Pressure Ulcer Risk Assessment Research Articles

Braden score predicts 30-day mortality risk in patients with ischaemic stroke in the ICU: A retrospective analysis based on the MIMIC-IV database.

Ischaemic stroke remains a significant global health challenge, associated with high mortality rates. While the Braden Scale is traditionally employed to assess pressure ulcer risk, its potential to predict mortality among the intensive care unit (ICU) patients with ischaemic stroke has not been thoroughly investigated. This study evaluates the predictive value of the Braden Scale for 30-day mortality among patients with ischaemic stroke admitted to ICU. We conducted a retrospective analysis of 4710 adult patients with ischaemic stroke from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The association between the Braden Scale scores and 30-day mortality was assessed using receiver operating characteristic (ROC) curve analysis, Cox regression models and Kaplan-Meier survival estimates. Patients with Braden Scale scores ≤ 15.5 showed significantly higher 30-day mortality rates (p-value < 0.001; hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.71-2.53). The area under the ROC curve (AUC) was 0.71, demonstrating good predictive performance. Multivariate analysis confirmed the Braden Scale as an independent predictor of mortality, after adjusting for age, gender and comorbidities. The Braden Scale effectively identifies high-risk ischaemic stroke patients in ICU settings, endorsing its integration into routine assessments to facilitate early intervention strategies. Integrating the Braden Scale into routine ICU evaluations can enhance mortality risk stratification and improve patient care tailoring.

Construct validity of the Braden scale in acute- and long-term care settings in Austria: A structural equation modeling analysis

Objective: The Braden scale is frequently used to assess pressure ulcer risk in health care settings. Selected psychometric properties have been tested using various methods of classical test theory in international studies. However, limited information on construct validity is available. Aim was to determine if the Braden subscale items correlate with the construct pressure ulcer risk and whether the construct validity concerning the factor structure of the Braden scale is adequate in acute and long-term settings.Methods: A quantitative design with secondary analysis of data from one acute (n = 328) and eight long-term care facilities (n = 311) in Austria was used to test construct validity. Data analysis included principal axis factor analysis with Promax rotation and assessment of internal consistency, followed by structural equation modeling.Results: For the acute care setting, a structure equation model with two latent factors and for the long-term care setting with one latent factor was tested according to principal axis factoring results. The Braden subscale items correlated with the construct pressure ulcer risk. Almost all examined model fit indices were within recommended reference values. Thus, the construct validity of the Braden scale was adequate in both settings.Conclusions: The factor structure in the acute care setting did not match that in the investigated long-term care setting. Further research regarding the construct validity of the Braden scale is therefore necessary.

Pressure ulcers acquired during inpatient rehabilitation after spinal cord injury, characterization and predictors: A 15-years' experience.

Most studies focus on the risk factors associated with the development of pressure ulcers (PUs) during acute phase or community care for individuals with spinal cord injury (SCI). This study aimed to i) compare clinical and demographic characteristics of inpatients after SCI with PUs acquired during rehabilitation vs inpatients without PUs and ii) evaluate an existing PU risk assessment tool iii) identify first PU predictors. Individuals (n = 1,135) admitted between 2008 and 2022 to a rehabilitation institution within 60 days after SCI were included. Admission Functional Independence Measure (FIM), American Spinal Injury Association Impairment Scale (AIS) and mEntal state, Mobility, Incontinence, Nutrition, Activity (EMINA) were assessed. Kaplan-Meier curves and Cox proportional hazards models were fitted. Overall incidence of PUs was 8.9%. Of these, 40.6% occurred in the first 30 days, 47.5% were sacral, 66.3% were Stage II. Patients with PUs were older, mostly with traumatic injuries (67.3%), AIS A (54.5%), lower FIM motor (mFIM) score and mechanical ventilation. We identified specific mFIM items to increase EMINA specificity. Adjusted Cox model yielded sex (male), age at injury, AIS grade, mFIM and diabetes as PUs predictors (C-Index = 0.749). Inpatients can benefit from combined assessments (EMINA + mFIM) and clinical features scarcely addressed in previous studies to prevent PUs.

The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Pressure ulcer risk assessment in the ICU. Is it time for a more objective measure?

