O'Halloran Peter D, Cran Gordon W, Beringer Timothy R O, Kernohan George, Orr Jean, Dunlop Louise, Murray Liam J
School of Nursing and Midwifery, Queen's University Belfast, UK.
Int J Nurs Stud. 2007 Jul;44(5):672-86. doi: 10.1016/j.ijnurstu.2005.12.005. Epub 2006 Feb 17.
Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines.
The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors.
An observational, correlation study designed to identify factors related to adherence.
Forty nursing and residential homes in the UK.
1346 residents of the homes who were not confined to bed and with no pressure sore on the hip.
The introduction of an evidence-based policy to offer Safehip hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks.
Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39-3.78) and cognitive impairment (95% CI 1.01-2.98); being male rather than female (95% CI 1.06-2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01-8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04-1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0-100% at 24 weeks).
Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes in practice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.
髋部保护器是一种防护垫，旨在覆盖大转子并充分减弱或分散跌倒时的力量，以防止髋部骨折。疗养院随机对照试验取得的良好结果使得髋部保护器在医疗保健文献和国家指南中得到广泛推荐。
本研究的目的是确定个体居民的特征以及他们所居住机构的组织特征，这些因素可能会影响佩戴髋部保护器的依从性。
一项旨在确定与依从性相关因素的观察性相关性研究。
英国的40家护理院和养老院。
这些机构中1346名未卧床且髋部无压疮的居民。
引入一项循证政策，在护士协助下为居民免费提供Safehip髋部保护器。在72周内观察佩戴髋部保护器的依从情况。
髋部保护器的初始接受率为37.2%。24周时持续依从率为23.9%；48周时为23.2%；72周时为19.9%。更高的依从性与以下个体居民特征相关：更高程度的依赖（95%可信区间1.39 - 3.78）和认知障碍（95%可信区间1.01 - 2.98）；男性而非女性（95%可信区间1.06 - 2.48）。更高的依从性还与以下机构组织特征相关：研究期间高级管理人员变动较少（95%可信区间1.01 - 8.51），以及居住在居民情况显示依赖程度较高的居民比例更大的机构中（95%可信区间1.04 - 1.27）。各机构在实施成功程度上存在很大差异（24周时依从率为0 - 100%）。
那些在护理院和养老院推行引入髋部保护器政策的人应考虑将目标对准有认知障碍的居民。这类居民髋部骨折风险更高，而且似乎更有可能持续佩戴髋部保护器。负责实施实践或政策变革的人应考虑如何优化实施环境以提高成功的可能性。
