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Revista Latino-americana de Enfermagem Aug 2018to identify existing instruments in the scientific literature about the care of pressure injuries in pediatric and hebiatric patients. (Review)
Review
OBJECTIVE
to identify existing instruments in the scientific literature about the care of pressure injuries in pediatric and hebiatric patients.
METHOD
an integrative review that selected 32 articles from the PubMed/Medline, LILACS, Scopus and CINAHL databases using the descriptors pressure ulcer, decubitus ulcer, pediatrics, adolescent and protocols and their equivalent terms in Portuguese and Spanish. Inclusion criteria: research articles in full, in Portuguese, English or Spanish without any temporal cut-off. The descriptive analysis was adopted to categorize the instruments found into the three domains of care: evaluative, preventive and curative.
RESULTS
25 instruments for the care of pressure injuries in pediatric and hebiatric patients were found, with an emphasis on the Braden Q Scale being the most commonly used to assess pressure injury risk, and the protocols containing pressure injury staging guidelines developed by the National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP).
CONCLUSION
the scientific literature has valid and reliable instruments that can be used in nursing care practice aimed at the evaluative, preventive and curative care of pressure injuries in pediatric and hebiatric patients.
Topics: Adolescent; Adolescent Medicine; Child; Clinical Protocols; Humans; Pediatrics; Pressure Ulcer; Young Adult
PubMed: 30110107
DOI: 10.1590/1518-8345.2289.3034 -
Journal of Wound Care Feb 2020The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the 'SEM...
The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the 'SEM scanner'. We also describe the mode of operation of the SEM scanner in monitoring tissue health and detecting subtle abnormal changes in tissue physiology in patients and anatomical sites at a risk of a pressure ulcer (PU: also known as a pressure injury). The technology of the SEM scanner was approved last year for sales in the US by the Food and Drug Administration (FDA). The SEM scanner detects changes in fluid contents of human skin and subdermal tissues, to a tissue depth of several millimetres, by measuring 'capacitance', an electrical property of the locally examined tissue site to store electric charge. The capacitance of tissues, called 'biocapacitance', is strongly affected by the amount of fluid (water) in the tissue. When the first cells die in a forming PU, inflammatory signalling causes the permeability of blood vessel walls to increase and oedema to develop. Simply, the scanner detects the early appearance of oedema, which is called 'micro-oedema.' Calculation of a 'SEM-delta' value, which compares biocapacitance measurements, acquired across several tissue sites, some of which are healthy and others where the PU may evolve, eliminates potential effects of systemic changes in tissue fluid contents and provides a consistent quantitative measure of the tissue health conditions at the monitored anatomical site. Here, we describe SEM scanner technology, how it operates and has been laboratory tested (in computer simulations, ) before commercial launch. We explain why targeting the physical biomarker of oedema leads to the documented success of the SEM scanner in the multiple published clinical trials, proving its ability to early detect PUs that form under intact skin.
Topics: Dermis; Early Diagnosis; Edema; Electric Capacitance; Humans; Pressure Ulcer; Skin; Subcutaneous Fat
PubMed: 32058838
DOI: 10.12968/jowc.2020.29.Sup2c.S10 -
Journal of Wound Care Apr 2018Hospital-acquired pressure ulcers (HAPUs) remain a problem despite numerous prevention initiatives. To understand why, it is necessary to know health professionals'...
OBJECTIVE
Hospital-acquired pressure ulcers (HAPUs) remain a problem despite numerous prevention initiatives. To understand why, it is necessary to know health professionals' perceptions regarding the importance of prevention, and the usability of current initiatives. We hypothesised that positive perceptions of existing initiatives would not be correlated with low HAPU prevalence, and that health professionals would perceive the initiatives to have a low usability.
METHOD
A two-part, online survey was developed and distributed electronically to nurses, in-training physicians and attending physicians, across all inpatient and perioperative departments of an academic hospital. Part one of the survey was the Agency for Healthcare Research and Quality (AHRQ) Staff Attitude Scale on beliefs regarding PU prevention; part two was additional questions on the usability of existing preventative initiatives. The results of the survey were compared with quarterly HAPU prevalence data by hospital unit.
