Reduce Pressure Ulcer Research Articles

Factors Reducing Pressure Ulcer Risk and the Importance of Care in ALS Patients: A Comprehensive Review

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by muscle atrophy, weakness, and loss of motor function. ALS patients are often bedridden for extended periods, increasing their risk of pressure ulcers. However, clinical data suggests that the incidence of pressure ulcers in ALS patients is lower compared to other bedridden patients. This review analyzes the factors contributing to reduced pressure ulcer risk in ALS patients, focusing on "pressure redistribution due to muscle atrophy," "stabilized postures caused by joint contractures," and "comprehensive care provided by caregivers." Additionally, this paper discusses a comprehensive approach to pressure ulcer prevention, including nutritional management, skincare, pressure redistribution techniques, and advanced technologies. Challenges in pressure ulcer prevention and the importance of ALS-specific care are also emphasized.

The Design Body Support Pillow Prevent and Reduce Pressure Ulcers

Patients with a long duration of bed rest have a potential risk of impaired skin integrity due to prolonged pressure that can lead to the appearance of decubitus. One alternative to prevent decubitus is by giving mobilization over the bed that is tilt right and left every 2 hours with an angle of 30° with a foam pillow as a buffer in bed. This study aims to design a right and left tilt body support pillow as an effort to prevent and reduce the risk of decubitus ulcers in bed rest patients. The method used in this study is Research and Development (R&D) with ADDIE method which consists of five stages which include analysis, design, development, implementation and evaluation. This study was conducted at Mitra Medika Clinic in Blitar Regency with 6 participants and 3 media experts. The results of this study show that the value of product feasibility from expert validators is 98% and from participants is 99%. The results showed the product has met the criteria very feasible based on the assessment of the participants. It is expected that this product can help nurses in maintaining the right and left tilt position as an effort to prevent and reduce the risk of decubitus ulcers in bed rest patients. Keywords: Pressure Ulcer, Body Support Pillow, Design

Evaluation of Nurses' attitudes, behaviors, and barriers toward pressure ulcer prevention in neonatal and pediatric intensive care units.

Pressure ulcers are a significant concern in pediatric intensive care units, with prevalence rates ranging from 0.8% to 27%. They pose serious physical and psychological challenges, particularly in neonatal and pediatric intensive care units (NICU and PICU). This study explores nursing strategies, attitudes, and barriers toward pressure ulcer prevention in NICU and PICU settings. Using a descriptive study design, data were collected from 80 nurses working in NICU and PICU through validated questionnaires, including a demographic profile and a pressure ulcer survey. Descriptive statistics were employed to calculate mean scores and percentages, while inferential statistics assessed associations between variables. The study revealed specific nursing strategies, along with significant barriers and attitudes toward pressure ulcer prevention in NICU and PICU. The total attitude mean score was 3.57, with the highest positive response (mean = 4.29) for "most pressure sores can be avoided", and the highest negative response (mean = 3.86) for "pressure sore prevention is a low priority for me". Among participants, 72.5% conducted risk assessments on all patients, 60% had written prevention care plans, and 76.3% implemented preventive strategies. Barriers such as staff shortages and time constraints were reported by 76.2% of nurses. Multivariate analysis indicated that nurses with more than 10 years of qualification (OR = 3.67) and permanent staff with over 10 years of employment (OR = 4.31) were significantly more likely to engage in preventive practices. The use of a pressure ulcer grading tool (OR = 2.49, P < 0.05) and participation in formal training (OR = 3.14, P < 0.05) were also positively associated with preventive practices. These findings underscore the importance of structured assessment tools, ongoing education, and the need to foster positive attitudes among nurses to effectively reduce pressure ulcer prevalence and enhance patient outcomes in NICU and PICU settings.

Peer support as pressure ulcer prevention strategy in special school learners with paraplegia.

Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown. To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school. A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants' narratives. The participants' perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support. Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes. Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention.

Using a prognostic medical device for early identification of pressure ulcers: protocol for study design.

