Senior nurses' control expectations and the development of pressure ulcers

AIM: The aim of this research was to establish whether the attitudes and expectations of senior nursing staff might adversely affect patient outcomes in the prevention of pressure ulcers. The hypothesis was that nursing locus of control affects clinical outcomes in patients. In particular, it affects departmental prevalence of pressure damage. METHOD: A population of nurses (n = 439) in an acute and community NHS trust were surveyed to test knowledge, control beliefs and value of pressure ulcer prevention relative to prevalence. The research was designed to provide different data against which to test the hypothesis: first, to assess acceptability of nurses' knowledge of prevention and appropriate use of risk assessment and equipment; second, to calculate a mean departmental pressure ulcer prevalence; and third, to measure locus of control and value, which is the focus of this article. RESULTS: There were strong associations between departmental prevalence of pressure ulcers and attitudes of senior nursing staff. For example, the more that ward sisters believed they could control pressure ulcer prevention, the higher the prevalence of ulcers in their department. The more that sisters believed that they could not control prevalence, the lower the prevalence of ulcers. CONCLUSION: The study shows that failure to account for beliefs, values and expectations of staff could lead to patient harm. It is suggested that it might be counterproductive to put great effort into developing clinical guidelines and refinement of risk assessment methods. The findings have important implications for nursing, and challenge the assumption that nurse leaders are universally beneficial to patients.     

Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers

Background. In the Netherlands much attention has been paid to pressure ulcer prevention. National guidelines on pressure ulcer prevention were developed in 1985 and adapted in 1992 at the request of a national organization for quality assurance in health care. Several studies indicate that nurses seem to be insufficiently informed about pressure ulcer preventive activities. There is, however, no information available about the reasons why nurses seem to be insufficiently informed. Aims and objectives. This study was planned to elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention. Design. A qualitative study with semi‐structured, tape‐recorded interviews. Method. Interviews were conducted with enrolled nurses, team leaders, head nurses, staff nurses and physicians. The interviews were coded and analysed. Results. Analysis of the interviews revealed that today's pressure ulcer preventive activities are very much based on old traditions in nursing. It also showed that enrolled nurses have no intention to change the care they deliver with regard to pressure ulcer prevention. Conclusions. It is concluded that a systematic approach is necessary to change nursing thinking and acting with regard to pressure ulcer prevention. Relevance to clinical practice. This study gives an overview of the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention. These views and beliefs can be used as a starting point for effective implementation of guidelines regarding the prevention of pressure ulcers.     

A structured educational model to improve pressure ulcer prevention knowledge in veterans with spinal cord dysfunction

OBJECTIVE: This paper describes an educational model for increasing and retaining the knowledge of pressure ulcer prevention and management in veterans with spinal cord injury (SCI) or multiple sclerosis (MS) who have had surgical repair of a pressure ulcer. It also describes the correlates of pressure ulcer knowledge at admission and discharge. METHODS: Before pressure ulcer surgery, 41 male veterans with SCI or MS were randomized to either an intervention group or a control group. A pressure ulcer prevention knowledge test was administered before surgery and at discharge from the hospital, as well as at 3, 6, 12, and 24 months after discharge for the intervention group and at the end of participation for the control group. Other measures obtained at admission included health locus of control and health beliefs. Near the end of their hospital stay, participants of the intervention group received 4 hours of structured, individualized education on the prevention of pressure ulcers while participants of the control group received standard education. RESULTS: Results indicated that participants in the intervention group gained more knowledge during hospitalization than did those in the control group. Lower admission knowledge scores were related to the "chance" dimension of locus of control, nonbelief that an ulcer would interfere "a lot" in one's life, and nonbelief that daily skin checks make "a lot" of difference in whether one gets an ulcer. Lower discharge knowledge scores were related to older age, older age at onset, a greater number of previous pressure ulcer surgeries, and nonbelief that daily skin checks make "a lot" of difference in whether one gets an ulcer. Both groups retained most of their discharge knowledge up to 24 months postdischarge or to discontinuation because of recurrence. CONCLUSIONS: Enhanced, individualized education about pressure ulcer prevention and management was effective in improving pressure ulcer knowledge during hospitalization for surgical repair of a pressure ulcer. The effect of the intervention on recurrence of pressure ulcers will be addressed in future reports.     

