Prevention Of Pressure Sores Research Articles

Myelodysplasia Rehabilitation in Children: a Review

INTRODUCTION. 1.5 thousand children with myelodysplasia (MD) are born in Russia every year. To improve the quality of life, most of them need lifelong medical supervision and rehabilitation. The topic of medical rehabilitation in MD in children is poorly covered. AIM. To search and analysis published data on the rehabilitation of children with MD identify the most effective methods. MATERIALS AND METHODS. The collection and analysis of publications on this topic from the PubMed and eLibrary databases published from 2014 to 2024 was carried out. Earlier fundamental works on secondary disorders in myelodysplasia and Spina bifida were also included in the review. A total of 512 publications in PubMed and 1096 publications in eLibrary were analyzed, 584 of them were unique. Publications of reviews, systematic reviews and clinical observations were included. RESULTS AND DISCUSSION. Rehabilitation for MD in children is multidisciplinary in nature, a violation of the structure of the nervous system entails, already in utero, the formation of deformities of the musculoskeletal system, combined changes in the functioning of the lower urinary tract and intestines. It is known that rehabilitation started from an early age helps to master motor skills in a timely manner, contributes to the prevention of metabolic syndrome, contractures, pressure sores, urodynamic disorders and constipation. There are different approaches regarding the intensity of physical activity during the day and week, following the recommendations of the World Health Organization (WHO), children should exercise for more than 60 minutes a day. Physical exercises should be carried out from the perspective of the concept of neuroplasticity and enhanced by the influence of magnetic stimulation, low-intensity laser, electromyostimulation, vibration therapy. It will be possible to effectively use acupuncture and massage. In addition, it is important to include urological and orthopedic care in medical rehabilitation from an early age. CONCLUSION. Due to the high disability, there is a question of effective methods for improving rehabilitation potential and improving the standard of living. Among the described methods, physiotherapy is distinguished, including therapeutic exercises, magnetic stimulation, low-intensity laser therapy, electromyostimulation, and ergotherapy. It is necessary to continue to study the effectiveness of the use of various physical factors in children with MD.

173 Pressure Sores in Spinal Patients Admitted to Intensive Care - a Retrospective Observational Study

Abstract Aim Spinal patients in the intensive care unit (ICU) have a high risk of developing pressure sores due to factors such as immobilisation and collar use. In a collaboration between the spinal surgery department and the ICU at a tertiary care hospital, this study aimed to assess the prevalence of pressure sores in spinal patients in the ICU as well as potential risk factors, to establish any required changes to patient care. Method NHS-mandated DATIX reports for all pressure sores in ICU were cross-referenced with a list of all spinal patients admitted to ICU between January 2018 and August 2022 (4-and-a-half years). We included pressure sores such as occipital, sacral, clavicular, hips. Exclusions were sores categorised below Grade 2 and those caused by intubation such as lips or mouth. Results 97 patients were included and fifteen (15.5%) developed grade 2 or above pressure sores in ICU. Admission age, days spent in hospital and days in ICU were significantly greater in those who developed pressure sores compared to those who did not (all P < 0.05). Advanced respiratory support time was also greater in those who developed pressure sores (P < 0.05). Conclusions Just over 1 in 7 spinal patients in the ICU developed pressure sores and clinicians should be aware of the potential risks for mutual benefits of patient comfort and the NHS cost burden. However, in comparison to other studies reporting percentages of 19.1% and 37.5%, the department appears to be doing comparatively well in preventing pressure sores.

Student nurses' knowledge levels and attitudes regarding pressure injury prevention

ObjectiveThe research was conducted to examine the relationship between student nurses' knowledge levels and attitudes regarding pressure ulcer prevention. MethodThe research was registered between 01.05.2022 and 01.12.2022, and the certification studies of the health sciences faculty of a state and a foundation university in Turkey are carried out on a multi-center basis. The lists of the research were created by 426 student pictures. "Nurse Introduction Form", "Pressure Sore Prevention Information Survey" and "Attitude Scale towards Preventing Pressure Ulcers" were used as data collection tools. Data was collected online via Google Forms and the SPPS 24.0 program was evaluated in detail. ResultsIt was determined that the PIPK total score of Student Certificates was 18.29 ± 5.98, and the total score of APUP was 33.96 + 4.66. The change analysis results revealed positive aspects and a low-level significant relationship between the average nutrition total knowledge scores and the pressure prevention attitude total scores (p < 0.05). ConclusionIn our study results, it was determined that the pressure values of the certificates and the knowledge scores of the students were insufficient and the attitudes were positive. The values of knowledge and attitudes regarding the nurturing of the values of certificates, starting from student life, states where the necessary knowledge and skills must be acquired in educational programs.

