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Kitamura JC, Nicolosi JT, Paggiaro AO, Fernandes de Carvalho V. Educational interventions on preventing pressure injuries targeted at nurses: systematic review and meta-analysis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S40-S50. [PMID: 37949494 DOI: 10.12968/bjon.2023.32.sup20.s40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease. AIM Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce. METHOD The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies. FINDINGS In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries. CONCLUSION The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.
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Affiliation(s)
| | | | - André Oliveira Paggiaro
- Professor, Nursing Postgraduate Programme, Guarulhos University, and Plastic Surgeon, Plastic Surgery Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Alshahrani B, Sim J, Middleton R. Nursing interventions for pressure injury prevention among critically ill patients: A systematic review. J Clin Nurs 2021; 30:2151-2168. [PMID: 33590917 DOI: 10.1111/jocn.15709] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
AIM To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. BACKGROUND Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings. DESIGN A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. METHODS Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis. RESULTS The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low. CONCLUSIONS Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries. RELEVANCE TO CLINICAL PRACTICE Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.
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Affiliation(s)
- Bassam Alshahrani
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Taibah University, Medina, Saudi Arabia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
| | - Rebekkah Middleton
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
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Serpa LF, Ortiz MM, Lima AC, Bueno L, Nogueira PC, Ferri C, Santos VLCDG. Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil. Wound Repair Regen 2020; 29:79-86. [PMID: 33047424 DOI: 10.1111/wrr.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/19/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.
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Affiliation(s)
- Leticia Faria Serpa
- School of Health Sciences Education, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Margarita Maria Ortiz
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anne Chaves Lima
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Línea Bueno
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Cristina Nogueira
- Department of Medical-Surgical Nursing and Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cleusa Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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Yu Y, Shen J, Fang G, Wang L, Lei S, Cai D, Shi Y, Jin S, Lu Q, Wang S, Sun Y, Yao J, Hu P, Wu X, He X. Use of autologous platelet rich fibrin-based bioactive membrane in pressure ulcer healing in rats. J Wound Care 2019; 28:S23-S30. [PMID: 30975063 DOI: 10.12968/jowc.2019.28.sup4.s23] [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 To verify the feasibility of treating pressure ulcers (PUs) with autologous platelet-rich fibrin-based (PRF) bioactive membrane, both in vitro and in vivo. METHOD An animal model using adult male Sprague-Dawley rats was used. Pressure was periodically exerted on the skin to induce localised ischaemia by using an external magnet and transplanted metal disc. After a PU developed, the rats were divided into two groups: a treatment group and a control group. Rats in the treatment group were then treated with PRF bioactive membrane every three days. RESULTS A total of 20 rats were used in this study. At days three and seven, the PU area in the PRF bioactive membrane-treated group was significantly smaller than that in the control group, and after 14 days of treatment, the PUs in the PRF bioactive membrane treatment group had healed. Haemotoxylin and eosin staining, immunohistochemistry and Western blot results indicated that PRF bioactive membrane induced wound healing by increasing the thickness of the regenerated epidermis and by upregulating vascular endothelial growth factor expression. Further, we found that different concentrations of rat autologous PRF soluble factors extraction components could significantly promote rat aortic endothelial cell proliferation, wound healing and migration ability in vitro. CONCLUSION Overall, results indicate that PRF bioactive membrane promotes PU healing in rats. Thus, it may represent a natural and effective wound-healing tool for use in the treatment of clinical skin PUs in humans in the future.
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Affiliation(s)
- Yajuan Yu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jian Shen
- Technologist-in-charge, Department of Blood Transfusion, Zhejiang Provincial People's Hospital; People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Guizhen Fang
- Lead Nurse Advanced Nurse Practitioner, Nursing Department of Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Lingcong Wang
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shu Lei
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Danli Cai
- Associate Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Ying Shi
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shuifang Jin
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Qiaoli Lu
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Sisi Wang
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Yunlei Sun
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jinmei Yao
- Associate Senior Technician, Department of Laboratory Medicine, Key Laboratory of Clinical In vitro Diagnostic Techniques of Zhejiang Province First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Peiya Hu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Xiaofei Wu
- Senior Nurse; Department of Central Vein Maintenance Center, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hubin Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xujun He
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
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Tayyib N, Coyer F. Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:432-444. [PMID: 27712030 DOI: 10.1111/wvn.12177] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention. AIMS The aim was to synthesize the best available evidence regarding the effectiveness of single strategies designed to reduce the incidence and prevalence of HAPUs development in ICUs. METHODS The search strategy was designed to retrieve studies published in English across CINAHL, Medline, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Mednar between 2000 and 2015. All adult ICU participants were aged 18 years or over. This review included randomized controlled trials, quasi-experimental and comparative studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. RESULTS The review included 25 studies, and the meta-analysis revealed a statistically significant effect of a silicon foam dressing strategy in reducing HAPUs incidence (effect size = 4.62; 95% CI: 0.05-0.29; p < .00001, effect size = 4.50; 95% CI: 0.05-0.31; p = .00001, respectively) in critically ill patients. Evidence of the effectiveness of nutrition, skin-care regimen, positioning and repositioning schedule, support surfaces, and the role of education in prevention of HAPUs development in the ICU was limited, which precludes strong conclusions. LINKING EVIDENCE TO ACTION The review provides an evidence-based guide to future priorities for clinical practice. In particular, a silicone foam dressing has positive impact in reducing sacrum and heel HAPUs incidence in the ICU.
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Affiliation(s)
- Nahla Tayyib
- Doctoral Candidate, School of Nursing, Queensland University of Technology, Queensland, Australia.,Lecturer, School of Nursing, Umm Al-Qura University, Saudi Arabia
| | - Fiona Coyer
- Professor of Nursing, School of Nursing, Queensland University of Technology, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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