Decubitus最新文献

There is not yet a universal system for describing the status of pressure sores. The purpose of this study was to assess the validity and reliability of an instrument developed by the researchers for evaluation of pressure sores, the Pressure Sore Status Tool (PSST). This study was part of a larger study, which included development of a theoretical model for creation of items for the PSST. A nine-member expert judge panel established content validity of items on the instrument. Data were analyzed using a content of validity index (average index for tool = .91) and judges' comments were used to modify two items on the PSST. Two Enterostomal Therapy (ET) nurses independently used the revised tool to rate 20 pressure sores on ten adult medical-surgical patients, at two observation times. Interrater reliability was established at r = .91 for first observation and r = .92 for the second observation (p < .001). Intrarater reliability was r = .99 for rater one and r = .96 for rater two (p < .001). Future research will focus on refinement and further reliability testing of the instrument.

What is pain? Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells, most sense pain and the fewest sense cold. When there is an injury to your body--in this case surgery--these tiny cells send messages along nerves into your spinal cord and then up to your brain. Pain medicine blocks these messages or reduces their effect on your brain. Sometimes pain may be just a nuisance, like a mild headache. At other times, such as after an operation, pain that doesn't go away--even after you take pain medicine--may be a signal that there is a problem. After your operation, your nurses and doctors will ask you about your pain because they want you to be comfortable, but also because they want to know if something is wrong. Be sure to tell your doctors and nurses when you have pain.

When choosing a tool or instrument to gather data, the clinician must consider many factors including the validity, reliability, sensitivity, and specificity of the measuring device. While all of these factors are important measurement issues, this article focuses on assessment and enhancement of reliability.

Medical records were retrospectively reviewed to examine factors which may predict skin breakdown in the hospitalized adult patient. One-hundred fourteen (114) subjects were selected for the study, 60 who developed skin breakdown and 54 who did not. Results suggested that the factors which predict skin breakdown in the hospitalized patient are: age greater than 65 years, decreased level of consciousness, low activity level, low-grade fever, presence of infection, incontinence, poor nutritional intake, and an altered metabolic state.

In order to conduct research the investigator must first get beyond the "gatekeepers," the people who have the power or the influence to keep the research project from being investigated. Two factors that get researchers past gatekeepers are integrating some basic assumptions about all institutions and using selected practical strategies to gain entry. Basic assumptions include consideration of the institution as a dynamic social system encompassing territoriality issues, a resistance to change, and investment in maintaining good public relations. Practical strategies include communicating with the "right" people, "marketing" your proposal effectively, and creating a "win-win" situation.

Meta-analysis is an alternative, quantitative approach to the analysis and synthesis of multiple investigations of the same clinical question. The statistical approaches that have been developed since Glass coined the term meta-analysis in 1976 are discussed. Clinicians will find meta-analysis helpful when there are conflicting research findings about perplexing clinical problems.

In a study of 1320 adult patients admitted to a community hospital, there was a pressure ulcer incidence rate of 8.4%, with 3.2% of pressure ulcers present on admission. Of the 190 ulcers found, 63% (n = 120) were hospital acquired and were less severe than those present on admission. There was an average of 1.6 ulcers per patient; 56.3% (n = 107) were Stage I ulcers and 36.3% (n = 69) were Stage II ulcers. The most frequent sites were coccyx-sacral area, heels, and elbows. Preventive measures used most frequently were turning, special mattresses, and special skin care. After a pressure ulcer developed, the most frequently used treatment measures were special bed or mattress, frequent turning, and special ointments and dressings.

The Agency for Health Care Policy and Research (AHCPR) Guideline Panel on Pressure Ulcers completed a comprehensive review of the literature related to the prediction and prevention of pressure ulcers in adults. On the basis of this review, the panel formulated a guideline for care. Additionally, the analysis of published research revealed gaps in knowledge, research issues, and methodological problems that need attention in future studies. The following were identified as focus areas for the future: research with pressure ulcers status as the outcome rather than other intermediate outcomes; studies of product and intervention efficacy; further delineation of pressure ulcer staging; refinement of risk assessment tools; and testing of risk-based multi-intervention trials.