Are patients with or at risk pressure ulcers allocated appropriate prevention measures?
Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden. International Journal of Nursing Practice
(Impact Factor: 0.6).
05/2005; 11(2):58-67. DOI: 10.1111/j.1440-172X.2005.00503.x
The aims of the study were to investigate the risk for and prevalence of pressure ulcers in different medical care groups, to discover if patients at risk for or with pressure ulcers are allocated appropriate pressure ulcer preventions and to investigate which variables are associated with appropriate pressure ulcer preventions. A cross-sectional survey design was used and followed the methodology developed by the European Pressure Ulcer Advisory Panel. A total of 612 patients participated in the study. The prevalence of pressure ulcers was greatest in geriatric care, followed by intensive care, acute care and neurological care. The majority of patients at risk for or with pressure ulcers did not receive appropriate preventative measures, either while they were in bed or in a chair. Significant variables associated with appropriate preventions in bed were intensive care, geriatric care, a low Braden score, a low score in the subscale activity and a long hospital stay.
Available from: Sharon Leanne Latimer
- "Numerous studies have reported varied implementation of CPG by nurses (Sving et al. 2012, Moore 2013) including repositioning (Gunningberg 2005, Vanderwee et al. 2007). Two European studies report the majority of patients at risk of PI were not regularly repositioned (Gunningberg 2005, Vanderwee et al. 2007), suggesting that PIP strategies were either not appropriately allocated (Vanderwee et al. 2007) or were aimed at the bed-ridden patient (Gunningberg 2005). Several reasons may explain a lack of repositioning. "
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ABSTRACT: AimTo determine the frequency of patient repositioning across three consecutive nursing shifts (day, evening and night) and to identify predictors of repositioning frequency.Background
Patient repositioning is a frequently implemented pressure injury prevention strategy. Yet, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility.DesignAn observational prospective study.Methods
Chart audits were used to gather clinical and demographic data. Semi-structured observations were conducted every 30 minutes for a continuous 24-hour period. Observational data included the patient's body position, the frequency of repositioning, assistance require to reposition and the use of support surfaces.ResultsPatients were repositioned frequently during the day and evening and least at night time. Elevation of the head of the bed (1–45°) was the most frequently adopted position. The independent predictors of repositioning frequency were age and gender, with older patients and males repositioned less frequently.
Available from: Jamal Qaddumi
- "Limited application of knowledge is a common problem in clinical practice . Nurses are not fully aware the importance of using up-to-date PU prevention protocols and may not have been exposed to current evidence-based practices; sometimes their practices can be influenced by intuition, experience, or habit . "
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ABSTRACT: Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses.
Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master's level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention.ANOVA and t-test analysis were used to test the differences in nurses' knowledge according to participants' characteristics. Means, standard deviation, and frequencies were used to describe nurses' knowledge levels, knowledge sources, and barriers to pressure ulcer prevention.
The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5-17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention.
This study highlights concerns about Jordanian nurses' knowledge of pressure ulcer prevention. The results of the current study showed inadequate knowledge among Jordanian nurses about pressure ulcer prevention based on National Pressure Ulcer Advisory Panel guidelines. Also, the low level of nurses' pressure ulcer knowledge suggests poor dissemination of pressure ulcer knowledge in Jordan, a suggestion supported by the lack of relationship between years of experience and pressure ulcer knowledge.
Available from: Sandy Middleton
- "An Australian survey of 2113 registered nurses found that only 30% documented assessment and treatment of pressure injuries; 53% followed repositioning guidelines and over 50% used the outdated practice of water-filled gloves to prevent pressure by over a half . A Belgian study of 22 hospitals found only 17.5% of at-risk patients were appropriately allocated a dynamic mattress system ; a Swedish study conducted in a large teaching hospital found that the majority of those at risk for pressure injuries did not get evidence-based care ; while only half of eligible patients across 89 Dutch institutions were allocated a pressure-relieving support surface and less than one-third were regularly repositioned . These studies and others have also found inadequacies and gaps in nurses’ documentation of pressure injury risk assessment, and prevention measures used [19,30-33]. "
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Patients are at risk of developing pressure injuries in the peri-operative setting. Studies evaluating the impact of educational interventions on peri-operative nurses’ knowledge and reported practice are scarce. The purpose of this study was to evaluate the effect of a multifaceted intervention on peri-operative nurses’ (a) knowledge of pressure injury risks, risk assessment and prevention strategies for patients in the operating suite; and (b) reported practice relating to risk assessment practices and implementation of prevention strategies for patients in the operating suite.
A before-after research design was used. A convenience sample of all registered and enrolled nurses employed in two hospitals’ operating suites was recruited. A multifaceted intervention was delivered which comprised a short presentation, educational materials and reminder posters. A 48-item survey tool was completed pre-and post-intervention to measure self-reported knowledge and practice.
70 eligible peri-operative nurses completed both surveys. Post-intervention, statistically significant improvements were seen in knowledge of correct descriptions of pressure injury stages (p=0.001); appropriate reassessment for patients with a new pressure injury (p=0.05); appropriate actions for patients with an existing stage 1 (p=0.02) and stage 2 pressure injury (p=0.04). Statistical improvements were also seen in reported practice relating to an increase in the use of a risk assessment tool in conjunction with clinical judgement (p=0.0008); verbal handover of patients’ pressure injury risk status from the operating room nurse to the recovery room (p=0.023) and from the recovery room nurse to the postoperative ward nurse (p=0.045). The number of participants reporting use of non-recommended and recommended pressure-relieving strategies was unchanged.
A multi-faceted educational intervention can improve some aspects of perioperative nurses’ knowledge and reported practice such as risk assessment practices but not others such as use of recommended pressure-relieving devices. Further research is required to ascertain effective interventions which improve all areas of practice and knowledge, particularly in the use of appropriate pressure-relieving devices in order to prevent pressure injuries in surgical patients.
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