An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders. The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues. Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials. A prospective, three-armed, multi-centre, stratified cluster-randomised controlled trial is proposed. The third arm is recommended as it is expected that patients will need to be moved for the medical device to be used and repositioning is a preventive strategy. A minimum of 16 200 patients in 33 wards would needed to be recruited to achieve statistical significance. Ethical considerations in terms of consent or assent need to be considered. The hypothetical study designed to evaluate the effectiveness of a diagnostic or prognostic medical device in reducing pressure ulcer incidence in secondary care, while accounting for biases, would require large sample sizes and involves risks of inter-operator and inter-device reliability, heterogeneity of users and the vague clinical interpretation of device results. Robust research in this field has the potential to influence or change policy and practice relating to the prevention of pressure ulcers in secondary care.

Role of nutritional support in nursing practice for improving surgical site wound healing in patients post-surgery with risk of pressure ulcers.

To explore the role of nutritional support in nursing practice on postoperative surgical site wound healing in patients undergoing surgery at risk for pressure ulcers. This study adopted a retrospective experimental design and included a total of 60 patients at risk of pressure ulcers, divided into a nutritional support group and a control group, with 30 people in each group. The nutritional support group implemented specific nutritional support measures after surgery, while the control group received standard postoperative care. Outcome measures included redness and swelling scores, edema scores, anxiety assessments, pain scores, bleeding volume, recovery time and incidence of pressure ulcers. The result indicates that patients who received nutritional support exhibited lower postoperative wound redness and swelling scores compared to the control group (3.11 ± 0.45 vs. 4.85 ± 0.74, p < 0.05). Additionally, the nutritional support group showed significantly lower edema scores (2.75 ± 0.37 vs. 3.53 ± 0.62, p < 0.05). Anxiety levels, as measured by the anxiety assessment scale (SAS), were also lower in the nutritional support group (6.52 ± 1.19 vs. 7.60 ± 1.62, p < 0.05). Moreover, the average healing time was shorter for the nutritional support group (7.27 ± 1.36 days) compared to the control group (9.71 ± 1.84 days, p < 0.05). Postoperative pain scores were lower in the nutritional support group (4.13 ± 0.72 vs. 5.43 ± 0.62, p < 0.05), and patient satisfaction scores were higher (9.42 ± 0.76 vs. 7.25 ± 0.81, p < 0.05). Nutritional support has a positive effect on postoperative wound healing at surgical sites in patients at risk of pressure ulcers in nursing practice. It can significantly reduce redness, swelling, edema, anxiety, and pain scores, reduce bleeding, shorten recovery time, and reduce pressure ulcers. incidence rate.

Asuhan Keperawatan Pada Pasien Stroke Hemoragik Dengan Pemberian Intervensi Posisi Miring Kanan Kiri Terhadap Pencegahan Dekubitus

The background of this research is based on a brain disease, namely stroke. Stroke results in much higher mortality and morbidity. Viewed from the aspects of risk of death, high medical costs, decreased quality of life and increased prevalence, stroke has a broad impact. Apart from that, decubitus problems also arise in stroke sufferers due to prolonged pressure, the parts that experience bruising are the hips, buttocks, foot joints and heels. Based on a preliminary study conducted at the Tangerang Regency General Hospital, there were 89 patients with a diagnosis of stroke starting from 2022. Meanwhile, in the Cempaka room, it was found that during the assessment there was 1 case with a diagnosis of stroke on January 2 2024. The results of this research are effectiveness. right and left tilt positions in reducing pressure sores or decubitus in patients with stroke. The conclusion of this study is that the right and left side positions are non-pharmacological techniques for reducing pressure ulcers or decubitus and can be used in patients who experience problems with prolonged bed rest. The suggestion from this research is that intervention in right and left tilt positions can be carried out according to the 2021 PPNI SOP.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score.

