Citty Sandra W, Cowan Linda J, Wingfield Zandra, Stechmiller Joyce
Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida.
Nursing Service and Research, Tampa VA Center of Innovation for Disability and Rehabilitation Research (CINDRR), Tampa, Florida.
Adv Wound Care (New Rochelle). 2019 Jul 1;8(7):309-322. doi: 10.1089/wound.2018.0925. Epub 2019 Jul 2.
It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.
据估计,高达50%的住院患者存在营养不良。营养不良会导致住院时间延长、免疫功能改变、皮肤完整性受损及伤口愈合不良。营养不良已被发现是影响压疮(PI)风险和伤口愈合的一个重要因素。虽然预防PI需要采用多种基于证据的策略进行多维度综合护理,但住院患者可从专注于改善口服营养以降低PI风险和促进伤口愈合的干预措施中获益。不幸的是,营养不良在住院患者中常常未得到充分认识和妥善管理,这可能导致诸如PI等并发症的发生率更高。最近的研究表明,营养护理在PI的预防和管理中具有重大影响。据报道,包括早期识别和管理营养不良、为高危患者提供特殊配方的口服营养干预措施、优化电子健康记录系统以加强营养治疗的给药、监测和评估,以及实施基于协议的计算机化决策支持系统等策略,可改善治疗结果。不幸的是,医院在营养护理的实施方面存在差距。需要及时识别和管理营养不良,以推进对住院患者的优质护理,减少营养不良及相关的PI。需要进一步研究营养护理过程各阶段有效、基于证据的实施策略,以减少住院患者的压疮和营养不良。