and 68 (15.3%), respectively. The OS rate is 55.3% at one month. OS is significantly associated with Braden Scale (BS) Score. The OS time is significantly shorter in patients with advanced disease. Conclusion: Cancer patients with PI have limited OS, especially those with ≤14 BS and advanced diseases.
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Affiliation(s)
- Ying Guo
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Faith Pattavana
- Wound Ostomy Continence Nursing, Harris Health System, Houston, Texas, USA
| | - Christian Siangco
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Qazi M, Khattak AF, Barki MT. Pressure Ulcers in Admitted Patients at a Tertiary Care Hospital. Cureus 2022; 14:e24298. [PMID: 35607569 PMCID: PMC9123348 DOI: 10.7759/cureus.24298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pressure ulcers (PUs) occur when the skin covering a weight-bearing part of the body is compressed for a long time between bone, any other part of the body, bed, chair, or any other hard surface. This study aimed to determine the prevalence of pressure ulcers at a tertiary care hospital in all specialty departments including COVID-19. Methods A retrospective study was conducted at North West General Hospital and Research Center, Peshawar, Pakistan. After obtaining ethical approval, data were obtained from the hospital database from July 2020 to June 2021. The keywords "bed sore," "pressure sore," and "pressure ulcer" were used to search for relevant cases, and patient demographics, including age and gender, site of pressure ulcer, stage of pressure ulcer, whether the pressure ulcer was single or multiple, length of stay at the hospital, and specialty department, were collected. Results In total, 99 patients met the inclusion criteria, of which 65 (65.7%) were males, while 34 (34.3%) were females. The age of the patients ranged from 15 to 92 years, with a mean age of 59.93 years. Of the patients, 87 (87.9%) had acquired only a single pressure ulcer. Stage 2 pressure ulcers were the most documented, making up 43.1% of the total cases reported, while stage 4 cases were only 3.3%. The sites most frequently affected by pressure ulcers were the gluteal and sacral regions, accounting for 34.4% and 30.3%, respectively. The incidence of pressure ulcers was the highest in the COVID-19 ward, i.e., 25.3%, followed by the neurosurgery ward with a 20.2% incidence. Conclusion Pressure ulcers occur frequently in almost all the specialty departments of a healthcare setting, especially in COVID-19 and neurosurgery wards, and impose significant physical, psychological, and financial burdens. The prevention of pressure ulcers is the best approach to avert patients and their families from all the burdens associated with pressure ulcers.
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Affiliation(s)
- Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Muhammad T Barki
- Neurological Surgery, North West General Hospital and Research Center, Peshawar, PAK
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Karadağ A, Çakar V. Evidence-Based Prevention and Management of Pressure Injuries in Home Care: A Scoping Review. Adv Skin Wound Care 2022; 35:172-179. [PMID: 35188484 DOI: 10.1097/01.asw.0000815484.50141.5d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the presence of evidence-based practice protocols for the prevention and management of pressure injuries (PIs) in home care settings, whether the contents of existing protocols were based on current evidence, and adherence to these protocols. DATA SOURCES Comprehensive and structured literature searches were conducted using PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Ovid, Scopus, Web of Science, and Joanna Briggs Institute Evidence-Based Practice Database. STUDY SELECTION A literature search retrieved 2,929 articles. Investigators evaluated the titles, abstracts, and full texts of the articles retrieved from the literature search in accordance with the review questions and eligibility criteria. The authors included four studies in this scoping review. DATA EXTRACTION The researchers extracted details of the full-text articles, including author(s)/year of publication/country, aim(s), study population and sample size, study design, intervention type, outcomes, and key findings. DATA SYNTHESIS The four articles included in this scoping review are descriptive cross-sectional studies published between 2005 and 2010. Although the articles provided significant data on the quality of practices for the prevention and management of PIs in home care, no studies reported on the achievement of objective results. CONCLUSIONS The use of protocols for the prevention and management of PIs, including evidence-based interventions in home care, and adherence to existing protocols were low. Comprehensive observational and randomized controlled studies are necessary to improve evidence-based prevention and management of PIs in home care settings.
