肿瘤患者难免性压疮预测评价指标的构建

目的探讨肿瘤患者难免性压疮的概念及预测指标,为难免性压疮管理提供依据。方法选择上海市、重庆市、广东省、湖南省、河南省、四川省共20名专家,采用德尔菲法就肿瘤患者难免性压疮的概念及预测指标进行3轮函询。结果肿瘤患者难免性压疮的概念界定为＂肿瘤患者在具有高度水肿、大小便失禁、恶病质、强迫体位等高危压疮因素的基础上,因翻身计划无法落实（≥3d）、皮肤有现存或潜在的损伤、脱离照护3项中的1项或多项所引起的压疮＂。其预测指标包括存在压疮高危因素、翻身计划持续不能实现、皮肤有现存或潜在的损伤、脱离护士照护4个条目,变异系数0.0856～0.1779,权重依次为0.2899、0.2743、0.2743、0.1615。3轮专家咨询的积极系数分别为90.9%、100%和100%;专家的权威系数为0.88。结论专家协调程度较高,肿瘤患者难免性压疮的概念和预测评价指标可作为制定肿瘤患者压疮管理制度和护理压疮的依据。

Development of evaluation indicators of unavoidable pressure ulcer in cancer patients

Objective To define unavoidable pressure ulcer and develop indicators for assessment in cancer patients.Methods Twenty experts were selected from Shanghai,Chongqing,Guangdong,Hunan,Henan,and Sichuan province and were asked to participate in a three-round Delphi process to gather their opinions on definition of unavoidable pressure ulcer and indicators for assessment in cancer patients.Results Unavoidable pressure ulcer in cancer patients was defined as：the pressure ulcer developed in cancer patients who had pressure ulcer risk（such as severe edema,incontinence,cachexia,and forced postures,etc）;and had one or more of the following indicators：patients may not be able to tolerate repositioning at the optimum frequency（≥3days）;patients with preexisting or potential skin damage;and patients discharged to home so that they could not get further nursing care.Evaluation indicators of unavoidable pressure ulcer included existence of pressure ulcer risk factors,impossible implementation of turning plan,preexisting or potential skin damage,and lack of transitional care.The variation coefficients of these four indicators ranged from0.0856 to 0.1779,and the weights were 0.2899,0.2743,0.2743,and 0.1615 respectively.The response rates in 3rounds were90.9%,100%,and 100%respectively,and the authority coefficient of experts was 0.88.Conclusion The definition and evaluation indicators of unavoidable pressure ulcer in cancer patients can provide evidence for pressure ulcer management,which can be confirmed from coordination of experts.