Braden压疮风险评估量表在ICU病人压疮管理中的应用

[目的]探讨Braden压疮风险评估量表在重症监护室(ICU)病人压疮预防中的应用.[方法]将2009年1月-12月ICU收治的1086例病人作为对照组,采取2h翻身1次、气垫床减压等护理措施;将2010年1月-12月ICU收治的1165例病人作为干预组,根据Braden压疮风险评估量表评分结果制定压疮预防与治疗方案.比较两组病人住院期间压疮的发生率.[结果]对照组压疮发生率为1.10％,干预组为0.26％,两组发生率比较,差异有统计学意义(P＜0.05).[结论]ICU病人护理中应用Braden压疮风险评估量表,并根据评估结果实施干预能提高预防压疮的有效性.     

Braden压疮风险评估量表在ICU病人压疮管理中的应用

[目的]探讨Braden压疮风险评估量表在重症监护室（ICU）病人压疮预防中的应用。[方法]将2009年1月-12月ICU收治的1086例病人作为对照组,采取2h翻身1次、气垫床减压等护理措施;将2010年1月-12月ICU收治的1165例病人作为干预组,根据Braden压疮风险评估量表评分结果制定压疮预防与治疗方案。比较两组病人住院期间压疮的发生率。[结果]对照组压疮发生率为1．10％,干预组为0．26％,两组发生率比较,差异有统计学意义（P〈0．05）。[结论]ICU病人护理中应用Braden压疮风险评估量表,并根据评估结果实施干预能提高预防压疮的有效性。     

Development of a new risk assessment scale for predicting pressure ulcers in an intensive care unit

Aims and objectives: The study aimed to evaluate the predictive validity and accuracy of a new pressure ulcer risk assessment scale in two Indonesia intensive care units (ICUs). Background: Several risk assessment scales have been designed to identify patients at risk of developing pressure ulcers in ICU. However, the relative weight of each variable that contributes to pressure ulcer development in these scales is not described to enable designing of a risk assessment scale. Currently, the risk factors contributing to pressure ulcer development include interface pressure, body temperature and cigarette smoking. Design: A prospective cohort study was conducted in two ICUs in Pontianak, Indonesia. Methods: A total of 253 patients were recruited to the study from both hospitals. Data collection included new risk assessment scale [i.e. the Suriadi and Sanada (S.S.) scale] scoring, demographic, pressure ulcer severity scores (based on the National Pressure Ulcer Advisory Panel) and skin condition measures. Using the S.S. scale, trained data collectors scored patients once and assessed the body temperature daily until patients were discharged. Additionally, daily data were also collected in relation to the patient‘s skin condition and stage of pressure ulcer. Results: Out of the 253 patients, 72 (28·4%) developed pressure ulcers. In ICU A, the incidence was 27%; pressure ulcers developed into stage I (41·7%), stage II (45·8%), stage III (10·4%) and stage IV (2·1%). In ICU B, the incidence was 31·6%; the development of pressure ulcers was 48% in stage I and 52% in stage II. Using the predictive validity test, the S.S. scale balanced sensitivity (81%) and specificity (83%) at a cut‐off score of 4. The area under the receiver‐operating characteristic curve was 0·888 (confidence interval: 0·84–0·93). Conclusion: The S.S. scale was found to be a valid risk assessment tool to identify the patients at risk of developing pressure ulcers in Indonesia ICU.     

Pressure ulcer risk assessment in long-term care nursing

The intent of this study was to determine whether the typical practice of using risk assessment tools in combination with the federally mandated Minimum Data Set (MDS) actually predict more cases of pressure ulcers (PUs) in long-term care facilities. Data in this study were collected from 555 resident charts in a sample of eight nursing homes. A total of 66 PUs were identified between September 1, 1996 and September 1, 1997 in a comparative test of the predictive abilities of the MDS versus the Braden Scale (BS) patient profiles. As shown by a Chi square test, the MDS and the BS assessment tools were valid in finding factors that placed residents in jeopardy of developing pressure ulcers: MDS chi 2 = 43.68, df = 1, p < .0001 and BS chi 2 = 52.47, df = 1, p < .001. However, a two-tailed t test, indicated results of the BS were significantly different than the MDS: t = 3.77, df = 97, p < .003 and BS = t = 3.77, df = 97, p < .001. Both the MDS and the BS identified patient factors: the MDS identified 311 at risk, resulting in accurate prediction of 62 of 66 PUs, while the BS found 172 at risk and predicted only 46 PUs accurately. Therefore, data indicate the BS did not make a significant difference in predicting the incidence of pressure ulcers in this sample of long-term care facilities. These unexpected findings would argue in favor of discontinuing the practice of using the BS for PU risk assessment simultaneously with the MDS, but rather at independent time frames such as immediately upon resident admission. This would continue to support the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP), and at the same time, provide a more timely pressure ulcer risk assessment.     

安宁缓和医疗中的预期寿命评估

预期寿命评估在安宁缓和医疗的研究与实践中占据重要位置.预测过程包括临床生存预测与精算判断两部分.临床预测和预测工具是生存期预测主要方法.本文对安宁缓和医疗患者预期寿命评估的可能、意义、相关方法和影响因素进行综述,以期为临床研究和实践提供借鉴.     