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Affiliation(s)
- Ayişe Karadağ
- At Koç University, Istanbul, Turkey, Ayişe Karadağ, PhD, RN, ET/WOCN, is Professor, School of Nursing; and Vildan Çakar, MS, RN, is Research Assistant, Graduate School of Health Sciences. Acknowledgments: The authors thank Ertaç Nebioğlu, librarian at Koç University Suna Kıraç Library for his assistance, support, and contributions. The authors have disclosed no financial relationships related to this article. Submitted February 18, 2021; accepted in revised form April 16, 2021
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25
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Li Z, Marshall AP, Lin F, Ding Y, Chaboyer W. Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study. Int Wound J 2021; 19:1165-1179. [PMID: 34729917 PMCID: PMC9284631 DOI: 10.1111/iwj.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi-structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient-focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t-test or χ2 test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.
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Affiliation(s)
- Zhaoyu Li
- School of Nursing and Midwifery, Griffith University, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Gocmen Baykara Z, Karadag A, Senol Celik S, Guler S, Ay A, Gul S, Ozturk D, Bulut H, Duluklu B, Karabulut H, Irmak B, Aktas D, Aydogan S, Cebeci F, Karakaya D, Avsar P. Impact of tailored training about pressure injuries on nurses' knowledge levels and pressure injury point prevalence: The case of Turkey. J Tissue Viability 2021; 30:552-558. [PMID: 34686419 DOI: 10.1016/j.jtv.2021.10.003] [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: 09/23/2020] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
AIM This study was conducted to determine the impact of tailored training provided to nurses for preventing pressure injuries (PIs) on nurses' knowledge levels and the PI point prevalence (PP). MATERIALS AND METHODS This interventional study was carried out in a university hospital with a bed capacity of 1114 in an urban center in Turkey. Ethics committee approval (28.06.2018/31) and institutional permission were obtained for the study, in addition to the nurses' written, informed consent. The study was completed in three stages. In the first stage an initial PP study was conducted in the clinics with the participation of the nurses and the members of the research team (n = 422 patients). In the second stage the knowledge levels of 194 nurses were measured before training was given on following-up and preventing PIs. The nurses then participated in the tailored training and their knowledge levels were re-measured afterwards. All the nurses were given individual advice related to the prevention of PIs for 30 days after they had completed the training. In the third stage a second PP study was conducted four months after the first PP study (n = 454 patients). The data were collected using the Pressure Injury Prevalence Form, the Braden Pressure Ulcer Risk Assessment Tool and the Knowledge Level Measurement Form. Descriptive values, the paired samples t-test, Pearson's chi-squared test and Fisher's Exact test were used to evaluate the data. RESULTS The nurses' pretest mean knowledge score was 55.36% ± 14.40 and their posttest mean score was 69.92% ± 9.73. The difference between these scores was statistically significant (p < 0.05). The study found no significant difference between the first PP ratio and the second PP ratio (p > 0.05), and the nurses were better able to evaluate skin and PIs after the training. CONCLUSION The study determined that the tailored training given to the nurses increased their knowledge; however, it had no impact on the PP after four months. It is recommended that any training programs using this model be continued and that PP studies of institutions be conducted annually.
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Affiliation(s)
- Zehra Gocmen Baykara
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | | | | | - Sevil Guler
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ali Ay
- Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
| | - Senay Gul
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Deniz Ozturk
- Department of Nursing, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| | - Hulya Bulut
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Burcu Duluklu
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Hatice Karabulut
- Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Burcin Irmak
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Dilek Aktas
- School of Nursing, Yildirim Beyazit University, Ankara, Turkey
| | - Sinan Aydogan
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Fatma Cebeci
- Faculty of Nursing, Hacettepe University, Ankara, Turkey.
| | | | - Pinar Avsar
- School of Nursing, Yildirim Beyazit University, Ankara, Turkey
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Seong YM, Lee H, Seo JM. Development and Testing of an Algorithm to Prevent Medical Device-Related Pressure Injuries. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211050219. [PMID: 34672226 PMCID: PMC8543706 DOI: 10.1177/00469580211050219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We developed and tested the effectiveness of an algorithm to prevent medical
device–related pressure injuries in intensive care unit patients. It was developed in four
stages: literature review and analysis of medical records; preliminary algorithm
development; validation of the preliminary algorithm by experts in two rounds; and
practical feasibility verification of the revised algorithm by 109 intensive care unit
nurses. To verify the algorithm’s effectiveness, we compared the incidence of medical
device–related pressure injuries between 324 patients without algorithm application
(control group) and 312 patients with algorithm application (experimental group). The
outcomes were skin inspection of the medical device attachment, pressure injury
evaluation, and implementation of pressure injury-preventive nursing care, based on the
medical device type. The incidence rates were 1.46 per 100 devices (control group) and
1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous
score of the Braden scale in the experimental and control groups, the results regarding
the incidence of pressure damage after applying the algorithm should be interpreted with
care. Applying this algorithm was a safe intervention that helped prevent medical
device–related pressure injuries in this population.
