Journal of Wound Ostomy and Continence Nursing最新文献

Background: The rise in gastrointestinal diseases in the Asia-Pacific region has led to an increased need for ostomy surgeries. The occurrence of peristomal skin complications (PSCs) challenges the principal goal of ostomy nursing, achieving self-efficacy in ostomy management and restoration of optimal physical health and health-related quality of life.

Cases: We present three cases to illustrate the challenges and solutions in ostomy care, emphasizing the role of moldable skin barriers. A female patient's anxiety related to the complex self-care process post-surgery was alleviated by a moldable skin barrier with an easier application process. A female patient with extensive skin maceration benefited from a moldable skin barrier with enhanced adhesion, paired with a protective crusting technique. In the third case, a young girl's social and educational life, hampered by constant ostomy pouch system leakage, improved with the adoption of a moldable skin barrier that provided a secure fit.

Conclusions: In each of these cases, use of moldable skin barriers improved self-care, skin health, and health-related quality of life. We have found a paucity of current literature reflecting the benefits of these barriers, and this article addresses this gap.

Purpose: The purpose of this systematic and metanalysis was to compare wound healing-related outcomes of negative pressure wound therapy (NPWT) to conventional therapy outcomes (time to granulation tissue formulation, ulcer depth, adverse effects amputation, pain, infection, and bleeding, along with hospital length of stay) for treatment of diabetic foot ulcers (DFU) in adults.

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

Search strategy: The electronic databases PubMed, Scopus, Web of Science, and Embase were searched. An artificial intelligence powered (Rayyan), proprietary software was used to retrieve, remove duplicates, and cite studies identified in our search. Two researchers and a conflict referee screened the studies in 2 phases; a title/abstract review, followed by reading all articles in full before identifying 12 studies included in this systematic review and metanalysis.

Results: Twelve studies were included in our metanalysis; 8 were clinical trials and 4 were observational studies. The pooled sample in the 8 clinical trials comprised 760 participants; 373 were managed with NPWT and 387 were managed with conventional therapy. No significant difference was observed for ulcer depth (P = .16). However, significant differences were found in mean difference in time to granulation tissue formation (P = .03), rate of amputation, pain (P = .01), infection rates (P = .005), and hospital length of stay (P < .001). The pooled sample evaluated in the 4 observational studies was 222; 100 were managed with NPWT and 122 with CT. Significant differences were found in time to granulation tissue formation (P < .001), amputation rates (P = .04), infection rate (P = .04), and hospital length of stay (P < .001).

Conclusions: NPWT improves time to granulation tissue formation, reduces hospital stay, and the risk of secondary amputations, infections, and pain. Based on these findings we recommend incorporating NPWT as a standard component of DFU management.

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 study was to compare leakage rates, skin health, fit, patient impact and usability for a concave ostomy system versus the non-concave ostomy system subjects were using prior to the study.

Design: Single-arm, open-label, multicenter, prospective study with subjects acting as their own control.

Subjects and setting: The sample comprised 20 subjects recruited from 3 outpatient clinics in Quebec, Canada. All participants were adults with an ostomy and had an outward peristomal body profile (OPBP).

Methods: Data were collected by investigators during in-person visits. Skin health was assessed using the Ostomy Skin Tool. Patient-reported outcomes were collected at each visit using a questionnaire designed for this study. Investigator-reported observations were also collected using a study-specific questionnaire at each visit. Generalized linear mixed model analyses were used to analyze the data.

Results: Use of the concave skin barrier significantly reduced leakage occurrences, improved peristomal skin health, provided a better fit, enhanced the users' sense of security, comfort, and ease of application of the concave pouching system when compared to a flat or convex skin barrier.

Conclusions: The use of a concave ostomy system for patients with an OPBP significantly reduced leakage while improving skin health, fit, patient impact and usability.

Purpose: This purpose of this study was to evaluate the validity and reliability of a Turkish language version of the Braden QD Scale for predicting medical device-related pressure injury (MDRPI) risk in pediatric patients.

