Purpose Pressure ulcers (PUs) are a common problem affecting the quality of life of patients and also hindering the quality of medical services. The purpose of this scoping review was to analyze Randomized Controlled Trials (RCTs) focusing on devices used for the prevention and treatment of PUs. Methods The scoping review was conducted using the scoping review process outlined by Arskey and O’ Malley and using the JBI template. The review was described by PRISMA-ScR. Studies on relevant interventional devices for PUs were searched using electronic databases. The medical databases PubMed, CINHAL, CENTRAL, and EMBASE, and several Korean databases were searched between 2010 and July 2021. Results Thirteen RCTs were included in the analysis. The devices used were found to be effective in the prevention and treatment of PUs by the mechanisms of either pressure relief, moisture retention, or increased blood flow. The effectiveness of the devices was measured by the incidence of PUs and the improvement in patients’ quality of life and comfort after therapy. Conclusion The use of devices for the prevention and treatment of PUs is helpful in clinical settings. However, more studies are needed that address the use of these devices in larger populations to improve the quality of patients’ life and medical service.
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Purpose This study aimed to identify the incidence, characteristics, and risk factors associated with Medical Device-Related Pressure Injuries (MDRPIs) in neurosurgery patients. Methods: Participants were 160 adult patients who underwent neurosurgery under general anesthesia from September 17, 2019 to August 11, 2020. Data were analyzed using SPSS 20 program. Descriptive statistics were used for general characteristics, clinical characteristics, surgical characteristics, MDRPIs incidence, and medical device related. Independent t-test and x2 test were used for differences in general characteristics, clinical characteristics, and surgical characteristics according to the occurrence of MDRPIs. Results Among 160 participants, MDRPIs occurred in 72 patients (45.0%). The result of the logistic regression analysis showed that the risk factors associated with MDRPIs were operation time (Odds Ratio [OR]=1.03, 95% Confidence Interval [CI]=1.01~1.04, p=.003), intraoperative blood loss (OR=1.02, 95% CI=1.01~1.03, p=.043). Conclusion Of the 160 patients who underwent neurosurgery, 72 (45%) developed MDRPIs. Additionally, the longer the operation time and anesthesia time and the higher the amount of blood loss, the higher the incidence of MDRPIs. Therefore, strategies to increase risk assessment and preventive actions against MDRPIs should be established.
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PURPOSE This methodological study was conducted to evaluate the interrater agreement in pressure ulcer risk assessment using the Braden scale, and in pressure ulcer classification, by nurses in a medium-sized hospital. METHODS Data were collected from a medium-sized hospital, located in Seoul, from December 18, 2017 to February 28, 2018. The author (Rater 1) and 20 randomly sampled nurses (Rater 2) independently assessed 100 patients. The Braden scale for risk assessment and the six-stage pressure ulcer classification system were used. The interrater agreement was evaluated using the Intraclass Correlation Coefficient (ICC), the proportion of agreement (Po), and the Bland-Altman plots. RESULTS For the total score on the Braden scale, the ICC was .85 and the Po was .29. Among the scale items, ‘moisture’ had the lowest agreement (ICC=.55, Po=.46). The interrater agreement had Po values of .84 and .69 for the presence and the classification of pressure ulcers, respectively. CONCLUSION For nurses in medium-sized hospitals, interrater agreement for the Braden scale and for the classification of pressure ulcers should be enhanced. In order to do this, overall institutional support is needed, including training in the accurate use of tools for pressure ulcer care.
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PURPOSE The aims of this study were to develop the unit specialist-led pressure ulcer nursing algorithm for hospital nurses, and to examine its clinical adequacy. METHODS The study used a methodological design. The algorithm was developed through the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model using the combination of systematic review, clinical staff interview, and expert panel interview. Thirty nurses in two hospital units applied the algorithm to 30 patients from September 7, 2017 to September 20, 2017. RESULTS The contents of the nursing algorithm included roles of the unit specialist, application of the algorithm, assessment, nursing interventions, and documentation. The algorithm had acceptable validity of Scale-level Content Validity Index (S-CVI) from .93 to .95. The Braden scale scores were significantly improved from 12.37±3.30 to 13.67±3.59 (t=20.55, p<.001) in the patients who used the algorithm. The hospital unit nurses rated the algorithm's clinical adequacy as acceptable, with a mean score ranging from 3.30±0.65 to 3.67±0.48. The most highly rated item was that “pressure ulcer has been detected and managed promptlyâ€. CONCLUSION The unit specialist-led pressure ulcer nursing algorithm in general hospital units facilitated the prompt and accurate decision-making for hospital unit nurses. Using this algorithm, the hospital unit nurses will be able to provide relevant and prompt care for pressure ulcer prevention and management.