Oh my,the pressure!

The intraoperative phase of a surgical patient's hospital stay has been overlooked as a major contributor of pressure ulcers that may arise postoperatively. Pressure ulcers are defined and then the hazards, underlying knowledge, and prevention tactics are reviewed. Bed sore, decubitous ulcer, pressure sore, and pressure ulcer are different terms describing the same problem encountered by medical and surgical patients. The common denominator is pressure--sustained pressure.     

Braden压疮风险护理记录单在卧床患者中的应用

目的:探讨Braden压疮风险护理记录单在卧床患者中的应用效果。方法:将2009年1月～2010年1月本科收治的卧床患者50例作为对照组,将2010年2月～2011年2月50例卧床患者作为试验组,对照组采用常规的防压疮护理,试验组采用Braden压疮风险护理记录单对卧床患者评估评分后实施防压疮护理,比较两组患者的压疮发生率。结果:试验组患者压疮发生率明显低于对照组(P<0.05)。结论:Braden压疮风险护理记录单的使用能有效降低卧床患者压疮的发生率,保障卧床患者的皮肤安全。     

Pressure ulcer: Prevention protocols and prevalence

Aims and objectives The aim of this paper is to analyse the protocols used in German hospitals and nursing homes for the prevention of pressure ulcers with regard to their contents and accordance with the national standard of the Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP) and the European Pressure Ulcer Advisory Panel (EPUAP) and Royal College of Nursing (RCN) guidelines. Additionally, it is to show the relation between the existence and contents of the protocols of pressure ulcer prevention and pressure ulcer prevalence in the institutions. Methods On a fixed date trained nursing staff gathers data regarding the frequency of pressure ulcers during a prevalence survey. The existence of a pressure ulcer is established by physical examination after the risk assessment with the Braden‐Scale. The patient’s or resident’s informed consent is a precondition for his or her participation in the survey. The protocols are available as hard copies on paper or electronic files. Results Only two out of the 21 protocols developed in‐house are completely concurrent with the expert standard. The EPUAP and RCN guidelines include the aspect of training and further education that is missing in the in‐house protocols and the DNQP expert standard. Evaluation of the data reveals that there is no relation between the availability of protocols and pressure ulcer prevalence. Neither is there any relation between the contents and pressure ulcer prevalence. The institutions currently developing protocols have the lowest prevalence rates. Conclusion It is obvious that, while developing in‐house protocols, the discussion about pressure ulcer prevention has led to a higher problem awareness in nurses and thus to an increased attentiveness in daily nursing practice which then results in improved outcomes. Two years after its publication, the expert standard is still not very well known, therefore this concentrated form of the most up‐to‐date knowledge is not available to all nursing staff as a basis for evidence‐based practice. In addition, the sometimes outdated knowledge of nursing staff impedes the implementation of evidence‐based practice guidelines. A systematic implementation strategy that assists guidelines being applied in practice is therefore required.     

Intervention studies to reduce the prevalence and incidence of pressure sores: a literature review

Much has been written about the prevention of pressure sores. However, electronic and manual searches located only 10 studies within the literature in the UK that described interventions able to reduce either their incidence or prevalence. All the studies located contained serious methodological flaws. Apparent success in reducing the number or severity of pressure sores could have resulted because staff involved in data collection were aware that the study was being undertaken and thus took more interest in pressure area care. From the review findings it is apparent that there is a dearth of research evidence upon which to base practice in the sphere of pressure sore prevention and further research is urgently required.     

电子压疮危险评估系统在临床中的应用

目的:探讨电子压疮危险评估系统在临床中的应用效果.方法:选取2011年9 ～12月采用手工评估的335例患者为对照组;2012年1～4月采用电子压疮危险评估系统的423例患者为观察组.比较两组患者压疮发生率及护理工作效率.结果:观察组患者应用电子压疮危险评估系统后高危患者压疮发生率低于对照组(P＜0.05).采用电子压疮危险评估系统的工作效率优于手工评估的工作效率(P＜0.05).结论:压疮危险评估系统不但可提高护士的工作效率,且对住院患者压疮的预防有重要意义.     