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Affiliation(s)
- Yeong-Mi Seong
- 194197Pusan National University Yangsan Hospital, Yangsan,South Korea
| | - Hyejin Lee
- College of Nursing, 34996Pusan National University, Yangsan, South Korea
| | - Ji Min Seo
- College of Nursing, 34996Pusan National University, Yangsan, South Korea
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A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler's Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199992. [PMID: 34639293 PMCID: PMC8507824 DOI: 10.3390/ijerph18199992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022]
Abstract
Insufficient research exists for position change intervals to eradicate pressure ulcers. We tried to provide evidence for the position change interval by comparing peak pressure, risk area ratio, and the time to reach 30 mmHg and 60 mmHg, and presented this in detail, according to the angle in the three positions. The study conducted RCTs on a total of 64 healthy adults. For two hours, interface pressure measurements were compared with 30° and 90° tilting at the inclined, 0° and 45° head-of-bed (HOB) elevation at the supine, and 30° and 45° HOB elevation at the Fowler’s position. The peak pressure on 30° tilting remained less than 60 mmHg for 2 h, unlike 90° tilting. To reach 60 mmHg took 78.18 min at 30° tilting, within 30 min at the 30° supine, 30° and 45° at the Fowler’s position, and 39.55 min at 0° supine. The pressure difference according to the angles was only significant at 30° and 90° tilting, with no difference in the other groups. To prevent pressure ulcers, position changes are required every 2 h in the 30° tilting position, every 1.5 to 2 h at 0° supine, and at least every 1.5 h for all the other positions.
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Tang Z, Li N, Xu J. Construction of a Risk Prediction Model for Intraoperative Pressure Injuries: A Prospective, Observational Study. J Perianesth Nurs 2021; 36:473-479. [PMID: 34417103 DOI: 10.1016/j.jopan.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the incidence and risk factors of intraoperatively acquired pressure injuries (IAPIs) in patients transferred to the intensive care unit (ICU) after surgery and establish a risk factor prediction model for IAPIs for guiding clinical intervention. DESIGN A prospective, observational study was conducted. METHODS This study was conducted in the West China Hospital of Sichuan University. A total of 648 patients who were transferred to the ICU after surgery were recruited from May 1, 2019, to October 30, 2020. Data were collected preoperatively, intraoperatively, and postoperatively (3 days after transfer to the ICU). The enrolled patients underwent well-developed preventive measures to prevent IAPIs in the operating room and ICU. A sociodemographic and clinical characteristic questionnaire, the Braden pressure injuries risk assessment scale, the activity of daily living scale, and the Nutrition Risk Screening-2002 were used. Descriptive, bivariate, and logistic regression analyses were conducted. FINDINGS The incidence rate of IAPIs within 3 days was 18.67%. The Braden pressure injuries score, preoperative fasting blood glucose level, emergency surgery, and types of vasoactive drugs in the ICU were significant factors for increased risk. The risk factor prediction model was established using the perioperative Braden pressure injuries score (P = 0.027, odds ratio [OR] = 0.901), preoperative fasting blood glucose level (P = 0.027, OR = 1.111), emergency surgery (P < 0.01, OR = 5.054), types of vasoactive drugs in the ICU (P = 0.038, OR = 1.668), and surgery time (P = 0.021, OR = 2.434). The area under the receiver operating characteristic curve was 0.74; 95% confidence interval was 0.671 to 0.810; sensitivity was 0.635; specificity was 0.860; and the Youden index was 0.495. CONCLUSIONS In patients transferred to the ICU after surgery, high fasting blood glucose level before surgery, emergency surgery, types of vasoactive drugs, and surgery time should be treated as predisposing factors in the prevention and control of IAPIs. However, the predictive effect of the perioperative Braden pressure injuries risk assessment scale on the risk of IAPIs needs to be further verified.
