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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33054619 DOI: 10.12968/jowc.2020.29.latam_sup_2.6] [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 Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33048017 DOI: 10.12968/jowc.2020.29.sup10.6] [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 Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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Wong G, Gabison S, Dolatabadi E, Evans G, Kajaks T, Holliday P, Alshaer H, Fernie G, Dutta T. Toward mitigating pressure injuries: Detecting patient orientation from vertical bed reaction forces. J Rehabil Assist Technol Eng 2020; 7:2055668320912168. [PMID: 32284876 PMCID: PMC7137131 DOI: 10.1177/2055668320912168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/06/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Prolonged bed rest without repositioning can lead to pressure injuries. However, it can be challenging for caregivers and patients to adhere to repositioning schedules. A device that alerts caregivers when a patient has remained in the same orientation for too long may reduce the incidence and/or severity of pressure injuries. This paper proposes a method to detect a person's orientation in bed using data from load cells placed under the legs of a hospital grade bed. METHODS Twenty able-bodied individuals were positioned into one of three orientations (supine, left side-lying, or right side-lying) either with no support, a pillow, or a wedge, and the head of the bed either raised or lowered. Breathing pattern characteristics extracted from force data were used to train two machine learning classification systems (Logistic Regression and Feed Forward Neural Network) and then evaluate for their ability to identify each participant's orientation using a leave-one-participant-out cross-validation. RESULTS The Feed Forward Neural Network yielded the highest orientation prediction accuracy at 94.2%. CONCLUSIONS The high accuracy of this non-invasive system's ability to a participant's position in bed shows potential for this algorithm to be useful in developing a pressure injury prevention tool.
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Affiliation(s)
- Gordon Wong
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Sharon Gabison
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Elham Dolatabadi
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Gary Evans
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Tara Kajaks
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Pamela Holliday
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hisham Alshaer
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Geoff Fernie
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Tilak Dutta
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Moya-Suárez AB, Canca-Sánchez JC, Enríquez de Luna-Rodríguez M, Aranda-Gallardo M, Morales-Asencio JM. Factors associated with variability in the prevention of pressure ulcers. J Tissue Viability 2018; 27:211-216. [PMID: 30389336 DOI: 10.1016/j.jtv.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/25/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
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Moya-Suárez AB, Morales-Asencio JM, Aranda-Gallardo M, Enríquez de Luna-Rodríguez M, Canca-Sánchez JC. Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU). J Tissue Viability 2017; 26:260-270. [PMID: 28911962 DOI: 10.1016/j.jtv.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/29/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
AIM OF THE STUDY The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers. MATERIAL AND METHODS An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016. RESULTS From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054). CONCLUSIONS The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers.
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Affiliation(s)
- Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071, Málaga, Spain.
| | - Marta Aranda-Gallardo
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | | | - José Carlos Canca-Sánchez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
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Gunningberg L, Bååth C, Sving E. Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. J Nurs Manag 2017; 26:140-147. [DOI: 10.1111/jonm.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology; Department of Health Sciences; Karlstad University; County Council of Värmland; Värmland Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Region Gävleborg; Gävle Sweden
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Predictors of pressure injury prevention strategies in at-risk medical patients: An Australian multi-centre study. Collegian 2017. [DOI: 10.1016/j.colegn.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Latimer S, Chaboyer W, Gillespie B. Pressure injury prevention strategies in acute medical inpatients: an observational study. Contemp Nurse 2016; 52:326-40. [PMID: 27228380 DOI: 10.1080/10376178.2016.1190657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients' pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning. METHOD An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The sample comprised adult medical inpatients with reduced mobility. A subsample of participants assessed at pressure injury risk on admission was drawn from this sample. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility. RESULTS There was suboptimal planning and implementation of pressure injury prevention strategies for the sample and subsample. There was a significant relationship between planned and implemented support surfaces at both hospitals; however, no relationship existed between the planned and implemented of regular repositioning at either site. CONCLUSION The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces; however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.
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Affiliation(s)
- Sharon Latimer
- a School of Nursing and Midwifery, Griffith University , L05 3.45 Logan campus, Queensland 4131 , Brisbane , Australia
| | - Wendy Chaboyer
- b NHMRC Research Centre for Excellence in Nursing Interventions (NCREN), Griffith University , G 01 2.03 Gold Coast campus, Queensland 4222 , Brisbane , Australia
| | - Brigid Gillespie
- b NHMRC Research Centre for Excellence in Nursing Interventions (NCREN), Griffith University , G 01 2.03 Gold Coast campus, Queensland 4222 , Brisbane , Australia
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Pickham D, Ballew B, Ebong K, Shinn J, Lough ME, Mayer B. Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial. Trials 2016; 17:190. [PMID: 27053145 PMCID: PMC4823913 DOI: 10.1186/s13063-016-1313-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$11 billion in annual health care spending each year. To date we are unaware of any study that has used a wearable patient sensor to quantify patient movement and positioning in an effort to assess whether adherence to optimal patient turning results in a reduction in pressure ulcer occurrence. Methods/design This study is a single-site, open-label, two-arm, randomized controlled trial that will enroll 1812 patients from two intensive care units. All subjects will be randomly assigned, with the aid of a computer-generated schedule, to either a standard care group (control) or an optimal pressure ulcer-preventative care group (treatment). Optimal pressure ulcer prevention is defined as regular turning every 2 h with at least 15 min of tissue decompression. All subjects will receive a wearable patient sensor (Leaf Healthcare, Inc., Pleasanton, CA, USA) that will detect patient movement and positioning. This information is relayed through a proprietary mesh network to a central server for display on a user-interface to assist with nursing care. This information is used to guide preventative care practices for those within the treatment group. Patients will be monitored throughout their admission in the intensive care unit. Discussion We plan to conduct a randomized control trial, which to our knowledge is the first of its kind to use a wearable patient sensor to quantify and establish optimal preventative care practices, in an attempt to determine whether this is effective in reducing hospital-acquired pressure ulcers. Trial registration ClinicalTrials.gov, NCT02533726.