Design: Validity and reliability study.

Subjects and setting: The sample comprised 71 children in the pediatric intensive care units of a maternity and child hospital; Cengiz Gökçek Maternity and Children's Hospital locates in Gaziantep, Turkey.

Methods: A Turkish language version of the Braden QD Scale was constructed, and its construct validity and content validity were measured. Several forms of reliability were measured, including internal consistency using Cronbach's alpha coefficient, along with intra-class and interobserver reliability. The sensitivity and specificity of the scale were tested by analyzing a receiver operating characteristics curve. Data were collected from May 1 to May 20, May 2022.

Results: The Braden QD-T had lower (fair) content validity (Kendall's W 0.217, P = .001) and adequate construct validity (Kaiser-Meyer-Olkin [KMO], 0.619; P = .000). It demonstrated excellent internal consistency (Cronbach's alpha 0.878). The intra-class correlation coefficient varied from 0.979 and 1.000, indicating excellent intra-class reliability. The interobserver reliability coefficients varied from acceptable to excellent at 0.661 and 0.984.

Conclusion: The Turkish version of the Braden QD Scale for predicting risk of MDRPI in pediatric population was determined to be a valid and reliable risk assessment tool for predicting risk for MDRPI.

Background: This case study describes progressive sitting in a hospitalized patient with chronic full thickness wounds. Promoting patient mobility is often a challenge. Patient adherence, logistics of progressive sitting, and potential threats to wound healing must be addressed to optimize wound healing.

Case: Ms. B was a 49-year-old obese female admitted to an acute care hospital with a worsening stage 4 sacral pressure injury. She became progressively deconditioned and was not adherent to recommended repositioning in bed due to pain and poor respiratory status. A physical therapist (PT) created a structured program to encourage out of bed sitting that included detailed instructions on transfer method, weight shift type, and sitting surface to address Ms. B's adherence and mobility impairments. The PT partnered with a certified WOC nurse and performed weekly wound treatments, provided recommendations on sitting time based on wound assessments, and addressed additional modifiable risk factors such as nutrition. Ms. B progressively increased the time spent sitting in an appropriate seating system. Upon discharge, she achieved her goal of sitting up daily in her own wheelchair for at least 4 hours with a 92% decrease in wound volume.

Conclusion: This case highlights the importance of a collaborative and structured approach to promoting mobility while managing chronic wounds. The case also demonstrates how to progressively increase out of bed sitting time without negatively impacting the healing of a stage 4 sacral pressure injury.

Purpose: The purpose of this project was to update the underlying evidence base for basic wound care in the Solutions Wound Care Algorithms and revise this resource as needed.

Methods: The 14 major algorithm goals, guidelines, and outcomes of patient care and 34 detailed qualifying assessment and management statements/steps were reconstructed to encompass 21 qualifying statements/steps and aligned with their most recent (2013) levels of evidence. Next, a systematic, focused review of the literature was conducted to update the evidence levels using the Strength of Recommendation Taxonomy.

Search strategy: An English language search of CINAHL, Medline, Cochrane Library, and Joanna Briggs Institute (JBI) electronic databases was conducted for the years 2015-2023. For each wound type, the following search terms were used: meta-analysis, systematic review, randomized controlled trial, clinical practice guideline, clinical trial, and wound care/healing and dressings. Publications not focused on the patient population or qualifying statements were excluded.

Findings: The search retrieved 59 elements that met the predetermined criteria for analysis and leveling. All qualifying statements and steps remain evidence-based. Higher quality evidence became available for nutritional status assessment, exercise to reduce risk factors for various types of lower extremity ulcers, using tap water to cleanse wounds; that delayed wound healing may be a sign of infection, and that silver-containing dressings are effective when used appropriately. No basic patient and wound care steps have the highest level of evidence (level 1) and strength of recommendation (A).

Conclusion: Compared to previous updates, we found fewer clinical trials indicating a need for research to improve evidence levels for various steps of basic wound assessment and care processes.