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Affiliation(s)
- Zhihong Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Na Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Callender LF, Johnson AL, Pignataro RM. Patient-Centered Education in Wound Management: Improving Outcomes and Adherence. Adv Skin Wound Care 2021; 34:403-410. [PMID: 34260418 DOI: 10.1097/01.asw.0000753256.29578.6c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To educate wound care practitioners about methods of communication that can help promote patient adherence to wound healing recommendations. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish the use of theoretical frameworks to promote patient adherence to prescribed wound healing recommendations.2. Synthesize the principles of motivational interviewing to best encourage patients to adhere to prescribed wound healing recommendations.3. Select the appropriate self-care strategies for patients who have nonhealing wounds.
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Evidence-Based Medicine G, Neonatologist S, Chinese Medical Doctor A. [Guidelines for neonatal skin management in the neonatal intensive care unit (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:659-670. [PMID: 34266521 PMCID: PMC8292657 DOI: 10.7499/j.issn.1008-8830.2106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Neonates are easily suffering from local or systematic infections due to their vulnerable skin barrier function, which leads to the increasing risk of death. Therefore, it is important to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU). Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and current evidence, the guidelines for neonatal skin management in the NICU were developed to provide recommendations on routine skin care and prevention and treatment of iatrogenic skin injury of neonates for health care providers.
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Lin YH, Chen YC, Cheng KS, Yu PJ, Wang JL, Ko NY. Higher Periwound Temperature Associated with Wound Healing of Pressure Ulcers Detected by Infrared Thermography. J Clin Med 2021; 10:jcm10132883. [PMID: 34209633 PMCID: PMC8269037 DOI: 10.3390/jcm10132883] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/25/2022] Open
Abstract
Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2–4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that result was also associated with better wound-healing (p = 0.002). Wound-bed and periwound temperatures differed significantly with the grade of the pressure ulcer, and a high periwound temperature was positively correlated with wound healing. Infrared thermography can objectively serve as indicators for assessing pressure-ulcer healing.
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Affiliation(s)
- Yen-Hsi Lin
- Department of Nursing, National Cheng Kung University Hospital, Tainan 701, Taiwan; (Y.-H.L.); (Y.-C.C.)
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, Tainan 701, Taiwan; (Y.-H.L.); (Y.-C.C.)
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Kuo-Sheng Cheng
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
| | - Po-Jui Yu
- Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Jiun-Ling Wang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 701, Taiwan
- Correspondence: (J.-L.W.); (N.-Y.K.); Tel.: +886-6-2353535 (ext. 4703) (J.-L.W.); +886-6-2353535 (ext. 5838) (N.-Y.K.)
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, Tainan 701, Taiwan; (Y.-H.L.); (Y.-C.C.)
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Correspondence: (J.-L.W.); (N.-Y.K.); Tel.: +886-6-2353535 (ext. 4703) (J.-L.W.); +886-6-2353535 (ext. 5838) (N.-Y.K.)
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Zhang Y, Zhuang Y, Shen J, Chen X, Wen Q, Jiang Q, Lao Y. Value of pressure injury assessment scales for patients in the intensive care unit: Systematic review and diagnostic test accuracy meta-analysis. Intensive Crit Care Nurs 2021; 64:103009. [PMID: 33640238 DOI: 10.1016/j.iccn.2020.103009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To review and examine the evidence of the value of pressure injury risk assessment scales in intensive care patients. RESEARCH METHODOLOGY We searched MEDLINE, Embase, CINAHL, Web of Science, the Cochrane Library, China Biomedical Literature Service System, VIP Database and CNIK from inception to February 2019. Two reviewers independently assessed articles' eligibility and risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-II (QUADAS-2). We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy. RESULT Twenty-four studies were included, involving 16 scales and 15,199 patients in intensive care settings. Results indicated that the top four risk assessment scales were the Cubbin & Jackson Index (SEN = 0.84, SPE = 0.84, AUC = 0.90), the EVRUCI scale (SEN = 0.84, SPE = 0.68, AUC = 0.82), the Braden scale (SEN = 0.78, SPE = 0.61, AUC = 0.78), the Waterlow scale (SEN = 0.63, SPE = 0.46, AUC = 0.56). The Norton scale and the other eleven scales were tested in less than two studies and need to be further researched. CONCLUSION The Braden scale, most frequently used in hospitals, is not the best risk assessment tool for critically ill patients. The Cubbin & Jackson Index has good diagnostic test accuracy. However, low quality of evidence and important heterogeneity were observed.
