压疮危险因素评估表在癌症晚期患者中的应用

目的探讨诺顿评分联合Waterlow’s压疮危险因素评估表在癌症晚期患者预防压疮中的应用方法与效果。方法对227例癌症晚期患者采用诺顿评分初筛，≤14分的患者使用Waterlow’s压疮危险因素评估表再次评估，根据评估结果采取预防措施。结果患者压疮发生率明显减少。结论联合使用诺顿评分及Waterlow’s压疮危险因素评估表，并及时采取预防措施，可以降低压疮发生率。     

改良压疮危险因素评估表在脑外科患者中的应用

目的探讨改良压疮危险因素评估表在颅脑外科中的应用效果。方法采用改良压疮危险因素评估表对56例新入院、手术后危重患者进行压疮危险因素评估。结果根据评分结果实施有针对性的护理干预措施,56例患者除2例特重型颅脑损伤者发生压疮,其余均未发生压疮。结论改良压疮危险因素评估表评估结果,可作为对患者进行压疮预防措施的循证证据,对有压疮危险因素的患者提供个体化护理,以降低压疮的发生率。     

糖尿病慢性并发症患者压疮危险因素评估与护理干预

目的:探讨糖尿病慢性并发症患者压疮危险因素的评估与干预措施.方法:将115例糖尿病慢性并发症患者按住院先后顺序分为实验组58例和对照组57例,实验组采用改进压疮危险因素评估表作危险因素评估比较,在护理干预中增加患者知情权、质量控制环节;对照组采用未改进压疮危险因素评估表作危险因素评估比较,实施常规护理方法.结果:实验组患者高危压疮例数明显高于对照组(P＜0.01),压疮危险因素评估比较显示,感觉与运动占危险首位,为55.17%;实验组压疮发生率明显低于对照组(P＜0.05).结论:对糖尿病慢性并发症患者进行压疮危险因素的评估与干预,能有效降低压疮发生率.     

Waterlow压疮评估量表在脊柱俯卧位手术中的应用

目的：分析Waterlow 压疮危险因素评估表在脊柱外科俯卧位手术患者压疮预防中的应用效果，探讨术中预防压疮的护理干预措施。方法针对术前采用Waterlow 压疮危险因素评估表评分大于20分以上的手术患者，手术开始前及时采取有效护理干预措施，加强手术体位与局部受压部位皮肤的管理。结果预防和减少了脊柱外科俯卧位手术患者急性压疮的发生。结论掌握Waterlow压疮评估量表的评估方法，做好体位护理，可以提高护理质量和患者满意度，降低压疮的发生率。     

晚期肝癌患者压疮量化评估表的设计与临床应用

目的探讨一种适合晚期肝癌患者的压疮预测评估工具,以更大程度减少压疮的发生率。方法根据晚期肝癌患者的病情特点及压疮高危因素,设计"晚期肝癌患者压疮危险因素评估表",2013年3月~2014年2月收治的141例晚期肝癌患者为观察组,采用"晚期肝癌患者压疮危险因素评估表"进行评估及分组护理,2012年3月~2013年2月收治的119例晚期肝癌患者为对照组,采用Braden量表进行评估及分组护理。结果观察组压疮发生率为2.1%,对照组压疮发生率为8.4%,两组比较有统计学意义(χ~2=5.351,P0.05)。结论 "晚期肝癌患者压疮危险因素评估表"较Braden量表示更适合于晚期肝癌患者压疮的风险预测,能更大程度降低压疮的发生率,值得临床借鉴应用。     

三种评估表对骶骨肿瘤术后患者压疮预测效果的研究

目的比较Braden评估表、Waterlow评估表、医院自制压疮评估表对骶骨肿瘤术后患者压疮预测的应用效果。方法将符合纳入标准的248例患者运用3种量表对每例患者进行压疮危险因素连续评估,计算各评估量表首、末次灵敏性、特异性、阳性预测值、阴性预测值与评价量表间的一致性。结果248例中,压疮发生率为8.75%;Braden评估表、Waterlow压疮危险评估表、医院自制压疮评估表3种评估表最佳临界值:首次评估临界值依次为18、16和21分,末次评估为17、19和24分。Pearson相关性分析显示3种压疮危险评估表的首末次评分具有显著相关(P0.01)。首次及末次评分的总体一致性差异有统计学意义(P0.05)。结论 Braden评估表对骶骨肿瘤术后患者压疮危险因素的预测能力较好,是临床较好的选择。     

压疮危险评估告知书在颅脑外科压疮高危患者中的应用

目的探讨压疮危险评估告知书在脑外科压疮高危患者中的应用效果。方法选取2008年1-12月在本院住院的89例颅脑外科压疮高危患者作为对照组,选择与对照组匹配的2009年1-12月收治的106例颅脑外科压疮高危患者作为实验组。对照组采用Braden压疮危险评估单对新入院或手术后危重患者进行压疮危险因素评估,然后对患者或家属进行口头告知和采取针对性的预防压疮的措施;实验组在对照组基础上,发放压疮危险评估告知书,并由专人实施压疮预防管理。比较两组患者出院时压疮的发生率。结果两组患者出院时压疮的发生率比较,P0.05,差异具有统计学意义,实验组压疮发生率明显低于对照组。结论在颅脑外科压疮高危患者中应用压疮危险评估告知书,有利于提高护患双方的重视程度,降低了患者压疮发生率;并充分体现了护士履行告知的义务,减少护患纠纷的发生。     