BackgroundThe Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit are at risk of pressure ulcer development meaning that the Braden score will usually indicate high risk for these patients. This study set out to determine the correlation between Sub-Epidermal Moisture measurements and Braden scores among Intensive Care Unit patients. MethodsThis study employed an observational research design. Braden score was assessed on all study days (1–5), in addition to visual skin assessment and Sub-Epidermal Moisture measurements at the sacrum and heels. Sub-Epidermal Moisture measurements were categorised as low (<0.5), borderline abnormal (≥0.5), and high (≥0.8). Correlation was assessed between Sub-Epidermal Moisture levels and Braden scores. ResultsA total of 53 participants were recruited. The median (interquartile range) baseline Braden score was 9 (9–10) and 81 % (n = 43) of participants were at very high/high risk of pressure ulcer development. Braden scores remained relatively constant over time with little fluctuation in scores. 19 % (n = 10) of patients had normal (<0.5) Sub-Epidermal Moisture delta measurements on enrolment, and all developed abnormal measurements by day 2. There were no significant correlations between Braden scores and Sub-Epidermal Moisture measurements. ConclusionAlthough this was not its original intention, a missing link with the Braden scale is that it does not provide information on how patients are responding to the adverse effects of pressure and shear forces. Furthermore, in patients who are critically unwell, most patients are classified as being “at risk” of pressure ulcer development. Therefore, an objective measure of how patients are responding to pressure and shear forces at different anatomical areas is needed. Implications to clinical practiceSub-Epidermal Moisture measurements can offer more information, not only on identifying those who are at risk, but also how those patients are tolerating this risk at different anatomical sites.

Medical device-related pressure injuries in intensive care patients: A prospective and descriptive study

BackgroundTreatment and care of patients in intensive care units require the use of many medical and technological instruments. Pressure injuries occur when medical devices, which are used more in intensive care patients and are in direct or indirect contact with the skin, cause focal and localized forces on the superficial or deep tissues. ObjectiveIn this study, it was aimed to examine the risk factors, incidence and characteristics of medical device-related pressure injuries in intensive care patients. MethodsThis study has a prospective and descriptive design. The study was carried out in the adult intensive care unit of a healthcare institution located in the western Turkey. 138 intensive care patients treated in the level 3 adult intensive care unit were enrolled in the study. The first observations and evaluations of intensive care patients in terms of pressure injuries were made within the first 24 h after admission to the clinic. Observations continued daily during the hospitalization period of the patient. Data were collected with the Intensive Care Patient Information Form, Glasgow Coma Scale, Braden Pressure Ulcer Risk Assessment Scale and Identification Form for Medical device-related Pressure Ulcers. Analysis of data was performed with descriptive statistical methods, Shapiro-Wilk Test, Mann-Whitney U Test and Chi-Square analysis. ResultsMedical device-related pressure injury developed in 11.6% (n = 16) of intensive care patients. Anatomically, pressure injury occurred most frequently on the lip (37.5%) and most frequently due to the intubation tube (37.5%). Most of the developed wounds (75.0%) were found to be stage 2. Multinominal logistic regression analysis, which was performed to determine the effect of independent variables on medical device-related pressure injuries in intensive care patients, was found to be statistically significant (X2 = 37.098, p < 0.001). When the regression coefficients were examined, it was found that total hospitalization time in the intensive care unit (β = 0.948, p < 0.01) and PaCO2 level (β = 0.923, p < 0.01) had a positive, and duration of aerobic respiration with nasal cannula or mask (β = −0.920, p < 0.01) and Braden score (β = −0.948, p < 0.01) had a negative and significant effect on medical device-related pressure injuries. ConclusionsIn this study found that the MDRPIs development rate was lower than other studies. It was observed that pressure injuries due to medical devices developed more frequently in patients with longer hospitalization days, higher PaCO2 levels, shorter duration of oxygenated breathing with nasal cannula or mask, and lower Braden scores.

Complementing Braden scale for pressure ulcer risk with clinical and demographic-related factors in a large cohort of hospitalized Italian patients

