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Journal of the American Academy of... Oct 2019Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure...
Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article focuses on pressure ulcer prevention and management, with an emphasis on the evidence for commonly accepted practices.
Topics: Debridement; Dermatology; Evidence-Based Medicine; Humans; Negative-Pressure Wound Therapy; Patient Positioning; Pressure Ulcer; Recurrence; Secondary Prevention; Skin Care
PubMed: 30664906
DOI: 10.1016/j.jaad.2018.12.068 -
Journal of the American Academy of... Oct 2019Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United...
Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while the associated costs of care continue to increase. Dermatologists can play a significant role in pressure ulcer prevention by becoming aware of at-risk populations and implementing suitable preventive strategies. Moreover, dermatologists should be able to recognize early changes that occur before skin breakdown and to properly identify and stage pressure ulcers to prevent delay of appropriate care. The aim of the first article in this continuing medical education series is to discuss the pathophysiology, risk factors, epidemiology, social and economic burdens, and clinical presentation of pressure ulcers.
Topics: Humans; Pressure Ulcer; Risk Assessment; Risk Factors
PubMed: 30664905
DOI: 10.1016/j.jaad.2018.12.069 -
Journal of Clinical Nursing Aug 2021To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. (Review)
Review
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.
Topics: Humans; Critical Care; Critical Illness; Cross-Sectional Studies; Delivery of Health Care; Intensive Care Units; Pressure Ulcer
PubMed: 33590917
DOI: 10.1111/jocn.15709 -
Advances in Skin & Wound Care Mar 2020To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific... (Review)
Review
GENERAL PURPOSE
To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with further discussion of nutrition for pressure injury management in the context of the recommendations.
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 should be better able to:1. Distinguish nutrition and malnutrition, especially as they relate to the development and healing of pressure injuries.2. Differentiate the tools and techniques that help clinicians assess nutrition status as well as the causes of pressure injuries in specific populations.3. Identify interventions for improving nutrition status and promoting pressure injury healing.
ABSTRACT
Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues. Specifically, nutrition plays an important role in the prevention and treatment of pressure injuries. The purpose of this manuscript is to review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Nutrition for pressure injury management is discussed in the context of the recommendations.
Topics: Education, Medical, Continuing; Female; Humans; Internationality; Male; Nutritional Status; Patient Care Team; Practice Guidelines as Topic; Pressure Ulcer; Primary Prevention; Role; Wound Healing
PubMed: 32058438
DOI: 10.1097/01.ASW.0000653144.90739.ad -
British Journal of Community Nursing Dec 2019Pressure ulcer/injury remains a significant health problem in the community, requiring comprehensive care. Nurses are involved in the management and prevention of... (Review)
Review
Pressure ulcer/injury remains a significant health problem in the community, requiring comprehensive care. Nurses are involved in the management and prevention of pressure injury. However, to date, studies focusing on applying nursing theory to pressure ulcer care have been limited. In the present study, the three dimensions of Lydia Hall's 1964 theory-core, care and cure-are extensively discussed and linked with the practice of pressure injury management. It is hoped that this review will help community nurses understand the application of this nursing theory to the prevention and management of pressure injury.
Topics: Community Health Nursing; Humans; Nursing Theory; Pressure Ulcer
PubMed: 31804885
DOI: 10.12968/bjcn.2019.24.Sup12.S38 -
Journal of Tissue Viability Aug 2020There has been an ongoing debate in the healthcare community about what pressure ulcers/injuries are, and how to name, define and classify them. The aim of this... (Review)
Review
There has been an ongoing debate in the healthcare community about what pressure ulcers/injuries are, and how to name, define and classify them. The aim of this discussion paper is to provide a brief theoretical background about pressure ulcer/injury classification, to explain the approach the Guideline Governance Group has taken during the 2019 update of the International Guideline for 'Prevention and Treatment of Pressure Ulcers/Injuries' and to share views on how to best implement pressure ulcer/injury classification. First formal pressure ulcer/injury classifications were introduced in the 1950s and today various pressure ulcer/injury classification systems are used worldwide. Dissimilarities between commonly used classification systems may be considered a limitation that impedes clinical and scientific communication. However, the conceptual meaning of pressure ulcer/injury categories described within the various classification systems is comparable and the current evidence does not indicate that one classification is superior to another. Therefore, the Guideline Governance Group created a crosswalk of the major pressure ulcer/injury classifications in common use across different geographic regions. Clinicians are encouraged to use the classification system adopted by their healthcare setting in the most consistent way. The validity of pressure ulcer/injury classification is closely linked to its intended purpose. Studying measurement properties of pressure ulcer/injury classification systems must follow state-of-the-art methods. Structured educational interventions are helpful for improving diagnostic accuracy and reducing misclassification of pressure ulcers/injuries. Implementation of innovative skin and soft tissue assessments and revised pressure ulcer/injury classifications are only worth implementing, when the diagnostic information improves clinical care.
