Nurses' knowledge and practice of pressure ulcer prevention and treatment: An observational study

Aims and objectivesTo assess nurses' knowledge on pressure ulcer (PU) prevention and treatment in Jordan, and the frequency of and factors influencing nurses’ implementation of PU prevention and treatment interventions.BackgroundHighly educated and experienced nurses can provide effective PU care; however, previous studies highlighted poor knowledge and implementation of PU care.DesignA correlational study examining nurses’ knowledge of PU prevention and frequency of PU preventive actions in Jordanian hospitals.MethodsParticipants were 377 nurses and 318 patients from 11 hospitals. Data were collected to quantify the frequency of nurses’ implementation of pressure ulcer prevention and treatment interventions for patients suffering from PUs and/or at risk of PU development using a self-reported cross-sectional survey and prospective 8-h observation.ResultsFor observed PU prevention while type of hospital and number of beds in units were significant it is not known without further work if this is replicable. For observed PU treatment, linear regression analysis revealed significant negative beta values for more than 50 beds in clinical unit (β = −2.49).ConclusionThe study addressed new factors, facilitating the provision of prevention and treatment strategies to PU development, including type of clinical institution and number of beds in clinical unit.Relevance to clinical practiceThere is a need to develop training programmes to improve insufficient nurses’ knowledge and, thus, clinical practices on PU prevention and treatment. These programmes would assist both junior and senior nurses and other key stakeholders (e.g. hospital managers, policy-makers, and educators) to improve the performance of PU services, thus, minimising patient suffering.     

Factors related to knowledge,attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study

IntroductionAs one of the main members of the health team, nurses have an important role in pressure ulcer prevention in health care centers. The aim of this study was to investigate knowledge, attitude, and practice of nurses on the prevention of pressure ulcers and their related factors.MethodsThis cross-sectional study was carried out in 2018. The total number of ICU nurses employed in educational-health centers affiliated to Iran University of Medical Sciences were examined. Among a total of 328 nurses, 308 questionnaires were completed by the participants. Pressure Ulcer Knowledge Questionnaire, Attitude Toward Pressure Ulcer, and Practice of Pressure Ulcer Prevention questionnaires were used to collect data. SPSS software version 16 and independent t-test, Chi-square, Fisher exact, one-way Analysis of variance, and multiple linear regressions tests were used for data analysis.FindingsBased on the mean score of knowledge, attitude, and practice of the nurses about the pressure ulcer prevention were 63.47 ± 10.31, 39.10 ± 40.22, and 32.03 ± 6.17, respectively. There was a positive and significant relationship between these three variables. Findings revealed that knowledge was increased by 0.051 units, with a one-year increase in work experience of nurses in the ICU. Moreover, women's knowledge and their attitude were higher than those of men as 3.132 and 1.65 units, respectively. Based on the findings, attitude of nurses increased by 0.43 units for an hour of extra work per week. Nurses' attitude score in the General ICU and their practice were higher than scores of other nurses as 2.144 and 2.574 units, respectively. Moreover, practice of nurses increased by 0.162 unit with one-year increase of their age.ConclusionGiven the undesirable level of knowledge and attitude and relatively desirable practice of nurses in the field of pressure ulcer prevention and the importance of improving the safety of patients admitted to the ICU, it is suggested that appropriate educational planning be developed to raise the level of knowledge, attitude, and practice of health care providers, especially nurses, in the area of pressure ulcer prevention.     

Effects of education about prevention of pressure ulcer on knowledge and attitudes of nursing students

BackgroundPressure ulcer is a significant healthcare problem throughout the world. Nurse educators should take the responsibility for students’ improving knowledge, skills and attitudes regarding prevention of Pressure ulcer and allocate sufficient time to teach them by using various teaching methods. In this study we evaluate effects of education about prevention of pressure ulcer on knowledge and attitudes of nursing students.MethodsThis is a quasi-experimental study with a control group and a posttest. The study population comprised of 96 second-year nursing students at a university in Middle Anatolia Region of Turkey. The study sample included 84 second year nursing students, of whom 42 were assigned into an intervention group and 42 were assigned into a control group. The intervention group was offered education for two hours weekly for four weeks. Data collection between April and May in 2019. The statistics program SPSS 22 packaged software was used in the analyses of data.ResultsThere was not a significant difference in sociodemographic features between the intervention and control groups. The groups significantly differed in their total scores for attitudes to prevention of pressure ulcer (p < 0.05). The intervention group got a significantly higher mean score for knowledge about prevention of pressure ulcer (63.00 ± 16.71) than the control group (39.35 ± 9.77) (p < 0.05).ConclusionThe control group had lower scores for knowledge and attitudes about prevention, evaluation and management of pressure ulcer. Educators should revise the content of the national nursing curriculum about pressure ulcer and update their learning material and lectures in accordance with national and international guidelines.     