Chrome-Free Sheep Leathers with Antimicrobiological Protection for Medical and Therapeutic Applications

Abstract The paper presents the results of tests, and an evaluation of sheep leather quality, tanned according to the new chrome-free tanning technology. The leathers were tested for physico-chemical parameters and antimicrobial activity. The tests were performed in accordance with Polish standards. Sheep leathers tanned according to the technology developed were characterized by high durability, health and hygiene parameters. Sheep leather samples protected with a zinc pyrithione formulation, showed effective action against all pathogenic bacteria and fungi used in the study. Anti-decubitus sheets, made of sheep leathers with fleece were tested during use by immobilized people lying for a long time. The sheets were rated as comfortable for the sick in the prevention of bedsores and the formation of other skin lesions.

Palliative care at the present stage in Krasnoyarsk

Palliative medicine, aimed at ensuring the quality of life of patients with severe and incurable diseases, is becoming increasingly important in medical practice. In this article, we consider the current state and prospects for the development of palliative medicine in the city of Krasnoyarsk. The study showed that the number of patients in need of palliative care is increasing, mainly people older than working age with diseases of the cardiovascular system and oncological diseases. Approaches to anesthesia, prevention and treatment of pressure sores in hospice patients are described. The problems include a lack of qualified personnel and violations of the socio-psychological status of medical personnel, limited access to palliative medicine for remote areas of the region.

IoT Enabled Real Time Low Cost Cardiac Monitor Using LabVIEW

The rapid advancement of the Internet of Things (IoT) and medical technology has paved the way for innovative healthcare solutions. The system incorporates IoT connectivity to enable remote monitoring, data collection, and analysis, enhancing patient care and medical decision making. Cardiac monitoring system used in hospitals to measure and record the cardiac parameters. Vital parameters are transferred within the hospitals either using Wi-Fi or Bluetooth. Range of transmission for such wireless communication is only effective within the hospitals and further transfer to a long distance is limited. The proposed cardiac monitoring system is developed using LabVIEW environment - a versatile Graphical User Interface (GUI). Data acquired through the electrodes are connected to my DAQ Unit (Data Acquisition Unit) which helps to integrate electrodes with computer or PC. Data acquired from the Software is connected to the firebase console and it will help the practitioners to share the data in live and updated. It offers benefits such as early detection of cardiac irregularities such as arrythmia, reduced hospitalization periods, and improved patient outcomes. Additionally, healthcare practitioners and caretakers can remotely access patient data, enabling timely interventions and personalized treatment plans. Since the cardiac monitors are often used by bedside patients, it may introduce bed sores in them. Hence, in addition to these parameters, body moisture level and temperature of the patient are measured using DHT11(temperature and humidity sensor) to ensure the prevention of bedsores. These additional parameters measured are also enabled to view through IoT.

