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Daibes MA, Iblasi AS, Demir Korkmaz F, Oden TN, Elagoz I. Assessing pressure injury knowledge among Jordanian and Turkish nursing students: A cross-cultural comparison. J Tissue Viability 2024:S0965-206X(24)00112-8. [PMID: 39034258 DOI: 10.1016/j.jtv.2024.07.007] [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: 05/22/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
AIM Pressure injuries, a prevalent issue in healthcare settings, have profound physical and emotional implications for patients and healthcare providers. However, further evidence is needed regarding the level of nursing students' knowledge of pressure injuries in the Middle East, a region where healthcare is rapidly evolving. This study examines the knowledge levels regarding pressure injuries among nursing students in Jordan and Turkey. MATERIALS AND METHODS This cross-sectional study collected data from a randomly selected sample of 282 nursing students studying in two private and two Public Universities in Turkey and Jordan. Data was collected using a demographic survey and the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). RESULTS The overall knowledge scores among students were alarmingly low, with significant differences between Jordanian and Turkish cohorts, with Turkish students scoring higher. Moreover, a significant difference was observed between students' knowledge levels from public and private universities in Jordan, but no difference was found between students of the two Turkish universities. CONCLUSION The knowledge gap among nursing students regarding pressure ulcers is a critical issue that needs immediate attention. These findings highlight the urgent need for improved educational strategies and standardized competencies in this aspect. This study strongly advocates for changing teaching strategies and incorporating evidence-based pressure injury prevention education into nursing curricula, interprofessional education initiatives, and continuous professional development for faculty. These measures can significantly enhance nursing students' knowledge and improve patient care.
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Affiliation(s)
- Mayada A Daibes
- School of Nursing, German Jordanian University, B.O Box: 35247, Amman, 11180, Jordan.
| | | | - Fatma Demir Korkmaz
- Department of Surgical Nursing, Ege University, Faculty of Nursing, Izmir, Turkey.
| | - Tugba Nur Oden
- Department of Organ Transplantation Center, Ege University Hospital, Izmir, Turkey.
| | - Islam Elagoz
- Department of Nursing, Yusuf Şerefoğlu Faculty of Health Sciences, Kilis 7Aralık University, Kilis, Turkey.
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Deng G, Lei Y, Tan H, Geng B, Liu Z. Effects of predictive nursing interventions on pressure ulcer in elderly bedridden patients. Int Wound J 2024; 21:e14690. [PMID: 38453139 PMCID: PMC10920028 DOI: 10.1111/iwj.14690] [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: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 03/09/2024] Open
Abstract
The study explores the impact of predictive nursing interventions on pressure ulcers (PUs) in elderly bedridden patients. A total of 120 elderly bedridden patients from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between August 2019 and August 2023 were selected as the subjects of the study and were randomly divided into an observation group and a control group using a random number table method. The control group received conventional nursing care, while the observation group received predictive nursing interventions. The study compared the incidence of PUs, Braden scale scores, the onset time of PUs, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, and nursing satisfaction between the two groups. In elderly bedridden patients, the application of predictive nursing interventions significantly reduced the incidence of PUs (p < 0.001), significantly lowered the SAS and SDS scores (p < 0.001), and also significantly increased Braden scale scores (p < 0.001) and delayed the onset time of PUs (p < 0.001). Additionally, it improved patients' nursing satisfaction (p = 0.008). Predictive nursing interventions in elderly bedridden patients have good application effects, reducing the occurrence of PUs, delaying the time of onset in patients, improving patients' negative emotions and enhancing nursing satisfaction rates. It is worthy of widespread use.
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Affiliation(s)
- Gui‐Liu Deng
- Department of General MedicineThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Yu‐Ling Lei
- School of NursingHangzhou Normal UniversityHangzhouChina
| | - Hui Tan
- Department of General MedicineThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Bing‐Chao Geng
- Department of GeratologyChongqing General HospitalChongqingChina
| | - Zhen Liu
- Department of AcupunctureChongqing Traditional Chinese Medicine HospitalChongqingChina
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L Cortés O, M Vásquez S. Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e07. [PMID: 39083819 PMCID: PMC11290892 DOI: 10.17533/udea.iee.v42n1e07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/14/2024] [Indexed: 08/02/2024]
Abstract
Objective This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.
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Affiliation(s)
- Olga L Cortés
- Nurse, PhD. Associate researcher, Department of Research and Nursing. Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
| | - Skarlet M Vásquez
- Nurse, Master's. Associate professor, Nursing Program, Universidad Autónoma de Bucaramanga, Floridablanca, Colombia.