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Affiliation(s)
- David Pickham
- General Medical Disciplines, Stanford Medicine, Menlo Park, CA, USA. .,Office of Research, Patient Care Services, Stanford Health Care, Stanford, CA, USA.
| | - Betsy Ballew
- Office of Research, Patient Care Services, Stanford Health Care, Stanford, CA, USA
| | - Kristi Ebong
- Digital Health, Stanford Health Care, Stanford, CA, USA
| | - Julie Shinn
- Patient Care Services, Stanford Health Care, Stanford, CA, USA
| | - Mary E Lough
- General Medical Disciplines, Stanford Medicine, Menlo Park, CA, USA
| | - Barbara Mayer
- General Medical Disciplines, Stanford Medicine, Menlo Park, CA, USA
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Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ Open 2015; 5:e008544. [PMID: 26597864 PMCID: PMC4663442 DOI: 10.1136/bmjopen-2015-008544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity). METHODS A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available. RESULTS Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001). CONCLUSIONS This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Scott D Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Latimer S, Chaboyer W, Gillespie BM. The repositioning of hospitalized patients with reduced mobility: a prospective study. Nurs Open 2015; 2:85-93. [PMID: 27708804 PMCID: PMC5047314 DOI: 10.1002/nop2.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022] Open
Abstract
AIM To determine the frequency of patient repositioning across three consecutive nursing shifts (day, evening and night) and to identify predictors of repositioning frequency. BACKGROUND Patient repositioning is a frequently implemented pressure injury prevention strategy. Yet, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility. DESIGN An observational prospective study. METHODS Chart audits were used to gather clinical and demographic data. Semi-structured observations were conducted every 30 minutes for a continuous 24-hour period. Observational data included the patient's body position, the frequency of repositioning, assistance require to reposition and the use of support surfaces. RESULTS Patients were repositioned frequently during the day and evening and least at night time. Elevation of the head of the bed (1-45°) was the most frequently adopted position. The independent predictors of repositioning frequency were age and gender, with older patients and males repositioned less frequently.
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Affiliation(s)
- Sharon Latimer
- Griffith UniversitySchool of Nursing and MidwiferyMeadowbrookQueenslandAustralia
| | - Wendy Chaboyer
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
| | - Brigid M. Gillespie
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
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Johansen E, Bakken LN, Moore Z. Pressure Ulcer in Norway-A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care. Healthcare (Basel) 2015; 3:417-28. [PMID: 27417771 PMCID: PMC4939547 DOI: 10.3390/healthcare3020417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/24/2015] [Accepted: 05/25/2015] [Indexed: 12/05/2022] Open
Abstract
Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.
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Affiliation(s)
- Edda Johansen
- Department of Nursing Science, Faculty of Health Sciences, Buskerud and Vestfold University College, Grønland 58, Drammen 3045, Norway.
| | - Linda N Bakken
- Department of Nursing Science, Faculty of Health Sciences, Buskerud and Vestfold University College, Grønland 58, Drammen 3045, Norway.
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland.
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Demarré L, Verhaeghe S, Annemans L, Van Hecke A, Grypdonck M, Beeckman D. The cost of pressure ulcer prevention and treatment in hospitals and nursing homes in Flanders: A cost-of-illness study. Int J Nurs Stud 2015; 52:1166-79. [PMID: 25862410 DOI: 10.1016/j.ijnurstu.2015.03.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The economic impact of pressure ulcer prevention and treatment is high. The results of cost-of-illness studies can assist the planning, allocation, and priority setting of healthcare expenditures to improve the implementation of preventive measures. Data on the cost of current practice of pressure ulcer prevention or treatment in Flanders, a region of Belgium, is lacking. AIM To examine the cost of pressure ulcer prevention and treatment in an adult population in hospitals and nursing homes from the healthcare payer perspective. DESIGN A cost-of-illness study was performed using a bottom-up approach. SETTINGS Hospitals and nursing homes in Flanders, a region of Belgium. METHODS Data were collected in a series of prospective multicentre cross-sectional studies between 2008 and 2013. Data collection included data on risk assessment, pressure ulcer prevalence, preventive measures, unit cost of materials for prevention and treatment, nursing time measurements for activities related to pressure ulcer prevention and treatment, and nursing wages. The cost of pressure ulcer prevention and treatment in hospitals and nursing homes was calculated as annual cost for Flanders, per patient, and per patient per day. RESULTS The mean (SD) cost for pressure ulcer prevention was €7.88 (8.21) per hospitalised patient at risk per day and €2.15 (3.10) per nursing home resident at risk per day. The mean (SD) cost of pressure ulcer prevention for patients and residents identified as not at risk for pressure ulcer development was €1.44 (4.26) per day in hospitals and €0.50 (1.61) per day in nursing homes. The main cost driver was the cost of labour, responsible for 79-85% of the cost of prevention. The mean (SD) cost of local treatment per patient per day varied between €2.34 (1.14) and €77.36 (35.95) in hospitals, and between €2.42 (1.15) and €16.18 (4.93) in nursing homes. CONCLUSIONS Related to methodological differences between studies, the cost of pressure ulcer prevention and treatment in hospitals and nursing homes in Flanders was found to be low compared to other international studies. Recommendations specific to pressure ulcer prevention are needed as part of methodological guidelines to conduct cost-of-illness studies.
