压疮高危患者居家护理相关因素的调查分析

目的：调查压疮高危患者居家主要照顾者对压疮预防知识、态度及行为的现状,分析家庭护理不当的相关因素。方法采用问卷调查法对抽取的108例压疮高危患者主要照顾者进行调查（一般资料调查、采用自行设计的压疮知信行评估问卷进行测评）。结果压疮高危患者居家主要照顾者对压疮的相关知识的认知程度不高,且缺乏正规的学习渠道。在压疮相关知识认知方面：大专及以上者优于大专以下者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。在防护压疮的态度和行为方面：大专以下主要照顾者优于大专及以上者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。结论压疮高危患者居家主要照顾者预防压疮的意识薄弱,应加强压疮防护知识的健康教育,广泛开展多种形式的健康宣教,降低压疮高危患者压疮的发生率,提高其生活质量。     

社区卧床老人主要照顾者预防压疮的自我效能水平及影响因素分析

目的调查社区卧床老人的主要照顾者压疮预防的自我效能及其影响因素。方法采用便利抽样的方法,通过一般资料调查表、预防压疮知识量表和预防压疮自我效能量表,对某社区123名社区卧床老年人的主要照顾者进行调查。结果社区卧床老年人主要照顾者预防压疮自我效能平均得分为(50.14±9.87)分,主要照顾者预防压疮知识平均得分为(24.55±6.85)分,单因素方差分析结果显示主要照顾者的年龄、文化程度、有无其他人协助照顾和自觉健康状况是影响主要照顾者预防压疮自我效能的因素(F/t值分别为4.89,-3.57,4.06,2.01;P<0.05)。多元逐步回归分析结果显示,主要照顾者的年龄、文化程度、预防压疮知识进入方程,两者共同解释健康行为41.8%的变异。结论临床护理人员对社区卧床老年人的主要照顾者进行健康宣教时,应关注他们的年龄、受教育程度,重点强调预防压疮方面的知识。     

脊髓损伤患者照顾者的照顾负担及其影响因素研究

目的调查脊髓损伤患者照顾者的照顾负担水平,并分析其影响因素。方法通过便利抽样法,采用生活自理能力量表、照顾者为患者提供护理情况问卷、一般自我效能量表、社会支持量表、Zarit护理负担量表和简易应对方式问卷,对150例脊髓损伤患者及其照顾者进行调查。结果脊髓损伤患者照顾者的照顾负担总分(52.91±11.56)分,88%的照顾者的负担处于中、重度水平;多元逐步回归分析显示,照顾者照顾负担的影响因素有:并发症、照顾时间、消极应对方式、患者的自理能力、照顾者的照顾能力、自我效能及积极应对方式。结论护理工作者应重视脊髓损伤患者照顾者的照顾负担,鼓励患者自理,增强社会支持系统,指导其采取积极的应对方式,以减轻照顾者的照顾负担。     

146例压疮患者居家照顾者的照顾行为调查

目的探讨压疮患者居家照顾者照顾行为现状。方法便利抽样,采用问卷调查法对146名Ⅱ-Ⅳ期压疮患者居家照顾者进行调查。结果本组照顾者照顾行为总分平均（39．98±6．33）分,仅17．8％的照顾者帮助患者抬高床头时从不超过30°,17．1％的照顾者给患者翻身侧卧时从不大于30°,25．3％的照顾者从不使用圈型气垫;各维度得分中,翻身行为维度得分最低为（18．55±3．84）分,创面护理维度得分次之（7．65±1．73）分,其次是营养支持维度得分（3．85±1．51）分,皮肤护理维度得分最高（9．88±2．21）分。结论压疮患者居家照顾者照顾行为存在不足和误区,尤其是翻身行为和创面护理方面比较薄弱。针对提高照顾者翻身行为和换药行为的护理干预有助于促进患者压疮愈合,降低压疮新发和再发生率。     

居家慢性心力衰竭患者家庭照顾者的生存质量及其影响因素

目的了解居家慢性心力衰竭患者家庭照顾者的生存质量并探讨其影响因素。方法方便性抽样选取155例居家慢性心力衰竭患者的家庭照顾者,采用家庭照顾者生存质量量表和一般自我效能感量表对其进行调查。结果居家慢性心力衰竭患者家庭照顾者的生存质量总分为(54.91±10.45)分;多元线性逐步回归分析显示,照顾者的自我效能、患者的纽约心脏病协会(the New York Heart Association,NYHA)心功能分级、照顾者的文化程度是居家慢性心力衰竭患者家庭照顾者生存质量的主要影响因素。结论居家慢性心力衰竭患者家庭照顾者的生存质量因照护任务而受损,尤其对于自我效能差、文化水平低、所照顾患者心功能差的照顾者更应给予关注。     