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Zeng M, Li Y, Hu J, Peng M, Hu Y, Zhou C. Effect of various repositioning regimens on pressure wound ulcer occurrence in at-risk adult persons without existing pressure wound ulcers: A meta-analysis. Int Wound J 2023; 20:3776-3785. [PMID: 37381159 PMCID: PMC10588354 DOI: 10.1111/iwj.14277] [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: 05/19/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
Meta-analysis research was implemented to appraise the effect of various repositioning regimens (RRs) on pressure wound ulcer (PWU) occurrence in at-risk adult persons without existing PWUs. Inclusive literature research till April 2023 was done and 1197 interconnected researches were revised. The 15 picked researches, enclosed 8510 at-risk adult persons without existing PWUs persons were in the utilised researchers' starting point, 1002 of them were utilising repositioning, 1069 were control, 3443 were utilising 2-<4 h repositioning and 2994 were utilising 4-6 h repositioning. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of various RRs on PWU occurrence in at-risk adult persons without existing PWUs by the dichotomous approach and a fixed or random model. Repositioning had significantly lower PWU (OR, 0.49; 95% CI, 0.32-0.73, p < 0.001) compared to control in at-risk adult persons without existing PWUs persons. 2-<4 h repositioning had significantly lower PWU (OR, 0.62; 95% CI, 0.42-0.90, p = 0.01) compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. Repositioning had significantly lower PWU compared to control in at-risk adult persons without existing PWU persons. 2-<4 h repositioning had significantly lower PWU compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of some of the chosen research found for the comparisons in the meta-analysis.
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Affiliation(s)
- Mei Zeng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yuan Li
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Juan Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Miao Peng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yingchun Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Chengli Zhou
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
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Tervo-Heikkinen T, Heikkilä A, Koivunen M, Kortteisto T, Peltokoski J, Salmela S, Sankelo M, Ylitörmänen T, Junttila K. Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study. BMC Nurs 2023; 22:198. [PMID: 37303039 DOI: 10.1186/s12912-023-01369-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/06/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Several nursing interventions for pressure injury prevention have been identified, including risk and skin status assessment. The aim of this study was to explore prevention of pressure injuries in Finnish acute inpatient care. The data were collected on pressure injury risk and skin status assessments, repositioning, the use of support surfaces, preventive skin care, malnutrition risk assessment, and nutritional care. METHODS This multicentre, cross-sectional study was conducted in 16 acute care hospitals, excluding psychiatric care. Adult patients from inpatient care were recruited on the annual international Stop Pressure Ulcers Day in 2018 and 2019. Enrolment covered 6,160 participants in 503 units. Descriptive statistics were used to describe pressure injuries, risk assessments, and preventive nursing interventions. Cross tabulation, Pearson's chi-square and Fisher's exact tests were also used. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS In all, 30% of the participants had their pressure injury risk assessed during the care, and for 19% within 8 h after admission. The same time limit in risk assessment was fulfilled for 16% of the participants with a pressure injury, and 22% of the participants using a wheelchair or being bedridden. A skin status assessment within 8 h after admission was conducted for 30% of all participants, and for 29% of the participants with a pre-existing pressure injury, and for 38% of the participants using a wheelchair or being bedridden. The risk of malnutrition was screened in 20% of the participants. Preventive interventions were targeted to participants with a pressure injury instead of patients with a high-pressure injury risk. CONCLUSION This study adds evidence about pressure injury risk assessments and the implementation of preventive nursing interventions in Finnish acute care. Skin status and pressure injury risk assessments were irregularly conducted, and the outcome was not used by nurses to guide the implementation of preventive interventions. The results reveal the gaps in evidence-based nursing practice, which require further efforts to prevent pressure injuries. Improving the national focus on pressure injury prevention practice is critical for improving healthcare for our patients.
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Affiliation(s)
- Tarja Tervo-Heikkinen
- Wellbeing Services County of North Savo, Kuopio University Hospital, PO Box 1711, Kuopio, FI70211, Finland.
| | - Anniina Heikkilä
- Helsinki University Hospital and University of Helsinki. Group Administration, FI00029 HUS. Helsinki, PO Box 705, Helsinki, Finland
| | - Marita Koivunen
- Wellbeing Services County of Satakunta, Department of Nursing Science, Pori, Finland, and University of Turku, Sairaalantie 3, Turku, FI28500, Finland
| | - Tiina Kortteisto
- Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Elämänaukio 2, PO Box 2000, Tampere, FI33521, Finland
| | - Jaana Peltokoski
- Wellbeing Services County of Central Finland, Hoitajantie 3, Jyväskylä, FI40620, Finland
| | - Susanne Salmela
- Wellbeing Services County of Ostrobothnia, Korsholmanpuistikko 44, Vaasa, FI65100, Finland
| | - Merja Sankelo
- Wellbeing Services County of South Ostrobothnia, Hanneksenrinne 7, Seinäjoki, FI60220, Finland
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tuija Ylitörmänen
- Finnish Institute for Health and Welfare, PO Box 30, Helsinki, FI00271, Finland
| | - Kristiina Junttila
- Helsinki University Hospital and University of Helsinki, HUS Nursing Research Center, PO Box 442, Helsinki, FI00029 HUS, Finland
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Liu S, Ostadabbas S. Pressure eye: In-bed contact pressure estimation via contact-less imaging. Med Image Anal 2023; 87:102835. [PMID: 37150066 DOI: 10.1016/j.media.2023.102835] [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: 08/25/2021] [Revised: 06/03/2022] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Computer vision has achieved great success in interpreting semantic meanings from images, yet estimating underlying (non-visual) physical properties of an object is often limited to their bulk values rather than reconstructing a dense map. In this work, we present our pressure eye (PEye) approach to estimate contact pressure between a human body and the surface she is lying on with high resolution from vision signals directly. PEye approach could ultimately enable the prediction and early detection of pressure ulcers in bed-bound patients, that currently depends on the use of expensive pressure mats. Our PEye network is configured in a dual encoding shared decoding form to fuse visual cues and some relevant physical parameters in order to reconstruct high resolution pressure maps (PMs). We also present a pixel-wise resampling approach based on Naive Bayes assumption to further enhance the PM regression performance. A percentage of correct sensing (PCS) tailored for sensing estimation accuracy evaluation is also proposed which provides another perspective for performance evaluation under varying error tolerances. We tested our approach via a series of extensive experiments using multimodal sensing technologies to collect data from 102 subjects while lying on a bed. The individual's high resolution contact pressure data could be estimated from their RGB or long wavelength infrared (LWIR) images with 91.8% and 91.2% estimation accuracies in PCSefs0.1 criteria, superior to state-of-the-art methods in the related image regression/translation tasks.
