Sharp C, Burr G, Broadbent M, Cummins M, Casey H, Merriman A
Faculty of Nursing, University of Sydney, Australia.
J Qual Clin Pract. 2000 Dec;20(4):150-7. doi: 10.1046/j.1440-1762.2000.00384.x.
The incidence and management of pressure ulcers in hospitalised patients is an ongoing concern for nurses. Efforts to prevent pressure ulcer development are plagued with inconsistencies and a general lack of best practice guidelines. Establishing current practice approaches to the assessment, prevention and management of pressure ulcers is a necessary first step in the implementation of evidence-based/best practice guidelines. Anecdotal evidence suggested a range of different approaches were being used in a Sydney metropolitan area health service (AHS) to assess patients to identify those at risk, to prevent pressure ulcers and to treat existing ulcers. A collaborative research project was undertaken to examine current practice and to explore the apparent clinical variance. It involved the distribution of a questionnaire to registered nurses working within the AHS (n = 2113) and a review of nursing policy documents in the various hospitals in the health service area. While the overall response rate was satisfactory (40%) many of the returned questionnaires were incomplete. Only 21% (n = 444) of the questionnaires were deemed suitable for analysis. The findings highlight a range of inconsistencies within and across nursing practice domains. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators to determine risk potential of developing pressure ulcers. Repositioning patients is the most common approach used in an attempt to prevent the development of pressure ulcers, but additional measures are diverse. Most nurses seem to be familiar with modern wound dressings such as hydrocolloids, foams and alginates in the treatment of second and third stage ulceration. However, the care provided by some nurses reflects an adherence to outdated practices, including the use of water filled gloves, povidone iodine and gauze packing.
住院患者压疮的发生率及处理一直是护士们持续关注的问题。预防压疮形成的努力存在诸多不一致之处，且普遍缺乏最佳实践指南。确立当前压疮评估、预防及处理的实践方法，是实施循证/最佳实践指南的必要首要步骤。轶事证据表明，悉尼大都市地区卫生服务机构（AHS）采用了一系列不同方法来评估患者以识别有风险者、预防压疮及治疗现有压疮。开展了一项合作研究项目，以审视当前实践并探究明显的临床差异。该项目包括向AHS内工作的注册护士（n = 2113）发放问卷，以及审查该卫生服务区各医院的护理政策文件。虽然总体回复率令人满意（40%），但许多回收的问卷不完整。只有21%（n = 444）的问卷被认为适合分析。研究结果凸显了护理实践领域内及领域间的一系列不一致之处。护士们一般不使用工具来评估压疮风险潜力，而是依靠一系列实践程序和风险指标来确定发生压疮的风险潜力。为预防压疮形成，最常用的方法是给患者重新摆放体位，但其他措施多种多样。大多数护士似乎熟悉用于治疗二期和三期溃疡的现代伤口敷料，如水胶体、泡沫敷料和藻酸盐敷料。然而，一些护士提供的护理反映出仍坚持过时的做法，包括使用注水手套、聚维酮碘和纱布填塞。
