School of Nursing and Midwifery, Griffith University, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
Int Wound J. 2022 Aug;19(5):1165-1179. doi: 10.1111/iwj.13712. Epub 2021 Nov 2.
Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi-structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient-focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t-test or χ test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.
压力性损伤是医院中经常发生的不良事件，会对患者安全和护理质量产生负面影响。如果使用有效的预防策略，大多数压力性损伤是可以避免的。然而，不同环境对这些预防策略的使用程度尚不清楚。本研究旨在描述和比较中国医疗和外科护士使用的压力性损伤预防策略。在这项观察性研究中，我们使用半结构化观察和病历审核，于 2020 年 6 月至 12 月在一家三级医院的两个内科病房和两个外科病房收集数据。观察以患者为中心；记录患者接受的任何预防措施，并使用病历审核来确定记录的预防策略。报告了每种预防策略的频率，并使用独立 t 检验或 χ 检验分析内科病房和外科病房之间的差异。共观察了 577 名患者（n=294，50.9%为内科；n=283，49.1%为外科），并对其病历进行了审核。所有患者入院时均进行了风险评估。翻身是最常用的策略，约 84%（n=486）的患者定期翻身。然而，皮肤护理、营养风险筛查和使用支撑面的情况并不理想。患者教育并不常见，但在 75%（n=433）的审核病历中都有记录。更多内科患者的皮肤保持清洁和湿润，但更多外科患者使用了防护霜，使用了支撑面，并接受了更多的营养支持，如果采用俯卧位，他们更有可能在 2 小时后翻身，在椅子上坐一个小时后也更有可能翻身。预防策略更有可能在外科患者的病历中记录。尽管提供了各种预防策略供护士应用，但根据压力性损伤预防指南的建议，一些策略的应用并不理想，如营养、皮肤护理和支撑面的使用。护士严重依赖翻身来预防压力性损伤。虽然大多数压力性损伤预防措施需要改进，但外科患者通常接受了更好的预防护理。这些发现可以为临床医生和护理经理在制定未来的压力性损伤预防工作时提供便利。