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Affiliation(s)
- Shuangjun Liu
- Augmented Cognition Lab, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Sarah Ostadabbas
- Augmented Cognition Lab, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA.
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Al-Moteri M. Evidence-based information-seeking behaviors of nursing students: Concurrent think aloud technique. Heliyon 2023; 9:e15549. [PMID: 37128317 PMCID: PMC10148032 DOI: 10.1016/j.heliyon.2023.e15549] [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: 11/12/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Background With the expansion of scientific information, and the beginning of evidence-based practice (EBP), embracing "evidence-based information-seeking behaviors" is essential to provide effective up-to-date nursing care. To better support students' evidence-based information-seeking behaviors, this study explores how nursing students actually search and identify evidence-based information. Methods A concurrent think aloud technique was employed in which 12 nursing students were asked to verbalize their thoughts whilst using search engines to find EBP to inform their practice. Results In general, searching literature per se is complex and many different searching activities are employed, including triggering, recalling, scanning, linking, accessing, retrieving, relating, extracting, evaluating and referencing. The search behavior may involve some iteration of the cyclical activities of scanning, linking and accessing. It is believed that background (recalling pre-existing knowledge), assessing relevancy, evaluating and referencing are pertinent to evidence-based practice information-seeking behavior. In view of this, the study proposes a new model of evidence-based information-seeking behaviors. Conclusion This study presents an evidence-based information-seeking behavior model based on a number of identified searching features. Results may have important practical implications for nursing educators.
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Affiliation(s)
- Modi Al-Moteri
- Taif University, P.O. Box 888, Hawiyah, Taif, Saudi Arabia.
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8
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Daigné D, Blanchard PY, Allain MC, Lambert G, Rodriguez S, Tessier B, Blayau C, Voiriot G, Bérard L, Rousseau A, Fartoukh M. Feasibility of a repositioning schedule on pressure ulcer prevention in a French Intensive Care Unit: A pre and post-intervention pilot study. J Tissue Viability 2023; 32:20-25. [PMID: 36599729 DOI: 10.1016/j.jtv.2022.12.007] [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: 06/29/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
AIMS As a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale. DESIGN A single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines. METHODS During the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers' adherence and workload, and the rate of adverse events. RESULTS In the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90). CONCLUSION A personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial.
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Affiliation(s)
- Daisy Daigné
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Pierre-Yves Blanchard
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Marie-Cécile Allain
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Gwendoline Lambert
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Séverine Rodriguez
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Benjamin Tessier
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Clarisse Blayau
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Guillaume Voiriot
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
| | - Laurence Bérard
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Paris, France.
| | - Alexandra Rousseau
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Paris, France.
| | - Muriel Fartoukh
- Assistance Publique - Hôpitaux de Paris. Sorbonne Université, DMU APPROCHES, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France.