脊柱后路手术中压疮预防的对照研究

[目的]探讨脊柱后路手术中预防压疮的措施及效果,并调查脊柱后路手术中病人发生压疮的危险因素,为完善手术中压疮的评估方法提供依据。[方法]选取行脊柱后路手术的病人100例,随机分为两组,实验组使用康惠尔透明贴和泡沫敷料预防压疮;对照组使用手术室常规防护措施,术后0h、24h、72h对病人进行压疮评估。[结果]术前血红蛋白、年龄、术中出血量是术中压疮发生的危险因素（P〈0.05）,对照组病人术后发生压疮5例,实验组病人术后发生压疮2例,两组比较有统计学意义（P〈0.05）。[结论]康惠尔透明贴和泡沫敷料对于脊柱后路手术中压疮的预防有一定作用。     

Pressure sore prevalence within a public health services area

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure‐sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure‐sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.     

Improving pressure ulcer prevention in a nursing home: action research

A study conducted in Sunderland investigated how staff in a private sector care home manage pressure ulcer prevention and what staff perceive to be the reasons why residents in their care develop pressure ulcers. It also identified how using a collaborative action research study design (utilizing an action research cycle with collaborative focus groups) can bring about an improvement in practice, by allowing the staff to reflect on and analyse the way they work and develop and implement strategies to provide solutions to the problems they identify.     

Effects of education and experience on nurses' value of ulcer prevention

Few studies have focused on the value that nurses place on pressure ulcer prevention, even though values are a key determinant of a person's behaviour and actions. Previous studies have reported that the value that a nurse places on pressure ulcer prevention is linked to the skin care that they deliver. This article describes a study that was undertaken to determine the value that nurses place on pressure ulcer prevention, which also identified how this value is formed. The participants in this study (n=16), were recruited from non-acute adult medical wards of 14 hospitals in one NHS trust, and a university. Data was gathered via semi-structured interviews and interpreted through Straussian grounded theory. The findings of this study show how the participants underwent a transition from placing a low to a high value on pressure ulcer prevention and how this affected patient care. The key point in this transition appears to be an encounter with a patient with a high grade pressure ulcer, which caused the nurses to reappraise their values. Looking after patients with pressure ulcers seems to increase the value that a nurse places on pressure ulcer prevention. The education that nurses receive on pressure ulcer prevention only appears to alter their values when they have some experience of looking after patients with pressure ulcers.     

持续压疮危险预警管理的研究

目的 探讨持续压疮危险预警管理效果,以便更有效地降低压疮的发生率.方法 采用压疮评估工具筛选高危患者,警示护士、患者及家属,采取压疮预防措施等,连续两年进行压疮预警管理,比较预警管理前后压疮高危者年压疮发生率.结果 2008年高危者年压疮发生率为35.07%,2009年发生率为15.02%,2009年高危患者压疮发生率明显低于2008年,P<0.01,差异有极显著意义.结论 实施压疮危险预警管理,能有效地降低压疮发生率,对压疮的预防有重要意义.     

Nurses' attitudes, behaviours and perceived barriers towards pressure ulcer prevention

Background. Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. Aims and objectives. The specific aims of the study were to identify: ? Staff nurses’ attitudes towards pressure ulcer prevention. ? The behaviour of staff nurses’ in relation to pressure ulcer prevention. ? Staff nurses’ perceived barriers towards pressure ulcer prevention. Design. A cross‐sectional survey method was used. Methods. A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1. Results. The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses’ positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area. Conclusion. This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change. Relevance to clinical practice. This study provides a unique exploration of Irish nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management.     