RESULTS
In total, 839 health professionals completed the survey (579 nurses, 131 residents, 119 attending physicians). The mean score for the AHRQ survey was 42.5 (≥40 denoting positive perceptions). There was a moderate correlation between AHRQ scores and prevalence of HAPUs (r=-0.60, p=0.402). For usability, repositioning was felt to be the most effective intervention (mean: 4.54, standard deviation (SD): 0.64), while educational posters were felt to be the least effective (mean: 3.31, SD: 0.99). Respondents generally rated satisfaction much lower, with no single initiative significantly better than the others (range: 3.21-3.79). Perceived effectiveness and satisfaction were all positively correlated.
CONCLUSION
High HAPU prevalence, despite position perceptions, suggests that prevention methods are not as effective as thought, or they are not being used as widely as they should. Further research should take advantage of positive attitudes by prospectively investigating the usability of novel interventions.
Topics: Adult; Attitude of Health Personnel; Female; Hospitals; Humans; Male; Middle Aged; Pressure Ulcer; Prevalence; Surveys and Questionnaires; United States
PubMed: 29641343
DOI: 10.12968/jowc.2018.27.Sup4.S29 -
Advances in Skin & Wound Care Apr 2015Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of... (Review)
Review
The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.
Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management.
Topics: Disease Management; Humans; Malnutrition; Nutritional Status; Pressure Ulcer
PubMed: 25775201
DOI: 10.1097/01.ASW.0000461911.31139.62 -
Nursing Standard (Royal College of... May 2015As patients increasingly care for themselves at home, they require accessible information to enable informed self-care. This article describes the development of an...
As patients increasingly care for themselves at home, they require accessible information to enable informed self-care. This article describes the development of an educational electronic application (app) designed for use by patients at risk of pressure ulcers, and their carers. The app can be downloaded to Windows, Android or Apple smartphones or tablets. The app is based on the current pressure ulcer prevention and management guidelines from the National Pressure Ulcer Advisory Panel and the National Institute for Health and Care Excellence, and is designed to educate patients and carers about how to prevent a pressure ulcer, how to recognise a pressure ulcer, and what to do if they suspect they are developing a pressure ulcer. We hope the app will be used to help with educational conversations among patients, carers and healthcare professionals.
Topics: Humans; Patient Education as Topic; Pressure Ulcer; Self Care; United Kingdom; Wound Healing
PubMed: 25942988
DOI: 10.7748/ns.29.36.64.e9956 -
Medecine Et Maladies Infectieuses Feb 2019Pressure ulcers are frequently observed in spinal cord injury (SCI) patients. They can be life-threatening and are a major medico-economic burden. Despite their... (Review)
Review
OBJECTIVES
Pressure ulcers are frequently observed in spinal cord injury (SCI) patients. They can be life-threatening and are a major medico-economic burden. Despite their frequency, their pathophysiology and optimal management are still poorly understood. Most available data comes from non-comparative studies, especially in terms of antimicrobial use.
METHODS
We performed a critical review of the literature and opinions of infectious disease specialists based in a French expert center for this disease. We mainly focused on antimicrobial treatments prescribed in this situation.
RESULTS
These infections are usually clinically diagnosed. Microbiological samples are not the gold standard for this assessment. Furthermore, reliable microbiological identification is a major challenge but should help select antimicrobial treatment. Imaging technique could be helpful but cannot replace the physical examination. The choice of antimicrobials must consider the potential ecological collateral damages in this vulnerable population. Antimicrobial therapy should be as short as possible, adapted to the microbiological identification, and must have suitable bioavailability.
CONCLUSION
Management of infected pressure ulcers is a major concern in disabled patients already highly exposed to antimicrobial treatment and multidrug-resistant organisms colonization. Extensive data is required.
Topics: Anti-Infective Agents; Drug Resistance, Multiple, Bacterial; Humans; Pressure Ulcer; Spinal Cord Injuries; Wound Infection
PubMed: 29937316
DOI: 10.1016/j.medmal.2018.05.004 -
Advances in Skin & Wound Care Jan 2022To provide an update on the epidemiology, pathophysiology, prevention, and patient preferences for care of pressure injuries (PIs). (Review)
Review
GENERAL PURPOSE
To provide an update on the epidemiology, pathophysiology, prevention, and patient preferences for care of pressure injuries (PIs).
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES
After participating in this continuing education activity, the participant will:1. Recognize the risks to ICU patients regarding PIs.2. Select evidence-based strategies that can help prevent PIs.3. Identify factors that can contribute to the development of PIs.4. Choose collaborative approaches when working with a patient who has a PI.