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Affiliation(s)
- Liesbet Demarré
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Health Economics, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, ICHER (Interuniversity Center for Health Economics Research), Ghent, Belgium; Brussels University, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
| | - Maria Grypdonck
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK; Department of Bachelor in Nursing, Artevelde University College, Ghent, Belgium
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Chaboyer W, Gillespie BM. Understanding nurses' views on a pressure ulcer prevention care bundle: a first step towards successful implementation. J Clin Nurs 2014; 23:3415-23. [DOI: 10.1111/jocn.12587] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing; Research Centre for Health Practice Innovation; Griffith Health Institute; Griffith University; Gold Coast Qld Australia
| | - Brigid M. Gillespie
- NHMRC Centre of Research Excellence in Nursing; Research Centre for Health Practice Innovation; Griffith Health Institute; Griffith University; Gold Coast Qld Australia
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Qaddumi J, Khawaldeh A. Pressure ulcer prevention knowledge among Jordanian nurses: a cross- sectional study. BMC Nurs 2014; 13:6. [PMID: 24565372 PMCID: PMC3946597 DOI: 10.1186/1472-6955-13-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 02/20/2014] [Indexed: 11/11/2022] Open
Abstract
Background Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses. Methods Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master’s level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention. ANOVA and t-test analysis were used to test the differences in nurses’ knowledge according to participants’ characteristics. Means, standard deviation, and frequencies were used to describe nurses’ knowledge levels, knowledge sources, and barriers to pressure ulcer prevention. Results The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5–17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention. Conclusions This study highlights concerns about Jordanian nurses’ knowledge of pressure ulcer prevention. The results of the current study showed inadequate knowledge among Jordanian nurses about pressure ulcer prevention based on National Pressure Ulcer Advisory Panel guidelines. Also, the low level of nurses’ pressure ulcer knowledge suggests poor dissemination of pressure ulcer knowledge in Jordan, a suggestion supported by the lack of relationship between years of experience and pressure ulcer knowledge.
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Affiliation(s)
- Jamal Qaddumi
- Faculty of Medicine and Health sciences, An-Najah National University, P,O, Box 7, Nablus, Palestine.
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Tubaishat A, Aljezawi M, Al Qadire M. Nurses' attitudes and perceived barriers to pressure ulcer prevention in Jordan. J Wound Care 2013; 22:490-7. [PMID: 24005783 DOI: 10.12968/jowc.2013.22.9.490] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore Jordanian nurses' attitudes toward pressure ulcer prevention and to identify their perceived barriers to care in pressure ulcer prevention. METHOD A cross-sectional multi-centre study was undertaken in four hospitals in Jordan. The registered nurses and nurse assistants working at these sites were requested to complete a self-administered questionnaire. RESULTS In total, 428 completed questionnaires were returned. The participant nurses hold positive attitudes regarding pressure ulcers prevention (mean=3.91). The only factor that seems to have an effect on the positive attitude was the experience of the participants (χ²[2, n=227]=6.38; [=0.041). The positive attitude was enhanced with increased number of years of experience. Several barriers to good practice were reported by the participants, including: lack of staff (86.2%), time (83.6%), and patient conditions (68.6%). CONCLUSION Findings of this study suggest that positive attitudes are not enough to change practice. Several barriers need to be resolved first if effective prevention is to be provided. This should form a reference dataset that needs to be addressed in the tissue viability field in Jordan, which is still in its infancy. DECLARATION OF INTEREST There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to the article or its content.