욕창예방 방석의 충격 흡수 시험 장치 개발과 적용

Bedsores mainly occur in bedridden patients who have to lie in the same position for a long period of time, or in people with spinal cord disabilities who use wheelchairs and cannot change positions on their own. In order to prevent excessive pressure on the skin over bone protrusions, which causes circulation problems in peripheral blood vessels and causes bedsores, the Ministry of Food and Drug Safety has designated and operates bedsore prevention cushions as medical devices. ISO, an international standardization organization, established and operates ISO 16840-2 to evaluate the performance of cushions to prevent bedsores for wheelchair users. The purpose of this study is to design and develop a test device to apply this international standard to the test and evaluation of domestic bedsore prevention cushions. In particular, the main purpose was to develop a shock absorption test device to determine how effectively bedsore prevention cushions cushion the shock that occurs when a wheelchair collides with the road surface on a bump or pothole.&#x0D; The impact absorption test device was manufactured by modifying part of the guidelines of ISO 16840-2. In the above international standard, the crash plate is to be supported with a piece of wood block. However, in this study, the time delay that may occur during removal of the block was shortened and convenience was improved by using a roller system instead of wooden block to drop the object. Using the manufactured test device, a shock absorption test was conducted on an air-grid type bedsore prevention cushion and a hybrid bedsore prevention cushion that is a mixture of foam type and air grid type. When the human hip model falls, the falling acceleration was reduced to 63% with the air-grid type cusion compared to the value with no cushion, and it decreased to 42% with the hybrid cushion. However, the occurrence of bedsores is affected not only by the impact force applied to the skin when the wheelchair collides with the ground, but also by the breathability and humidity of the impact area, so it is necessary to comprehensively evaluate various risk factors, including shock absorption tests. The roller-type shock absorption test device will be proposed as an amendment to ISO 16840-2 to the International Standards Committee.

A novel in-bed body posture monitoring for decubitus ulcer prevention using body pressure distribution mapping

BackgroundDecubitus ulcers are prevalent among the aging population due to a gradual decline in their overall health, such as nutrition, mental health, and mobility, resulting in injury to the skin and tissue. The most common technique to prevent these ulcers is through frequent repositioning to redistribute body pressures. Therefore, the main goal of this study is to facilitate the timely repositioning of patients through the use of a pressure mat to identify in-bed postures in various sleep environments. Pressure data were collected from 10 healthy participants lying down on a pressure mat in 19 various in-bed postures, correlating to the supine, prone, right-side, and left-side classes. In addition, pressure data were collected from participants sitting at the edge of the bed as well as an empty bed. Each participant was asked to lie in these 19 postures in three distinct testing environments: a hospital bed, a home bed, and a home bed with a foam mattress topper. To categorize each posture into its respective class, the pre-trained 2D ResNet-18 CNN and the pre-trained Inflated 3D CNN algorithms were trained and validated using image and video pressure mapped data, respectively.ResultsThe ResNet-18 and Inflated 3D CNN algorithms were validated using leave-one-subject-out (LOSO) and leave-one-environment-out (LOEO) cross-validation techniques. LOSO provided an average accuracy of 92.07% ± 5.72% and 82.22% ± 8.50%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively. Contrastingly, LOEO provided a reduced average accuracy of 85.37% ± 14.38% and 77.79% ± 9.76%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively.ConclusionThese pilot results indicate that the proposed algorithms can accurately distinguish between in-bed postures, on unseen participant data as well as unseen mattress environment data. The proposed algorithms can establish the basis of a decubitus ulcer prevention platform that can be applied to various sleeping environments. To the best of our knowledge, the impact of mattress stiffness has not been considered in previous studies regarding in-bed posture monitoring.

Assess the Effectiveness of Self-instructional Module on Knowledge and Practice regarding Prevention and Management of Pressure Sores in Bed Ridden patients among Staff Nurses Working in selected Hospitals, at Bangalore

Assess the Effectiveness of Self-instructional Module on Knowledge and Practice regarding Prevention and Management of Pressure Sores in Bed Ridden patients among Staff Nurses Working in selected Hospitals, at Bangalore