长期居家老年人压疮发生风险与自理能力研究分析

目的描述长期居家老年人压疮发生状况,明确日常生活自理能力和老年人压疮之间的关系。方法运用分层整群抽样方法,采用日常生活能力量表等对长期居家的909位老年人进行调查。结果长期居家老年人压疮发生率25．77％;其中Ⅰ期压疮33．33％,Ⅱ期压疮49．57％;压疮组老年人ADL、IADL总分为（47．19±24．20）分和（4．40±5．20）分,明显低于无压疮组,差异有显著意义（P〈0．05）;两组老年人ADL及IADL分级差异也有显著意义（P〈0．05）。Logistic回归分析显示,中度及重度功能障碍、失能是压疮发生的影响因素。结论长期居家老年人压疮发生率高,以Ⅱ期压疮为主;日常生活活动能力和工具性日常生活活动能力是其压疮发生的重要影响因素。居家护理应采取针对性的预防和干预。     

预见性护理干预在预防肝移植手术中发生压疮的效果

目的探讨预见性护理干预在预防肝移植手术中发生压疮的效果。方法选取本院80例行肝移植手术患者随机分为2组,对照组患者给予传统护理,实验组患者则加施预见性护理干预,比较2组患者干预前后焦虑、抑郁情绪程度、依从性、生活质量、应激指标、感染率、压疮率与护理满意度。结果实验组患者干预后SAS评分与SDS评分组间比较均高于对照组,依从性评分与QOL评分组间比较均高于对照组,MDA水平低于对照组,SOD水平高于对照组,护理满意度显著性优于对照组,感染率与压疮率低于对照组,2组比较差异有统计学意义(P0.05)。结论预见性护理干预在预防肝移植手术中发生压疮的效果显著,可提高满意度,具有借鉴意义。     

分级分期管理对压疮预防和治疗的研究

目的 探讨分级分期管理在压疮临床护理中的作用.方法 选择住院的压疮高危人群402例,随机分为干预组(202例)与对照组(200例),干预组进行临床护理压疮护理知识培训、成立二级压疮委员会、及时填写皮肤压疮危险度评分表和上报报告、分级分期进行护理,对照组采取常规护理方法,即对压疮高危人群进行翻身、按摩、治疗等方法,分析干预组与对照组压疮发生率.结果 对照组压疮发生率为2.3%,二三期发生率为1.5%;干预组压疮发生率为1.2%,二三期发生率为0.4%,两组差异有统计学意义(P＜0.05).结论 在压疮的临床护理中,进行分级分期管理对压疮的发生率有明显的降低,转归有显著的效果.     

骑跨椅在截瘫并发压疮患者应用中的效果观察

目的探讨骑跨椅在截瘫并发压疮患者护理治疗中的效果。方法选择截瘫并发压疮入院治疗患者19例为对照组,行常规康复训练,压疮创面行改良封闭负压引流治疗;取同期截瘫并发压疮入院治疗患者23例为试验组,在对照组基础上行骑跨椅康复锻炼。比较两组患者压疮治疗效果以及出院时生活自理能力的差异。结果试验组压疮治疗效果、治愈时间及出院时生活自理能力优于对照组,两组比较,差异具有统计学意义(均P<0.05)。结论截瘫患者应用骑跨椅可有效预防与治疗压疮,从而降低其住院时间。     

COPD危重症患者应用无创正压通气压疮的护理

目的:探讨无创呼吸机所致压疮的有效护理干预措施。方法:将我院接受无创呼吸机治疗的患者192例分为试验组100例、对照组92例,试验组患者采用综合护理干预,对照组患者采用常规护理。结果:试验组患者出现皮肤不适症状、压疮例数明显低于对照组(P<0.05)。结论:采用综合护理干预对预防无创呼吸机患者的压疮管理有较好的效果,值得推广。     

Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial

BackgroundPressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking.ObjectiveTo evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting.DesignPragmatic randomised controlled trial.SettingA geriatric/internal medical ward with 26 beds in a Swedish university hospital.Participants190 patients were recruited (intervention: n = 91; control: n = 99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4 pm and Friday 4 pm, and expected to stay in the ward ≥3 days.InterventionThe continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body–mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care.ResultsNo significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34–3.79).ConclusionsThis study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.