利用临床数据存储库中的数据探索预防性压疮护理中的实践差异。

Exploring practice variation in preventive pressure-ulcer care using data from a clinical data repository.

机构信息

Inha University, Department of Nursing, Incheon, South Korea.

出版信息

Int J Med Inform. 2011 Jan;80(1):47-55. doi: 10.1016/j.ijmedinf.2010.10.019. Epub 2010 Dec 3.

DOI:10.1016/j.ijmedinf.2010.10.019

PMID:21130682

Abstract

OBJECTIVE

The aims of this study were to explore pressure ulcer incidences and practice variations in the nursing intervention provided for preventive pressure-ulcer care to patients either with pressure ulcers or at risk of pressure ulcers, and to examine them in relation to the patients' medical problems and the characteristics of the nurses who cared for them.

METHODS

The narrative nursing notes of 427 intensive-care patients who were discharged in 2007 that were documented at the point-of-care using standardized nursing statements were extracted from a clinical data repository at a teaching hospital in Korea and analyzed. The frequencies of five nursing interventions for pressure-ulcer prevention were compared between pressure-ulcer and pressure-ulcer risk groups, as were the characteristics of the nurses who were treating the patients in these two groups. Nursing interventions for pressure-ulcer prevention were also assessed relative to the patients' medical problems.

RESULTS

The overall incidence of pressure ulcers was 15.0%. Position change was the most popular nursing intervention provided for pressure-ulcer prevention in both the pressure-ulcer and at-risk groups, followed by skin care. There was a statistically significant tendency toward a greater frequency of providing skin care and nutritional care in the at-risk group than in the pressure-ulcer group. There was no statistically significant difference in the mean frequencies of nursing interventions relative to the patients' medical problems in the pressure-ulcer group. However, frequencies of nursing interventions did differ significantly between patients with neurological problems and those with other medical problems in the at-risk group. Analysis of the nurses' characteristics revealed that more nursing interventions were documented by those who were younger, less experienced, and more educated.

CONCLUSION

A standardized nursing-terminology-based electronic nursing record system allowed us to monitor the variations in nursing practice with regard to preventive pressure-ulcer care in intensive-care patients with and at risk of pressure ulcers. We found that pressure-ulcer prevention care was provided at frequencies much lower than the recommended guidelines. Further studies on identifying the factors affecting pressure-ulcer prevention care and ways to improve the quality of that care are needed.

摘要

目的

本研究旨在探讨对存在压疮或有压疮风险的患者提供预防压疮护理的护理干预的压疮发生率和实践差异，并分析这些差异与患者的医疗问题和护理人员的特点之间的关系。

方法

从韩国一所教学医院的临床数据存储库中提取了在 2007 年出院的 427 名重症监护患者的叙事护理记录，这些记录是在护理点使用标准化护理陈述记录的。比较了压疮组和压疮风险组中 5 种预防压疮护理干预的频率，并比较了两组患者的护士特点。还根据患者的医疗问题评估了预防压疮的护理干预措施。

结果

总的压疮发生率为 15.0%。体位变换是压疮和有压疮风险组中最受欢迎的预防压疮护理干预措施，其次是皮肤护理。有压疮风险组中皮肤护理和营养护理的实施频率明显高于压疮组。在压疮组中，护理干预措施的平均频率与患者的医疗问题之间没有统计学差异。然而，在有压疮风险组中，有神经问题的患者与其他医疗问题的患者之间，护理干预措施的频率存在显著差异。对护士特点的分析表明，年轻、经验较少和教育程度较高的护士记录的护理干预措施更多。