AimsTo determine the prevalence, risk, and determinants of pressure ulcer risk in a large cohort of hospitalized patients. DesignA prospective cross-sectional study with data collection in January 2023. MethodsRegistered nurses collected data from 798 patients admitted to 27 health care units of an Italian hospital. The pressure ulcer risk was assessed using the Braden scale. The presence of comorbidities was collected from clinical reports. Obesity was assessed according to international indicators (Body Mass Index). The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of different Braden scores for identifying participants with pressure ulcers. ResultsThe prevalence of pressure ulcers was 9.5%, and 57.4% of the sample were at risk of developing pressure ulcers. The area under the ROC curve was 0.88. The best sensitivity and specificity were found for a Braden cutoff score of 15.5 (sensibility = 0.76; specificity = 0.85). The determinants of lower Braden scores were older age (p < 0.001), comorbidities (p < 0.001), wounds of other nature (p = 0.001), urinary incontinence (p < 0.001), fecal incontinence (p < 0.001), and urinary catheterization (p < 0.001). ConclusionSeveral demographic factors and specific clinical indicators have been identified as determinants of the risk of developing pressure ulcers, which are easily ascertainable by healthcare providers; thus, they may routinely complement the Braden Scale in the assessment of pressure ulcer risk in order to reinforce and accelerate clinical judgment.

Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence

ObjectiveTo determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs. Research Methodology/DesignA pre-post test intervention study without a control group. SettingThe study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients). Main Outcome MeasuresThe data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E). ResultsThe mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses’ MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001). ConclusionThe study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings. Implications for clinical practiceSince MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study.

The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation. A qualitative descriptive phenomenological study. The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method. The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales. The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Prevalence of Bedsores Among Elderly Hospitalized in Imam Reza Hospital in Kermanshah: A Cross-sectional Study

Introduction: Pressure ulcer is one of the serious complications of patients, especially the elderly during hospitalization, which increases the cost of health care and decreases the quality of life of the patient, and often results from long stay in the hospital. Therefore, this study was conducted with the aim of determining the prevalence of bedsores among elderly hospitalized in Imam Reza hospital in Kermanshah. Methods: This cross-sectional study was conducted on 5698 patients referred to Imam Reza hospital between 2019 and 2022. The inclusion criteria were more than 65 years old. Wound assessment was performed based on Braden criteria and wound grading by trained experts. After entering the SPSS version 16 software, the data were analyzed using a chi-square test. Results: The average age of the participants in the study was 77.02 ± 8.27 years, and the highest frequency of bedsores (22.3%) was reported in the age group of 65 to 69 years. Wound grades 1 and 4 had the highest and lowest frequency respectively. The chi-square test analysis showed that the degree of wound and the risk assessment of pressure ulcers were not significant according to gender (P&lt;0.05). Conclusion: According to the results of this study, the prevalence of bedsores in Imam Reza hospital in Kermanshah is high, therefore, health and medical units can play an important role in preventing bedsores by knowing about the at-risk populations and implementing appropriate preventive strategies.

Investigetion of Pressure Sores Frequency and Risk Factors of Patients Registered to Home Health Unit

Aim: The study was to investigate the frequency of pressure sores, the risk factors causing their formation, and their relationship with nutrition in patients receiving home health services. Materials and Methods: After scanning all 4098 patients registered with the Home Health Unit of an Education and Research Hospital in İzmir, Turkey, it was discovered that 186 of them had pressure sores. The study concluded with 151 patients as 35 patients passed away during the data collection process. The questionnaire employed in the study comprised two parts: The first part examined patients' sociodemographic and clinical characteristics, while the second part utilized the Pressure Ulcer Scale for Healing, Braden Pressure Ulcer Risk Assessment Scale, and Malnutrition Universal Screening Tool. Results: Pressure sores were found in 3.69% of the 4098 patients. The mean age of the patients was 78.29 (78.28±14.51), and 103 (68.2%) were female patients. Upon analyzing patients based on the presence of chronic diseases, it was noted that the risk of pressure sore development was notably higher in the high and very high-risk groups, particularly among those with neurological diseases. Approximately 44.4% of the patients utilized nutritional products. A statistically significant correlation was observed between the use of high-protein dietary products and the Braden scale score.. Conclusion: This study shows that the patients receiving Home Health Care Services are in the risky group in terms of pressure sores and malnutrition, but the incidence decreases with good care and caregiver education. The most important factors that increased the risk of pressure sore formation and the severity of pressure sores were neurological disease, nutritional status, and urinary and fecal incontinence.

Instrumentos para a avaliação do risco de lesões por pressão para adultos em situação crítica: scoping review*

Objective: to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments’ use/limitations. Method: a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample. Results: we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin &amp; Jackson, EVARUCI, RAPS-ICU, Song &amp; Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments. Conclusion: the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units.