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

Comparison of aloe vera gel dressing with conventional dressing on pressure ulcer pain reduction: a clinical trial

BackgroundAloe Vera has a strong analgesic and anti-inflammatory effect, and its use effectively controls pain. This study aimed to determine the effect of Aloe Vera gel versus saline on pain relief of pressure ulcers.MethodsThis study is a double-blind, randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran from May 2020 to April 2022. Using the available sampling method, 95 patients with pressure ulcers were assessed for eligibility, 64 patients were selected, 33 patients were placed in the experimental and 34 patients in control. For the experimental group, the ulcers were first cleaned with normal saline to remove the slough and then the already prepared Aloe Vera gel was evenly applied. For control groups, the ulcers were first washed with normal saline to remove off the slough and then covered with a sterile cotton gage, and the wound was tightly bandaged with a cotton roll to keep the “daily dressing” in place. A visual pain scale was used to assess the patient’s pain level. Data analysis was done using SPSS 17. Descriptive statistics, ANOVA, and greenhouse tests were used. The significance level was 0.05.ResultsThe results showed that the average pain score in both groups had a downward trend; that is, both dressings effectively reduced pressure ulcer pain (P < 0.001). The greenhouse test results showed that the difference between the two groups was significant (P < 0.001).ConclusionThe results showed the effect of Aloe Vera gel in reducing pressure ulcer pain. Dressing with Aloe Vera gel is preferable to reducing pain during dressing changes in patients with pressure ulcers.Trial registrationIranian Registry of Clinical Trials IRCT20180715040478N2, 2021-08-17.

Evaluating the Effectiveness and Safety of Fecal Management Systems among Severely Ill Patients Suffering from Fecal Incontinence: A Retrospective Cohort Study

Background. Few large‐sample studies have examined the use of fecal management systems (FMSs) in intensive care units (ICUs) or evaluated the associated complications. This study aims to assess the effectiveness and safety of FMS for stool diversion in ICU patients with fecal incontinence (FI). Methods. We enrolled 381 FI patients, assigning them to either an FMS group (n = 134), which used a fecal management device, or a usual care (UC) group (n = 247) that received standard care including regular perianal cleaning. Results. The FMS group reported lower incidence and severity of incontinence‐associated dermatitis (IAD) and higher Braden Scale scores (10.42 ± 2.77) compared to the UC group (9.71 ± 2.56), indicating reduced pressure ulcer risk. Notably, FMS‐associated complications were minimal, with only 5 patients (3.73%) affected; one required surgical intervention for rectal mucosal bleeding. Conclusions. FMS significantly reduced stool‐associated skin irritation, lowered the incidence of IAD and pressure injuries, and improved nurses’ convenience compared to UC.

Proactive Patient Rounding Impacts on Patient Satisfaction in UAE

Background: The patient experience is an essential dimension of patient satisfaction. An interesting initiative that has been reported internationally is the Proactive Patient Rounding intervention (PPR), a process of proactive, purposeful, directed communication and evaluation of patient needs. It entails visiting and monitoring patients at an interval of one to two hours. PPR implementation has not been evaluated in the UAE, or in the GCC counties. Objective: This study aimed to assess the effect of PPR implementation on patient satisfaction levels. Methods: Post-test quasi-experimental non-equivalent design was used to conduct this study, with a convenience sample of 60 participants from surgical units (comprising 30 control and 30 experimental subjects). The participants were requested to fill out the survey on the 3rd day of admission Results: The study revealed positive increases in patient satisfaction scores. as the experimental group scores were slightly higher than the control group for most of the satisfaction statements and for the overall satisfaction score (experimental m = 4.6, control m = 4.41). However, the independent t-test indicated that this difference was not statistically significant (sig. 0.161). This study is useful in directing attention to the influence of PPR on several aspects like patient satisfaction, reduce pressure ulcers, and decrease call light. Conclusion: PPR interventions are a practical approach for addressing the needs of hospitalized patients, and nurse managers should monitor its implementation to get purposeful patients feedback.

Effect of an Educational Program on Nurses’ Performance regarding Reducing Pressure Ulcer and Safety of Immobilized Patients

Effect of an Educational Program on Nurses’ Performance regarding Reducing Pressure Ulcer and Safety of Immobilized Patients

Interdisciplinary Protocol for Surgery in Older Persons: Development and Implementation.

