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: This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. Discussion Paper. The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010-2011) and an international expert group meeting (conducted December 2011). A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research.
    Journal of Advanced Nursing 03/2014; · 1.53 Impact Factor
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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.
    Advances in skin & wound care 03/2014; 27(3):133-40.
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    ABSTRACT: AimTo agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BackgroundA recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DesignConsensus study.MethodA modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010–December 2011.FindingsThe risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.Conclusion The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework.
    Journal of Advanced Nursing 05/2014; · 1.53 Impact Factor