Purpose Of Systematic Review
Knowledge is translated from research into clinical practice based on the evidence reported by systematic reviews . Yet, there has not been a systematic review of the intensive care literature published since 2002 for HAPU prevention strategies incorporating the Braden scale , and none focused on care bundles. The purpose of this systematic review was to evaluate the effectiveness of care bundles incorporating the Braden scale for risk assessment in reducing the HAPU prevalence in older adults hospitalized in the ICU.
Perceived Barriers To Engaging Patients In The Pupcb
Nurses suggested that whilst the PUPCB may work for some, it was not appropriate for all patients as it required active participation and engagement, to which there were many barriers. Three sub-themes were evident: Cognitive impairment restricts participation in PUP, Taking a passive approach to health care and Undervaluing of PUP by patients.
Cognitive impairment restricts participation in PUP
Many nurses believed that cognitively impaired patients, who may be at higher risk of PU, were unable to benefit from this intervention. Patients with dementia, delirium or confusion were described as being very high risk, but being unable to participate in PUP activities due to limited ability to self-care and being unable to understand or retain information provided in PUP education. It was interesting that nurses did not acknowledge differences in patients abilities to participate depending on their stage of dementia . However, nurses did often mention a solution to this barrier, which was involving the family or carers in the patients care. Educating carers and family members around PU risk factors and PUP strategies was seen to be extremely important for patients with cognitive impairment.
Taking a passive approach to health care
Undervaluing of PUP by patients
Youd say to them you need to start moving but they wouldnt really because theyre like, Im young but they still do get red bottoms and red heels.
Hospital Acquired Ulcer Prevention Programs With Care Bundles
In a systematic review comparing intervention effectiveness for a HAPU clinical practice guideline, Qaseem et al. reported care bundles significantly improved skin care and reduced HAPU rates, with a cost savings of at least $3,000 per case. Similarly, Sullivan & Schoelles reported care bundles significantly reduced HAPU rates in 11 , with a mean reduction of 82% . For assessment within the care bundles, there was also no significant difference reported in diagnostic accuracy between the Braden, Cubbin and Jackson, and Norton and Waterlow scales .
The single randomized controlled trial was reported from Saudi Arabia . In this study researchers compared a care bundle with a training program for the intervention group to normal care for the control group. HAPU incidence was significantly reduced in the intervention group when compared to the control . There was also significantly less stage I/II pressure ulcers, with no stage III/IV, development for the intervention group. Differences in care processes were also observed for repositioning and health protector application . Furthermore, a retrospective observational cohort study found there was a longitudinal impact of payment policies on the quality improvement interventions to prevent HAPUs. In this regard, Padula et al. observed hospitals adopting bundled interventions had a 27% reduction in HAPUs . The bundled interventions were attributed to changes in reimbursement policy, resulting in a 100% reduction in HAPU cases .
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A Registered Nurse’s Understanding Of Pressure Ulcer Prevention And Treatment
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- Jennifer N. King, MSN, APRN, FNP-C, RN-BC
- Sigma Affiliation
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This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 10744078 ProQuest document ID: 2019929990. The author still retains copyright.
This item has not gone through this repository’s peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Appreciating The Positive Aspects Of Patient Participation In Care
Nurses had overwhelmingly positive views of patient participation in care. Appreciation took two forms including understanding and supporting participation and realising the benefits of patient participation in care.
Understanding and supporting patient participation in care
Nurses explained how they understood patient participation in care, including what they thought it meant in theory and what activities it involved in practice. They described aspects of participation such as shared responsibility and knowledge/information exchange, and also acknowledged considerations such as patients abilities and level of engagement when involving them in their care. They discussed their personal views on and experiences with patient participation, with most nurses advocating an active role for patients in care.
The more information we can provide to the patient to start taking some form of responsibility right from admission throughout their journey, I think thats imperative. We need to give some of the responsibility back to them as well.
Its good for them to have an awareness that theyre responsible and they are playing a part in their own health care and their processes of getting discharged out of hospital.
Realising the benefits of patient participation
If we teach the patients on how to take control of their own care, then we can enable them to do it more proactively than waiting on the nurses to tell them what to do and everything.
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Study Design And Setting
Institutional based cross-sectional multi-center study using quantitative method was conducted from August 1322, 2018. Thera are 10 public hospitals functional in Wollega zones. The study setting includes five public hospitals including one teaching hospital , five Public Referral Hospitals: Nekemte, Gimbi, Nedjo, and Shambu Referral hospitals. Among ten hospitals, the investigators purposively selected five hospitals where large number of patients visit, referred and admitted. Wollegas main town is 330km to the west from the capital city of the country, Addis Ababa, Ethiopia. .
Swedish missionaries introduced the modern nursing to Ethiopia around 1866. Then, Russia and French were delivering the nursing service in limited areas of Ethiopia. After the Second World War , the Ethiopian Red Cross Society established the first nursing school in at Haile Selassie I hospital. Swedish Missionaries at the Princess Tsehai Memorial Hospital opened the second nursing school. These two nursing schools were only admitting females to train in nursing profession. Males were admitted to nursing programs in 1954 in Ethiopia in Nekemte nursing school found in the current study area, Wollega zones. Currently, in Ethiopia nursing profession could be educated after completed grade ten or twelve .