Acute neuromuscular disorders in critically ill children

Acute neuromuscular disorders are a group of neurological emergencies characterized by rapid onset of motor weakness commonly involving the respiratory and bulbar muscles. These can be acute or an exacerbation of the chronic neuromuscular disease. An accurate and timely diagnosis allows for the timely institution of specific therapies, improving long-term functional outcomes. Landry–Guillain–Barre syndrome (LGBS), acute transverse myelitis, compressive myelopathy, traumatic spinal lesions, and anterior horn cell myelitis (due to viral infections) are some of the common causes of acute motor weakness in children. LGBS is the most common among all. The diagnosis relies on clinical presentation, signs, cerebrospinal fluid analysis, electrophysiological studies, and neuroimaging of the spine. Once compressive or traumatic spinal lesions are suspected, immediate neuroimaging of the spine is essential to plan early neurosurgical intervention. Pediatric intensive care unit (PICU) admission is often required for supportive management and immunomodulation. Supportive management typically includes endotracheal intubation to protect the airway, mechanical ventilation (MV) to support breathing, monitoring, management of autonomic dysfunction, control of pain, physiotherapy, adequate nutrition, prevention of pressure sores, bladder–bowel care, psychological support, and planning of long-term care. Autonomic dysfunction can cause hemodynamic instability, arrhythmias, sudden cardiac arrest, and death, requiring close monitoring and management in PICU. Tracheostomy is often needed in children who continue to have respiratory paralysis and are predicted to require long-term term mechanical ventilation. The outcome generally depends on the primary disease and long-term care.

Optimal Image Characterization for In-Bed Posture Classification by Using SVM Algorithm

Identifying patient posture while they are lying in bed is an important task in medical applications such as monitoring a patient after a surgical intervention, sleep supervision to identify behavioral and physiological markers, or for bedsore prevention. An acceptable strategy to identify the patient’s position is the classification of images created from a grid of pressure sensors located in the bed. These samples can be arranged based on supervised learning methods. Usually, image conditioning is required before images are loaded into a learning method to increase classification accuracy. However, continuous monitoring of a person requires large amounts of time and computational resources if complex pre-processing algorithms are used. So, the problem is to classify the image posture of patients with different weights, heights, and positions by using minimal sample conditioning for a specific supervised learning method. In this work, it is proposed to identify the patient posture from pressure sensor images by using well-known and simple conditioning techniques and selecting the optimal texture descriptors for the Support Vector Machine (SVM) method. This is in order to obtain the best classification and to avoid image over-processing in the conditioning stage for the SVM. The experimental stages are performed with the color models Red, Green, and Blue (RGB) and Hue, Saturation, and Value (HSV). The results show an increase in accuracy from 86.9% to 92.9% and in kappa value from 0.825 to 0.904 using image conditioning with histogram equalization and a median filter, respectively.

Prevention of Pressure Sore Using Silicone Gel Pad in Prolonged Surgery

Pressure ulcers develop primarily from friction and shear and are progressive. It is usually found in bedridden and immobile people. Spinal cord injury patients have loss of sensation which adds to the problem. Patients with stroke, who have undergone long surgery, long bone fracture, not able to move tend to develop a pressure sore. Pressure ulcers are preventable usually and their management depends on their severity. This article discusses the prevention of pressure sore by using silicone gel pad in operation theatre that is undergoing prolonged surgery

Maximizing Result of Bedsore Prevention in Mechanical Ventilated Patient

Objectives: According to the Clinical Practice Guideline (CPG), there are several preventive interventions for Pressure ulcers, including a thorough initial examination during admission to identify risk factors, education about PUs, repositioning, and nutritional support. Hydrocolloid dressings have been used to prevent bed sores in several places, although there has not been much research. The study sought to determine the relationship between hydrocolloid dressing and the prevention of bedsores among ventilated patients. Method: an observational retrospective study that included patients on mechanical ventilators. Participants were selected from the covid ward in the Ibri hospital population. Pretest and post-test investigations were done using conventional or conventional care with preventive hydrocolloid dressing. Information was obtained from staff recordings and assessments in AlShifa 3 plus program. Result: Seventy-four patients were included in the study. Forty patients were included in the pretest, using conventional care only, and 34 patients were included in the post-test, using conventional treatment and hydrocolloid dressing. A decrease in the number of occurrences of bedsores from 22 (55%) at the pretest to 5 (15%) at the post-test. Most bedsore stage occurs in the post-test was stage one (4 out of 34) and was mainly related to patients with comorbidities. Conclusion: The study findings reveal a significant difference between the post-test and PUS variable of using CC+HD (p-value - 0.000&lt;0.05), reducing harm to the patients. It is necessary to promote trials that lead to comparing different preventive measures

A Wireless and Wearable Body-Pressure-Monitoring System for the Prevention of Pressure-Induced Skin Injuries.

