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Journal of Wound Care Sep 2023
Topics: Humans; Pressure Ulcer
PubMed: 37682789
DOI: 10.12968/jowc.2023.32.9.529 -
International Wound Journal Aug 2023This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for... (Randomized Controlled Trial)
Randomized Controlled Trial
This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.
Topics: Aged; Humans; Long-Term Care; Pressure Ulcer; Prevalence; Skin Care; Suppuration
PubMed: 36584884
DOI: 10.1111/iwj.14067 -
Journal of Wound Care Jul 2023Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk...
OBJECTIVE
Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs.
METHOD
This study used a cohort design. The data were collected at Acıbadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data.
RESULTS
Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001).
CONCLUSION
Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Pressure Ulcer; Operating Rooms; Risk Factors; Risk Assessment; Skin
PubMed: 37405971
DOI: 10.12968/jowc.2023.32.Sup7a.cxxviii -
Revista Da Escola de Enfermagem Da U S P 2023Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. (Review)
Review
OBJECTIVE
Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.
METHOD
Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.
RESULTS
15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.
CONCLUSION
Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.
Topics: Humans; Pressure Ulcer; Systematic Reviews as Topic
PubMed: 38133528
DOI: 10.1590/1980-220X-REEUSP-2023-0039en -
Advances in Skin & Wound Care Sep 2023To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries. (Review)
Review
GENERAL PURPOSE
To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries.
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates.
Topics: Humans; Pressure Ulcer; Crush Injuries; Education, Continuing; Nurse Practitioners; Physicians
PubMed: 37603315
DOI: 10.1097/ASW.0000000000000025 -
Intensive & Critical Care Nursing Dec 2023To explore nurses' knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention.
OBJECTIVE
To explore nurses' knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention.
DESIGN/METHOD
A pre-and post-intervention study. Pre-intervention data collection involved administering an instrument, including demographic information, the Pressure Ulcer Knowledge Assessment Tool version 2, and the Attitudes towards Pressure Ulcer Prevention instruments. Following the analysis of pre-intervention data, an educational intervention was implemented. Post-intervention data were collected using the same instrument.
SETTING
Intensive care units at three Saudi Arabian hospitals.
MAIN OUTCOME MEASURES
Nurses' knowledge and attitudes towards pressure injury prevention.
RESULTS
The pre-intervention phase included 190 participants, and the post-intervention phase included 195 participants. Participants completed a paper-based survey at two different time points between June 2021 and March 2022. The mean pre-intervention scores for nurses' knowledge and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively. Following the educational intervention, the knowledge and attitude scores increased significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury prevention was positively associated with positive attitudes towards prevention practices. Age, clinical nursing experience, and experience in intensive care units were identified as factors correlated with knowledge of pressure injury prevention. A Bachelor's qualification or higher predicted better knowledge and attitudes towards pressure injury prevention.
CONCLUSIONS
Nurses' knowledge and attitudes towards pressure injury prevention greatly improved following tailored, evidence-based education. The educational intervention featured multiple on-site bedside discussions, case studies, small-group presentations, and the provision of printed resources.
IMPLICATIONS FOR CLINICAL PRACTICE
Nurses' knowledge and attitudes towards pressure injury prevention should be examined, and education provided to ensure evidence-based prevention practices are implemented. Tailored small-group education sessions delivered conveniently could be an effective approach. Efforts should focus on attracting and retaining experienced, highly qualified nurses to ensure the adoption of evidence-based prevention practices.
Topics: Humans; Pressure Ulcer; Clinical Competence; Saudi Arabia; Nurses; Critical Care; Attitude
PubMed: 37603978
DOI: 10.1016/j.iccn.2023.103528 -
AORN Journal Jul 2023Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and...
Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.
Topics: Child; Humans; Pressure Ulcer; Perioperative Period; Practice Guidelines as Topic
PubMed: 37368530
DOI: 10.1002/aorn.13948 -
Journal of Advanced Nursing Sep 2023To explore patient perceptions and understanding of their pressure ulcer risk and how information is communicated between a nurse and patient in the home setting.
AIMS
To explore patient perceptions and understanding of their pressure ulcer risk and how information is communicated between a nurse and patient in the home setting.
DESIGN
A pragmatic qualitative research design including community-dwelling patients, who were deemed at risk of developing a pressure ulcer.
METHODS
Observation of routine interactions between nurse and patient regarding their pressure ulcer risk and semi-structured interviews with 15 community patients following the nursing interaction.
RESULTS
Four key overarching themes emerged from the data analysis that were related to patient perceptions and understanding of pressure ulcer risk. These included Pressure Ulcer Awareness, Importance of Repositioning, Healthy Eating and Risk Interpretation.
CONCLUSION
Patient perception and understanding of pressure ulcer risk is different from the scientific, professional view. Patient risk perception was based on heuristics and wider personal factors and social influences.
IMPACT
The study provides important new insights into clinical practice in relation to how pressure ulcer advice and information are provided and interpreted in the community setting.
REPORTING METHOD
Adhered to the Standards for Reporting Qualitative Research (SRQR) PATIENT OR PUBLIC CONTRIBUTION: A small selection of patients within the NHS Trust in which the research was conducted contributed to the design of the study, in particular some of the interview questions and timing.
Topics: Humans; Pressure Ulcer; Patients; Qualitative Research
PubMed: 36919007
DOI: 10.1111/jan.15637 -
International Journal of Nursing Studies Jan 2024Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package.
TRIAL DESIGN
A two-arm cluster-randomised controlled trial was conducted.
METHODS
In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed.
RESULTS
A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial.
CONCLUSIONS
The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function.
TRIAL REGISTRATION
This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31, 2019).
Topics: Humans; Aged; Pressure Ulcer; Quality of Life; Skin; Intertrigo; Pain
PubMed: 37956524
DOI: 10.1016/j.ijnurstu.2023.104627 -
Journal of Wound Care Sep 2023The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically... (Review)
Review
OBJECTIVE
The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage.
METHOD
The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022.
RESULTS
Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com.
CONCLUSION
Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position.
Topics: Humans; Prone Position; Education, Distance; Patient Positioning; Pressure Ulcer; Qualitative Research
PubMed: 37682782
DOI: 10.12968/jowc.2023.32.9.570