As the population ages, more older adults will undergo surgical procedures, and common physiologic changes can raise the risk for surgical complications while increasing morbidity and mortality. In conjunction with the National Surgical Quality Improvement Program, we piloted a comprehensive and interdisciplinary assessment and intervention protocol for perioperative care for patients aged ≥75years undergoing elective general, gynecology-oncologic, and orthopedic surgery. The intervention included screening tools for cognitive, functional, and nutritional deficits, a Geriatric Nurse Champion on each inpatient surgical unit, and an interdisciplinary Geriatric Surgery Quality Committee. Our intervention group was compared to surgical patients during the same time period 1year prior to the intervention, and the groups were well matched in demographics and comorbidities. The intervention group had significantly higher rates of advance care plan documentation in analysis of all patients (P < .001) and in subgroup analysis of those 85 and older (P= .006). The preintervention group had less postoperative delirium compared to the postintervention group but it was not significant and there was no difference in length of stay between groups. Various explanations for the minimal impact of the protocol exist: small sample size, presence of other hospital initiatives to reduce pressure ulcer and delirium, and clinician's awareness of project planning that led to incorporating ideas prior to official implementation. Future research implementing this protocol in naïve and/or underperforming institutions may demonstrate a greater effect. Larger sample size as well as implementation in other surgical fields may reveal a significant impact. However, if additional study does not reveal a meaningful impact of a comprehensive geriatric assessment for surgical patients, then consideration must be made regarding unrecognized factors in surgical care for older adults or perhaps that factors cannot be mitigated in older adults because they are intrinsically a higher surgical risk.

Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence.

To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.

Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions.

Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.

Effects and Interventions of Pressure Injury Prevention Bundles of Care in Critically Ill Patients: A Systematic Review

Background: Many studies on pressure injury prevention bundles have been conducted outside the Intensive Care Unit (ICU). The bundles, which include multi interventions, have proven effective in reducing pressure ulcer incidents compared to a single intervention. However, the existing review studies on pressure injury prevention in ICUs still only investigate a single intervention rather than multi interventions. Only few reviews, to our knowledge, involves prevention bundle strategies in the ICU.Purpose: This study aims to review the effects of the pressure injury prevention bundles of care on the incidents of pressure injury in critically ill patients and the intervention measures of the care bundles.Methods: This review searched published articles from several databases, namely EBSCO, ScienceDirect, PubMed, ProQuest, Google Scholar, and Scopus from 2009 up to 2020. PRISMA flowchart was used to select relevant articles using several inclusion and exclusion criteria, resulting in 17 article from 50 eligible full-text articles for assessment. The included studies were assessed for their quality using Joanna Briggs Institute (JBI) critical appraisal tools. The synthesis was then conducted narratively.Results: As many as 17 studies, which mostly had good quality yet evidence level of II, were included in the analysis. The findings showed that the pressure injury prevention bundles of care decreased pressure injury incidents as many as 4.3%-36.2% in developed countries and 4.16%-21% in developing countries. Moreover, the bundles of care which significantly reduced the incidents of pressure injury consisted of 7 intervention measures, which were pressure injury risk assessment using Cubbin Jackson scale, skin assessment and care, repositioning, nutrition, education, support surface, and medical device care.Conclusion:The review concluded that the pressure injury prevention bundles of care in critically ill patients significantly reduced the incidents of pressure injury. The study recommends more studies with stronger evidence levels to carry out and utilize 7 intervention measures as a preventive standard of care in critically ill patients.

Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis.

Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis.

Alternating pressure (active) air surfaces for preventing pressure ulcers

Alternating pressure (active) air surfaces for preventing pressure ulcers

Reducing pressure ulcers in care homes in Barnet: a quality improvement project.

Pressure ulcers are increasingly seen as an untoward event for patients. While there has been a strong focus on patients in the acute sector, community services have also had to be increasingly innovative in addressing this issue. Carers in care homes in the London borough of Barnet were identified as needing additional support to improve their knowledge and skills surrounding pressure ulcer prevention and treatment. An informal pilot training session showed that carers felt better equipped in terms of identifying new pressure ulcers and were able to escalate issues to district nurses in record time. Subsequently, there was a noticeable reduction in the reporting of pressure ulcers of categories 2 and above. In the present article, the authors describe the quality improvement project undertaken at Barnet care homes to prevent pressure ulcers.

Effects of a pressure-ulcer audit and feedback regional programme at 1 and 2 years in nursing homes: A prospective longitudinal study.

IntroductionPressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes.MethodsPressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses.ResultsA total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers.ConclusionAudit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.