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Affiliation(s)
- A Tubaishat
- Assistant Professor, Assistant Dean and Chairman of Adult Health Nursing Department, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Moore Z, Johanssen E, van Etten M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). J Wound Care 2013; 22:361-2, 364-8. [PMID: 24159658 DOI: 10.12968/jowc.2013.22.7.361] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide a critical appraisal and synthesis of the published literature pertaining to pressure ulcer (PU) prevalence, incidence and prevention practices from the context of Scandinavia, Iceland and Ireland. METHOD An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU prevalence or incidence in adults or children, in any care setting, were included. RESULTS Fifty-five papers were data extracted, quality appraised and included in the qualitative synthesis of the review. Mean prevalence in Norway was 17% (4.8-29%) in Ireland was 16% (4-37%), in Denmark was 15% (2.2-35.5%) and in Sweden was 25%, (0.04-42.7%). Prevalence in Iceland was 8.9%. In acute care, mean prevalence was 21% (0-42.7%) and in long stay was 12% (2.4-23.7%). Prevalence among hospice patients was 35.7%, and in community care was 0.04% and 4%. No incidence study from Iceland was identified; the single incidence study from Norway noted a figure of 16.4%. The mean incidence from Ireland was 11% (8-14.4%) from Sweden was 20% (3.1-49%) and Denmark was 1.8% (1.4-2.7%). Mean incidence in acute care setting was 17.6%, (1.4-49%); in long stay was 6.63% (3.1-8.4%). Incidence in the hospice setting was 20.4%. No study reported PU incidence figures from the community setting. CONCLUSION Figures for both prevalence and incidence were similar in Ireland and Norway and highest in Sweden, whereas Denmark demonstrated the lowest incidence rates and Iceland demonstrated the lowest prevalence rates. Figures were consistently highest in acute care and hospice settings, and lowest in the care of the older person setting.
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Affiliation(s)
- Z Moore
- School of Nursing, Royal College of Surgeons of Ireland, Dublin, Ireland.
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Tubaishat A, Aljezawi M. The prevalence of pressure ulceration among Jordanian hospitalised patients. J Wound Care 2013; 22:305-6, 308-10. [PMID: 24049813 DOI: 10.12968/jowc.2013.22.6.305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To measure the prevalence rate of pressure ulcers (PUs) among hospitalised patients and to assess the adequacy of preventative care provided to patients at-risk for PUs. METHOD A cross-sectional survey was conducted by inspecting the skin of each patient included; if a PU was noted, it was classified according to the European Pressure Ulcer Advisory Panel grading system. Risk was assessed using the Braden scale and the use of preventative interventions was also documented. RESULTS The sample included was 295 patients; mean age of the patients was 49.1 +/- 18.6 years (range 18-87 years) and 55% (n = 162) were male. The prevalence rate was 16% (8.8% excluding category I). Category I was the most common grade of PU (n = 22; 46%). The heels were the most commonly affected sites (n = 23; 49%). Only 19% of patients in need of prevention actually received proper adequate prevention. CONCLUSION PU prevalence rate was lower than published rates in studies that employed the same method. The young age and general health of our sample could be the best explanation. A very small percentage of at-risk patients receive adequate prevention. This should open the door to scrutinising the provision of PU prevention in Jordan.
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Affiliation(s)
- A Tubaishat
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
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Moore Z, Johansen E, van Etten M. A review of PU risk assessment and prevention in Scandinavia, Iceland and Ireland (part II). J Wound Care 2013; 22:423-4, 426-8, 430-1. [PMID: 23924842 DOI: 10.12968/jowc.2013.22.8.423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide a critical appraisal of nurses risk assessment and pressure ulcer (PU) preventive practices across Scandinavia, Iceland and Ireland. METHOD An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU risk assessment or preventative practices, in any care setting, were included. RESULTS Risk assessment practice was primarily investigated in the acute care setting and was found to be irregular, based on both numeric scales and clinical judgments. This irregular practice means that some vulnerable patients are not screened for pressure ulcer risk, conversely, when risk assessed, a care plan is not necessarily provided.A significant gap in nurse documentation, together with a lack of supporting evidence for repositioning and use of appropriate redistribution devices was also identified,indicating a lack of a standardised approach to pressure ulcer prevention. CONCLUSION Despite an abundance of literature exploring this subject, it is clear that current practice in pressure ulcer prevention is not embedded within best practice recommendations. Therefore, to address the potential patient safety implications, clinical practice could benefit from exploration and identification of practical methods for improving actual pressure ulcer preventive practice.
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Affiliation(s)
- Z Moore
- School of Nursing, Royal College of Surgeons of Ireland, Dublin, Ireland.
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Sutherland-Fraser S, McInnes E, Maher E, Middleton S. Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nurs 2012; 11:25. [PMID: 23176368 PMCID: PMC3573907 DOI: 10.1186/1472-6955-11-25] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED BACKGROUND Patients are at risk of developing pressure injuries in the peri-operative setting. Studies evaluating the impact of educational interventions on peri-operative nurses' knowledge and reported practice are scarce. The purpose of this study was to evaluate the effect of a multifaceted intervention on peri-operative nurses' (a) knowledge of pressure injury risks, risk assessment and prevention strategies for patients in the operating suite; and (b) reported practice relating to risk assessment practices and implementation of prevention strategies for patients in the operating suite. METHODS A before-after research design was used. A convenience sample of all registered and enrolled nurses employed in two hospitals' operating suites was recruited. A multifaceted intervention was delivered which comprised a short presentation, educational materials and reminder posters. A 48-item survey tool was completed pre-and post-intervention to measure self-reported knowledge and practice. RESULTS 70 eligible peri-operative nurses completed both surveys. Post-intervention, statistically significant improvements were seen in knowledge of correct descriptions of pressure injury stages (p=0.001); appropriate reassessment for patients with a new pressure injury (p=0.05); appropriate actions for patients with an existing stage 1 (p=0.02) and stage 2 pressure injury (p=0.04). Statistical improvements were also seen in reported practice relating to an increase in the use of a risk assessment tool in conjunction with clinical judgement (p=0.0008); verbal handover of patients' pressure injury risk status from the operating room nurse to the recovery room (p=0.023) and from the recovery room nurse to the postoperative ward nurse (p=0.045). The number of participants reporting use of non-recommended and recommended pressure-relieving strategies was unchanged. CONCLUSION A multi-faceted educational intervention can improve some aspects of perioperative nurses' knowledge and reported practice such as risk assessment practices but not others such as use of recommended pressure-relieving devices. Further research is required to ascertain effective interventions which improve all areas of practice and knowledge, particularly in the use of appropriate pressure-relieving devices in order to prevent pressure injuries in surgical patients.
