Risk factors for pressure ulcer development in critically Ill patients: a conceptual model to guide research.

Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
Research in Nursing & Health (Impact Factor: 2.18). 04/2012; 35(4):340-62. DOI:10.1002/nur.21481
Source: PubMed

ABSTRACT This paper presents a proposed conceptual model to guide research on pressure ulcer risk in critically ill patients, who are at high risk for pressure ulcer development. However, no conceptual model exists that guides risk assessment in this population. Results from a review of prospective studies were evaluated for design quality and level of statistical reporting. Multivariate findings from studies having high or medium design quality by the National Institute of Health and Clinical Excellence standards were conceptually grouped. The conceptual groupings were integrated into Braden and Bergstrom's (Braden and Bergstrom [1987] Rehabilitation Nursing, 12, 8-12, 16) conceptual model, retaining their original constructs and augmenting their concept of intrinsic factors for tissue tolerance. The model could enhance consistency in research on pressure ulcer risk factors.

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    ABSTRACT: To enhance the learner's competence with knowledge of the results of research examining suspected deep tissue injury profiles. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to: : The purpose of this study was to examine (1) the incidence of potential precipitating events of suspected deep tissue injuries (SDTIs) identified over a 7-day period prior to cutaneous manifestation, (2) physiological variables related to the formation of SDTIs, and (3) the time since precipitating events and the occurrence of the SDTI. A descriptive exploratory study. A retrospective chart review was conducted. A 348-bed community Magnet-redesignated hospital, Baptist Health Lexington Kentucky PARTICPANTS:: Eighty-five participants with SDTIs identified between January 2008 and March 2010. Precipitating events evaluated were tissue perfusion, surgery, transfers, mobility, and falls. Physiological variables included anticoagulation, albumin/prealbumin, hemoglobin, partial thromboplastin time, and hemoglobin A1c. Timeline differences between precipitating events and SDTI were measured. Precipitating events identified from most to least frequent were transfers = 67 (78.8%), tissue perfusion = 36 (42.5%), surgery = 33 (40.2%), mobility = 26 (30.9%), and falls = 14 (16.9%). Of the 85 charts reviewed, 69 of the charts met the criteria for timeline difference between precipitating event and SDTI manifestation. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) years. Meaningful physiological variables noted were anticoagulation 52 (61.2%), anemia (hemoglobin 6-9 g/dL) 53 (67.1%), and hemoglobin A1c less than 7.5 mmol/L 29 (74.4%). This exploratory pilot study evaluating patients with SDTI revealed the most common precipitating event was transfers. In addition, the physiological variables that appeared to contribute to the development of SDTIs were anticoagulation and anemia. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) days.
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Richard Benoit