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PURPOSE The purpose of this study was to describe the illness experience of patients with pressure ulcer. METHODS A phenomenological methodology was used for the study. The data were collected by individual in-depth interview with seven participants with pressure ulcer during 2013~2014. All interviews were audio-taped and verbatim transcripts were made for the analysis. The data were analyzed using Colaizzi's phenomenological method. RESULTS All participants had underlying disease, such as spinal paralysis and diabetes. Average period of having pressure ulcer was 18 months, ranged from 3 to 36 months. A total of seven theme clusters were derived from the analysis; unexpected wound, inherent vulnerability to infection, reversal of the treatment policy, unpleasant and strange feeling of wound, sweeping fear and helplessness, socioeconomic burden, and healing through specific actions and reflection. The participants faced various contradictory and paradoxical situations in managing their pressure ulcers as well as underlying diseases in their everyday life. However, they slowly overcome these situations by strictly practicing concrete action-oriented strategies that they have learned through suffering and appreciating miraculous wound healing. CONCLUSION The results of this study can help developing a patient-specific intervention program with sufficient emotional support by providing insights of the paradoxical illness experience of patients with pressure ulcer.
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PURPOSE The purpose of this study was to develop an algorithm for preventing and managing of pressure ulcer and to verify the its appropriateness. METHODS: The first step was development of a pre-algorithm through a literature review and expert opinion. The second step was to establish content validity by submitting the algorithm questionnaires about the content to 12 experts. The third step was the revision of the algorithm. The fourth and last step was to establish the clinical validity of the algorithm with 25 experienced nurses. RESULTS: For the ease of the practitioner the algorithm for prevention and the management of pressure ulcers was confined to one page depicting the main algorithm pathway and seven stepwise guidelines. The guidelines included skin care of pressure ulcer prevention, mechanical loading care, support surface care , reposition care of pressure ulcer, and Stages II, III and IV explanations along with debridement/wound irrigation and infection control. Most of all algorithm courses chosen more than 80% of agreement by expert index of content validity. The usefulness, appropriateness, and convenience of the algorithm were demonstrated through clinical validity with intensive care unit and ward nurses. CONCLUSION: The algorithm will improve the quality of pressure ulcer nursing care as it provides a model for decision making for clinical nurses as well as providing consistent and integrated nursing care for patients with pressure ulcer throughout an institution.
PURPOSE To examine pressure ulcer care from the standpoints of perceived importance, educational needs, knowledge and performance among clinical nurses. METHODS This descriptive study was conducted with a convenient sample of 289 nurses from four hospitals. Questionnaire data collected from June to August 2008 was analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficients. RESULTS The mean scores of importance and educational needs concerning pressure ulcer care were high, performance was moderate, and knowledge was low. Knowledge level differed significantly according to career, performance differed significantly according to pressure ulcer care education and the main healer(the person primarily responsible for treatment). Perceived importance differed significantly according to the main healer, and educational needs differed significantly according to working area and the main healer. Significant correlations were evident between performance and importance, performance and educational needs, importance and knowledge, and importance and educational needs. CONCLUSION Focus on perceived importance and educational needs to clinical nurses about pressure ulcer care may be beneficial to improve knowledge and practice of pressure ulcer care, and should be reflected in the development of effective programs to enhance relevant nursing skills.
The purpose of this study was to evaluate the knowledge level of pressure ulcer among hospital nurses through a cross-sectional survey by using the pressure ulcer knowledge assessment tool of Beitz et al.(1998). The total of subjects was 160 voluntary participants (60 were from Hospital A and 100 were from Hospital B) working at adult patients' units in two university hospitals located in the same city. None of the hospitals had expert nurses of pressure ulcer nor provided a regular pressure ulcer education program during the past one year. The survey tool consisted of 32 true-false items which were grouped into the risk factors knowledge category(13 items), the wound assessment knowledge category(4 items), and the treatment methods knowledge category(15 items). An internal consistency reliability test of the tool yielded an overall coefficient of 0.72; the coefficient for the risk factors knowledge category was 0.40, that for the wound assessment knowledge category was 0.33; that for the treatment knowledge category was 0.54. The main findings of the study are as follows. 1)Demographic characteristics of the two hospital nurses were similar except for the educational level(p=0.029) and the work units(p=0.001). These observations were maintained even if Hospital A and B were separately compared. 2)The knowledge level of the subjects about pressure ulcer in general was low as indicated by 53.3 points(of 100 possible points) on average. The knowledge level about treatment methods of pressure ulcer was the lowest as indicated by 47.0 points on average. 3)No correlation between the knowledge level of the pressure ulcer and the demographic characteristics of nurses was found except that the knowledge level of I.C.U. nurses was significantly higher(p=0.0003) than that of nurses in other units(p=0.2926) in the case of Hospital A. 4)The knowledge level of nurses in Hospital B was higher than for nurses in Hospital A. The reason was not identified, but it seems that it is related to the role of the I.C.U. or some other factors. The study results confirmed the existing literature that knowledge level of nurses about pressure ulcer is low regardless of age, educational level, or work experience. However, the working place(unit) affected the knowledge level. Further research on the exact reason for the differences in the knowledge level is needed in the future.
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