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Affiliation(s)
- Yi Zhang
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 311500, China; School of Medicine, Huzhou University, Huzhou Central Hospital, No. 759, East 2nd Road, Huzhou 313000, China
| | - Yiyu Zhuang
- Department of Nursing, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 311500, China
| | - Jiantong Shen
- Branch Center of Chinese Cochrane Center, Huzhou University, Huzhou 313000, China; School of Medicine, Huzhou University, Huzhou Central Hospital, No. 759, East 2nd Road, Huzhou 313000, China.
| | - Xianggping Chen
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 311500, China
| | - Qiuyue Wen
- School of Medicine, Huzhou University, Huzhou Central Hospital, No. 759, East 2nd Road, Huzhou 313000, China
| | - Qi Jiang
- School of Medicine, Huzhou University, Huzhou Central Hospital, No. 759, East 2nd Road, Huzhou 313000, China
| | - Yuewen Lao
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 311500, China
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Scientific and Clinical Abstracts From WOCNext® 2021: An Online Event ♦ June 24-26, 2021. J Wound Ostomy Continence Nurs 2021; 48:S1-S49. [PMID: 37632236 DOI: 10.1097/won.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Song J, Gao Y, Yin P, Li Y, Li Y, Zhang J, Su Q, Fu X, Pi H. The Random Forest Model Has the Best Accuracy Among the Four Pressure Ulcer Prediction Models Using Machine Learning Algorithms. Risk Manag Healthc Policy 2021; 14:1175-1187. [PMID: 33776495 PMCID: PMC7987326 DOI: 10.2147/rmhp.s297838] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose Build machine learning models for predicting pressure ulcer nursing adverse event, and find an optimal model that predicts the occurrence of pressure ulcer accurately. Patients and Methods Retrospectively enrolled 5814 patients, of which 1673 suffer from pressure ulcer events. Support vector machine (SVM), decision tree (DT), random forest (RF) and artificial neural network (ANN) models were used to construct the pressure ulcer prediction models, respectively. A total of 19 variables are included, and the importance of screening variables is evaluated. Meanwhile, the performance of the prediction models is evaluated and compared. Results The experimental results show that the four pressure ulcer prediction models all achieve good performance. Also, the AUC values of the four models are all greater than 0.95. Besides, the comparison of the four models indicates that RF model achieves a higher accuracy for the prediction of pressure ulcer. Conclusion This research verifies the feasibility of developing a management system for predicting nursing adverse event based on big data technology and machine learning technology. The random forest and decision tree model are more suitable for constructing a pressure ulcer prediction model. This study provides a reference for future pressure ulcer risk warning based on big data.
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Affiliation(s)
- Jie Song
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yuan Gao
- First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Pengbin Yin
- Fouth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yi Li
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yang Li
- First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jie Zhang
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qingqing Su
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Xiaojie Fu
- First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Cai F, Jiang X, Hou X, Wang D, Wang Y, Deng H, Guo H, Wang H, Li X. Application of infrared thermography in the early warning of pressure injury: A prospective observational study. J Clin Nurs 2021; 30:559-571. [PMID: 33258199 DOI: 10.1111/jocn.15576] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To verify the ability of infrared thermography in objectively identifying pressure injury and its application value in the early warning of pressure injury. BACKGROUND There is subjectivity in assessing the risk of pressure injury as well as diagnosis in clinical settings, which makes early detection and prevention difficult. DESIGN Prospective, cohort study. METHOD Four hundred and fifteen patients admitted to the adult intensive care units were enrolled by a convenience sampling method, and they received a follow-up monitoring for 10 days. The risk of pressure injury was assessed via Braden scale, and thermal images of sacral area were obtained by infrared thermal imager once a day. The predictive effects of infrared thermography and Braden scale on pressure injury were compared by the receiver operating characteristic curve from which the optimal cut-off value of skin temperature for predicting pressure injury was determined. The effect of skin temperature on pressure injury was described and compared, using Kaplan-Meier curve and Cox proportional hazard regression model, respectively. We followed STROBE checklist for reporting the study. RESULTS The relative temperature of sacral area was negatively correlated with the risk of pressure injury. The efficiency of infrared thermography for diagnosing pressure injury was better than that of Braden scale. Based on the relative temperature optimal cut-off value (-0.1°C), Kaplan-Meier curve and Cox proportional hazard regression model analysis showed the incidence of pressure injury with relative temperature below -0.1°C was higher than the group with relative temperature above -0.1°C. CONCLUSIONS Infrared thermography can objectively and accurately identify local hypothermia warnings of pressure injury before visual recognition. The application of infrared thermography into routine pressure injury risk assessment provides a timely and reliable method for nursing practitioners. RELEVANCE TO CLINICAL PRACTICE Infrared thermography has great value of clinical application in daily pressure injury assessment. It is of great significance to make a faster and more objective clinical judgement for patients at risk of pressure injury.