This article presents a wireless and wearable body-pressure-monitoring system for the on-site, real-time prevention of pressure injuries for immobilized patients. For the prevention of pressure-induced skin injuries, a wearable pressure sensor system is designed to monitor the pressure at multiple sites on the skin and to alert the danger of prolonged application of pressure on the skin with a pressure-time integral (PTI) algorithm. The wearable sensor unit is developed using a pressure sensor based on a liquid metal microchannel and integrated with a flexible printed circuit board that includes a thermistor-type temperature sensor. The wearable sensor unit array is connected to the readout system board for the transmission of measured signals to a mobile device or PC via Bluetooth communication. We evaluate the pressure-sensing performances of the sensor unit and the feasibility of the wireless and wearable body-pressure-monitoring system through an indoor test and a preliminary clinical test at the hospital. It is shown that the presented pressure sensor has high-quality performance with excellent sensitivity to detect both high and low pressure. The proposed system measures the pressure at bony sites on the skin for about six hours continuously without any disconnection or failure, and the PTI-based alarming system operates successfully in the clinical setup. The system measures the pressure applied to the patient and provides meaningful information from the measured data for early diagnosis and prevention of bedsores to doctors, nurses, and healthcare workers.

The application of a multidisciplinary methodological approach to the training of physical therapists in the process of rehabilitation of a patient with a gunshot wound to the spinal cord

rehabilitation is one of the key areas of medicine, especially during periods of full-scale war, when militaries and civilians require long-term rehabilitation interventions. The use of a multidisciplinary approach in rehabilitation made it possible to expand the scope and opportunities of rehabilitation treatment and improve the recovery of patients. A physical therapist plays an important role in a multidisciplinary team and carries out rehabilitation measures to eliminate, stop or reduce pain, restore body functions, achieve a normal level of health, physical independence and activity, optimal physical condition and well-being. The training of qualified physical therapists is an important component of successful rehabilitation. The article presents the results of the cooperated work of specialists of the multidisciplinary team of the Military Medical Clinical Treatment and Rehabilitation Center of city Irpin, and physical therapy higher education applicants of the Department of Physical Rehabilitation and Sports Medicine of the Bogomolets National Medical University. The aim of the work was to improve the practical skills of physical therapy higher education applicants by integrating them into the work process of a multidisciplinary rehabilitation team for the rehabilitation of a patient with a gunshot wound to the spinal cord. Higher education applicants took part in the rehabilitation examination and had the opportunity to expand practical skills in this direction. The team of specialists conducted the following rehabilitation tests and obtained results - according to the ASIA scale, the degree of damage to the patient's spinal cord is complete - there is no sensitivity and motor function of the S4-S5 segments, according to the modified Rankin scale 5 points, which corresponds to severe functional disability; according to the Barthel index, 10 points, which corresponds to the patient's complete dependence on external assistance, according to manual muscle testing, the strength of the muscles of the upper shoulder girdle corresponded to 3 points - the full amplitude of movement against the force of gravity. On the basis of the obtained results, the multidisciplinary team determined the main violations according to the domains of the international classification of functioning, and in accordance with them, the higher education applicants developed the key goals of rehabilitation and methods that must be included in the rehabilitation process. Physical therapy higher education applicants conducted rehabilitation interventions aimed at improving patient mobility and self-care, prevention of bedsores, contractures, improvement of the musculoskeletal system, and increased tolerance to physical exertion. After six weeks of the rehabilitation process, repeated rehabilitation examinations were carried out, positive dynamics were admitted according to the Rankin scale, according to the Barthel index and manual muscle testing. The higher education applicants survey showed that while working in a multidisciplinary team, physical therapist higher education applicants managed to expand their knowledge, practical skills and acquire the necessary components for work and close interaction with all team members, to increase the effectiveness of rehabilitation measures for a patient with a spinal cord injury.