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Li J, Zhu C, Liu Y, Li Z, Sun X, Bai Y, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Critical care nurses' knowledge, attitudes, and practices of pressure injury prevention in China: A multicentric cross-sectional survey. Int Wound J 2022; 20:381-390. [PMID: 35906851 PMCID: PMC9885482 DOI: 10.1111/iwj.13886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen-item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low-level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Ying Liu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Zhaoyu Li
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Xiangyu Sun
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yunfeng Bai
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Baoyun Song
- Department of NursingHenan Provincial People's HospitalZhengzhouChina
| | - Jingfen Jin
- Department of NursingZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Yilan Liu
- Department of NursingWuhan Union HospitalWuhanChina
| | - Xianxiu Wen
- Department of NursingSichuan Academy of Medical Sciences and Sichuan People's HospitalChengduChina
| | - Shouzhen Cheng
- Department of NursingSun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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Mamom J, Daovisan H. Repositioning mattress: how a lateral tilt position reshapes the prevention of pressure ulcers in bedridden patients. J Med Eng Technol 2022; 46:658-669. [PMID: 35801990 DOI: 10.1080/03091902.2022.2094007] [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: 01/11/2023]
Abstract
Pressure ulcers have been part of tissue damage without effectiveness in medical, surgical, and intensive care units. This study aims to focus on developing lateral tilt positions for effective pressure ulcer relief for bedridden patients. A repositioning mattress was placed in the side-lying left lateral tilt position (15°, 30°, 45°), sheering (0.680, 1.323, 1.870), interface pressure (2.550, 2.290, 2.830), and placed at 1.5 m long piece of polyethylene rubber. The design strength was set at 6000 N and 2100 mm x 1105 mm (σt,0,d = 42, σc,0,d = 34). The design shows the greatest supine position at 30°, 1.323, 2.290, pressure load (Δp0 = 1.125 (1820) ≈ 2050 psi, Δp3000 = 1.125 (620) ≈ 700 psi), tensile stress (σt,0,d (MPa) = 42), compressive stress (σc,0,d (MPa) = 34), and FOS (σt,0,d = 42, σc,0,d = 34). The factor of safety illustrated that the 30° lateral tilt position is more consistent in repositioning for pressure ulcer prevention compared to the supine-to-tilt region. Further, an application of repositioning mattresses was developed to test in bedridden patients with tissue ulcers in nursing homes.
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Affiliation(s)
- Jinpitcha Mamom
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Pathum Thani, Thailand.,Department of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, Pathum Thani, Thailand
| | - Hanvedes Daovisan
- Human Security and Equity Research Unit, Chulalongkorn University Social Research Institute, Chulalongkorn University, Bangkok, Thailand
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Langemo D, Anderson J, Hanson D, Thompson P, Johnson E. The Conundrum of Turning/Repositioning Frequency, Sleep Surface Selection, and Sleep Disruption in Preventing Pressure Injury in Healthcare Settings. Adv Skin Wound Care 2022; 35:252-259. [PMID: 35442917 DOI: 10.1097/01.asw.0000824780.10098.d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing and Professional Development, University of North Dakota, Grand Forks, United States. Julie Anderson, PhD, RN, is Dean, Winona State University, Minnesota. Also at the University of North Dakota, Darlene Hanson, PhD, RN, is Clinical Professor, College of Nursing and Professional Development; Patricia Thompson, MS, RN, is Clinical Assistant Professor, College of Nursing and Professional Development; and Erika Johnson, MLIS, is Clinical Campus Librarian, School of Medicine and Health Sciences. Submitted June 8, 2021; accepted in revised form October 20, 2021
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12
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Posture Monitoring for Health Care of Bedridden Elderly Patients Using 3D Human Skeleton Analysis via Machine Learning Approach. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For bedridden elderly people, pressure ulcer is the most common and serious complication and could be prevented by regular repositioning. However, due to a shortage of long-term care workers, repositioning might not be implemented as often as required. Posture monitoring by using modern health/medical caring technology can potentially solve this problem. We propose a RGB-D camera system to recognize the posture of the bedridden elderly patients based on the analysis of 3D human skeleton which consists of articulated joints. Since practically most bedridden patients were covered with a blanket, only four 3D joints were used in our system. After the recognition of the posture, a warning message will be sent to the caregiver for assistance if the patient stays in the same posture for more than a predetermined period (e.g., two hours). Experimental results indicate that our proposed method is capable of achieving a high accuracy in posture recognition (above 95%). To the best of our knowledge, this application of using human skeleton analysis for patient care is novel. The proposed scheme is promising for clinical applications and will undertake an intensive test in health care facilities in the near future after redesigning a proper RGB-D (Red-Green-Blue-Depth) camera system. In addition, a desktop computer can be used for multi-point monitoring to reduce cost, since real-time processing is not required in this application.
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Iblasi AS, Aungsuroch Y, Gunawan J, Gede Juanamasta I, Carver C. Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis. SAGE Open Nurs 2022; 8:23779608221106443. [PMID: 35720208 PMCID: PMC9201313 DOI: 10.1177/23779608221106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Repositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes. Objective To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis. Concept Description Repositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences. Discussion Repositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications. Conclusion Repositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.