ABSTRACT
The literature on pressure injuries continues to expand at a rapid rate such that keeping current is a challenge for busy clinicians. In this article, the authors summarize six important articles related to pressure injuries published in 2020. The articles cover a range of topics including epidemiology, pathophysiology, prevention, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information should help clinicians incorporate these new data into their clinical practice.
Topics: Crush Injuries; Humans; Pressure Ulcer; Skin; Wound Healing
PubMed: 34935717
DOI: 10.1097/01.ASW.0000800200.98475.87 -
Advances in Skin & Wound Care Sep 2018To determine the pressure injury knowledge of health professionals before and after providing an interactive, educational intervention.
OBJECTIVE
To determine the pressure injury knowledge of health professionals before and after providing an interactive, educational intervention.
DESIGN AND SETTING
The research design was a quasi-experimental study using a nonrandomized pretest/posttest methodology in Manila, Philippines.
PATIENTS AND INTERVENTION
The population for this study was healthcare professionals who participated in a 2-day Basic WoundPedia course. There were 57 participants on day 1 and 55 participants on day 2. The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT, version 2), a standardized, validated instrument with 72 items, was used to measure 3 domains: prevention (28 items), staging (20 items), and wounds (24 items). The test was used to determine the baseline pressure injury knowledge of the students on day 1 before the course began and on day 2 after related content was completed. The intent of this approach was to document that knowledge deficits were met, especially for future courses.
MAIN RESULTS
There was a statistically significant increase in pressure injury knowledge scores after healthcare professionals received an interactive, educational intervention.
CONCLUSIONS
Measuring knowledge before and after educational intervention should be considered to determine whether knowledge deficits are corrected. This methodology reinforced the adult learning theory and to help participants realize their own knowledge deficits. The PZ-PUKT may prove a valuable nonthreatening instrument for adult learners to self-identify, self-learn, and self-correct knowledge according to the best new evidence as it becomes available. These findings documented that this interactive, educational intervention did improve the percentage of correct pressure injury knowledge concepts for this group in all 3 subscales. This study also added support for the newly revised PZ-PUKT.
Topics: Clinical Competence; Educational Measurement; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Philippines; Practice Guidelines as Topic; Pressure Ulcer
PubMed: 30134276
DOI: 10.1097/01.ASW.0000540071.45158.29 -
British Journal of Community Nursing Mar 2020Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article...
Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article discusses how one NHS trust reduced the incidence of heel pressure ulcers within adult inpatient settings. In 2016/17, the trust identified 14 avoidable category 3 and above pressure ulcers/injuries in inpatient settings, of which 10 had developed on the heels. Through root cause analysis, the organisation identified themes, which prompted action, and a quality improvement project 'Deal with heels' was planned and implemented. Changes were introduced through a collaborative and structured approach; the key stakeholders included the tissue viability team, procurement, medical devices, patient safety, managers, matrons, ward sisters and tissue viability link advisors, who worked together to reduce heel ulcer prevalence through education and standardised practice. As a result of improved organisational awareness and some changes, the number of heel pressure ulcers/injuries reduced to two over a 3-year period, which also helped reduce the total number of avoidable pressure ulcers/injuries.
Topics: Heel; Hospitalization; Humans; Patient Care Team; Pressure Ulcer; Quality Improvement; United Kingdom
PubMed: 32160061
DOI: 10.12968/bjcn.2020.25.Sup3.S6 -
Journal of Tissue Viability Feb 2024Pressure ulcers are a significant health problem that affects a large population, especially the elderly and individuals with physical limitations. These injuries cause... (Review)
Review
Pressure ulcers are a significant health problem that affects a large population, especially the elderly and individuals with physical limitations. These injuries cause pain, are difficult to heal, and can be expensive to manage, leading to a negative impact on the quality of life of those affected. This scientific paper provides an overview of medical devices such as support surfaces, dressings, and topical agents for preventing and managing pressure ulcers. This review focuses on the importance of understanding the viscoelastic mechanical properties, water vapor transmission rate, and biocompatibility testing of medical devices, which can help define performance criteria needed to prevent and manage pressure ulcers effectively. The paper highlights the potential use of alginate, polyurethane, silicone, polyvinyl alcohol, and collagen as pressure relief and wound care solutions. Synthesizing this research can help medical device manufacturers make better decisions and improve the quality of care for patients with pressure ulcers.
Topics: Humans; Aged; Pressure Ulcer; Quality of Life; Bandages; Skin Care
PubMed: 38142200
DOI: 10.1016/j.jtv.2023.12.001