Anita Voz, BSN, CWCN, Kootenai Health, Department of Nursing, Coeur d'Alene, ID, USA.
J Wound Ostomy Continence Nurs. 2011 Jul-Aug;38(4):413-8. doi: 10.1097/WON.0b013e318220b6ec.
This study sought to establish if nurses at a community hospital could correctly identify patients at high risk for skin breakdown and determine whether the resources needed to reposition high-risk patients per protocol were available.
The sample comprised 101 registered nurses from 8 acute care units in a 246-bed community-owned district Magnet® hospital. The study facility serves patients from a wide geographic area in the "panhandle" of Idaho with a largely rural population.
Face-to-face interviews were conducted on all shifts for 4 days. The instrument consisted of demographic questions and patient assignment questions including which patients the nurse identified at high risk for skin breakdown, which patients the nurse received information on about skin risks at change of shift, whether the nurse knew the Norton Pressure Ulcer Scale scores for their patients, whether patients were repositioned, who performed the repositioning, and how many times that shift. Surveyors obtained patients' Norton scores from computer records and recorded whether the nurse correctly identified patients at high-risk for skin breakdown.
Most nurses (73%) stated they did not know their patients' Norton scores. About 60% of nurses reported turning their high-risk patients every 2 to 4 hours. The repositioning was completed most often by RNs alone (39%), RN and CNA (36%), and by patients themselves (35%). Reasons for not repositioning included the following: allowed to sleep, off unit, patient refused, not enough time, family refused, pain, not enough help, and patient receiving end-of-life care. Assessment of patient's skin risk status was correct in 232 out of 348 patients (66%). Nurses predicted high risk when the Norton score indicated low risk in 35.9% of patients and low risk when the Norton scale indicated high risk in 35.1%. Nurses reported receiving information about skin risk in 33% of their assigned patients.
Nurses reported adequate resources to reposition patients. Most were not aware of their patients' Norton scores and were found to have poor accuracy when identifying patients' risk status.
本研究旨在确定社区医院的护士是否能够正确识别有皮肤破损风险的患者，并确定是否有协议规定的资源来为高风险患者翻身。
样本包括来自一家拥有 246 张床位的社区所有的 246 张床位的地区磁铁®医院 8 个急症护理病房的 101 名注册护士。该研究机构为爱达荷州“狭长地带”广大农村地区的患者提供服务。
在四天的所有班次上进行面对面访谈。该工具包括人口统计学问题和患者分配问题，包括护士识别出哪些患者有皮肤破损风险，护士在换班时收到哪些关于皮肤风险的信息，护士是否知道他们患者的诺顿压疮量表评分，患者是否被翻身，谁进行了翻身，以及该班次翻了几次身。调查员从电脑记录中获取患者的诺顿评分，并记录护士是否正确识别出有皮肤破损高风险的患者。
大多数护士（73%）表示他们不知道自己患者的诺顿评分。约 60%的护士报告说，他们每 2 到 4 小时就会给高风险患者翻身。翻身最常由 RN 单独完成（39%），由 RN 和 CNA 共同完成（36%），也由患者自己完成（35%）。不翻身的原因包括：允许睡觉、不在病房、患者拒绝、没有足够的时间、家属拒绝、疼痛、没有足够的帮助和患者接受临终关怀。在 348 名患者中，有 232 名患者（66%）的皮肤风险状况评估正确。当诺顿评分表明低风险时，护士预测为高风险的占 35.9%，而当诺顿量表表明高风险时，护士预测为低风险的占 35.1%。护士报告说，他们在 33%的指定患者中收到了有关皮肤风险的信息。
护士报告有足够的资源来为患者翻身。大多数护士不知道自己患者的诺顿评分，而且在识别患者的风险状况时准确性较差。