个体化教育方案对压疮患者居家照顾者照顾行为的影响

目的探讨个体化教育方案对改善压疮患者居家照顾者照顾行为的作用。方法采用方便抽样法选取2010年3-11月复旦大学附属华山医院伤口造口护理门诊就诊患者的照顾者46例作为研究对象,以随机数字表法将其分为干预组和对照组各23例。对照组接受门诊常规护理教育;干预组在门诊常规护理教育的基础上,实施个体化教育方案,为期3个月。以主要照顾者照顾行为、照顾者为患者翻身和换药行为、患者压疮愈合率和再发生率作为评价指标,分别于干预后1周、1个月和3个月进行效果评价。结果干预后1周,干预组照顾者为患者翻身和换药行为总均分明显高于对照组,差异有统计学意义(P0.01);干预后1、3个月,干预组照顾者照顾行为优于对照组,差异均有统计学意义(均P0.01);干预后3个月,干预组患者压疮愈合率和再发生率与对照组差异均无统计学意义(均P0.05)。结论个体化的教育方案可有效改善压疮患者居家照顾者的照顾行为,但其对促进压疮愈合、降低再发生率的效果需延长干预时间进一步评价。     

基层压疮高危人群居家照顾现状及策略

总结了我国压疮高危人群居家照顾现状,主要包括基层压疮高危人群居家现状、照顾者技能培训现状。认为通过对基层压疮高危人群居家照顾者的培训,可以有效改善照顾者照顾行为,降低压疮高危人群压疮发生率及压疮再发生率。     

结构化干预对居家压疮患者照顾者的影响

目的:探讨结构化干预对居家压疮患者照顾者的影响。方法:将32例居家Ⅱ~Ⅳ期压疮患者的照顾者随机分为干预组和对照组各16例,对照组采用传统单一的压疮健康指导方法,干预组采用结构化干预,比较两组干预效果。结果:两组干预后心理状况、生活质量、照顾压力比较差异有统计学意义(P0.05)。结论:结构化干预可调整居家压疮患者照顾者的心理状态,提高生活质量,缓解照顾压力。     

压疮患者居家换药护理管理模式探索

目的：探讨压疮患者居家换药护理模式,解决居家压疮患者行动不便、就医困难、家属及照顾者处理方法落后的局面．为居家压疮患者家属提供简单实用的换药操作流程和压疮预防指南,减少居家压疮患者压疮相关医疗费用支出,改善居家压疮患者及居家压疮高危人群的生存质量。方法：总结247例居家压疮患者换药模式,遴选成功案例与失败案例相关因素进行比对分析,讨论居家压疮患者换药成功与失败的相关因素,探讨居家压疮患者照顾者评估、教育、培训、指导的要点与方法,制定科学合理的居家换药操作流程和通俗易懂的居家压疮高危人群压疮预防指南。结果：大多数居家压疮患者的照顾者在培训后可以掌握简单的换药操作流程,但是要达到较好的换药效果,需要1～5次的教育、演示、考核,并提供书面的换药操作流程和压疮高危人群居家护理指南,确认居家照顾者掌握基本换药方法,方可提供1—5次的换药物品,并通过电话随访、网络沟通等方式保持联络与支持。结论：经过积极的院内清创处理和换药,评估遴选适合居家换药的压疮患者,并对居家压疮患者的照顾者进行培训,提供书面的换药操作流程和压疮高危人群居家护理指南,保持联络与支持,是护理居家压疮患者的可行方法。     

住院脑卒中患者主要照顾者负担及影响因素的研究

目的调查住院脑卒中患者主要照顾者的负担情况,并分析其影响因素。方法 2009年9-11月对75例住院的脑卒中患者及主要照顾者进行调查,包括主要照顾者的一般情况、照顾负担、社会支持和自我效能,被照顾者的一般情况、日常生活活动能力（actives of daily life,ADL）和认知能力。结果脑卒中患者主要照顾者负担总分为（32.45±16.11）分,为轻度负担水平;多因素分析显示,对社会支持的利用度、照顾者的教育水平、患者的ADL、与患者的关系及照顾者的自我效能是照顾者负担的影响因素。结论护理人员应了解脑卒中患者主要照顾者的负担水平及其影响因素,并提供有针对性的护理措施以减轻其负担。     

家庭跟进式护理提高家庭陪护预防卧床患者压疮依从性的效果

目的探讨以家庭跟进式护理模式为指导的居家护理对提高长期卧床患者家庭陪护预防压疮依从性的影响。方法 2008年2月至2009年5月,将即将出院的长期卧床患者的陪护120人按随机数字表法分为干预组和对照组各60人。对照组陪护施以常规的出院指导,干预组在此基础上施以家庭跟进式的居家护理。按照美国压疮顾问小组（National Pressure Ulcer Advisory Panel,NPUAP）推荐的4级分期标准以及自制家庭陪护依从性量表,评估两组患者的压疮发生率、分期及陪护的依从性。结果干预组家庭陪护对压疮防范措施的依从性显著优于对照组,差异有统计学意义（P〈0.05）,患者压疮的发生率及严重程度显著低于对照组,差异有统计学意义（P〈0.05）。结论以家庭跟进式护理模式指导长期卧床患者家庭陪护的居家护理行为,可以有效地提高陪护预防压疮的依从性,降低卧床患者压疮的发生率,提高患者的生活质量。     

