OBJECTIVES:To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites.
DATA SOURCES:MEDLINE, Embase, the ...Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature.
STUDY SELECTION:Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries.
DATA EXTRACTION:Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury.
DATA SYNTHESIS:Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0–25.9% and 16.9–23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4–27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6–36.8% and 12.2–24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0–23.8% and 12.4–15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as followssacrum 26.9–48.0%, buttocks 4.1–46.4%, heel 18.5–38.9%, hips 10.9–15.7%, ears 4.3–19.7%, and shoulders 0.0–40.2%.
CONCLUSIONS:Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.
Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no ...national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics.
Using a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy.
Participants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy.
Improved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients' needs and health capabilities to better support people to engage in effective self-management for chronic diseases.
The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device‐related pressure ulcers (PUs) in intensive care patients for up to 7 ...days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device‐related ulcers were followed daily for up to 7 days. The outcome measures were device‐related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device‐related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device‐related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7‐day observation period. In conclusion, device‐related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device‐related ulcers, especially in patients with NG and ET tubes.
Purpose
To develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin ...injuries in older hospitalized adults.
Organizing Construct
Discussion paper.
Methods
A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014.
Findings
There is a multiplicity of literature outlining the etiology, prevention, and management of specific iatrogenic skin injuries. Complex and interrelated factors contribute to iatrogenic skin injury in the older adult, including multiple comorbidities, factors influencing healthcare delivery, and acute situational stressors. A range of injuries can result when these factors are complicated by skin irritants, pressure, shear, or friction; however, despite skin injuries sharing multiple antecedents, no unified overarching skin safety conceptual model has been published.
Conclusions
The SSM presented in this article offers a new, unified framework that encompasses the spectrum of antecedents to skin vulnerability as well as the spectrum of iatrogenic skin injuries that may be sustained by older acute care patients. Current skin integrity frameworks address prevention and management of specific skin injuries. In contrast, the SSM recognizes the complex interplay of patient and system factors that may result in a range of iatrogenic skin injuries. Skin safety is reconceptualized into a single model that has the potential for application at the individual patient level, as well as healthcare systems and governance levels.
Clinical Relevance
Skin safety is concerned with keeping skin safe from any iatrogenic skin injury, and remains an ongoing challenge for healthcare providers. A conceptual framework that encompasses all of the factors that may contribute to a range of iatrogenic skin injuries is essential, and guides the clinician in maintaining skin integrity in the vulnerable older patient.
Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with ...evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice.
This study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education.
A qualitative descriptive study using online and in-person focus groups.
Focus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis.
Three distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles.
This study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.
Understanding Skin Failure: A Scoping Review Dalgleish, Lizanne; Campbell, Jill; Finlayson, Kathleen ...
Advances in skin & wound care,
10/2021, Letnik:
34, Številka:
10
Journal Article
Recenzirano
ABSTRACT OBJECTIVE To map the use of the term “skin failure” in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched ...for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included “skin failure,” “acute skin failure,” “chronic skin failure,” and “end stage skin.” All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term “skin failure” was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term “skin failure” has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.
Aim To undertake a scoping review of research on the assessment, management and prevention of acute wounds, from both primary research studies in Australia and from worldwide synthesised evidence, in ...order to provide a global context of future research needs.
Methods Databases, trial registries and professional organisation websites were searched from January 2010 to April 2022 inclusive. All Australian research studies, in addition to worldwide reviews and guidelines, were included. Articles were reviewed by two independent researchers and conflicts were resolved by a third researcher.
Results were synthesised in a narrative review. Results The searches yielded 318 Australian studies and 833 international studies, the latter comprising of 680 systematic reviews (SRs), 28 evidence-based guidelines (EBGs), 79 evidence summaries and 46 consensus documents. The Australian research studies consisted mostly of cohort studies, focused on burns (46%) and surgical wounds (44%), with fewer studies on skin tears and other acute wound types. Australian studies were primarily investigating wound management or treatments (60%), with only 38% on assessment and 2% on the prevention of wounds.
Conclusions This review found research on acute wounds focused on surgical wounds and burns, with gaps in research on skin tears or traumatic wounds, wound prevention, and research in primary healthcare settings, despite the high prevalence of wounds cared for in these settings.
Background: Mechanical skin injuries have been a neonatal complication since the 1980s but a number of factors affect their assessment, particularly the assessment of injury severity. Whilst there is ...a single severity and classification system used to assess adult pressure injuries within Australia, there are no neonatal-specific standards for injury assessment. Unfortunately, neonates sustain skin injuries frequently and, whilst there are some similarities to adult injuries, the maturity of neonatal skin puts the application of adult injury scales into question. In addition, several severity systems are currently utilised, thus outcomes for skin injury prevention or management strategies are difficult to compare.
Aims: This review will investigate severity scales used for neonatal skin injury. Secondly, this review will determine the (i) characteristics of severity scales such as ordinal or categorical groupings and (ii) assessment of scale validation for population.
Methods: This scoping review will utilise the PRISMA-ScR framework and the 2015 Joanna Briggs Institute methodology. The electronic medical databases chosen are PubMed, CINAHL, COCHRANE Central and Scopus. Publications from within the last 20 years will be included to ensure the scales and the neonatal population reflect the timepoint when neonatal skin care became a safety and quality outcome as recognised by international seminal works.
Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have ...resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units.
The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients.
A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse–patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers.
Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events.
While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.
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