Journal of Wound Ostomy and Continence Nursing最新文献

Purpose: The purpose of this quality improvement project was to determine whether hospital-acquired pressure injuries (HAPIs) could be prevented by implementing an educational tool kit for patient care technicians (PCTs).

Participants and setting: Data were collected from 24 PCTs and 43 patients in a 26-bed inpatient adult acute care unit at an academic medical center in the mid-Atlantic region of the United States.

Approach: Outcome data were collected over an 8-week period from September to November 2021. Hospital-acquired pressure injury prevalence was collected using the National Database of Nursing Quality Indicators (NDNQI) survey process. Full- and part-time PCTs' knowledge and attitudes were assessed through modified Pressure Injury Prevention Knowledge and Attitudes towards Pressure Ulcer Prevention Instruments. The PCTs' compliance with prevention strategies was assessed among patients using the modified NDNQI audit scores. Descriptive statistics, Fisher's Exact test, and Mann-Whitney U test were used for analysis.

Outcomes: Among the 24 PCTs, 66.7% (n = 16) had received prior education on HAPI prevention strategies. Hospital-acquired or unit-acquired pressure injury prevalence rates did not change significantly following the educational intervention. Mean Pressure Injury Prevention Knowledge scores increased from pre- to post-intervention (92.86; SD 9.63 vs 94.05; SD 12.86). Average Attitude towards Pressure Ulcer Prevention scores decreased from pre- to post-intervention (27.79; SD 4.88 vs 21.0; SD 7.51), indicating poorer attitudes toward pressure injury prevention. The mean NDNQI audit scores significantly improved from pre-implementation (M 1.40; SD 0.82, n = 20) to measurement following the intervention (M 2.35; SD 0.99, n = 23; P= .014).

Implications for practice: An educational curriculum tailored for PCTs increased HAPI prevention strategies. The project site incorporated the HAPI prevention educational tool kit from this quality improvement project into their annual hospital-wide training for all PCTs to learn and implement HAPI prevention strategies in their work setting.

Purpose: The purpose of this quality improvement project was to implement and evaluate an algorithm for management and prevention of diaper dermatitis (DD) embedded in a scoring tool. The specific aim of the project was to decrease DD occurrences with a severity score of 3 to 4 by 25%.

Participants and setting: Quality improvement participants comprised 164 neonates; 89 were cared for prior to project implementation and 75 post-implementation. Data were collected over a 3-month period. The setting of this quality improvement project was a 98-bed, Level IV neonatal intensive care unit (NICU) located in the Midwestern United States (Oklahoma City, OK). The NICU is part of a freestanding children's hospital affiliated with a university.

Approach: Diaper dermatitis occurrences and severity scores were collected prior to and 3 months after the protocol was implemented in the NICU. We collected pre-implementation data, followed by staff education concerning the DD protocol. We also provide guidance for protocol implementation at the bedside and in our Electronic Medical Record. Data on DD rates and severity were provided during the National Database for Nurse Quality Indicators (NDNQI) prevalence days the 4th quarter of 2020 and the 1st quarter of 2021. We compared data before and after protocol implementation to evaluate its effect on DD rates and severity.

Outcomes: Analysis before and after implementation of the protocol showed no significant differences in DD occurrences or severity scores. The unintended introduction of water-based cleansing wipes was identified as a confounding factor that we believe influenced outcomes. The DD scoring system and algorithm were permanently implemented for DD score quantification, DD management and treatment guidance, and ease of DD documentation with interventions, despite non-significant group differences.

Implications for practice: Next steps for this project are to implement the water-based cleansing wipes facility wide, along with the scoring tool and DD prevention protocol.

While convex skin barriers have been used in patient care for decades, regulatory bodies and manufacturers have not established consistent parameters for measuring the most essential characteristics of a convex skin barrier. A transdisciplinary panel of manufacturers, engineers, marketing specialists and clinical subject matter experts from the United States was convened to address this gap. An initial consensus meeting was held to establish consensus around measurement parameters for 5 characteristics of convex skin barriers: depth, slope, flexibility, compressibility, and tension location. Consensus around 3 characteristics (depth, slope, and tension location) was achieved. In contrast, while multiple possible techniques for establishing measurement parameters for the remaining 2 characteristics (flexibility and compressibility) were discussed, final consensus for standardized measurement parameters was not achieved. The proceedings of this initial and novel approach to achieving consensus on measurement parameters for essential convexity characteristics lay the groundwork for development of international clinical practice standards on convex ostomy products. These standards aim to ensure predictable outcomes for persons with ostomies who use these products.

Purpose: The purpose of this study was to analyze the outcomes and influencing factors of patients with community-acquired pressure injuries (CAPIs) and provide insights for clinical practice.

Design: Retrospective cohort study.

Subjects and setting: We reviewed medical records of 413 patients with a total of 522 CAPIs. Patients with CAPIs who were hospitalized at Mianyang Central Hospital, Sichuan Province, China, between December 2021 and December 2022.