安宁缓和医疗的躯体症状评估

在人口老龄化的背景下,安宁缓和医疗的重要性逐渐凸显,它是减少生命末期患者痛苦、提高生活质量的学科.生命末期患者常常出现多重躯体症状,如疼痛、呼吸困难、乏力等.为减轻患者痛苦,医护团队需迅速对躯体症状做出准确评估.本文就安宁缓和医疗躯体症状评估的一般流程进行综述.     

安宁缓和医疗中的心理及社会评估

心理社会评估是安宁疗护工作的核心内容之一.本文以北京市海淀医院安宁疗护病房开展心理社会评估的经验体会为基础,阐述了心理社会评估的意义以及有效开展评估工作的相关要点,供开展安宁缓和医疗的医护人员参考.     

Pressure ulcer risk assessment

The Department of Health wants to reduce harm caused by pressure ulcers dramatically. Identifying which patients are at risk is an important part of prevention. This article discusses the most common risk factors, the advantages and disadvantages of risk assessment tools, and challenges in prevention.     

Assessing pressure ulcer risk in long-term care using the Waterlow scale

This article reports on a mixed-methods study examining the use of the Waterlow scale by nurses working in long-term care for older people in Scotland. Eight nurses from four long-term care facilities in two health board regions took part. They were observed carrying out 16 pressure ulcer risk assessments, after which they were interviewed about their assessment and plan of care. Results from the observations and interviews suggest that an assessment of pressure ulcer risk and plan of care went beyond the information that was contained in, or produced by, the Waterlow scale.     

Pressure ulcer prevention in palliative care 1: results of a UK survey

Pressure ulcer prevention is an important aspect of palliative care nursing. This article reports part 1 of the results of a postal questionnaire survey of all 206 palliative care inpatient units listed in the St Christopher's' information service hospice directory. The key areas surveyed were current pressure ulcer prevention policies in use in UK palliative care units and current practice in relation to pressure ulcer risk assessment. Issues arising from these results are also discussed: the key elements of a pressure ulcer policy and the role and timing of pressure ulcer risk assessment.     

压疮危险因素评估表预测不同患者群体压疮发生的研究

目的比较压疮危险因素评估表（Norton ulcer risk assessment scale,以下简称Norton量表）对不同年龄组及不同病区患者压疮的预测效果。方法运用Norton量表对内外科住院患者进行连续评估,计算量表对不同患者群体预测的灵敏度、特异性、预测值。结果 Norton量表对老年患者灵敏度96.96%、特异性87.68%、阳性预测值22.96%,阴性预测值99.87%;对中青年患者灵敏度97.37%、特异性96.73%、阳性预测值12.05%、阴性预测值99.98%,Norton量表对老年患者及中青年患者压疮预测均具有较高的灵敏度和特异性。Norton量表对内科、外科及不同病区患者均具有较高的预测灵敏度;对神经外科、ICU患者预测特异性较低。结论 Norton量表对不同年龄组和不同病区患者皆具有较好的预测效果,内外科各病区可以统一使用Norton量表对患者进行压疮高危筛查和评估。     

Telenursing in hospice palliative care

During the last months of life, many people with advanced illness will be living in their homes. Coping with changing symptoms, and ultimately preparing for death, becomes part of daily life. Whether the ill person is at home for days or for months, they depend on family or friends to be primary caregivers, supported by home-based services. However, after physician and home health offices close, many patients and their caregivers are left to cope alone. The authors describe an innovative partnership between B.C. NurseLine (a provincial tele-triage and health information call centre), the British Columbia Ministry of Health and Fraser Health Hospice Palliative Care program that created after-hours access to care for dying patients and their families in one of Canada's largest health authorities. The article outlines how information and communications technology enabled merging the capacity and expertise of B.C. NurseLine with the expertise of specialized community-based palliative care services to achieve outcomes of improved symptom management, decreased visits to emergency rooms and enhanced support for families who are caring for loved ones at home. For nurses caring for home-based patients, there are lessons to be learned about how to maximize technology to create systems that both improve access to care and are sustainable in the future.     

以评估为基础开展安宁缓和医疗实践

安宁缓和医疗在我国刚刚起步,迫切需要结合各个地区的实际情况来开展相关实践.确认安宁缓和医疗的服务内容,有效评估患者的预期寿命、评估患者"身、心、社、灵"各方面的需求,根据不同的需求给予合适的干预,是开展安宁缓和医疗实践的关键.恰当的评估可有助于高效开展安宁缓和医疗工作.     

An audit of pressure ulcer incidence in a palliative care setting

This article reports a continuous audit of pressure ulcer incidence within a specialist palliative care unit over 2 years. Details of every patient admission were considered (542 patients). Of these, 26.1% were admitted with pressure ulcers while 12.0% developed pressure damage during their stay. The retrospective audit looked at the ulcers developing in the unit and found these patients were older, stayed 12 days longer and more of them died than the average for all patients admitted to the unit. In total, 95.3% were accurately assessed at 'high' or 'very high' risk using the Waterlow (1985) Pressure Sore Risk Assessment Tool and 89.2% of ulcers were Grade 1 or 2 measured using the Stirling Pressure Sore Severity Scale (Reid and Morrison, 1994). Of all developing ulcers, 78.4% were sacral and the position of the tumour, as well as comfort and positioning difficulties were considered most often responsible. Despite this knowledge and many 'improvements' introduced, the incidence did not improve with superficial ulcers often developing in the last days of life.