Preventing Pressure Injuries In Vulnerable Nursing Home Residents Using A Dynamic Overlay: A Pilot Study
Symposium on Advanced Wound Care, Las Vegas, NV, October 7-9, 2016.
Pressure injury incidence rates vary from 2.2% to 23.9% in skilled nursing facilities and nursing homes. Patients from a nursing home are more than five times more likely to have a pressure ulcer on admission to the hospital than other patients. This study evaluates the effectiveness of an alternating pressure overlay when placed over static foam mattress to prevent pressure injuries in nursing home residents assessed to be at high risk for developing pressure injuries.
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Dabir Alternating Nodal Support
Dabir surfaces achieve alternating support/relief utilizing independent rows of small comfort nodes that promote interstitial blood flow between areas of contact. In addition, the Dabir electronic controller provides adjustable cycle speed and firmness control to maximize patient comfort and enhance tissue re-perfusion between alternating support cycles.
Support Surfaces For Pressure Ulcer Prevention: A Network Meta
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* E-mail:
Affiliation Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Jo C. Dumville,
Roles Conceptualization, Data curation, Methodology, Software, Supervision, Writing review & editing
Affiliation Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Nicky Cullum
Roles Conceptualization, Methodology, Resources, Supervision, Writing review & editing
Affiliations Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom, Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Quantitative Research On Pressure Ulcer Prevention
Write a critical appraisal that demonstrates comprehension of the two quantitative research studies provided. Use the Research Critique Guidelines Part II document attached, to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.Use the PICOT question below and the two quantitative, peer-reviewed research articles identified below to complete this assignment.In a 1,0001,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.
PICOT: How does repositioning or turning the patient with decreased mobility at frequent intervals as compared to not repositioning or turning reduce the development of pressure ulcers over a 90-day period?
Research Critique Guidelines Part IIUse this document to organize your essay.
Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the studies in your responses.
Quantitative Studies
What Additional Resources Are Available To Identify Best Practices For Pressure Ulcer Prevention
A number of guidelines have been published describing best practices for pressure ulcer prevention. These guidelines can be important resources to use in improving pressure ulcer care. In addition, the International Pressure Ulcer Guideline released by the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel is available. A Quick Reference Guide can be downloaded from their Web site at no charge.
Resources
Clinical Practice Guideline 3: Pressure ulcers in adults: prediction and prevention. Rockville, MD: Agency for Healthcare Policy and Research May 1992. AHCPR Pub. No. 92-0047. Archived at: .
Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals. Consortium for Spinal Cord Medicine Clinical Practice Guidelines. J Spinal Cord Med 2001 Spring 24 Suppl 1:S40-101.
National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel . Quick Reference Guide version of the NPUAP/EPUAP International Pressure Ulcer Prevention Guidelines: Available at: and .
The following guidelines are available for a fee:
American Medical Directors Association: Pressure Ulcers in the Long-Term Care Setting. Available at: http://www.amda.com
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Strengths And Limitations Of This Study
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This is a systematic review and meta-analysis of randomised controlled trials.
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This review will be the first to synthesise the evidence regarding the effectiveness of guidelines used in pressure ulcer prevention for elderly patients in hospitals and offer the highest level of evidence for informed decisions on use of Pressure Ulcer Prevention Practice Guidelines in prevention pressure ulcers in the elderly patients in hospital.
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There may be heterogeneity of interventions used on eligible studies and incomplete information reported about the interventions in the literature which could limit our ability to statistically compare the effectiveness of interventions.
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The main limitation of this review might be scarcity of randomised controlled trials on the use of PUPPG for preventing pressure ulcers in elderly patients, publication bias and methodological quality of grey literature that shall be found.
Systematic Reviews Investigating Interventions For Chronic Or Complex Wounds More Generally
In addition to the PU-focussed reviews mentioned above, a further four Cochrane reviews relate more broadly to wounds, chronic wounds or acute and chronic wounds, some of which were PUs.
A systematic review of autologous platelet-rich plasma for treating chronic wounds included 10 trials . The Cochrane review concluded that it was unclear whether platelet-rich plasma influences the healing of chronic wounds other than foot ulcers associated with diabetes. Whilst two trials appeared to include two participants with PUs, these were not participants with SCI .
A systematic review of honey as a topical treatment for wounds included a total of 26 RCTs . The review concluded that although honey may speed the healing of partial thickness burns and surgical wounds, its effect on other wounds such as PUs is highly uncertain. Whilst one trial included adult orthopaedic patients with PUs , there was no evidence from the review that these were participants affected by SCI.
