Gunningberg L, Lindholm C, Carlsson M, Sjödén P O
Section of Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, University Hospital, Uppsala, Sweden.
J Adv Nurs. 2000 May;31(5):1155-64.
The aims of the study were to investigate, on a daily basis: (i) the development and progress of pressure ulcers, (ii) the documented nursing interventions for prevention and treatment of pressure ulcers, and (iii) when nursing interventions regarding prevention and treatment of pressure ulcers were documented, in relation to patient risk status and the development of pressure ulcers. The study design was prospective, comparative and descriptive. A total of 55 patients with hip fracture were included. To facilitate the nurse's assessment, a 'pressure ulcer card' was developed, consisting of the Modified Norton Scale (MNS) and descriptions of the four stages of pressure ulcers. The incidence of pressure ulcers was 55%. The mean rank of the lowest MNS score was significantly lower for patients who developed pressure ulcers than for patients without pressure ulcers. The majority of the pressure ulcers occurred between admission to the ward and the fourth day after surgery. Documented interventions regarding prevention and treatment were: repositioning, overlays, cushions, use of lotion and observation. The mean number of interventions per patient was 2.2 for patients who developed pressure ulcers during their hospital stay. The comprehensiveness and quality of the nursing record was unsatisfactory, and only three nursing records reached the level required by Swedish law. Preventive interventions such as repositioning were documented when the pressure ulcer had already occurred. The lack of nursing documentation regarding prevention and treatment of pressure ulcers may indicate that nurses did not identify pressure ulcers as a prioritized nursing problem for this patient group. The Modified Norton Scale could be a valuable tool for nurses, both identifying the patient at risk and acting as a guide for nursing interventions. The study was approved by the ethics committee of the Faculty of Medicine at Uppsala University.
（i）压疮的发生与进展；（ii）预防和治疗压疮的记录在案的护理干预措施；（iii）记录预防和治疗压疮护理干预措施的时间，以及与患者风险状况和压疮发生情况的关系。本研究设计为前瞻性、比较性和描述性。共纳入55例髋部骨折患者。为便于护士评估，开发了一张“压疮卡片”，其中包括改良诺顿量表（MNS）和压疮四个阶段的描述。压疮发生率为55%。发生压疮的患者的最低MNS评分的平均秩次显著低于未发生压疮的患者。大多数压疮发生在入院至术后第四天之间。记录在案的预防和治疗干预措施包括：翻身、使用衬垫、坐垫、涂抹乳液和观察。住院期间发生压疮的患者，每位患者的干预措施平均次数为2.2次。护理记录的完整性和质量不尽人意，只有三份护理记录达到瑞典法律要求的水平。在压疮已经发生时才记录诸如翻身等预防性干预措施。缺乏压疮预防和治疗的护理记录可能表明护士没有将压疮确定为该患者群体的优先护理问题。改良诺顿量表可能是护士的一个有价值的工具，既能识别有风险的患者，又能作为护理干预的指南。本研究获得乌普萨拉大学医学院伦理委员会的批准。