Methods: Depending on CAPI outcome at the time of discharge, the patients were split into "improvement" and "no improvement" groups. Factors influencing CAPI outcomes were examined using univariate analysis followed by multivariate analysis (logistic regression).

Results: A majority of patients (n = 324, 78.5%) showed improvement, and 89 (21.5%) showed no improvement. Logistic regression analysis showed statistically significant associations between CAPI outcomes and Braden Scale for Pressure Sore Risk scores, Barthel Index for Activities of Daily living scores, along with serum albumin, hemoglobin, interleukin-6, and C-reactive protein levels.

Conclusions: The outcomes of patients with CAPIs were influenced by the Braden score, the Barthel score, serum albumin and hemoglobin levels, as well as inflammatory markers, including interleukin-6 and C-reactive protein. To effectively treat and care for patients with CAPIs, nurses should develop customized nursing interventions based on the unique characteristics of patients.

Purpose: The purpose of this study was to explore the experiences of intermittent catheter users after using both reusable and single-use catheters, with a particular focus on factors that affected acceptability.

Design: Qualitative descriptive study following a clinical trial.

Participants and setting: Thirty-six participants who had used both reusable and single-use catheters in a clinical trial were interviewed between June 2022 and March 2024. All were living at home in England or Wales, UK.

Methods: Participants were invited to interview following one-year's use of a reusable catheter as part of a clinical trial. The reusable catheter was used in combination with their usual single-use catheter. Semi-structured telephone and video interviews were used to enable participants to describe their experiences. Data were analyzed using inductive methods and framework analysis to develop themes and subthemes.

Results: Data analysis identified 4 themes. Successful use of the reusable catheter depended on capacity, confidence and willingness of the individual to adapt. Most people found reuse easier to do at home but there were significant barriers when going out. The design of the catheter used in the trial and the process of reuse did not suit everyone. While there was a desire to continue reuse, this was conditional on the provision of single-use catheters to enable users to mix and match both types in different situations.

Conclusions: This study presents data from participants who were enthusiastic to try reusable catheters, mainly for environmental reasons, as part of a trial. For most there was a desire to mix and match, combining single use and reusable catheters for different situations. Innovation is needed to create a range of reusable catheter designs and cleaning processes that better meet individual needs.

Purpose: A meta-analysis was conducted to comprehensively identify risk factors of incontinence-associated dermatitis (IAD) in adults and provide evidence-based support for healthcare professionals to formulate IAD preventive interventions and bundled interventions.

Methods: Systematic review and meta-analysis of pooled findings.

Search strategy: Two researchers independently searched databases PubMed, EBSCO, Cochrane Library, Embase, Medline, Web of Science and Scopus and 4 Chinese databases (CNKI, Wanfang Data, VIP and CBM) for relevant studies published from their inception to March 15, 2023. Two researchers independently extracted relevant data and literature characteristics and evaluated the quality of the included studies.

Findings: Twenty-seven studies that collectively enrolled 4046 participants were included in our systematic review. Five were written in English, 1 was written in Spanish, and the other 21 were written in Chinese. The odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors for IAD were determined. Fecal incontinence, an etiologic factor (OR = 5.79; 95% CI = [1.88-17.87]), stool characteristics (OR = 5.28; 95% CI = [2.51-11.07]), and daily frequency of bowel movements (OR = 5.76; 95% CI = [4.48-7.42]) were associated with an increased likelihood of IAD. The following risk factors: fever (OR = 4.23; 95% CI = [1.89-9.46]), age (OR = 1.04; 95% CI = [1.01-1.09]), hypoproteinemia (OR = 3.30; 95% CI = [1.90-5.72]), impaired consciousness (OR = 2.43; 95% CI = [1.66-3.54]), days of antibiotic use (OR = 4.13; 95% CI = [3.11-5.49]), diabetes mellitus (OR = 2.90; 95% CI = [1.73-4.86]), and a higher overall Perineal Assessment Tool (PAT) score (OR = 2.56; 95% CI = [1.23-5.30]) emerged as independent risk factors for IAD in adult patients. In contrast, a higher serum albumin level (OR = 0.88; 95% CI = [0.84-0.93]), a higher Braden Scale for Predicting Pressure Score Risk (Braden Scale) score (OR = 0.66; 95% CI = [0.56-0.77]), and a higher Braden Scale mobility subscale score (OR = 0.86; 95% CI = [0.74-1.00]) were protective factors that reduced the likelihood of IAD.

Implications: Identification of risk factors for IAD may be used to identify patients at risk and in need of preventive interventions. Identification of modifiable risk factors may be used to design novel preventive interventions.

Purpose: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients.

Participants and setting: Health care staff (n = 112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n = 24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n = 9) between January and March 2021.

Approach: Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices.

Outcomes: Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P = .042) and medical-surgical care units ( P = .025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences ( P = .017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk.

Implications for practice: There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this practice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.