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Affiliation(s)
- Fuman Cai
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China.,School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiaoqiong Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiangqing Hou
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yu Wang
- Medical Engineering Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haisong Deng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hailei Guo
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haishuang Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
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Choi YH, Kim SR. The effect of uncoated paper application on skin moisture, risk of pressure injury and incidence of pressure injury in neurologic intensive care unit patients: A randomized controlled trial. Int J Nurs Pract 2021; 27:e12919. [PMID: 33462904 DOI: 10.1111/ijn.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/25/2020] [Accepted: 01/01/2021] [Indexed: 12/11/2022]
Abstract
AIM This study aimed to evaluate the effects of uncoated paper on skin moisture, pressure injury risk and pressure injury incidence in neurological intensive care unit patients. METHODS A randomized controlled design was used. The experimental group (n = 68) received usual care (repositioning every 2 h and use of an air mattress) and application of uncoated paper on the sacral area for 5 days, whereas the control group (n = 67) received only usual care. A repeated measures analysis of variance was used to determine changes in the skin moisture and risk of pressure injury between the groups. A chi-squared test was used to determine the change in the incidence of pressure injuries for sacral area. Data were collected from 20 October 2017 to 6 March 2018. RESULTS There were statistically significant differences in the skin moisture and risk of pressure injuries between the experimental and control groups. However, a significant difference was not observed in the incidence of pressure injuries between the groups. CONCLUSION The use of uncoated paper may be a valid nursing intervention for the prevention of pressure injuries in neurological intensive care unit patients.
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Affiliation(s)
- Yoo-Hyung Choi
- Department of Nursing, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung Reul Kim
- College of Nursing, Korea University, Seoul, Republic of Korea
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The Role of Physical and Occupational Therapy in Pressure Injury Prevention. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide appropriate dressing and treatment selection. The interprofessional team, patient, and family should collaborate to create a plan of care for wound healing.
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Affiliation(s)
- Andrea L Roufogalis
- Wound Care Team, VA Puget Sound Healthcare System, 1660 South Columbian Way, B1 R330 Seattle WA 98108, USA
| | - Melissa L Hutchinson
- Wound Care Team, VA Puget Sound Healthcare System, 1660 South Columbian Way, B1 R330 Seattle WA 98108, USA.
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Abstract
Patients in critical care units have a multitude of diseases and conditions that contribute to their illness and as such are susceptible to comorbid conditions such as heel pressure injuries. Prevention is a key strategy to avoid heel pressure injury occurrence. Risk factor identification can help a clinician identify those patients at risk for a heel pressure injury requiring timely prevention strategies. The purpose of this article is to raise awareness regarding the critical care patient's vulnerability to heel pressure injuries and strategies that can help avoid their occurrence or expedite their healing if occur.
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Wei M, Yang D, Chen L, Wu L, Jiang Q, Niu N, Yang T. The prevalence and prevention of pressure ulcers: A multicenter study of nine nursing homes in eastern China. J Tissue Viability 2020; 30:133-136. [PMID: 33139158 DOI: 10.1016/j.jtv.2020.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022]
Abstract
AIM To assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China. MATERIALS AND METHODS In this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019. RESULTS Of the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes. CONCLUSIONS The prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.