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Affiliation(s)
| | | | - Joko Gunawan
- Faculty of Nursing, Chulalongkorn University Bangkok, Thailand
| | - I. Gede Juanamasta
- Faculty of Nursing, Chulalongkorn University Bangkok, Thailand
- Nursing Program, STIKes Wira Medika Bali, Denpasar, Bali, Indonesia
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Lemaire JJ, Chaix R, Sontheimer A, Coste J, Cousseau MA, Dubois C, San Juan M, Massa C, Raynaud S, Usclade A, Pontier B, El Ouadih Y, Abdelouahab K, Maggiani L, Berry F. Risk-Taking Behaviors of Adult Bedridden Patients in Neurosurgery: What Could/Should We Do? Front Med (Lausanne) 2021; 8:676538. [PMID: 34447760 PMCID: PMC8382714 DOI: 10.3389/fmed.2021.676538] [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] [Received: 03/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Risk-taking behaviors of adult bedridden patients in neurosurgery are frequent, however little analyzed. We aimed to estimate from the literature and our clinical experience the incidence of the different clinical pictures. Risk-taking behaviors seem to be more frequent than reported. They are often minor, but they can lead to death, irrespective of the prescription of physical or chemical constraints. We also aimed to contextualize the risks, and to describe the means reducing the consequences for the patients. Two main conditions were identified, the loss of awareness of risk-taking behaviors by the patient, and uncontrolled body motions. Besides, current experience feedback analyses and new non-exclusive technological solutions could limit the complications, while improving prevention with wearable systems, neighborhood sensors, or room monitoring and service robots. Further research is mandatory to develop efficient and reliable systems avoiding complications and saving lives. Ethical and legal issues must also be accounted for, notably concerning the privacy of patients and caregivers.
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Affiliation(s)
- Jean-Jacques Lemaire
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Rémi Chaix
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Sontheimer
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Coste
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Anne Cousseau
- Direction de la Recherche et de l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlène Dubois
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mélanie San Juan
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Christelle Massa
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sandrine Raynaud
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Usclade
- Direction de la Recherche et de l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bénédicte Pontier
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Youssef El Ouadih
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - François Berry
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France
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Tarigan S, Yusuf S, Syam Y. Effect of interface pressure and skin surface temperature on pressure injury incidence: a turning schedule pilot study. J Wound Care 2021; 30:632-641. [PMID: 34382846 DOI: 10.12968/jowc.2021.30.8.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate the interface pressure and skin surface temperature in relation to the incidence of pressure injury (PI) using three different turning schedules. METHOD This was a pilot study with a three-armed randomised clinical trial design. Participants at risk of PI and treated in the high dependency care unit in a regional hospital in Makassar, Indonesia participated in this study. Patients were repositioned at three different turning schedules (two-, three- and four-hourly intervals). Interface pressure measurement and skin surface temperature were measured between 14:00 and 18:00 every three days. The incidence of PI was assessed during the two-week observation period. RESULTS A total of 44 participants took part in the study. A one-way ANOVA test revealed no difference in interface pressure among the three different turning schedule groups within two weeks of observations: day zero, p=0.56; day four, p=0.95; day seven, p=0.56; day 10, p=0.63; and day 14, p=0.92. Although the average periumbilical temperature and skin surface temperature were not significant (p>0.05), comparison between these observation sites was significant on all observation days (p<0.05). Regarding the incidence of PI, the proportional hazard test for the development of PI in the three groups was considered not different (hazard ratio: 1.46, 95% confidence interval: 0.43-4.87, p=0.54). CONCLUSION No difference in interface pressure and incidence of PI on the three turning schedules was observed; however, there was a potential increase in skin surface temperature in comparison with periumbilical temperature for all three turning schedules.
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Affiliation(s)
- Sumiati Tarigan
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Saldy Yusuf
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Yuliana Syam
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
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Comparing Pressure Injury Incidence Based on Repositioning Intervals and Support Surfaces in Acute Care Settings: A Quasi-Experimental Pragmatic Study. Adv Skin Wound Care 2021; 34:1-6. [PMID: 34260424 DOI: 10.1097/01.asw.0000755912.27170.9a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. METHODS This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. RESULTS There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). CONCLUSIONS The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.
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Okamoto S, Ogai K, Mukai K, Sugama J. Association of Skin Microbiome with the Onset and Recurrence of Pressure Injury in Bedridden Elderly People. Microorganisms 2021; 9:microorganisms9081603. [PMID: 34442680 PMCID: PMC8400065 DOI: 10.3390/microorganisms9081603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 01/01/2023] Open
Abstract
Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.
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Affiliation(s)
- Shigefumi Okamoto
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa 920-0942, Japan;
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan
- Correspondence:
| | - Kazuhiro Ogai
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan;
| | - Kanae Mukai
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan;
| | - Junko Sugama
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa 920-0942, Japan;
- Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake 470-1192, Japan
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Lin W, Tian X, Lu X, Ma D, Wu Y, Hong J, Yan R, Feng G, Cheng Z. Prediction of Bedridden Duration of Hospitalized Patients by Machine Learning Based on EMRs at Admission. Comput Inform Nurs 2021; 40:251-257. [PMID: 34723871 DOI: 10.1097/cin.0000000000000765] [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: 11/27/2022]
Abstract
Being bedridden is a frequent comorbid condition that leads to a series of complications in clinical practice. The present study aimed to predict bedridden duration of hospitalized patients based on EMR at admission by machine learning. The medical data of 4345 hospitalized patients who were bedridden for at least 24 hours after admission were retrospectively collected. After preprocessing of the data, features for modeling were selected by support vector machine recursive feature elimination. Thereafter, logistic regression, support vector machine, and extreme gradient boosting algorithms were adopted to predict the bedridden duration. The feasibility and efficacy of above models were evaluated by performance indicators. Our results demonstrated that the most important features related to bedridden duration were Charlson Comorbidity Index, age, bedridden duration before admission, mobility capability, and perceptual ability. The extreme gradient boosting algorithm showed the best performance (accuracy, 0.797; area under the curve, 0.841) when compared with support vector machine (accuracy, 0.771; area under the curve, 0.803) and logistic regression (accuracy, 0.765; area under the curve, 0.809) algorithms. Meanwhile, the extreme gradient boosting algorithm had a higher sensitivity (0.856), specificity (0.650), and F1 score (0.858) than that of support vector machine algorithm (0.843, 0.589, and 0.841) and logistic regression (0.852, 0.545, and 0.839), respectively. These findings indicate that machine learning based on EMRs at admission is a feasible avenue to predict the bedridden duration. The extreme gradient boosting algorithm shows great potential for further clinical application.