卧床老年患者压疮危险因素评估及护理措施

目的:评估老年住院患者压疮危险因素,探讨有效预防压疮的方法,最大限度降低压疮的发生率。方法:采用B raden量表对302例卧床老年患者压疮危险因素进行评估,根据评估结果采取相应措施。结果:302例患者中无危险199例,轻度危险58例,中度危险18例,高度危险17例,极度危险10例。301例未发生新发压疮,1例出现新发压疮。结论:运用B raden量表可以评估卧床老年患者压疮危险,采取相应护理措施可以显著降低压疮的发生率。     

骨科压疮危险因素量化评估表的设计与临床应用

[目的]探讨一种适合骨科病人病情特点的压疮预测评估工具,方便临床护士的操作应用,最大限度降低骨科压疮的发生率.[方法]根据骨科压疮危险因素,设计骨科压疮危险因素评估表、建立骨科病人皮肤情况交接班记录单.按入院顺序随机将625例病人分成两组,对照组324例采用Braden量表评估加分组护理,实验组301例采用"骨科病人压疮危险因素量化评估表"评估加分组护理(护理方法同对照组).[结果]压疮发生率:观察组为1.33％(4/301),对照组为4.32％(14/324),两组比较有统计学意义(x2=4.99,P＜0.05);两组压疮分期比较,差异也有统计学意义(Uc=2.23,P＜0.05).[结论]"骨科压疮危险因素量化评估表"较Braden量表更适合于骨科压疮的风险预测,能有效控制骨科卧床病人压疮的发生率,提高临床护理质量.     

内科住院患者发生压疮危险因素分析及对策

目的 探讨护士对内科住院患者压疮危险因素的评估能力,最大限度降低压疮的发生率.方法 通过对内科住院患者压疮情况进行调查,分析各种诱发压疮的危险因素,制订有效的护理措施,预防和治疗压疮.结果 压疮的危险因素除了有感知能力、潮湿度、活动能力、移动能力、营养摄取能力、摩擦力和剪切力外,还有年龄、疾病因素、体温变化、管道压迫、应激等.结论 应加强护士对压疮危险因素的评估能力,以便采取相应的措施,有效预防和治疗压疮,减轻患者痛苦.     

皮肤压疮管理流程的设计与应用

目的降低皮肤压疮的漏报率,加强护士对患者皮肤评估及护理重要性的认识,提高对皮肤压疮的防治效果。方法将质量持续改进与业务流程有机结合,制定了皮肤压疮管理流程。对化疗患者的皮肤损伤以及压疮高危因素进行评估并制定对策,对院外患者带入的大面积压疮进行及时会诊,采取有效的护理措施;细化质量控制标准,将皮肤压疮管理纳入病房管理中。结果提高了护士预防皮肤压疮的意识和护理能力,对皮肤压疮管理流程的知晓率达100%;对压疮发生高危因素评估表的掌握率从原来的40%提高到90%;压疮基础护理合格率达100%,医院内可避免压疮发生率为零。结论应用皮肤压疮管理流程,可以提高护士的参与意识和质量意识,提高其对患者皮肤压疮防治的效果。     

实施三级质量控制预防压疮的管理体会

目的通过加强压疮质量管理,降低或避免压疮的发生。方法采取压疮三级质量管理评估,院外带入压疮皮肤记录单等管理措施。结果通过完善压疮三级质量管理,使护理管理目标明确、措施得当,提高了护士对压疮管理的风险预测能力,降低了压疮的发生率,提高了院外带入压疮的治愈率。结论通过实施压疮三级质量管理,使压疮管理科学化、规范化、制度化,为有效预防压疮,提高基础护理质量提供了保证。     

Risk assessment scales for pressure ulcer prevention: a systematic review

AIM: This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. BACKGROUND: Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. METHOD: A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. FINDINGS: Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). CONCLUSION: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.     

Inter-rater reliability and Waterlow's pressure ulcer risk assessment tool

AIM: To ascertain whether a lack of inter-rater reliability with the original Waterlow (1996) pressure ulcer risk assessment scale is due to different perceptions of patients by nurses or different interpretations of Waterlow as a tool. METHOD: A sample of 110 qualified nurses, who used the Waterlow pressure ulcer risk assessment scale in their daily work and were delegates at five study days, were given a case study and an uncompleted copy of the tool. They were asked to complete a risk assessment for the patient. The risk assessment score obtained by delegates was analysed using the Wilcoxon Signed Rank Test to measure the null hypothesis that there is no significant difference between the median of the nurses' scores and the patient's actual or 'gold standard' score. RESULTS: Nurses tend to over-rate (n=72, 65 per cent) rather than under-rate (n=25, 23 per cent) the patient's risk of developing a pressure ulcer. Only 13 of the 110 nurses (12 per cent) accurately rated the patient's score as 18. The Wilcoxon Test rejected the null hypothesis that there was no difference in the risk scores arrived at by individual nurses and the patient's actual score, that is, there is a significant difference between the scores obtained by the nurses in the study and the gold standard score. CONCLUSION: The results show poor inter-rater reliability when using the Waterlow pressure ulcer risk assessment scale. Part of the problem is that nurses are not using the tool in the way it was intended.     