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Affiliation(s)
- Sally Sutherland-Fraser
- Clinical Nurse Consultant for Peri-operative Practice Development, St Vincents Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Elizabeth McInnes
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Elizabeth Maher
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Sandy Middleton
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- Director, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University. Director, Executive Office, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
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Rich SE, Margolis D, Shardell M, Hawkes WG, Miller RR, Amr S, Baumgarten M. Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair Regen 2011; 19:10-8. [PMID: 21134034 PMCID: PMC3059225 DOI: 10.1111/j.1524-475x.2010.00644.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.
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Affiliation(s)
- Shayna E Rich
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Baldi I, Ferrando A, Foltran F, Ciccone G, Gregori D. Studying factors related to pressure ulcers prevention: a marginal scale model for modelling heterogeneity among hospitals. J Eval Clin Pract 2010; 16:1085-9. [PMID: 20666887 DOI: 10.1111/j.1365-2753.2009.01257.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The purpose of this study was to analyse risk factors associated with the presence of pressure ulcer development in patients referred to several Italian hospitals, taking properly into account the within-hospital outcome correlation. METHODS We analysed data from a prevalence survey coordinated by the European Pressure Ulcer Advisory Panel on 12,000 hospitalized patients in Italy, collecting information on patient's risk, presence of ulcers and prevention measures. The article describes the bases which generalized estimating equations rely on as well as their statistical properties. The article compares different model specifications in the light of background knowledge of the survey data and model assumptions, and discusses the potential for this modelling approach to apply in similar statistical situations. RESULTS In accordance with existing literature, factors associated with pressure ulcers in hospitalized patients were identified as Braden scale, age and assistance-connected aspects. Between-hospital variability seemed to be explained by the adopted degree of prevention (use of preventive equipment combined with a repositioning strategy). CONCLUSIONS Modelling the covariance matrix or the scale argument of the correlated binary responses (presence/absence of pressure ulcers) by using moment estimators based on generalized estimating equations prevents optimistic inference and provides an important insight into the role of structural differences among hospitals.
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Affiliation(s)
- Ileana Baldi
- Unit of Cancer Epidemiology, C.P.O. Piemonte and University of Torino, Torino, Italy
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Adejumo PO, Ingwu JA. Nurses' use of water-filled gloves in preventing heel pressure ulcer in the University College Hospital, Ibadan, Nigeria. Int Wound J 2010; 7:472-9. [PMID: 21073682 PMCID: PMC7951663 DOI: 10.1111/j.1742-481x.2010.00713.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This cross-sectional descriptive survey examined use (knowledge, perception and practices) of water-filled gloves (WFGs) by nurses in the prevention of heel pressure ulcer (PU) in the University College Hospital (UCH), Ibadan, Nigeria. Participants were 250 purposively selected nurses working in the Neurosciences and Surgical units. Quantitative data were generated through the administration of a semi-structured questionnaire, whereas the qualitative data were collected through in-depth interview. Hypotheses were tested using chi-square analysis at a significance level of 0.05, whereas the manual content analysis was used to analyse the qualitative data. Results showed that a significant number of nurses at UCH, Ibadan, were knowledgeable about WFGs and actually used them in their clinical practice. Years of experience in clinical practice was found to be significantly related to knowledge and use of WFGs in heel PU (X(2) = 41·677; DF = 5; P = 0·001). Nurses with adequate knowledge of risk factors in the development of PU used WFGs more than those who were not aware (X(2) = 44·907; DF = 3; P = 0·009). Nurses' perception about WFGs was also significantly related to its use (X(2) = 4·527; DF = 1; P = 0·033). Although knowledge level and perception of WFGs and its use by nurses was fairly adequate, continuous education for practicing nurses should be encouraged in resource-limited settings.