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Affiliation(s)
- Weijie Lin
- Author Affiliations: College of Information Science & Electronic Engineering (Messrs Lin, Lu, and Ma and Dr Cheng), Department of Neurology, Second Affiliated Hospital, School of Medicine (Ms Tian), and Department of Surgery, Zhejiang University Hospital (Ms Wu), and Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine (Mr Hong and Drs Yan and Feng), Zhejiang University, Hangzhou, China
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Gillespie BM, Walker RM, Latimer SL, Thalib L, Whitty JA, McInnes E, Lockwood I, Chaboyer WP. Repositioning for pressure injury prevention in adults: An abridged Cochrane systematic review and meta-analysis. Int J Nurs Stud 2021; 120:103976. [PMID: 34090235 DOI: 10.1016/j.ijnurstu.2021.103976] [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: 03/17/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A pressure injury is an area of localised damage to the skin and underlying tissues. Patient repositioning is an important prevention strategy, as those with limited mobility are at increased risk of developing pressure injury. OBJECTIVES To assess the clinical and cost-effectiveness of repositioning schedules on the prevention of pressure injury in adults. DESIGN Systematic review and meta-analysis. DATA SOURCES The Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); Embase (Ovid) and Cumulative Index of Nursing and Allied Health Literature Plus (EBSCO) were searched in February 2019. No restrictions were applied to language or date of publication. REVIEW METHODS Studies were eligible if they were randomised controlled trials including cluster trials, published or unpublished, and undertaken in any healthcare setting that assessed the clinical and/or cost effectiveness of repositioning schedules for prevention of pressure injury in adults. Methodological quality of the studies was independently assessed by three authors. Heterogeneity between studies was assessed using the I2 statistic, and the pooled risk ratios along with their 95% confidence intervals were estimated using either fixed and random effects models, as indicated. Grading of Recommendations Assessment, Development and Evaluation was used to appraise the certainty of evidence. RESULTS Eight eligible trials involving 3,941 participants published between 2004 and 2018 were identified. Trials compared either different repositioning frequencies or positioning regimens. Three trials (1074 participants) compared 2-hourly with 4-hourly repositioning (risk ratio 1.06, 95% confidence interval 0.80 to 1.41; I2 = 45%). Two other trials (252 participants) compared a 30-degree tilt with a 90-degree tilt (risk ratio0.62, 95% confidence interval 0.10 to 3.97; I2 =69%). Only two trials included economic analyses, both amongst nursing home residents. One study estimated the costs of repositioning to be Canadian dollars $11.05 and Canadian dollars $16.74 less per resident per day for the 3-hourly or 4-hourly regimens, respectively, when compared to 2-hourly regimen. The second study reported 3-hourly repositioning using a 30-degree tilt to cost €46.50 (95% confidence interval €1.25 to €74.60) less per patient in nursing time compared with 6-hourly repositioning with a 90-degree lateral rotation. CONCLUSION It remains unclear which repositioning frequencies or positions are most effective in preventing pressure injury in adults. There is limited evidence to support the cost effectiveness of repositioning frequencies and positions. Registration: Cochrane protocol published in 2012.
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Affiliation(s)
- Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; Gold Coast University Hospital, Gold Coast Health, Southport, Australia; School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia.