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study

BackgroundPressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK.ObjectiveTo examine healthcare support workers’ knowledge and attitudes regarding pressure ulcer prevention.MethodsA cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool.ResultsA total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005).ConclusionWhile positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers’ pressure ulcer knowledge and to inform a national continuous education strategy.     

Knowledge,attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study

IntroductionPressure ulcers (PU) are a major, but preventable health problem in all health settings, but especially in intensive care units (ICUs). This study aimed to investigate the knowledge, attitude, and practice (KAP) of Iranian ICU nurses related to the prevention of PU.MethodsIn a cross-sectional study, data obtained from 183 ICU nurses working in four hospitals affiliated to Mazandaran University of Medical Sciences, Sari, Iran were evaluated. The study was conducted from July to October 2020. Data were collected using a four-part questionnaire including demographic characteristics, Pieker Pressure Ulcer Knowledge Test (PPUKT), Attitude toward Pressure Ulcer Prevention (APUP) tool, and the practice of nurses related to the prevention of PU.FindingsThe mean scores of KAP of ICU nurses toward PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. There was a positive correlation between nurses' attitude and practice (r = 0.232, P = 0.002), and a negative correlation between knowledge and attitude (r = ?0.156, P = 0.035) of nurses regarding PU prevention. Additionally, a positive correlation was found between nurses' years of working experience in ICU and their knowledge regarding PU prevention (r = 0.159, P = 0.032).ConclusionAccording to the results of the present study, the level of KAP of Iranian ICU nurses related to PU prevention were desirable, positive, and relatively desirable. Therefore, nurse managers and policymakers should try to eliminate the main barriers such as heavy workload, inadequate nurse staffing, and lack of appropriate guidelines for PU prevention which consequently affect the practice of ICU nurses in the prevention of PU.     

The prevalence and prevention of pressure ulcers: A multicenter study of nine nursing homes in eastern China

AimTo assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China.Materials and methodsIn this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019.ResultsOf the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes.ConclusionsThe prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.     

Polypoid granulation tissue in pressure ulcers: Significance of describing individual ulcers

Granulation tissue formation is required for the healing of deep pressure ulcers. The wound healing process is often delayed at the stage of granulation tissue formation. The pathogenesis of pressure ulcers showing granulation tissue may vary; however, no terminology has been defined to describe existing ulcers. Thus, we previously defined terminology for granulation tissue to describe individual ulcers. Based on these terms, we retrospectively evaluated the findings of deep pressure ulcers. In particular, we focused on polypoid granular tissue, a unique morphological feature. Polypoid granulation tissues were frequently observed in pressure ulcers over the sacrum compared with those over the foot. Chronological observation of a few cases indicated that external forces from specific directions during the healing process caused the development of polypoid granulation tissue. In addition, most pressure ulcers showing polypoid granulation tissue exhibited a trench-like appearance in individual wounds. Based on these observations, polypoid granulation tissue may generate from specific external forces, which lead to wound deformity. Morphological findings in an individual wound may be useful to predict the mechanical factors on existing pressure ulcers.     

Knowledge,attitude, and practice of Iranian nurses towards pressure ulcer prevention: A systematic review

IntroductionPressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review aimed to evaluate the knowledge, attitude, and practice of Iranian nurses towards PU prevention.MethodsA systematic search was conducted on PubMed, Web of Science, Scopus databases, Google Scholar Search Engine, as well as Magiran, Iranmedex, and Scientific Information Database (SID) Persian databases using the relevant keywords, from the earliest date available to August 21, 2020. Studies were appraised using the appraisal tool for cross-sectional studies (AXIS tool).FindingsAmong a total of 1,543 Iranian nurses included in the 9 studies, 80.53% were female with a mean age of 31.14 (SD = 5.52) years. The mean work experience of the participants was 7.94 years (SD = 5.44). The knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. Also, the present study showed that nurses' attitudes toward PU prevention were contradictory. Age, gender, level of education, work experience, and participation in previous educational workshops were possible factors related to nurses' knowledge about PU prevention. Women with higher work experience had a more positive attitude.ConclusionThis review found inappropriate knowledge, attitude, and practice of Iranian nurses toward PU prevention and highlights the importance of regular upgrading of nurses' knowledge and practice related to PU prevention.     

Personalized modeling for real-time pressure ulcer prevention in sitting posture

Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up.     

Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019

Aim

The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the ‘Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline’ (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update.

