Amir Yufitriana, Tan Frans E S, Halfens Ruud, Lohrmann Christa, Schols Jos
Nursing Department, Universitas Riau, Pekanbaru, Indonesia.
Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
Ostomy Wound Manage. 2017 Feb;63(2):8-23.
Although the number of studies on pressure ulcer (PU) occurrence continues to grow, research regarding the quality of PU care and its effect on outcomes is limited. Using an extended Donabedian model, a 1-day, multicenter, cross-sectional evaluation of the quality of PU care was conducted in a convenience sample of Indonesian hospitals among patients ≥18 years of age in the medical, surgical, and intensive care units. Structure (ie, hospital attributes), process (recommended PU preventive measures), and outcome indicators (nosocomial PU prevalence excluding nonblanchable erythema), along with patient characteristics (age, gender, ethnicity, admission days, diseases [per ICD-10], recent surgery, PU categorization [4 categories according to National Pressure Ulcer Advisory Panel-European Pressure Ulcer Advisory Panel guidelines], PU history, care dependency, and Braden score) were examined. Patient data were collected by 2 nurses -1 from the patient's unit and 1 from another unit - using the Landelijke Prevalentiemeting Zorgproblemen-International questionnaire, a paper-and-pencil survey translated into Indonesian. Heads of wards and nursing units completed the questionnaires at institutional and ward levels, respectively. The data were analyzed using descriptive and bivariate analyses, and multilevel logistic regression modeling was applied according to the generalized estimating equation approach. Among the 4 participating hospitals, 66 care units, 36 pairs of nurses, and 1132 adult patients (mean age 48.7 ± 17.4 years, 40.9% women) were involved. Ninety-one (91) patients developed 1 or more PUs; the nosocomial PU prevalence (excluding nonblanchable erythema, category I) was 3.6%. The most frequently used PU preventive measures were patient education (329, 29.1%), repositioning (269, 23.8%), and skin moisturizing (266, 23.5%). The factors most associated with nosocomial PU rate excluding category I were the inclusion of PU care in patient care files (P = .001), repositioning (P = .002), skin moisturizing (P = .009), age (P = .013), admission days (P = .001), care dependency scores (P = .047), immobility (P = .001), sensory perception limitation (P = .001), moist skin (P = .032, OR 13.74), and friction and shear problem (P = .001). The prevalence of nosocomial PUs in this study was comparable to previous research in the Netherlands and rather low, even though limited structural indicators and suboptimal preventive measures were noted. Also, outdated preventive measures such as massage, donuts, and water-filled gloves were still used. The quality of PU care in these hospitals may be improved by addressing the absence of structural factors, including protocols/guidelines. Future research is needed for guideline implementation programs in Indonesian hospitals.
尽管关于压疮（PU）发生情况的研究数量持续增加，但有关PU护理质量及其对治疗结果影响的研究却很有限。本研究采用扩展的唐纳贝迪安模型，在印度尼西亚医院≥18岁的内科、外科和重症监护病房患者的便利样本中，进行了为期1天的多中心横断面PU护理质量评估。研究考察了结构（即医院属性）、过程（推荐的PU预防措施）和结果指标（不包括不可压红的医院获得性PU患病率），以及患者特征（年龄、性别、种族、住院天数、疾病[根据国际疾病分类第10版]、近期手术、PU分类[根据国家压疮咨询小组-欧洲压疮咨询小组指南分为4类]、PU病史、护理依赖程度和布拉德评分）。患者数据由2名护士收集，1名来自患者所在科室，1名来自另一个科室，使用《荷兰全国护理问题患病率调查-国际问卷》，这是一份翻译成印尼语的纸质调查问卷。病房主任和护理单元负责人分别在机构和病房层面完成问卷。数据采用描述性和双变量分析进行分析，并根据广义估计方程法应用多水平逻辑回归模型。在4家参与研究的医院中，共有66个护理单元、36对护士和1132名成年患者（平均年龄48.7±17.）参与。91名患者发生了1处或多处PU；医院获得性PU患病率（不包括不可压红，I类）为3.6%。最常用的PU预防措施是患者教育（329例，29.1%）、翻身（269例，23.8%）和皮肤保湿（266例，23.5%）。与不包括I类的医院获得性PU发生率最相关的因素包括在患者护理档案中纳入PU护理（P = 0.001）、翻身（P = 0.002）、皮肤保湿（P = 0.009）、年龄（P = 0.013）、住院天数（P = 0.001）、护理依赖评分（P = 0.047）、活动受限（P = 0.001）、感觉知觉受限（P = 0.001）、皮肤潮湿（P = 0.032，比值比13.74）以及摩擦和剪切问题（P = 0.001）。本研究中医院获得性PU的患病率与荷兰此前的研究相当，且相当低，尽管注意到结构指标有限且预防措施未达最佳标准。此外，诸如按摩、环形垫和充水手套等过时的预防措施仍在使用。通过解决包括协议/指南在内的结构因素缺失问题，这些医院的PU护理质量可能会得到改善。印度尼西亚医院的指南实施项目需要未来的研究。