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Affiliation(s)
- Min Wei
- Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | | | - Lu Chen
- Nursing Department Office, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Qixia Jiang
- Wound Care Center of Outpatient Department, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Niu Niu
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ting Yang
- Jiangsu College of Nursing, Huaian, Jiangsu, China
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Wound Healing in the Long-Term Acute Care Setting Using an Air Fluidized Therapy/Continuous Low-Pressure Therapeutic Bed: A Multiple Case Series. J Wound Ostomy Continence Nurs 2020; 47:284-290. [PMID: 32384532 DOI: 10.1097/won.0000000000000646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated a new bed that updates the functionality of the current air fluidized therapy (AFT)/continuous low-pressure (CLP) pressure redistributing beds. This bed was evaluated in conjunction with standard wound care interventions in a long-term acute care hospital (LTACH). The AFT feature is designed to provide pressure distribution via a fluid-like medium that forces air though millions of tiny silicone beads that float the patient's body to achieve maximum immersion and envelopment. The CLP feature of the bed provides pressure distribution for the upper body. Standard wound care was provided that included debridement, topical treatments, and biophysical therapies such as negative pressure wound therapy, as indicated. CASES Our multiple case series comprised 10 medically compromised patients with 25 wounds. Their mean age was 63 years, 50% were male, and the mean cumulative Braden Scale score was 12.4 out of 23, indicating a high risk for pressure injury (PI). Seven of 10 patients were incontinent of urine, 6 had fecal incontinence, and 2 had ostomies. Types of wounds treated included 2 large tissue defects from surgical excisions for the treatment of gangrene and 23 PIs. On admission, wounds had an average surface area of 139.1 cm. The mean percentage of reduction in wound surface area was 59.3% over an average of 31.3 days of therapy. No new wounds formed during their course of care despite being at elevated risk. CONCLUSIONS Findings from this multiple case series suggest that the AFT/CLP bed facilitates healing of advanced wounds in medically complex patients when included as part of a wound care program. Despite mild to high risk, no new PIs developed, and severe PIs and large tissue defects significantly improved or completely resolved. One hundred percent of surveyed staff members recommend use of the AFT/CLP bed.
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duan H, Li H, Liu H, Zhang H, Liu N, Dong Q, Li Z. Extracorporeal shockwave therapy combined with alginate dressing for treatment of sacroiliac decubital necrosis in older adults: A case report. Medicine (Baltimore) 2020; 99:e19849. [PMID: 32384429 PMCID: PMC7220157 DOI: 10.1097/md.0000000000019849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Pressure sores are major clinical problems with limited treatment options. PATIENT CONCERN A 62-year-old man, admitted with unresponsive, indifferent mood, and malnutrition. A noval-shaped skin lesion deeping into the fascia was found in the sacrococcygeal region. DIAGNOSIS The patient was diagnosed with delayed carbon monoxide poisoning encephalopathy and stage IV sacrococcygeal pressure sores. INTERVENTION The patient received neurologic rehabilitation therapy and simple debridement dressing care followed by extracorporeal shockwave therapy. OUTCOMES The scores for the pressure ulcer healing scale were 17 points, 13 points, 9 points, and 5 points, respectively, before treatment and at the 4-, 8-, and 12-week follow-ups. At 2 weeks after discharging the total pressure ulcer healing scale score was 0, which signifies that the sacroiliac decubital necrosis healed without adverse reactions and side effects. LESSONS This study presents a therapeutic solution for treating older adults with pressure ulcers by using extracorporeal shockwave with alginate dressing, which proved effective and safe.
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Competent Patient Refusal of Nursing Care: An Innovative Approach to a Complex Problem. J Wound Ostomy Continence Nurs 2020; 46:390-395. [PMID: 31513125 DOI: 10.1097/won.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pressure injury development results in significant morbidity and costs. Despite well-defined guidelines, nurses are frequently faced with subtle and overt patient resistance when implementing prevention strategies. Case law and hospital policies guide decision making when confronted with refusal of medical care; however, there are limited recommendations that guide competent patient refusal of nursing care. This article presents findings of an integrative literature review and idea-generating forum about competent patient refusal of nursing care. Emerging topics from the literature review were mirrored in responses generated during the innovation forum; responses from the forum confirmed the clinical relevance of the issue and the lack of resources to guide care in this area for approach.
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Assessment and Management of Pressure Injuries. J Wound Ostomy Continence Nurs 2020; 47:190-192. [DOI: 10.1097/won.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how the system can improve to reduce the number and severity of pressure injuries. The process of RCA begins with being certain the wound is a pressure injury using differential diagnoses of similar appearing skin disease and injury, followed by an examination of the processes of care (human roots) for missed actions or inactions that are linked to development of a particular pressure injury. The final step of RCA is a critical examination of the system (including people and processes) to look for modifiable trends or patterns are identified that are used to prevent recurrences.