压疮预防指南临床应用的效果分析

目的 评价<成人压疮预测和预防实践指南>对指导和规范护士预防压疮的效果.方法 对2008年5月至2010年4月在住院期间有压疮发生危险的成人患者11808例进行观察分析.2008年5月至2009年4月共2081例为对照组,按照<医疗护理常规>第4版中的预防压疮常规实施护理;2009年5月至2010年4月共9727例为观察组,按照2009年出版的<成人压疮预测和预防实践指南>实施护理.观察两组院内获得性压疮发生例数及压疮分期.结果 两组院内获得性压疮例数和Ⅲ期压疮发生数有显著差异.结论 <成人压疮预测和预防实践指南>的应用可有效降低压疮发生率和压疮严重度,规范护士预防压疮的护理行为.     

成人心血管手术压疮发生的现状及相关因素研究

目的：调查成人心血管手术患者手术压疮发生的现状,并探析相关因素,为实施有针对性的护理干预奠定基础。方法：回顾性调查2016年2月至2016年11月实施心血管手术的成人患者1163例,分析心血管手术患者手术压疮发生的现状;按国际压疮分类标准将患者分为压疮组和非压疮组,收集一般情况、生化指标、手术情况、药物使用、体外循环等资料,通过单因素分析和Logistics回归方程的建立探析成人心血管手术压疮发生的高危因素。结果：成人心血管手术压疮的发生率为19.86%; Logistic回归分析结果：心血管手术压疮发生概率LogitP=-11.745+0.024术前血红蛋白值+0.118血钠值-0.014前白蛋白量-0.213术中平均体温-0.058最低平均动脉压+0.646术前血钾值+0.264吸烟史+0.760高血压史+0.536年龄≥70周岁。结论：年龄≥70周岁、术前低前白蛋白水平、高血红蛋白值、高血钠值、高血钾值、吸烟史、高血压史、术中低体温、低平均动脉压的患者是心血管手术压疮发生的高危人群,应予以关注。     

Pressure ulcer prevention and management: the current evidence for care

Pressure ulcers, a common occurrence across healthcare settings, are a costly phenomenon. Since the publication of the AHCPR Guidelines on Pressure Ulcer Prevention and Treatment in the 1990s, additional attention has been focused on pressure ulcer prevention and management. This article discusses current evidence regarding known causes of pressure ulcers, pressure ucler prevention, pressure ulcer classification and assessment, and interventions to effectively manage pressure ulcers.     

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter‐rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs. Design. Survey was among pressure ulcer experts. Methods. Fifty‐six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter‐rater reliability was calculated. Results. The multirater‐Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers). Conclusions. The inter‐rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear. Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning.     

Development of pressure ulcer program across a university health system

Pressure ulcers were designated as a priority for quality care initiatives at the University of Pennsylvania Health System. The Penn Medicine Pressure Ulcer Collaborative was developed to address the complex issues of pressure ulcers. The Collaborative used a systematic approach to analyze, plan, and implement a health system-wide pressure ulcer program. As a result, the entire health system had a decrease in hospital-acquired pressure ulcer prevalence rates of 37%. This article describes the Collaborative's innovative approach to quality improvement.     

Reliability of the European Pressure Ulcer Advisory Panel classification system

AIM: This paper reports a study examining the interrater and intrarater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using photographs of pressure ulcers and incontinence lesions. BACKGROUND: Pressure ulcer classification is an essential tool for assessing ulcers and their severity and determining which preventive or therapeutic action is needed. Many classification systems are described in the literature. There are only a limited number of studies that evaluate the interrater reliability of pressure ulcer grading scales. The intrarater reliability is seldom studied. METHODS: The study consisted of two phases. In the first phase 56 photographs, together with a random selection of nine photographs from the same set, were presented to 473 nurses. In the second phase, the 56 photographs were presented twice to 86 other nurses with an interval of one month and in a different order. All the nurses were familiar with the European Pressure Ulcer Advisory Panel classification. They did not receive any additional training on classification, and were asked to classify the lesions as normal skin, blanchable erythema, pressure ulcers (four grades, European Pressure Ulcer Advisory Panel classification) or incontinence lesions. RESULTS: In the first phase, the multirater-Kappa for the 473 participating nurses was 0.37 (P < 0.001). Non-blanchable erythema was often confused with blanchable erythema and incontinence lesions. Also incontinence lesions were frequently not correctly classified. The intrarater agreement was low (kappa = 0.38). In the second phase, the interrater agreement was not significantly different in both sessions. The intrarater agreement was 0.52. CONCLUSION: Both the interrater and intrarater reliability of the European Pressure Ulcer Advisory Panel classification of lesion photographs by nurses was very low. Differentiation between pressure ulcers and incontinence lesions seems to be difficult.