An evidence based approach to a perennial problem: Pressure ulcers
Barbara Newman
Senior Lecturer, Faculty of Nursing, Department of Family and Community Nursing, University of Sydney, Camperdown, Sydney NSW
Fui Ping Lim
Clinical Nurse Specialist, Wound/Stoma Management, Tan Tock Seng Hospital, Singapore
PP: 102 - 108
Abstract
The nursing care required to prevent the development of pressure ulcers on patients of various ages and with a range of physical and medical problems is an increasing challenge for nursing staff. The challenge for the nursing staff is multifactorial. Concerns include a complexity of factors associated with discerning, interpreting and implementing the results from evidence based studies, and maintaining cognisance of the ever-spiralling health cost while balancing this with the patient's wishes.
The prevention of pressure ulcers is a cost-effective strategy about which little is written. This paper defines pressure ulcers using the International Classification for Nursing Practice (International Council of Nurses, 1999), and outlines the evidence featured in the research literature on the strategies for prevention.
Keywords
pressure ulcer; nursing; evidence based practice; nursing care; strategies
References
Agency for Health Care Policy and Research (AHCPR), Public Health Service, US Department of Health and Human Services, Panel for the Prediction and Prevention of Pressure Ulcers in Adults (May 1992) Pressure ulcers in adults: Prediction and prevention. Clinical Practice Guideline Number 3.AHCPR, publication no. 92, Rockville, Maryland, USA.
Aronovitch S, Wilber M, Slezak S, Martin T & Utter D (1999) A comparative study of an alternating air mattress for prevention of pressure ulcers in surgical patients. Ostomy Wound Management 45(3): 34-38, 40, 42-44.
UK Audit Commission (1995) United they stand: Co-ordinating care for elderly patients with hip fracture. In Tingle J (1997) Pressure sores: Counting the legal cost of nursing neglect. British Journal of Nursing 6(13): 757-758.
Bates-Jensen BM (1998) Pressure ulcers: Patho- physiology and prevention in wound care: A collaborative practice. In Sussman C & Bates-Jensen BM (eds) Therapists and Nurses, pp. 49-82. Aspen Publishers, Gaithersburg, Maryland, USA.
Bergstrom N, Braden BJ & Carlson CE (1994) Treatment of Pressure Ulcers. Clinical Practice Guidelines No. 15. Agency for Health Care Policy and Research (AHCPR), publication no. 95-0652, Rockville, Maryland, USA.
Bergstrom N, Demuth P & Braden B (1987) A clinical trial of the Braden Scale for predicting pressure sore risk. Nursing Clinics of North America 22: 417-428.
Berlowitz DR, Brand HK & Perkins C (1999) Geriatric syndromes as outcome measures of hospital care: Can administrative data be used? Journal of the American Geriatrics Society 47(6): 692-696.
Brandeis GH, Ooi WL & Hossain M (1994) A longitudinal study of risk factors associated with the formation of pressure ulcers in nursing homes. Journal of American Geriatric Society 42: 388-395.
Byran CS, Dew CE & Reynolds KL (1983) Bacteraemia associated with decubitus ulcers. Archives of Internal Medicine 143: 2091-2098.
Colin D, Abraham P, Preault L, Bregeon C & Saumet J (1996) Comparison of 90 degrees and 30 degrees laterally inclined positions in the prevention of pressure ulcers using transcutaneous oxygen and carbon dioxide pressures. Advances in Wound Care: Journal of Prevention and Healing 9(3): 35-38.
Courtney M & Spencer L (2000) Clinical indicators of quality in residential aged care facilities: What's best? Collegian 7(2): 14-19.
Dealey C (1993) Measuring the prevalence and incidence of pressure sores. British Journal of Nursing 2(20): 998-1006.
Defloor T & Grypdonck M (1999) Sitting posture and prevention of pressure ulcers. Applied Nursing Research 12(3): 136-142.
Department of Health and Aged Care (2000) Consumer-Provider Partnership in Health Project, pp. 1-6. Australian Government Printing Service (AGPS), Canberra, ACT.