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Seo Y, Roh YS. Effects of pressure ulcer prevention training among nurses in long-term care hospitals. NURSE EDUCATION TODAY 2020; 84:104225. [PMID: 31698290 DOI: 10.1016/j.nedt.2019.104225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/27/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nurses caring for elderly patients with a high risk of pressure ulcer at long-term care hospitals require the necessary knowledge, behaviors, and attitudes regarding preventing pressure ulcers. OBJECTIVES To identify the effects of pressure ulcer prevention training on nurses' knowledge, behaviors, and attitudes regarding pressure ulcer prevention. DESIGN A comparison group pretest-posttest design. SETTINGS Long-term care hospitals in a metropolitan area of the Republic of Korea. PARTICIPANTS Participants were conveniently assigned to team-based learning (n = 30) or lecture-based learning (n = 30) groups. METHODS We examined pre-post differences in the scores for pressure ulcer prevention knowledge, behaviors, and attitudes in each group using the paired t-test. Additionally, pre-post difference scores were compared between the two groups using the independent samples t-test. RESULTS Both groups exhibited significant increases in scores for pressure ulcer prevention knowledge, behaviors, and attitudes after the intervention as compared before it. However, we found no significant differences in the pre-post difference scores for any of the variables between the two groups. CONCLUSIONS Pressure ulcer prevention training, regardless of whether it utilizes team-based or lecture-based learning, is useful for enhancing nurses' pressure ulcer prevention knowledge, behaviors, and attitudes. Further study is needed to verify the longitudinal effects of pressure ulcer prevention training on nurses' actual performance and the incidence of pressure ulcers among patients.
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Affiliation(s)
- Yukyeong Seo
- Graduate School of Nursing and Health Professions, Chung-Ang University, Seoul, Republic of Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
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Abstract
BACKGROUND Validated perioperative pressure injury (PI) risk assessment measures are few and often cumbersome to complete, leading to missed opportunities to identify and target prevention interventions to those patients at increased risk for developing a postsurgical PI. OBJECTIVES Previous validation of a six-item perioperative risk assessment measure for skin (PRAMS) was conducted in our community hospital with positive findings. The purpose of this study was to increase generalizability by revalidating the PRAMS in a larger sample. METHODS This was a retrospective chart review of all surgical patients aged ≥18 years positioned in the supine or lateral position in a Midwest quaternary care, multispecialty, 1,500-bed hospital during a 6-month period (n = 1,526). The intent of the study was to revalidate the PRAMS. The main outcome of interest was the development of PI after surgery. Risk indicators of interest included diabetes, age, surgical time, Braden score, previous surgery, and preexisting PI. The diagnostic ability of any of the risk indicators on the development of a postsurgical PI was evaluated using sensitivity, specificity, and predictive values. RESULTS Postsurgical PIs occurred in 121 patients. Comparing current to previous study results, the PRAMS was effective in identifying surgical patients at risk for PI (sensitivity = .98). Those patients with a postsurgical PI had a lower mean Braden score, were more likely to have a preexisting PI, and were more likely to have a previous surgery during the same admission (p < .001 for all risk indicators), comparing favorably to the original study. Patients without risk indicators were unlikely to develop a postsurgical PI (negative predictive value = .98). DISCUSSION Results of this validation study demonstrate that the PRAMS is effective in identifying patients who developed a postsurgical PI using information readily available to the perioperative staff.
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Differentiating Deep Tissue Pressure Injury (DTPI) From Other Causes of Purpura in the Sacrococcygeal Area: A Multiple Case Series. J Wound Ostomy Continence Nurs 2019; 46:256-262. [PMID: 31083070 DOI: 10.1097/won.0000000000000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent revisions to the pressure injury staging system include guidance on differential diagnoses for deep tissue pressure injury (DTPI). Accurately identifying DTPI is critical; however, purpura in the setting of vascular disorders and systemic infectious processes can share similar features confounding diagnosis. CASES In this three-case series, we describe suspected DTPI with an uncharacteristic shape or occurring in the presence of additional lesions distributed outside of typical pressure areas prompted further evaluation. CONCLUSIONS The interdisciplinary approach we adapted was useful in determining the cause of purpura when the DTPI was ruled out by the certified wound care nurse.
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