荷兰养老院的患者比德国养老院的患者有更多的压疮吗？一项前瞻性多中心队列研究。
Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.
机构信息
Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
出版信息
J Am Med Dir Assoc. 2013 Aug;14(8):605-10. doi: 10.1016/j.jamda.2013.03.005. Epub 2013 Apr 28.
OBJECTIVES
To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents.
DESIGN
A prospective multicenter cohort study.
SETTING
Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg).
PARTICIPANTS
A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer.
MEASUREMENTS
Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants.
RESULTS
A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home.
CONCLUSION
The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls.
目的
调查荷兰和德国养老院的压疮发生率是否存在差异，如果存在差异，确定与居民相关的风险因素、护理相关干预措施以及与养老院居民压疮发展相关的结构因素。
设计
前瞻性多中心队列研究。
地点
荷兰的 10 家养老院和德国（柏林和勃兰登堡附近）的 11 家养老院。
参与者
共有 547 名新入住的养老院居民，其中 240 名是荷兰人，307 名是德国人。居民预计入住时间为 12 周或更长时间。
测量
在 12 周的时间内，为每位居民收集数据，包括居民特征（例如，人口统计学、病史、Braden 量表评分、营养因素）、压疮预防和治疗特征、人员配备比例和其他结构养老院特征以及结果（研究期间发生压疮）。数据由经过培训的研究助理收集。
结果
荷兰养老院的压疮发生率（33.3%）明显高于德国养老院（14.3%）。确定了 6 个解释压疮发生率差异的因素：痴呆、使用止痛药、使用转移辅助工具、重新安置居民、病房内有组织活力护士以及养老院定期进行内部质量控制。
结论
荷兰养老院的压疮发生率明显高于德国养老院。与居民、护理和结构相关的因素解释了发病率的差异。所有医疗保健环境和国家都应持续关注压疮护理，但荷兰养老院尤其应注意重新安置居民、转移辅助工具的必要性和正确使用、止痛药使用的必要性、组织活力护士的任务以及定期进行内部质量控制。
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