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia; Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sharon L Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; Gold Coast University Hospital, Gold Coast Health, Southport, Australia; School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Lukman Thalib
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Elizabeth McInnes
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
| | - Ishtar Lockwood
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia
| | - Wendy P Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
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Wang L, Lu H, Dong X, Huang X, Li B, Wan Q, Shang S. The effect of nurse staffing on patient‐safety outcomes: A cross‐sectional survey. J Nurs Manag 2020; 28:1758-1766. [DOI: 10.1111/jonm.13138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Limin Wang
- Peking University School of Nursing Beijing China
| | - Han Lu
- Peking University School of Nursing Beijing China
| | - Xu Dong
- Peking University School of Nursing Beijing China
| | - Xiuxiu Huang
- Peking University School of Nursing Beijing China
| | - Bei Li
- Peking University School of Nursing Beijing China
| | - Qiaoqin Wan
- Peking University School of Nursing Beijing China
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Avsar P, Moore Z, Patton D, O'Connor T, Budri AMV, Nugent L. Repositioning for preventing pressure ulcers: a systematic review and meta-analysis. J Wound Care 2020; 29:496-508. [DOI: 10.12968/jowc.2020.29.9.496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective:The aim of this systematic review was to assess the effects of different repositioning regimens on pressure ulcer (PU) incidence in at-risk adult individuals without existing PUs.Method:Using systematic review methodology, randomised controlled trials (RCTs), including cluster-RCTs, prospective non-RCTs, pre–post-studies and interrupted-time-series studies were considered. Specifically explored was the impact of the frequency of repositioning, use of repositioning systems and use of turning teams. The search was conducted in January 2019, using PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan.Results:A total of 530 records were returned, of which 16 met the inclusion criteria. Half of studies were conducted in intensive care units (50%). The mean sample size was 629±604 participants. Frequency of repositioning was explored in nine studies. PU incidence was 8% (n=221/2834) for repositioning every 2–3 hours, versus 13% (n=398/3050) for repositioning every 4–6 hours. The odds ratio (OR) was 0.75 (95% confidence interval (CI): 0.61–0.90, p=0.03), suggesting that there is a 25% reduction in the odds of PU development in favour of more frequent repositioning. Use of a repositioning system was explored in three studies. PU incidence was 2% (17/865) for the repositioning system, versus 5.5% (51/926) for care without using the repositioning system. The OR was 0.26 (95% CI: 0.05–1.29, p=0.10); this finding was not statistically significant. Use of a turning team was explored in two studies. PU incidence was 11% (n=22/200) with use of a turning team versus 20% (n=40/200) for usual care. The OR was 0.49 (95% CI: 0.27–0.86, p=0.01) suggesting that there is a 51% reduction in the odds of PU development in favour of use of a turning team. Using GRADE appraisal, the certainty of the evidence was assessed as low.Conclusion:The results of this systematic review indicate that more frequent repositioning and use of a turning team reduce PU incidence. However, given the low certainty of evidence, results should be interpreted with caution.
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Affiliation(s)
- Pinar Avsar
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
| | - Zena Moore
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Lida Institute, Shanghai
- Monash University, Melbourne, Australia
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Declan Patton
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Lida Institute, Shanghai
- Monash University, Melbourne, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Tom O'Connor
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Monash University, Melbourne, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Aglecia MV Budri
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
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Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J 2020; 17:1924-1934. [PMID: 32830460 DOI: 10.1111/iwj.13482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital-acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital-acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score-adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in-hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30-, 60-, and 90-day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital-acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.
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Gillespie BM, Walker RM, Latimer SL, Thalib L, Whitty JA, McInnes E, Chaboyer WP. Repositioning for pressure injury prevention in adults. Cochrane Database Syst Rev 2020; 6:CD009958. [PMID: 32484259 PMCID: PMC7265629 DOI: 10.1002/14651858.cd009958.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A pressure injury (PI), also referred to as a 'pressure ulcer', or 'bedsore', is an area of localised tissue damage caused by unrelieved pressure, friction, or shearing on any part of the body. Immobility is a major risk factor and manual repositioning a common prevention strategy. This is an update of a review first published in 2014. OBJECTIVES To assess the clinical and cost effectiveness of repositioning regimens(i.e. repositioning schedules and patient positions) on the prevention of PI in adults regardless of risk in any setting. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, and EBSCO CINAHL Plus on 12 February 2019. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised trials (c-RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PI incidence in adults in any setting. DATA COLLECTION AND ANALYSIS Three review authors independently performed study selection, 'Risk of bias' assessment, and data extraction. