养老院新发失禁患者中失禁相关性皮肤损伤的发生率及预测因素
Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence.
作者信息
Bliss Donna Z, Mathiason Michelle A, Gurvich Olga, Savik Kay, Eberly Lynn E, Fisher Jessica, Wiltzen Kjerstie R, Akermark Haley, Hildebrandt Amanda, Jacobson Megan, Funk Taylor, Beckman Amanda, Larson Reed
机构信息
Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Michelle A. Mathiason, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Olga Gurvich, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kay Savik, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Lynn E. Eberly, PhD, School of Public Health Division of Biostatistics, Minneapolis, Minnesota. Jessica Fisher, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kjerstie R. Wiltzen, BSN, BA, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Haley Akermark, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Hildebrandt, BA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Megan Jacobson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Taylor Funk, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Beckman, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Reed Larson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota.
出版信息
J Wound Ostomy Continence Nurs. 2017 Mar/Apr;44(2):165-171. doi: 10.1097/WON.0000000000000313.
PURPOSE
The purpose of this study was to determine the incidence and predictors of incontinence-associated dermatitis (IAD) in nursing home residents.
METHODS
Records of a cohort of 10,713 elderly (≥65 years) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed up for IAD development. Potential multilevel predictors of IAD were identified in 4 national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression.
RESULTS
The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits.
CONCLUSION
Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A WOC nurse offers expertise in these interventions and can educate staff about IAD predictors, which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits.
目的
本研究的目的是确定疗养院居民中失禁相关性皮炎（IAD）的发生率及预测因素。
方法
对来自28个州448家疗养院的10713名新出现失禁的≥65岁老年疗养院居民进行队列记录随访，观察IAD的发生情况。在4个国家数据集中确定IAD的潜在多层次预测因素，这些数据集包含有关个体疗养院居民特征、疗养院护理环境以及疗养院所在社区的信息。一组独特的医疗从业者医嘱提供了有关IAD以及会阴扩展区域IAD预防和压疮预测因素的信息。分析基于分层逻辑回归。
结果
IAD的发生率为5.5%。IAD的显著预测因素包括未接受IAD预防性干预、存在会阴压疮、日常生活活动功能受限更严重、灌注问题更多以及认知缺陷较轻。
结论
研究结果突出了预防IAD以及治疗/预防压疮的重要性。伤口造口失禁护理护士在这些干预措施方面具有专业知识，并且可以对工作人员进行IAD预测因素方面的培训，这可以改善居民的预后。其他建议包括实施护理计划以改善功能状态、治疗灌注问题，并为认知缺陷较轻以及较重的居民提供失禁和皮肤护理方面的帮助。
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