Antimicrobial hydrocolloid composite sponge with on-demand dissolving property, consisting mainly of zinc oxide nanoparticles, hydroxypropyl chitosan, and polyvinyl alcohol

Abstract Effective anti-infection prophylaxis for chronic wounds can reduce the risk of wound infection and improve healing rates. The use of good anti-infection wound dressings is particularly important. In this paper, an antimicrobial composite hydrocolloid sponge dressing with zinc oxide nanoparticles, hydroxypropyl chitosan, and polyvinyl alcohol as the main components was prepared using freeze-drying of the formulated suspensions. The characterizations by scanning electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy were performed; the antibacterial activity was determined; the on-demand dissolving properties were evaluated; and the basic properties such as porosity, vapor permeability, and water absorption were measured. The results showed that, when the mass ratio of HPCs/PVA was 6:4, the porosity, the steam permeability, the water absorption ratio, and dynamic complete dissolving time in 1 % acetic acid aqueous solution, respectively, reached the optimum value of 63.2 %, 57.7 %, 54.4, and 35 min. Antibacterial activity experiments showed that the sponges significantly inhibited Staphylococcus aureus, Escherichia coli, and Candida albicans. In conclusion, the above results indicate that the prepared hydrocolloid composite sponge has good air permeability, water absorption, antibacterial activity, and on-demand dissolving property and has potential applications in anti-infection treatment of hypo-exudative chronic wounds and pressure sore prevention.

Clock for the change of decubitus position

Currently a decubitus clock is a device used in hospitals to monitor the patient's position in bed. In addition to preventing pressure sores, the decubitus watch can improve patient comfort and recovery by allowing medical staff to monitor and adjust positions more frequently and effectively. Following this premise, this project is inspired by the low-cost Lowthian watch model, using parts built in a 3D printer, arduino uno, buzzer, leds, protoboard, acrylic box and stepper motor. In addition to improving the physical structure, an easy-to-understand hygienic and practical model was introduced. In the end, the project results in an automated profile that contributes to the learning process related to innovation, stimulating creativity through the insertion of these resources in the daily routine of the hospital environment.

Massage Efflurage VCO Terhadap Pencegahan Dekubitus pada Pasien Tirah Baring di RSUD Pandan Arang Boyolali

Background: Decubitus ulcers are damage/death of the skin to the tissue under the skin, if not treated immediately it will be one of the factors a person dies. The prevalence of decubitus in America is around 25%, in Europe it is 10.5% and in England it is from 6.7% to 42.7%, and in Indonesia as a whole it is 33%.The implementation of preventing decubitus pharmacologically, one of which is by rubbing massage on the back which is called massage efflurage. Purpose: to determine whether there is an effect of massage efflurage on decubitus prevention. Method: this type of research is descriptive with a case study. The application was carried out on 2 patients selected by purposive sampling method with inclusion and exclusion criteria. This efflurage massage is carried out for 4-5 minutes 2x/day for 3 days. The research instrument used SOP massage efflurage by doing massage by applying a little rubbing pressure, observation sheets and informed consent. Results: from the results of observations made for 3 days on 2 respondents Ny. S and Mr. M indicates that the braden scale increases from day 2 and 3, which means that there is a reduced risk of developing decubitus in 2 respondents. Conclusion: there is an effect of VCO efflurage massage to prevent pressure sores in patients in the ICU.

Application of self-made anti-pressure sore cotton cover in preventing facial pressure injury in patients with non-invasive ventilation

