Department of Nursing Science, University of Turku, Turku, Finland.
Satakunta Hospital District, Pori, Finland.
J Clin Nurs. 2019 Jul;28(13-14):2420-2442. doi: 10.1111/jocn.14767. Epub 2019 Jan 25.
To explore the effectiveness of interventions aimed at pressure ulcer (PU) prevention in long-term older people care facilities (LOPC).
Pressure ulcers cause suffering for patients and constitute a major financial burden. Although most PUs could be prevented, their number has remained high. To avoid unnecessary suffering and costs, PU prevention must be effective.
A systematic review.
A systematic search was conducted in six electronic databases PubMed (MEDLINE), CINAHL, Web of Science Core Collection, Scopus, Cochrane Wounds Group Specialized Register and Cochrane Central Register of Controlled Trials. The inclusion criteria were: (a) study published in 2005-2017, (b) intervention with pre- and post-tests, focusing on PU prevention, (c) implemented in LOPC facilities, (d) persons >65 years as study population, and (e) outcomes reported as PU incidence or prevalence or healing time. The PRISMA guidelines were followed. The methodological quality of the studies was evaluated using the Joanna Briggs Institute's MAStARI critical appraisal checklist. The data were analysed with narrative synthesis.
The review included eighteen studies. The study designs were RCTs (n = 10), comparable cohort or case-control studies (n = 3), and descriptive or case series (n = 5). PU incidence in LOPC facilities decreased by using computerised decision-making support systems, PU prevention programmes, repositioning or advanced cushions. PU prevalence decreased with PU prevention programmes, by using advanced mattresses and overlays, or by adding protein and energy supplements to diet.
There are many ways to prevent PUs in LOPC facilities; no single effective way can be identified. One-third of the preventive interventions in LOPC facilities were effective. However, systematic evidence from randomised trials on preventive interventions of PUs in LOPC settings is still lacking.
The findings can be used in practice for selecting and in research for developing effective preventive interventions of PUs in LOPC facilities.
探索旨在预防长期老年人护理机构（LOPC）中压疮（PU）的干预措施的有效性。
压疮会给患者带来痛苦，并构成重大的财务负担。尽管大多数压疮是可以预防的，但它们的数量仍然很高。为了避免不必要的痛苦和费用，PU 预防必须有效。
系统评价。
在六个电子数据库中进行了系统搜索：PubMed（MEDLINE）、CINAHL、Web of Science 核心合集、Scopus、Cochrane 伤口组专业登记册和 Cochrane 对照试验中心注册。纳入标准为：（a）2005-2017 年发表的研究，（b）干预措施有前后测试，重点是预防压疮，（c）在 LOPC 设施中实施，（d）研究人群> 65 岁，（e）结果报告为压疮发生率或患病率或愈合时间。遵循 PRISMA 指南。使用 Joanna Briggs 研究所的 MAStARI 批判性评估清单评估研究的方法学质量。使用叙述性综合分析对数据进行分析。
综述包括 18 项研究。研究设计为 RCT（n = 10）、可比队列或病例对照研究（n = 3）和描述性或病例系列研究（n = 5）。使用计算机化决策支持系统、压疮预防计划、翻身或高级垫可降低 LOPC 设施中的压疮发生率。使用压疮预防计划、先进的床垫和覆盖物，或在饮食中添加蛋白质和能量补充剂可降低压疮患病率。
有许多方法可以预防 LOPC 设施中的压疮；无法确定单一有效的方法。三分之一的 LOPC 设施预防措施有效。然而，在 LOPC 环境中预防压疮的随机试验系统证据仍然缺乏。
研究结果可用于实践中选择和研究中开发 LOPC 设施中压疮的有效预防措施。