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Tubaishat A, Anthony D, Saleh M. Pressure ulcers in Jordan: a point prevalence study. J Tissue Viability 2010; 20:14-9. [PMID: 20880710 DOI: 10.1016/j.jtv.2010.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 08/28/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pressure ulcers are a common problem among hospitalised patients. Several prevalence studies have been conducted internationally but there is a paucity of research on pressure ulcer in the Arab world in general and in Jordan specifically. PURPOSE The aim of this study was to quantify the prevalence rate of pressure ulcers in Jordan, and to compare these figures with other studies conducted using the same methods. DESIGN A cross-sectional survey design. PARTICIPANTS All inpatients older than eighteen in both university and general hospitals in Jordan. Patients in the emergency, day care and maternity wards were excluded. INSTRUMENTS European Pressure Ulcer Advisory Panel (EUPAP) data collection form. METHODS The survey was conducted by examining patients' skin. Pressure ulcers were classified according to the EPUAP grading system. Risk of pressure ulcer development was assessed using the Braden scale. Data were collected on preventive measures recorded in the clinical setting. RESULTS The overall prevalence rate was 12% (All percentages are rounded to the nearest digit) (7% when Grade I excluded). The sacrum and heel were the most common affected sites. Grade one was the most common grade (44%). Only 17% of the patients at risk received adequate prevention. CONCLUSION The pressure ulcer prevalence rate in Jordan is lower than that published in most studies utilising the same methodology. Despite this relatively low prevalence very few patients at risk received adequate prevention, and there is therefore a need to raise the awareness for pressure ulcer prevention in Jordan. Furthermore, differences in age and frailty in the Jordanian sample could explain the low prevalence.
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Abstract
AIM This paper is a report of a study conducted to determine the usability and utility of the Braden in intensive care units. BACKGROUND An understanding of the clinical usage of the Braden Scale is valuable when considering the incidence of pressure ulcers in a critical-care setting. METHODS A retrospective analysis of 21,115 hospital-days of 715 inpatients in an intensive-care unit in 2006 in South Korea was applied to data extracted electronically from an electronic medical record system in October 2007. RESULTS Of the 715 patients, 42 (5.9%) developed a pressure ulcer, corresponding to an incidence density of 198 ulcers per 1000 hospital-days. The usage rate of the Braden Scale was 11.26%, and an analysis of its utility, based on a receiver operating characteristic analysis with the cutoff set at 13, gave sensitivity, specificity, positive predictive values and negative predictive values of 75.9%, 47.3%, 18.1% and 92.8% respectively. There were weak correlations between the scores and nursing interventions except for the category of position changes. The variety of nursing interventions was also limited. CONCLUSION Our data suggest that the Braden Scale has a very low usage rate and a low-to-moderate positive predictive performance. Our quantification of the relationship between Braden Scale score and nursing interventions indicates the need for a more comprehensive and fundamental approach to the use of this scale.
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Affiliation(s)
- InSook Cho
- Department of Nursing, Inha University, Incheon, South Korea.
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Meesterberends E, Halfens R, Lohrmann C, De Wit R. Pressure ulcer guideline development and dissemination in Europe. J Clin Nurs 2010; 19:1495-503. [DOI: 10.1111/j.1365-2702.2010.03229.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Knowledge translation: summarizing and synthesizing the evidence for WOC best practices. J Wound Ostomy Continence Nurs 2010; 37:132-6. [PMID: 20228652 DOI: 10.1097/won.0b013e3181cf886c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Physiological rationale and current evidence for therapeutic positioning of critically ill patients. AACN Adv Crit Care 2009; 20:228-40; quiz 241-2. [PMID: 19638744 DOI: 10.1097/nci.0b013e3181add8db] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. This article reviews therapeutic positions including stationary positions (supine, semirecumbent with head of bed elevation, lateral, and prone) and active repositioning (manual, continuous lateral rotation, and kinetic therapy). The physiological rationale and current evidence for each position are described. Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.
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Baumgarten M, Margolis D, Orwig D, Hawkes W, Rich S, Langenberg P, Shardell M, Palmer MH, McArdle P, Sterling R, Jones PS, Magaziner J. Use of pressure-redistributing support surfaces among elderly hip fracture patients across the continuum of care: adherence to pressure ulcer prevention guidelines. THE GERONTOLOGIST 2009; 50:253-62. [PMID: 19587108 DOI: 10.1093/geront/gnp101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. DESIGN AND METHODS Patients (n = 658) aged >or=65 years who had surgery for hip fracture were examined by research nurses at baseline and on alternating days for 21 days. Information on PRSS use and pressure ulcer risk factors was recorded at each assessment visit. Other information was obtained by interview and chart review. RESULTS A PRSS was observed at 36.4% of the 5,940 study visits. The odds of PRSS use were lower in the rehabilitation setting (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3-0.6), in the nursing home (adjusted OR 0.2, 95% CI 0.1-0.3), and during readmission to the acute setting (adjusted OR 0.6, 95% CI 0.4-0.9) than in the initial acute setting. There was wide variation in frequency of PRSS use by admission hospital, even after adjusting for pressure ulcer risk factors. The relationships between PRSS use and pressure ulcer risk factors were not strong. IMPLICATIONS In this study of hip fracture patients, adherence to guidelines for PRSS use was low and was based more on facility-related factors than on patient risk. There is an urgent need for health care providers to improve strategies for the prevention of pressure ulcers in high-risk patients.
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Affiliation(s)
- Mona Baumgarten
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA.
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Abstract
BACKGROUND Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies. OBJECTIVE The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record. METHODS This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction. RESULTS Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score < or =14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination. DISCUSSION Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.