To observe the application effect of self-made anti-pressure sore cotton cover on the prevention of facial pressure injury in patients with non-invasive ventilation, and to explore the effective method of preventing facial pressure injury. A prospective study was conducted. Patients with mild to moderate respiratory failure and non-invasive ventilation admitted to the department of intensive care medicine of Harisen International Peace Hospital Affiliated to Hebei Medical University from March 2020 to August 2021 were enrolled, and they were divided into gauze pad group, foam dressing group and self-made anti-pressure ulcer cotton cover group by random number table method. Before wearing the ventilator mask, the gauze pad group and the foam auxiliary dressing group should fold or cut out the auxiliary dressing with the corresponding size and suitable for the patient's facial contour. In the self-made anti-pressure sore cotton cover group, the ventilator cotton cover could be worn only by selecting the cotton cover suitable for the patient's face shape, aligning the vent to the mouth and nose, and tying the fixed belt behind the ear. The incidence of facial pressure sore, the time required to connect man-machine interface (from the preparation of auxiliary dressing for pressure sores to the connection of ventilator) and the cost of dressing were compared among the three groups. A total of 150 patients with non-invasive ventilation were enrolled, with 50 patients in each group. Compared with the gauze pad group and the foam dressing group, the incidence of facial pressure sore in the self-made anti-pressure sore cotton cover group was significantly reduced [6.0% (3/50) vs. 44.0% (22/50), 12.0% (6/50), both P < 0.05], and the time required to connect the man-machine interface was significantly shortened (minutes: 5.0±1.5 vs. 10.0±1.5, 8.0±2.0, both P < 0.05), dressing cost was significantly reduced (yuan: 30±10 vs. 150±20, 118±29, both P < 0.05). Compared with the gauze pad and the foam dressing, the incidence of facial pressure sore in non-invasive ventilation patients with self-made anti-pressure sore cotton cover is lower, the time required to connect man-machine interface is shorter, and the cost of pressure sore prevention dressing is less, which is suitable for the prevention of facial pressure injury in non-invasive ventilation patients.

Nursing Shortage in Pakistan

The health workforce including Medical, Nursing and Allied Health Professionals is the foundation of any health care system. Investment in the health sector reduces disease burden, improves productivity and ultimately contributes positively in economic growth of the country. Pakistan is generally confronted with dire shortage of qualified health professionals especially the nursing staff that is the backbone of every healthcare systems across the world. Nurses have incredible contribution in assisting the doctors in every aspect of patient care, thus ensuring that individuals receive the best possible care at all stages [1]. The nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. The nursing staff employed in the hospitals is primarily responsible to provide all kind of nursing care to the admitted patients i.e., monitoring of vital signs, fluid management, and administration of medication in line with the orders of the attending physicians. Nurses are also responsible to monitor the nutrition intake, look after personal hygiene of patients and care of bowels, prevention of bedsores etc., maintain medical record and ensure the ambiance conducive to recovery. Their role therefore, requires essential nursing skills, apart from commitment and vigor. There are however, issues of quality in nursing education, particularly regarding development of proficiency in basic nursing &amp; midwifery skills [2]. Nursing Institutions lack in quality output, due to deficiencies in nursing faculty, infrastructure and professional supervision. It is expedient to remain abreast with contemporary advancements in nursing education and practices to produce competent and skillful nursing workforce for better clinical outcomes. According to the Pakistan Economic Survey 2020-2021, Pakistan had a total of 116,659 registered nurses in 2020 for a population of about 200 million people. In the general wards of Pakistani hospitals, the current nurse-patient ratio is 1: 40, while the Pakistan Nursing Council recommends a nurse-patient ratio of 3:10 [3]. The deficiency in the actual number of nurses rendering services is further aggravated by positions remaining vacant due to shortage of skilled nurses, thus compromising quality of nursing care. This shortage in nursing strength is also worsened by an urge to move overseas particularly the Gulf countries, as large number of nurses opt for employment abroad for better financial incentives [4]. The situation is even worst in the private sector particularly, in the smaller hospitals that end up with hiring semi- qualified and poorly trained or self-trained staff on meager salary and poor employment terms on the pre-text of shortage of qualified nurses. Larger private setups often resort to make shift arrangements by engaging nurses employed in the public hospital for second shift. Such nurses are therefore, required to work for up to 16 hours a day, thus, further compromising quality of care. It is highly recommended to increase the number of nursing training opportunities and slots to overcome this serious shortfall and to ensure availability of sufficient number of nurses in the public as well as private sector to comply with the recommended Nurse: Bed ratio and to fill vacancies as per the sanctioned strength in public hospitals on priority basis. Also to improve the training facilities at Nursing Colleges in terms of qualified faculty and proper infrastructure to improve quality of training of the nursing cadre. Introduction of Continuous Professional Development (CPD) Programs for nurses with mandatory completion of credit hours on regular basis for continually building the skills and improving the quality of nursing and midwifery services can also prove to be a great initiative [5]. Enrolling more male nurses can help provide nursing care at hospitals located in the relatively hard to reach areas.