Dorouiche RO, Landon GC & Klima M (1994) Osteomyelitis associated with pressure sores. Archives of Internal Medicine 154: 750-758.
Ferral BA (1997) Pressure ulcers: Assessment of healing. Clinics in Geriatric Medicine 13(3): 573-586.
Flanagan M (1997) Wound Management, pp. 113-120. Churchill Livingstone, New York.
Garibaldi RA, Brodine S & Matsumiya S (1981) Infections among patients in nursing homes. New England Journal of Medicine 305: 730-736.
Gruen RL, Chang S & MacLellan DG (1997) The point prevalence of wounds in teaching hospitals, Australia and New Zealand. Journal of Surgery 67(10): 686-688.
Haalboom J (2000) A new century without pressure ulcers? British Journal of Nursing 9(6) (Supplement): 4-6.
Harrison M, Wells G, Fisher A. & Prince M (1996) Practice guidelines for the prediction and prevention of pressure ulcers: Evaluating the evidence. Applied Nursing Research 9(1): 9-17.
Hunter SM, Cathcart-Silberberg T, Langemo DK, Olson B, Hanson D, Burd C & Sauvage TR (1992) Pressure ulcer prevalence and incidence in a rehabilitation hospital. Rehabilitation Nursing 17(5): 239-242.
International Council of Nurses (1999) ICNP - International Classification of Nursing Practice, p. 26. ICN, Switzerland, Geneva.
Joanna Briggs Institute for Evidence Based Nursing and Midwifery: Best Practice Information Sheets for Health Professionals (1997) Pressure Sores - Part I: Prevention of Pressure Related Damage 1(1): 1-6.
Joanna Briggs Institute for Evidence Based Nursing and Midwifery: Best Practice Information Sheets for Health Professionals (1997) Pressure Sores - Part II: Management of Pressure Related Tissue Damage 1(2): 1-6.
Krouskop T,William R & Krebs M (1985) Effectiveness of mattress overlays in reducing interface pressures during recumbency. Journal of Rehabilitation Research and Development 22: 3-12.
Krouskop T, Randall C, Davis J, Garber S, Williams S & Callaghan R (1994) Evaluating the long-term performance of the foam care hospital replacement mattress. Journal of Wound Care Nursing 21(6): 241-246.
Land L (1995) A review of pressure ulcer damage prevention strategies. Journal of Advanced Nursing 22(2): 329-337.
Morse J, Miles M, Clark D & Doberneck B (1994) 'Sensing' patient needs: Exploring concepts of nursing insight and receptivity used in nursing assessment. Scholarly Inquiry for Nursing Practice: An International Journal 8(3): 233-255.
National Pressure Ulcer Advisory Panel (NPUAP) (1989) Pressure ulcer prevalence, cost and risk assessment: Consensus development. Conference statement, Decubitus 2: 24-30.
Norton D, McLaren R & Exton-Smith A (1975) An Investigation of Geriatric Nursing Problems in Hospitals, p. 42. Churchill Livingstone, London.
Oertwich A, Kinderschuh A & Bergstrom N (1995) The effects of small shifts in body weight on blood flow and interface pressure. Research and Nursing Health 18: 481-488.
Partridge J (1993) The psychological effects of facial disfigurement. Journal of Wound Care 2(3): 168-171.
Perdue RW & Wilson JL (1989) Decubitus ulcers. Journal of American Board Family Practice 2: 43-48.
Remsburg R & Bennett R (1997) Pressure relieving strategies for preventing and treating pressure sores. Clinics in Geriatric Medicine 13(3): 513-529.
Reuler J & Cooney T (1981) The pressure sore: Pathophysiology and principles of management. Annals of Internal Medicine 94: 661-666.
Sugarman B (1987) Pressure sores and underlying bone infection. Archives of Internal Medicine 147: 552-557.
Topping A (1992) The trauma of burns. Wound Management 2(3): 8-9.
Vanden Bosch T, Montoye C, Satwicz M, Durkee-Leornard K & Boylan-Lewis B (1996) Predictive validity of the Braden Scale and nurses' perception in identifying pressure ulcer risk. Applied Nursing Research 9(2): 80-86.
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