Prevalence of Pressure Ulcer in Orthopaedic Bedridden Patients With a Higher Braden Pressure Ulcer Score in a Tertiary Care Government Hospital in Jammu

In this research, our primary objective was to determine the prevalence of pressure ulcers (PU) in bedridden patients with risk of higher Braden Pressure Ulcer scores who were admitted to the orthopaedic wards at the tertiary care government hospital in Jammu. Methodology To achieve this, we conducted a cross-sectional point prevalence study utilising the Braden Pressure Ulcer Risk Assessment Scale and the European Pressure Ulcer Advisory Panel (EPUAP) grading scale and data form. Our research sample consisted of 180 bedridden patients with higher Braden scores admitted to the orthopaedic ward of the selected facility. We monitored these patients using an observational checklist based on the established EPUAP minimal dataset form and grading scale. We conveniently selected patients who had moderate to severe Braden Pressure Ulcer Risk scores. Result Our findings revealed that 22.8% of the bedridden patients with moderate to high-risk Braden pressure ulcer scores developed pressure ulcers. Among the respondents, the majority (67.78%) were categorised as high risk, followed by severe risk (18.89%) and moderate risk (13.33%). Of those who developed pressure ulcers, 28 had Grade 1 ulcers and 12 had Grade 2 ulcers. The most common locations for these ulcers were the sacrum (40%), followed by the iliac region (35%), and the buttocks (25%). We did not observe any significant association between clinical variables and the incidence of pressure ulcers, except for skin turgor.

Impact of educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention: A pilot study

Background: Professional nurses are saddled with a unique role in patient's skincare among hospitalized patients. Inadequate nurses’ knowledge of pressure ulcer risk assessment (PURA) and prevention as a major contributory factor to development of pressure ulcer among “at risk” patients has been identified by previous studies. Aim: To evaluate the impact of an educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention at a tertiary hospital, Ibadan, Nigeria. Methods: A pilot study with sample size of 26 nurses selected through simple random sampling technique from selected nursing units of the facility. Data collection was done through a structured questionnaire. Hypotheses were tested with inferential statistics using t-test. Results were presented in descriptive statistics and charts. Level of significance was p-value &lt;0.05. Results: Almost all participants’ knowledge mean score of PURA increased from 4.92 ±1.26 at pre-test to 14.00 ± 0.71 at post-test (p&lt;0.001). Also, knowledge mean score of pressure ulcer prevention improved among intervention group (14.00 ± 0.707) post educational intervention as compared to their counterparts in control group (11.85±1.41). Educational intervention was statistically significant with participants’ knowledge of PURA and prevention (p&lt;0.001). Conclusion: The results of this study confirmed that educational intervention was impactful positively on nurses’ knowledge regarding PURA and prevention strategies at UCH, Ibadan, Nigeria. Thus, a structured educational program on the subject matter is needed to promote quality nursing care delivery according to international best practices among Nigerian nurses.

Nurses’ Knowledge of Pressure Ulcer Risk Assessment and Prevention Strategies: A Cross-Sectional Study in Nigeria

The development of PUs consequently results in significant physical, financial, and emotional burdens on the affected patients and their relatives including healthcare providers. This study aimed to assess knowledge of pressure ulcer risk assessment (PURA) and prevention strategies among nurses at University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design among 264 nurses was selected through a simple random sampling technique using a structured pre-tested questionnaire for data collection. Data were analyzed using descriptive and inferential statistics. The level of significance is set at a p-value &lt;0.05. The mean age of participants was 40.59 ± 9.88 years. Findings revealed that an average of 51.1% of respondents had adequate knowledge of PURA. However, adequate knowledge of pressure ulcer prevention strategies was recorded among just a little above average 67.8%. Analysis of Variance (ANOVA) showed no significant relationship between respondents’ level of education and their knowledge of pressure ulcer risk assessment as well as their knowledge of pressure ulcer prevention strategies (p&gt;0.05). Knowledge of pressure ulcer and prevention strategies was inadequate. Nurses need regular training programs to improve their knowledge and skills in PURA and the prevention of pressure ulcers among at-risk patients according to international best practices in order to bridge the previously identified gaps.&#x0D;

Determining the Risk of Intraoperative Pressure Injury in Patients Undergoing Elective Cranial Surgery