Prevalence of pressure ulcers in africa: A systematic review and meta-analysis

BackgroundA recent global review of pressure ulcers contained no studies from Africa.ObjectiveTo identify the prevalence and incidence of pressure ulcers in Africa.Data sourcesBibliographic databases, African specific databases, grey literature.Study eligibility criteriaStudies with prevalence or incidence data of pressure ulcers from Africa since the year 2000.ParticipantsAny age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings.Study appraisal and synthesis methodsHoy score for bias, Joanna Briggs Institute Critical Appraisal Instrument.MethodWe followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data.ResultsNineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%.Limitationsrestricted to English, French and Arabic.ConclusionPrevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases.Implications of key findingsFurther prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the “Checklist for Prevalence Studies” from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed.Systematic review registration numberProspero registration number CRD42020180093     

Design and evaluation of a dynamic air cushion for pressure ulcers prevention

Wheelchair users have a higher risk of developing pressure ulcers due to prolonged seated pressure. Pressure ulcers can be painful, may require surgical intervention, and even become life-threatening if infection occurs. To prevent pressure ulcers from forming the patient must either offload themselves or rely on a caregiver to move them allowing pressure redistribution over the seated area. In this work, we designed a dynamic air cushion to relieve pressure on loaded areas using sequences of inflation and deflation of the air cushion cells. The purpose of these sequences is to offload pressure from high-risk areas. To evaluate the effect of the alternating sequences on seated pressure and blood perfusion, we recorded interface pressure, skin blood flow, superficial tissue oxygen saturation, blood concentrations of oxygenated hemoglobin, and deoxygenated hemoglobin from twenty-one healthy volunteers who were asked to sit on the air cushion for static mode recording (3 min) and during the inflation/deflation sequences (up to 22 min). The alternating sequences consisted of ten combined inflation and deflation steps. Results showed that, after applying the alternating sequences, interface pressure reduced significantly $(p=0.02)$ compared to the static mode. Moreover, the coefficient of variation of the seated pressure was higher ($p<0.001)$ during the alternation sequence compared to the static mode. However, interface pressure under the right and left ischial tuberosities increased ($p<0.001)$ during the alternation sequence compared to the static mode. In addition, during the alternating sequences, males had larger dispersion index values of both right and left ischial tuberosities pressure compared to females. Furthermore, the maximum value of oxygen saturation ($p=0.04$) and skin blood flow ($p=0.001$) increased during the pressure alternation sequences compared to the static mode. The study findings highlighted the positive effects of the designed dynamic air-cushion to relieve pressure on compressed areas and enhance blood perfusion similar to manual offloading approaches. The outcomes of this study are encouraging to evaluate the performance of the designed air cushion in studies involving wheelchair users.     

Location-dependent depth and undermining formation of pressure ulcers

Aim of the studyWe examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing.MethodsWe conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations.ResultsA total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation.ConclusionOur results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue.     

Reporting of pressure ulcers and medical device related pressure ulcers in policy and practice: A narrative literature review

Pressure ulcers (PUs) occur in a range of care settings, resulting in reduced quality of life for the individual. There has been a growing awareness that medical devices can cause PUs, although reporting has been limited. There is a need to evaluate PU reporting practice and identify whether standards exist for medical device-related pressure ulcers (MDRPUs).AimTo synthesize academic and grey literature relevant to reporting of PUs and MDRPUs in healthcare settings.MethodsA systematic search of multiple scientific and grey literature databases was undertaken. Key search terms and Boolean operators were used to identify relevant literature. All sources of evidence discussing reporting practices were included in a synthesis. Primary topics are discussed in the corresponding analysis.ResultsThirty-one evidence sources met the inclusion criteria, including 16 journal articles and 15 policy and guidance documents. The results revealed a variation in reporting practices. MDRPUs were often not identified as a separate category in local and national systems. Policies for related patient safety reporting varied across all organisational levels, with more serious categories of PUs reported more consistently. Reporting to medical device regulatory bodies was not mandatory.ConclusionThis narrative review identified inconsistencies in local and national reporting of PUs and MDRPUs, prohibiting meaningful comparisons and improvements in patient safety. Lack of specific medical device data and low levels of voluntary reporting to regulatory bodies is likely to result in an under-reporting, with little evidence of specific devices which may be a patient safety concern.     

The effect of pH-compatible cleansing cloths on skin pH and the development of pressure ulcers

AimSkin care plays an important role in the prevention of the development of pressure ulcers. The aim of this study was to determine the effect of skincare with a body pH-compatible cleansing cloth on the development time of pressure ulcers and on skin pH.MethodsThis experimental research was conducted with 156 patients hospitalized in intensive care clinics of a state hospital between September 2019 and 2020. The sample was calculated with a power of 80% and a significance level of 0.05 (α error) and as a result, 78 elderly patients formed the intervention group and another 78 elderly patients made up the control group. Data were collected using the Elderly Information Form, Braden Risk Assessment Scale, Pressure Ulcer Staging Tool and Skin pH Measurement Form. The pre- and post-care skin pH of both groups was measured with a skin pH meter. P < 0.05 was considered statistically significant.ResultsThe average development time for pressure ulcers was 14.9 days in the control group, 18.9 days in the intervention group and the difference was not statistically significant (p > 0.05). Skin pH decreased in the intervention group after the skin care routine was applied, whereas it increased in the control group.ConclusionIt can be said that care of one's skin with a body pH-compatible cleansing cloth has a positive effect on the development time of pressure ulcers and also positively changes the skin pH to acidic.