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Van Herck P, Sermeus W, Jylha V, Michiels D, Van den Heede K. Using hospital administrative data to evaluate the knowledge-to-action gap in pressure ulcer preventive care. J Eval Clin Pract 2009; 15:375-82. [PMID: 19335500 DOI: 10.1111/j.1365-2753.2008.01019.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Issues of overuse, underuse and misuse are paramount and lead to avoidable morbidity and mortality. Although evidence-based practice is advocated, the widespread implementation of this kind of practice remains a challenge. This is also the case for evidence-based practice related to the prevention of pressure ulcers, which varies widely in process and outcome in Belgian hospital care. One major obstacle to bridging this knowledge-to-action gap is data availability. We propose using large-scale hospital administrative data combined with the latest evidence-based methods as part of the solution to this problem. METHOD To test our proposal, we applied this approach to pressure ulcer prevention, using an administrative dataset with regard to 6030 patients in 22 Belgian hospitals as a sample of nationally available data. Methods include a systematic review approach, evidence grading, recommendations formulation, algorithm construction, programming of the rule set and application on the database. RESULTS We found that Belgian hospitals frequently failed to provide appropriate prevention care. Significant levels of underuse, up to 28.4% in pressure ulcer prevention education and 17.5% in the use of dynamic systems mattresses, were detected. Figures for overuse were mostly not significant. Misuse couldn't be assessed. CONCLUSIONS These results demonstrate that this approach can indeed be successfully used to bridge the knowledge-to-action gap in medical practice, by implementing an innovative method to assess underuse and overuse in hospital care. The integrative use of administrative data and clinical applications should be replicated in other patient groups, other datasets and other countries.
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Affiliation(s)
- Pieter Van Herck
- Research Fellow at the Centre for Health Services and Nursing Research, Catholic University Leuven, Belgium.
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Shahin ESM, Dassen T, Halfens RJG. Pressure ulcer prevention in intensive care patients: guidelines and practice. J Eval Clin Pract 2009; 15:370-4. [PMID: 19335499 DOI: 10.1111/j.1365-2753.2008.01018.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention. DESIGN The design of this study was a cross-sectional study (point prevalence). Setting The study setting was intensive care units. The sample consisted of 169 patients - 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards. RESULTS The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients. CONCLUSIONS The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines.
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Affiliation(s)
- Eman S M Shahin
- Department of Nursing Science, Centre for the Humanities and Health Sciences, Charité, Universitätsmedizin Berlin, Berlin.
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Ligita T, Jayasekara R. Skin care strategies to prevent pressure ulcer for patients in acute care settings: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2009; 7:1-12. [PMID: 27819995 DOI: 10.11124/01938924-200907161-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Titan Ligita
- 1Health Training Officer, Centre for Health Training, West Kalimantan Province, Indonesia 2Research Fellow, The Joanna Briggs Institute, Adelaide, South Australia
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Wann-Hansson C, Hagell P, Willman A. Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital. J Clin Nurs 2008; 17:1718-27. [PMID: 18578778 DOI: 10.1111/j.1365-2702.2008.02286.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to describe and identify risk factors associated with hospital-acquired pressure ulcers among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. BACKGROUND Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital-acquired pressure ulcers compared with patients with pre-existing pressure ulcers. DESIGN A point prevalence study with a cross-sectional survey design was conducted at a Swedish university hospital. METHOD Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. RESULTS The prevalence of pressure ulcers was 27% (95% confidence interval, 23-31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. CONCLUSION The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development. RELEVANCE TO CLINICAL PRACTICE Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.
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Affiliation(s)
- C Wann-Hansson
- Faculty of Health and Society, Malmö University, Malmö, Sweden.
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Anthony D, Parboteeah S, Saleh M, Papanikolaou P. Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement. J Clin Nurs 2008; 17:646-53. [PMID: 18279297 DOI: 10.1111/j.1365-2702.2007.02029.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To consider the validity and reliability of risk assessment scales for pressure ulcers. BACKGROUND Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. DESIGN A literature review and commentary. METHODS Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. RESULTS There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment scales has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. CONCLUSIONS There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. RELEVANCE TO CLINICAL PRACTICE Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.
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Affiliation(s)
- Denis Anthony
- Mary Seacole Research Centre, De Montfort University, Leicester, UK.