Topics: Humans; Internationality; Pressure Ulcer; Severity of Illness Index
PubMed: 32414554
DOI: 10.1016/j.jtv.2020.04.003 -
Annals of Surgery Apr 2020Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to... (Review)
Review
BACKGROUND
Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to $17.8 billion in the United States alone. Despite considerable resources it exhausts, the disease remains very prevalent, and the incidence is on the rise. This is in part due to aging population, growing number of nursing home residents, poorly understood biology, and dismal track record of clinical research in this field.
METHODS
In our Review Article, we discuss the disease pathophysiology, clinical manifestation, evidence based recommendations for risk assessment, prevention and timely management, existing challenges, and directions to improve research on the field. This article encompasses dedicated sections on the full spectrum of the pressure related pathologies including "conventional pressure ulcers", "medical device related pressure injuries", "pressure injuries in mucosal membranes", "pressure injuries in pediatric population", "pressure injury at end of life", and the "role of pressure in pathogenesis of diabetic foot ulcers".
Topics: Humans; Incidence; Pressure Ulcer; Prevalence; Risk Assessment; Risk Factors; United States
PubMed: 31460882
DOI: 10.1097/SLA.0000000000003567 -
Critical Care Nursing Clinics of North... Dec 2020Medical device-related pressure injuries result from use of medical devices, equipment, furniture, and everyday objects in direct contact with skin and because of... (Review)
Review
Medical device-related pressure injuries result from use of medical devices, equipment, furniture, and everyday objects in direct contact with skin and because of increased external mechanical load leading to soft tissue damage. The resultant pressure injury generally mirrors the pattern or shape of the device. The nurse and clinician must be hypervigilant of increased risk of pressure injuries with the use of these devices. This article provides evidence-based information regarding the most common devices that cause pressure injuries in adults and describes current best evidence-based prevention strategies. Evidence-based prevention strategies are key to minimizing the harm devices can cause.
Topics: Compression Bandages; Drainage; Equipment and Supplies; Evidence-Based Practice; Humans; Intubation, Intratracheal; Pressure Ulcer
PubMed: 33129412
DOI: 10.1016/j.cnc.2020.08.004 -
British Journal of Nursing (Mark Allen... Jun 2022Pressure ulcers are debilitating and often painful problem, particularly in people who are elderly, immobile and/or obese. It is estimated that more than 100 000 new...
Pressure ulcers are debilitating and often painful problem, particularly in people who are elderly, immobile and/or obese. It is estimated that more than 100 000 new pressure ulcers develop each year. These wounds are caused by friction and shear and are particularly prevalent in older people, where malnutrition can be a factor in their development. Nutrition plays a key role in pressure ulcer care because wounds need both macronutrients and micronutrients to heal. It is essential that nurses understand the role of nutrition in pressure ulcer management.
Topics: Aged; Humans; Malnutrition; Nutritional Status; Pressure Ulcer; Wound Healing
PubMed: 35736848
DOI: 10.12968/bjon.2022.31.12.S26 -
Revista Brasileira de Enfermagem 2020To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its...
OBJECTIVE
To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its prediction potential to develop pressure ulcer (PU).
METHODS
A cross-sectional, quantitative study that evaluated all patients hospitalized in an ICU between November 2016 and February 2017, with the Braden Scale.
RESULTS
The prevalence of PU was 35.8% (24/67), in male individuals 58.3% (14/24), diagnosed with ischemic CVA 51.9% (12/27), and with hemorrhagic CVA 7.4% (2/27). Among patients classified at severe risk of developing pressure ulcer, 83.3% (20/53) developed it, and 76.7% (33/53) did not develop it.
CONCLUSION
The performance of the Braden Scale showed a balance between sensitivity and specificity, confirming it as a better predictive risk assessment instrument in this group of patients.
Topics: Cross-Sectional Studies; Humans; Male; Nursing Assessment; Predictive Value of Tests; Pressure Ulcer; Risk Assessment; Risk Factors
PubMed: 32785503
DOI: 10.1590/0034-7167-2019-0413