Dat et al. conducted a systematic review of aloe vera for treating acute and chronic wounds, which included seven trials . The review concluded that there was an absence of high-quality evidence from RCTs to support the use of aloe vera as a treatment for acute and chronic wounds. One included trial was an RCT, which compared a hydrogel dressing derived from the aloe plant with a saline gauze dressing and included only participants with PUs . However, it is unclear whether this included people with SCI.
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Assessment Of Methodological Quality
Two independent reviewers will be used to assess the methodological validity of the quantitative papers that will be selected for retrieval prior to their inclusion in the review using standard critical appraisal tools from the Joanna Briggs Institute for Meta-Analysis of Statistics Assessment and Review Instrument . All disagreement between the two reviewers shall be settled through discussions.
Support Pressure & Duration Of Pressure
Evidence indicates pressure and injury prevalence at anatomical sites are not directly correlated. This suggests that there is a high influence of other factors associated with pressure injuries and their formation. Duration of pressure turns out to be the key variable to control and Dabir surfaces optimizes the duration of pressure by providing periodic tissue offloading to promote healthy tissue perfusion.
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Systematic Reviews Of Interventions For The Prevention And Treatment Of Pus: Search Of The Cochrane Library
A range of Cochrane systematic reviews has been undertaken to summarise the current evidence from RCTs of interventions for the prevention and treatment of PUs. A search of The Cochrane Library up to July 2017 revealed 50 results , 27 of which are relevant to this review . Of these, 23 reviews evaluate interventions specifically relating to PUs, and 4 relate to several types of chronic or complex wound including PUs. Twenty-one reviews found trials, which were eligible for inclusion, whilst five were empty reviews and another, whilst including various types of wound, did not include any patients with PUs. Of the 50 retrieved results from the search, 23 reviews were not relevant to this overview .
Fig. 1
An Innovative Solution To Pressure Ulcer Prevention
Dabir systems are an innovation in pressure ulcer prevention and are well suited for patients who are at risk for pressure injury formation. Dabir surfaces help prevent pressure injuries by systematically providing tissue offloading in areas of the body that experience sustained periods of concentrated high pressure to promote healthy tissue reperfusion. Dabir surfaces have been clinically shown to reduce hospital acquired pressure ulcers .
Dabir surfaces are designed for patient comfort and has been well accepted by clinical staff.
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Implementation Of A Low
Symposium on Advanced Wound Care, Las Vegas, NV, October 20-22, 2017.
Patients undergoing cardiac surgery are at increased risk for developing perioperative pressure injuries, with reported incidence of up to 29.5%.1 A low-profile alternating pressure micropressure support surface with hundreds of comfort nodes, designed to periodically off-load static tissue pressure and minimize shear stress during surgery, was evaluated. The device was recently employed for cardiac operations in a large tertiary care center, and its effect on rates of perioperative pressure injuries was studied.
Nering With Nursing Staff To Facilitate Pupcb Implementation
Most nurses thought the PUPCB tested in the INTACT trial should be adopted by their ward as usual practice. Participants highlighted how important it was that the research team partnered with nursing staff to successfully implement the care bundle into practice, and discussed a number of perceived barriers and enablers to implementation.
Communication and dissemination
Nurses expressed the importance of communicating information and disseminating evidence in successful implementation of the PUPCB . Many nurses stated that for future implementation, education sessions or inservices would be needed to introduce the bundle to staff, familiarise them with what it involves and train them in its use. Nurses thought ideally, these sessions should be frequent, brief and concise and involve all staff on the ward. The importance of providing evidence to nurses around the effectiveness of the PUPCB and the benefits of patient participation in care was also emphasised. They thought nurses need to view the intervention as necessary and important in order for it to be adopted in practice, and providing evidence was a way to ensure this.
Providing some evidence about how much more the patients participate doing an inservice on how pressure areas have gone down since the INTACT trial started, some hard evidence on the stuff.
Leadership and influence
.having an independent person to come in and thats been their focus, to educate the staff.
Keeping the PUPCB simple
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Quantitative Analysis Of Pressure Ulcers
Info: 1929 words Nursing Essay 11th Feb 2020
Quantitative Analysis
Background and Significance
Pressure ulcers are due to bony prominences meeting or touching hard surfaces . The occurrence of bedsores can increase the occurrence of death, hospitalization, and decrease the quality of life for many patients . Current guidelines state pressure ulcers can be decreased by turning every two hours and using pressure distributing mattresses. Preventing Pressure Ulcers: A Multisite Randomized Control Trial in Nursing Home Patients evaluates the optimum turning frequency of patients in a long-term care facility aged 65 or older using a high-density foam mattress in the United States and Canada .
Review of the Literature
The article references several scholarly articles and flows logically in an organized format. The article states the strength and weaknesses of the study and arrives at a logical hypothesis. Bergstrom et al. state the results of the study follow with previous studies performed. However, the study presents with other observations such as the possible improvement of the quality of life for patients at risk for pressure ulcers on high-density foam mattresses and reducing treatments costs .
Methods
Internal and External Validity
Sampling
Legal and Ethical Issues
Data Collection Methods and Procedures
Reliability and Validity
Data Analysis
Applicability to Nursing Practice
References