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Bååth C, Hall-Lord ML, Idvall E, Wiberg-Hedman K, Wilde Larsson B. Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form-Mini Nutritional Assessment by registered and enrolled nurses in clinical practice. J Clin Nurs 2008; 17:618-26. [DOI: 10.1111/j.1365-2702.2007.02131.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Feuchtinger J, Halfens R, Dassen T. Pressure ulcer risk assessment immediately after cardiac surgery--does it make a difference? A comparison of three pressure ulcer risk assessment instruments within a cardiac surgery population. Nurs Crit Care 2008; 12:42-9. [PMID: 17883663 DOI: 10.1111/j.1478-5153.2006.00198.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The intensive care unit (ICU) population has a high risk of developing pressure ulcers. According to several national expert guidelines for pressure ulcer prevention, a risk assessment for every situation in which the patient's condition is changing should be performed using a standardized risk assessment instrument. The aims of this study were to (a) assess the number of patients who are 'at risk' for the development of pressure ulcer according to three commonly used risk assessment instruments in the intermediate period after cardiac surgery procedures, (b) assess which instrument best fits the situation of the ICU patients and c) decide if 'static' risk assessment with an instrument should be recommended. The modified Norton scale, the Braden scale and the 4-factor model were used in a convenience sample of 53 patients to assess the risk for development of pressure ulcer in the first 5 days (in ICU) after cardiac surgery procedures. The number of patients at risk were >60% by the 4-factor model, >70% by the modified Norton scale and >80% by the Braden scale. Sensitivity and specificity in all scales were not satisfactory. Forty-nine per cent (n= 26) of the patients developed a pressure ulcer in the operating room, 13% (n= 7) up to day 5 in the cardiac surgery ICU. Only 1.9% (n= 1) of the pressure ulcers were stage 2. The study concluded that the patients in the cardiac surgery ICU can be identified as at risk during the first 5 days after surgical procedure without continuously using a standardized risk assessment instrument in every changing condition. Individual risk assessment by a standardized risk assessment instrument is only recommended to enable initiation of preventive measures based on patient-specific risk factors.
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Affiliation(s)
- Johanna Feuchtinger
- Quality and Development in Nursing, University Hospital Freiburg, Freiburg, Germany.
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Hulsenboom MA, Bours GJJW, Halfens RJG. Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC Nurs 2007; 6:2. [PMID: 17349049 PMCID: PMC1821326 DOI: 10.1186/1472-6955-6-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 03/09/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pressure ulcers are a common, painful and costly condition. Results of a 1991 study into the knowledge among Dutch hospital nurses on the usefulness of measures to prevent pressure ulcers showed moderate knowledge. Results were confirmed by subsequent studies. In recent years, Dutch guidelines have been updated and the attention given to pressure ulcer care has been increased. This was expected to improve pressure ulcer care and to increase nurses' knowledge. The aims of the current study were to investigate (1) how much nurses employed in Dutch hospitals know about the usefulness of 28 preventive measures considered in the most recent national pressure ulcer guideline; (2) whether differences in knowledge exist between nurses working in hospitals that audit pressure ulcers and those employed in hospitals that do not; and (3) to study whether knowledge among Dutch hospital nurses regarding the usefulness of preventive measures had changed between 1991 and 2003. METHODS A cross-sectional study design among nurses employed in Dutch hospitals in 2003 was used to investigate their knowledge and differences in knowledge between nurses employed in different types of institution. A comparative design was used to assess whether knowledge differed between this population and that of Dutch hospital nurses in 1991. The nurses' knowledge was assessed by a written questionnaire. Data of 522 respondents meeting the inclusion criteria were analyzed and compared with the results of the 351 nurses included in the 1991 study. RESULTS Knowledge in 2003 was slightly better than that in 1991. The nurses were moderately aware of the usefulness of preventive measures. Nurses employed in organizations that monitored pressure ulcers did not display greater knowledge than those employed in organizations that did not do so. CONCLUSION Knowledge among Dutch hospital nurses about the usefulness of measures to prevent pressure ulcers seems to be moderate. Being employed in an institution that monitors pressure ulcer care hardly affects the knowledge level. Knowledge about prevention has improved little since 1991.
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Affiliation(s)
- Mirjam A Hulsenboom
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
| | - Gerrie JJW Bours
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
- Zuyd University, Center of expertise on Autonomy and Participation, The Netherlands
| | - Ruud JG Halfens
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
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Bååth C, Hall-Lord ML, Johansson I, Wilde Larsson B. Nursing assessment documentation and care of hip fracture patients’ skin. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.joon.2006.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stekelenburg A, Oomens CWJ, Strijkers GJ, de Graaf L, Bader DL, Nicolay K. A new MR-compatible loading device to study in vivo muscle damage development in rats due to compressive loading. Med Eng Phys 2006; 28:331-8. [PMID: 16118060 DOI: 10.1016/j.medengphy.2005.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 06/09/2005] [Accepted: 07/08/2005] [Indexed: 10/25/2022]
Abstract
To study the aetiology of pressure ulcers an MR-compatible loading device was developed. Magnetic resonance imaging provides the possibility of non-invasive evaluation of muscle tissue after compressive loading. Pressure was applied to the tibialis anterior region of rats by means of an indenter. The developed MR-compatible loading device allowed high quality consecutive MR measurements for up to 6h. Tissue was evaluated both during and after loading. Two loading protocols were used; a large indentation of 4.5mm (mean pressure 150 kPa) was applied for 2h and a small indentation of 2.9 mm (mean pressure 50 kPa) was applied for 4h. T2-weighted MR images after the large indentation showed an immediate increase in signal intensity, associated with damage, following load removal. After 20 h the signal intensity remained higher in the affected regions. Afterwards the tissue was perfusion fixated for histological examination. Histological evaluation revealed an inflammatory response and severe muscle necrosis. No signal increase was observed after small indentation. With this new set-up, the different factors that may play a role in the onset of muscle damage can be studied, what we believe will lead to a better understanding of the contributing factors to pressure ulcer development.
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Affiliation(s)
- A Stekelenburg
- Department of Materials Technology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
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