Review of literature: Prevention Pressure Ulcer

Review of literature: Prevention Pressure Ulcer
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Grand Canyon University
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Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A. J., Reitel, K., & Buckley, D. I. (2013). Pressure Ulcer Risk Assessment and Prevention. Annals Of Internal Medicine, 159(1), 28-38.
The authors evaluate pressure ulcer prevention and risks assessment instruments, while also comparing effectiveness of various interventions. The review focuses on randomized trials and observation studies on risk assessment and interventions. Static advances surfaces appear to reduce the incidences of pressure ulcers in comparison to standard mattresses. Use of formal risk assessment tools facilitates pressure ulcer development, but there is still need to conduct more robust studies comparing various interventions and there applications in evidence based practice.
Dini, V., Bertone, M., & Romanelli, M. (2006). Prevention and management of pressure ulcers. Dermatologic Therapy, 19(6), 356-364. doi:10.1111/j.1529-8019.2006.00094.x
Article evaluates management and prevention of pressure ulcers for the elderly population as the health problem is burdening to healthcare systems. The authors note that poor nutrition and limited mobility place the elderly at higher risk of pressure ulcers. Since preventive measures are effective in reducing rates of pressure ulcers, it is necessary to use appropriate strategies that meet patient requirements. Furthermore, there is a need for prevention guidelines to streamline efforts towards preventing pressure ulcers.
Garber, S. L., Rintala, D. H., Holmes, S. A., Rodriguez, G. P., & Freidman, J. (2002). A structured educational model to improve pressure ulcer prevention knowledge in veterans with spinal cord dysfunction. Journal of Rehabilitation Research and Development, 39(5), 575-88.
Even though, nurses are aware about using repositioning, fewer nurses rely on evidence based practice when using interventions. An education model to help nurses and patients to retain knowledge has the potential to improve their practice. The authors studied 41 male patients, whereby they used a prevention knowledge test preoperative and post operative. Patients who received individualized education gained more knowledge on repositioning underlying the importance of nursing education and patient education.
Gillespie, B. M., Chaboyer, W.P., Mclness, E., Kent, B., Whitty, J.A.,, & Thalib, L. (2014). Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev, 4:1-35. DOI: 10.1002/14651858.CD009958.
This article reviews the effects of differ repositioning schedules and risk of patients developing pressure ulcer. The authors searched electronic databases on randomized controlled trials, focusing on the 30 degrees tilt and the 90 degrees tilt position. There appears to be minimal differences between repositioning after 6 and after 4 hours and this has a cost implication for hospitals. Hence there is a need for more robust research on repositioning frequency and positions that are appropriate.
Källman, U., Bergstrand, S., Ek, A., Engström, M., Lindberg, L., & Lindgren, M. (2013). Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients. Journal Of Advanced Nursing, 69(1), 133-144. doi:10.1111/j.1365-2648.2012.06000.x
Article addresses the impact of different lying positions on tissue microcirculation in patients aged 65 years or above. The researchers relied on measurement in tissue blood flow comparing results between supine and lateral positions. There was a decrease in blood flow when patients lay in the 30 degree lateral position compared with supine positions. However, there was no trend similar to all individuals, but the study is easy to replicate in other studies. Lying positions affect blood flow and temperatures around the superficial skin. Nurses need to rely more on evidence based medicine when deciding on lying positions.
Lahmann, N., Kottner, J., Dassen, T., & Tannen, A. (2012). Higher pressure ulcer risk on intensive care? - Comparison between general wards and intensive care units. Journal Of Clinical Nursing, 21(3/4), 354-361. doi:10.1111/j.1365-2702.2010.03550.x
The authors delved into the differences between patients with pressure ulcers being treated in general wards and intensive care units while controlling for risk factors. The study relied on a survey in German hospitals. There were differences between the two hospital settings where there were incidences of PU in intensive care units than general wards. Thus, when controlling for repositioning, age, surface, immobility there is a higher risk for developing in intensive care units. Other studies can rely on the model for health care planning and comparing pressure ulcer occurrence between and among different hospital specialties.
Moore, Z., Cowman, S., & Conroy, R. (2011). A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. Journal Of Clinical Nursing, 20(17/18), 2633-2644. doi:10.1111/j.1365-2702.2011.03736.x
This is an evaluation of the effectiveness of 30° tilt repositioning intervention versus the six hour 90° lateral rotation. Since there is no clarity on the recommended frequency of repositioning, the researchers compare results form the two interventions with 99 participants in the 30° tilt group and 144 participated in the 90° lateral rotation and repositioning. Repositioning the patients for every three hours at 30° tilt was associated with lower incidences of pressure ulcers than standard care. Hence, it is pertinent to use appropriate intervention strategies including repositioning schedules, and the study implies that there is a need to review current practices on repositioning.
Park, S., Boyle, D. K., Bergquist-Beringer, S., Staggs, V. S., & Dunton, N. E. (2014). Concurrent and Lagged Effects of Registered Nurse Turnover and Staffing on Unit-Acquired Pressure Ulcers. Health Services Research, 49(4), 1205-1225. doi:10.1111/1475-6773.12158
This study focuses on the impact of nursing staffing on pressure ulcer incidence, specifically nurse turnover. The authors point out that an increase in nursing turnover had a negative effect on rates of pressure ulcer. Higher nurse turnover was related to lower staffing during the same period and in future if there was no replacement. Hence, there is a need to focus on the impact of nurse staffing on quality of care, as lowed nurse staffing is associated with adverse patient outcome. Stable nursing management is related to this because it involves nurse staffing and long-term planning.
Peterson, M. J., Gravenstein, N., Schwab, W. K., van Oostrom, J. H., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer risk-Monitoring interface pressures of at-risk patients. Journal Of Rehabilitation Research & Development, 50(4), 477-488. doi:10.1682/JRRD.2012.03.0040
Even though repositioning is a common intervention for patients with PU, it is not entirely effective even for nondisabled patients. Hence, the study looks into the efficacy of repositioning routine on tissue areas while also relying on pressure mapping. Using mapping helps to identify at risk body areas, and results of the study show that there is also a need to improve repositioning practi...