加强压疮预防管理的对策

目的:提高压疮的防治率,最大限度降低压疮的发生率。方法:制定压疮管理措施,应用《褥疮危险因素评估量表》,实施压疮登记预报制度。结果:提高了预防压疮的护理能力和意识,降低了压疮的发生率。结论:预见性地进行有效的健康教育,加强过程管理,保证护理措施的落实,是防治压疮的关键和有效手段。     

护士对手术患者告知压疮风险的质性研究

目的探讨告知手术患者压疮风险的真实体验,为有效防范压疮发生提供依据。方法采用质性研究的深度访谈法,对手术室12名高年资护士进行访谈,录音记录访谈内容,归纳分析,提炼主题。结果告知手术患者压疮风险环节中,主要存在6个方面的问题,包括告知方式与内容参差不齐,无法确定压疮风险评估量表的结果,压疮评估与预防互补性差,风险告知不明确,告知时机不合适,外围问题没有明确回答。结论手术患者压疮风险评估知情同意的实施有赖于规范的谈话内容,专科属性的评估量表,提高压疮预防能力的同时必须要有与评估相对应的预防措施。     

自制神经外科压疮危险因素评估量表与Braden量表信度与效度的比较研究

目的 更准确地评估神经外科患者发生压疮的危险性,降低压疮发生率.方法 采用两个评估量表(即自制神经外科压疮危险因素评估量表和Braden量表)评估500例神经外科患者的压疮危险因素,并进行信度和效度的比较.结果 自制神经外科压疮危险因素评估量表的Cronbach's α为0.941,Braden量表的Cronbach's α为0.743.因子分析结果显示,两个量表的结构效度与原设想的基本一致.预测效度显示,当自制神经外科压疮危险因素评估量表的诊断界值取16分时,灵敏度和特异度分别为89%和78%;当Braden量表取18分时,灵敏度和特异度分别为78%和58%.结论 两种量表均具有较好的内部一致性信度、结构效度和预测效度,但自制神经外科压疮危险因素评估量表优于Braden量表,是适合神经外科患者人群的压疮危险评估工具.     

Validity of the Waterlow scale for pressure ulcer risk assessment in the intensive care unit: a prospective analysis of 698 patients

Critically ill patients are at a particular risk for developing pressure ulcers. Yet until now, no sufficiently specific, validated pressure ulcer risk assessment instruments exist for critically ill patients. In a prospective study of 698 patients of medical intensive care unit (ICU), we therefore analyzed if the Waterlow scale is suitable for pressure ulcer risk assessment in the ICU. Only patients with no pressure ulcer on admission to the ICU were included. The Waterlow scale was used to assess pressure ulcer risk on admission to the ICU, and the number of points on the scale were analyzed with regard to pressure ulcers development in the course of the ICU stay (121 patients). Our results show that adequate pressure ulcer risk assessment on admission to the ICU is not possible with the Waterlow scale. Sensitivity and specificity reached their maximal values of 64.6% and 48.8%, respectively, at a comparably high cut-off of 30 points on the Waterlow scale (positive and negative likelihood ratio being 1.26 and 0.73, respectively). The area under the curve (AUC) was 0.59 in the receiver-operator-characteristic curve. Adding intensive care related parameters to the scale yielded some degree of improvement (AUC 0.69), but the development of ICU specific pressure ulcer risk scales still seems to be necessary to allow reliable pressure ulcer risk assessment in the ICU.     

压疮管理流程的建立与应用

目的降低住院患者压疮的发生率。方法于2002年建立并实施高危压疮筛查-高危压疮预报-压疮预防-压疮护理会诊-护理质量考评的压疮管理流程。结果住院患者压疮发生率明显降低(P<0.01),护理人员预防压疮的意识提高。结论压疮管理流程的实施能有效降低住院患者压疮的发生。     

3种压疮危险评估量表在老年患者中应用的信效度研究

目的 比较和评价Norton、Braden和Waterlow 3种压疮危险评估量表在老年患者中应用的信效度.方法 选取某三级甲等医院老年患者271例,运用3种量表连续评估患者的压疮危险,以Cronbach's α系数、内容效度指数、因子分析、ROC曲线等方法评价和比较各量表的信效度.结果Norton、Braden、Watedow量表的内部一致性信度分别为0.71、0.79、0.32;内容效度指数分别为0.85、0.91、0.87;因子分析得到的方差累计贡献率分别为71.73%、70.34%、65.76%;灵敏度和特异度分别为(0.75、0.62)、(0.74、0.59)、(0.86、0.59).结论 Waterlow量表的内部一致性信度低,但预测能力最好;Braden量表的信效度均高,但预测能力偏低.