Purpose: Neurosurgical interventions are long and complex, and additional difficulties are encountered in positioning in the operating room.The aim of the study is to determine the risk of pressure injury development in the intraoperative period of patients undergoing elective cranial surgery. &#x0D; Methods: This descriptive cross-sectional study was conducted with 127 patients who met the inclusion criteria and underwent elective cranial surgery in a city hospital between September and October 2021. 3S Operating Room Pressure Injury Risk Diagnostic Scale were used to collect data. &#x0D; Results: It was determined that 55.1% of the patients were female, their mean age was 53.22±13.47 years, and 61.4% had at least one chronic disease. It was determined that 71.7% of the patients were operated with the diagnosis of cerebellar tumor. Stage 1 pressure ulcers were observed in 37% of the patients. It was determined that the total score obtained from the scale was 14.87±2.83 and the patients were at low risk for pressure injury. Age, body mass index and duration of the surgical procedure were found to be independent factors affecting the patients' operating room pressure ulcer risk assessment scale score. &#x0D; Conclusion:It was determined that the risk of pressure injury in patients who underwent cranial surgery was low level.

Effect of Intervention Training on Nurses’ Knowledge of Pressure Ulcer Risk Assessment and Prevention at a Tertiary Hospital, Nigeria

Background: Despite advances in healthcare, inadequate knowledge of pressure ulcer risk assessment (PURA) and prevention strategies among nurses as a major contributory factor to development of pressure ulcers among “at risk” patients has been identified by previous studies. Aim: This study evaluated effect of intervention training on nurses’ knowledge of pressure ulcer risk assessment and prevention strategies at University College Hospital, (UCH) Nigeria. Methods: A randomized controlled trials research design. Sample size was 268 (134 participants each in intervention and control groups) nurses selected through simple random and systematic sampling techniques. A structured pre-tested questionnaire was used for data collection. Data were analyzed using descriptive and inferential statistics. Level of significance set at p-value &lt;0.05. Results: Mean ages of participants were 42.45±8.89 and 38.81±10.56 years for intervention and control groups respectively. Almost all participants in intervention group during pre-test had adequate knowledge of pressure ulcer risk assessment, and pressure ulcers prevention strategies compared to during pre-test in which poor knowledge of those areas was recorded among majority of them. Also, adequate knowledge of pressure ulcers prevention strategies was observed among intervention group after the training as compared to control group in which poor knowledge was recorded. Furthermore, intervention training was highly statistically significant with all studied domains at p&lt;0.001. Conclusion: The intervention training on nurses’ knowledge regarding PURA and prevention strategies was positive at a high rate. Regular training programs on the subject matter for all nurse clinicians to promote quality nursing care according to international best practices is crucial.

Feasibility and clinical utility of Bates-Jensen wound assessment tool among nurses caring of patients having pressure ulcers

Aims: One of the vital roles of nurses is to perform pressure ulcer risk assessment that enables them to appropriately assess and track healing progress of wound and pressure ulcers among patients. Our aim was to assess the feasibility and clinical utility of the Bates-Jensen Wound Assessment Tool (BWAT) among nurses caring of patients with pressure ulcer. Methods: A descriptive cross-sectional design used to collect data from 177 registered nurses caring of patients who developed or have a risk of developing pressure ulcers working in three hospitals in Jordan. Results: The mean feasibility score of the BWAT was 28.3 out of 36 (SD=3.4) with a median score of 29. Most of nurses reported that the BWAT was easy to use on a scale of 1-4 (best) (M=3.40/4, SD=0.62) and can successfully assess wound characteristics (M=3.40/4, SD=0.59). The mean utility score of the BWAT was 21.3 out of 28 (SD=2.7) with a median of 21. Nurses had a perception that using the BWAT enhances care of patients with wounds (M=3.36/4, SD=0.61) and makes communication easier between nurses and physicians. Conclusion: This study provided evidence that support the use of the Bates-Jensen Wound Assessment Tool for patients with pressure ulcer. Nurses perceived BWAT as easy to use, understandable, and relevant for assessing patients with pressure ulcers. Funding statement: This work was supported by supported and funded by The Deanship of Scientific Research at The University of Jordan, Amman, Jordan [number1953/2017/19].

Consistent pressure ulcer prevention practice: The effect on PU prevalence and PU stages, and impact on PU prevention-A quasi-experimental intervention study.

This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n=115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.

Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study

BackgroundCOVID-19 patients are at risk for the development of pressure injuries (PI). AimThe aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s. MethodsThe sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form. ResultsOf the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36). ConclusionsMDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.