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We identified five additional trials and one economic substudy in this update, resulting in the inclusion of a total of eight trials involving 3941 participants from acute and long-term care settings and two economic substudies in the review. Six studies reported the proportion of participants developing PI of any stage. Two of the eight trials reported within-trial cost evaluations. Follow-up periods were short (24 hours to 21 days). All studies were at high risk of bias. Funding sources were reported in five trials. Primary outcomes: proportion of new PI of any stage Repositioning frequencies: three trials compared different repositioning frequencies We pooled data from three trials (1074 participants) comparing 2-hourly with 4-hourly repositioning frequencies (fixed-effect; I² = 45%; pooled risk ratio (RR) 1.06, 95% confidence interval (CI) 0.80 to 1.41). It is uncertain whether 2-hourly repositioning compared with 4-hourly repositioning used in conjunction with any support surface increases or decreases the incidence of PI. The certainty of the evidence is very low due to high risk of bias, downgraded twice for risk of bias, and once for imprecision. One of these trials had three arms (967 participants) comparing 2-hourly, 3-hourly, and 4-hourly repositioning regimens on high-density mattresses; data for one comparison was included in the pooled analysis. Another comparison was based on 2-hourly versus 3-hourly repositioning. The RR for PI incidence was 4.06 (95% CI 0.87 to 18.98). The third study comparison was based on 3-hourly versus 4-hourly repositioning (RR 0.20, 95% CI 0.04 to 0.92). The certainty of the evidence is low due to risk of bias and imprecision. In one c-RCT, 262 participants in 32 ward clusters were randomised between 2-hourly and 3-hourly repositioning on standard mattresses and 4-hourly and 6-hourly repositioning on viscoelastic mattresses. The RR for PI with 2-hourly repositioning compared with 3-hourly repositioning on standard mattress is imprecise (RR 0.90, 95% CI 0.69 to 1.16; very low-certainty evidence). The CI for PI include both a large reduction and no difference for the comparison of 4-hourly and 6-hourly repositioning on viscoelastic foam (RR 0.73, 95% CI 0.53 to 1.02). The certainty of the evidence is very low, downgraded twice due to high risk of bias, and once for imprecision. Positioning regimens: four trials compared different tilt positions We pooled data from two trials (252 participants) that compared a 30° tilt with a 90° tilt (random-effects; I² = 69%). There was no clear difference in the incidence of stage 1 or 2 PI. The effect of tilt is uncertain because the certainty of evidence is very low (pooled RR 0.62, 95% CI 0.10 to 3.97), downgraded due to serious design limitations and very serious imprecision. One trial involving 120 participants compared 30° tilt and 45° tilt with 'usual care' and reported no occurrence of PI events (low certainty evidence). Another trial involving 116 ICU patients compared prone with the usual supine positioning for PI. Reporting was incomplete and this is low certainty evidence. Secondary outcomes No studies reported health-related quality of life utility scores, procedural pain, or patient satisfaction. Cost analysis Two included trials also performed economic analyses. A cost-minimisation analysis compared the costs of 3-hourly and 4-hourly repositioning with 2-hourly repositioning schedule amongst nursing home residents. The cost of repositioning was estimated at CAD 11.05 and CAD 16.74 less per resident per day for the 3-hourly or 4-hourly regimen, respectively, compared with the 2-hourly regimen. The estimates of economic benefit were driven mostly by the value of freed nursing time. The analysis assumed that 2-, 3-, or 4-hourly repositioning is associated with a similar incidence of PI, as no difference in incidence was observed. A second study compared the nursing time cost of 3-hourly repositioning using a 30° tilt with standard care (6-hourly repositioning with a 90° lateral rotation) amongst nursing home residents. The intervention was reported to be cost-saving compared with standard care (nursing time cost per patient EUR 206.60 versus EUR 253.10, incremental difference EUR -46.50, 95% CI EUR -1.25 to EUR -74.60). AUTHORS' CONCLUSIONS Despite the addition of five trials, the results of this update are consistent with our earlier review, with the evidence judged to be of low or very low certainty. There remains a lack of robust evaluations of repositioning frequency and positioning for PI prevention and uncertainty about their effectiveness. Since all comparisons were underpowered, there is a high level of uncertainty in the evidence base. Given the limited data from economic evaluations, it remains unclear whether repositioning every three hours using the 30° tilt versus "usual care" (90° tilt) or repositioning 3-to-4-hourly versus 2-hourly is less costly relative to nursing time.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
- Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sharon L Latimer
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
| | - Wendy P Chaboyer
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
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24
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Jocelyn Chew H, Thiara E, Lopez V, Shorey S. Turning frequency in adult bedridden patients to prevent hospital-acquired pressure ulcer: A scoping review. Int Wound J 2018; 15:225-236. [PMID: 29243356 PMCID: PMC7949701 DOI: 10.1111/iwj.12855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to identify current research on turning frequencies of adult bed-bound patients and inform future turning practices for hospitals based on evidence-based practice. We undertook a scoping review framework that provided a transparent and systematic methodology using 8 electronic databases (CINAHL, PubMed, Cochrane Library, ScienceDirect, PsycINFO, Scopus, ProQuest, and Web of Science) to identify articles published from 2000 to 2016. Articles were included if they focused on the prevention of hospital-acquired pressure ulcers related to the frequency of turning or repositioning of bed-bound patients. Literature search and data extraction were performed independently by 3 authors. The study followed the PRISMA guidelines. In total, 911 articles were identified, of which 10 were eligible. Of the eligible articles, 8 studies could not reach a conclusion on the effective frequency of turning and duration for repositioning patients to prevent the development of pressure ulcers. Only 2 studies found significant differences among the intervention and control groups. Results regarding turning and repositioning schedules are inconclusive; however, the topic needs further exploration to improve the outdated guidelines surrounding pressure ulcer prevention. This may, in turn, make the work of nurses more efficient and make treatment cost-effective for both the patients and the hospitals.
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Affiliation(s)
- H‐S Jocelyn Chew
- The Nethersole School of NursingChinese University of Hong KongChina
| | - Emelia Thiara
- Paediatric Intensive Care UnitNational University HospitalSingapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of Medicine, National University of SingaporeSingapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of Medicine, National University of SingaporeSingapore
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