Background Pressure ulcer prevention has been an important and a common health care problem in every health care setting. Pressure ulcers are the clinical situation that can be avoided. To prevent pressure ulcer, the main strategy is to reduce either the pressure contact time, or magnitude of pressure, between a patient and his or her support surface. Pressure-relieving support surfaces are shown to be effective in preventing the development of pressure ulcer with strong evidence support. In Hong Kong, the low compliance of the ward staff to apply pressure-relieving support surfaces for at risk patients is compared with other countries. Therefore, a feasible evidence-based guideline of using pressure-relieving support surfaces to prevent pressure ulcers stands out from the multi-interventions pressure ulcer prevention guideline to maximize its effectiveness in this clinical issue. Purpose Reviewing the needs in modifying the current clinical practice and guidelines in local setting, the aim of the dissertation is to develop evidence-based guidelines for prevention of pressure ulcers using pressure‐relieving support surface for bedbound elderly. The findings are used to develop recommendations for nursing guideline to prevent pressure ulcers through the utilization of pressure‐relieving support surface in Hong Kong public hospital setting. Methods Four electronic databases published from 1937 to 2012 were searched. All the studies extracted were randomised controlled trials while focusing on using pressure-relieving support surfaces to prevent pressure ulcers of adult patients. The quality of each study was assessed by a methodology checklist, the Scottish Intercollegiate Guideline Network in order to justify the level of evidence of the studies’ internal validity. Conclusion From the evidence, the clearest conclusion that can be drawn is that a range of pressure‐relieving mattresses and overlays in the prevention of pressure ulcers can outperform the standard hospital mattress. It can be applied to any health care settings. The reviewed studies have shown that pressure‐relieving mattresses are effective on at risk patients, especially they are in advanced age with low mobility. Therefore, this evidence-based guidelines will serve in the medical rehabilitation wards to reduce the number of elderly from developing pressure ulcer after using the pressure‐relieving supporting surfaces. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Pressure ulcer is one of many health problems in the healthcare system. Pressure ulcer prolongs the suffering of patients and the cost of treating them is high. In 2006, in the USA almost US$11 billion was spent on hospitalizations in which the patient was dignosed with pressure ulcer as primary or secondary causes, excluding neonatal and maternal conditions. This reflects an increase of nearly 80% since 1993. Most pressure ulcers are potentially preventable; early and proper intervention to high risk groups can decrease the incidence of newly developed pressure ulcer and its consequence impacts. Moreover, pressure ulcer is a key performance index for assessing the quality of hospital service and patient safety. Maintaining a low incidence and prevalence of the pressure ulcer leads to both reduced health expenditure and patient’s suffering from wound pain. Aims and objectives The paper aims to study the current literature of pressure relieving devices application and its effectiveness to risk group. There are lots of pressure relieving devices in the market and here to assess its effectiveness to the risk group in hospital. Methods The electronic search was done through searching of electronic database, PubMed, MEDLINE ProQest; and hand search through Google Scholar and other online resources. Search strategies and criteria for inclusion and exclusion had been applied. The key words were used in retrieving studies through databases: (pressure ulcer OR decubitus ulcer) AND(prevention) AND (pressure relieving OR repositioning OR mattress OR cushion OR overlay OR re-distributing) Results There were twelve English articles for reviewing finally. Those articles were grouped into three pressure relieving device categories; they are cushion, re-positioning and mattresses for the review. In Defloor 2005, it found an obvious reduction in newly developed pressure ulcer if it combines4-hourly turning with pressure reliefing mattress; only 3% of participants had newly developed pressure ulcer. Furthermore, the frequect turning may not reduce the pressure ulcer development in lower risk group. The proper intervention of pressure relieving and tailor to individuals are essential. Conclusions It demonstrated the effectiveness of pressure relieving devices to patient at risk, but the present of significant differences is not consistent. It is essential to ensure the utilization of the pressure relieving support surfaces function with right skill to the right person in order to maximize patient’s benefit during hospitalization. Further clinical trial is preferable. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

No description available.

Older adults are particularly vulnerable to the development of pressure ulcers (PUs) as a result of skin changes and reduced mobility (Knox, Anderson & Anderson, 1994; Russell et al., 2003). This is associated with diminished quality of life, longer hospitalisations and increased morbidity and mortality (Margolis et al., 2002).In view of the high incidence of PUs (grade 1-4) occurring in elderly patients in acute care, a systematic review of related studies was conducted in August 2011. The optimal frequency and methods of repositioning are described in the literature. With well-designed implementation and evaluation plans, the proposed repositioning guidelines are likely to reduce the incidence of PUs (grade 1-4), while in turn lessening the healthcare burden and preserving patients’ quality of life. Pilot testing, a trial run to test the feasibility of the innovation, will be carried out in the proposed medical ward, and training provided to all staff before the intervention. To proceed with the change, the intervention must be cost-effective and beneficial to all stakeholders. Outcome evaluation determines the number of goals achieved by the innovation and to what degree, and is very important (Melnyk & Fineout-Overholt, 2005).The PU incidence (grade 1-4) is expected to be different after the implementation of the innovation. / published_or_final_version / Nursing Studies / Master / Master of Nursing

[Truncated abstract] Pressure ulcers affect a substantial proportion of patients admitted to health care services worldwide imposing considerable physical, social and economic burdens on patients and communities. As largely preventable wounds their prevalence is likely to escalate as the life expectancy and incidence of people living longer with other chronic diseases increases. Clinical practice guidelines are promulgated as evidence-based tools to assist clinicians and patients to determine care strategies, reduce inequities in healthcare provision and lower the burden of illness through improved health outcomes. This prospective multi-centre study evaluated the effectiveness of the Australian Wound Management Association?s Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers within ten selected Australian tertiary hospitals. The data, collected in 2000, examined pressure ulcer prevalence in a subset of five of these hospitals and junior doctors’ and nurses’ knowledge of pressure ulcers in all ten hospitals at two time points, before and after guideline implementation. Pressure ulcer prevalence was ascertained by two surveyors who independently examined the skin of all consenting adult patients on a designated day. ... In addition, it is recommended that all Australian health care facilities providing in-patient, residential aged or domiciliary care services be required to demonstrate compliance with the Australian Council of Health Care Standards framework for pressure ulcers in order to be an accredited healthcare provider. The use, benefits and cost utility of pressure reducing / relieving devices in the prediction and prevention of pressure ulcers in Australian contexts of care, is required to substantiate current guideline recommendations and assist service providers and clinicians in choosing devices according to patient need. A recommendation will be forwarded to the Australian Wound Management Association suggesting the Association develop a toolkit to facilitate implementation and adoption of their guidelines. It is recommended that training of doctors, nurses and allied health personnel in the prediction, prevention and management of pressure ulcers should be of a higher priority within under-and-postgraduate education programs. From a community perspective and with a view to improving the health of the community, it is proposed that pressure ulcers be the subject of ongoing health promotion campaigns aimed at raising patients’, caregivers’ and community awareness of the potential for pressure ulcers due to the secondary effects of lifestyle related chronic diseases and ensuing reduced levels of immobility.

Using an information processing approach, this study examines how nurses working in the area of continuing care for older people in Scotland use the Waterlow scale to inform their judgement and decision making in risk of pressure ulcers and plan of care. While assessment tools are commonly used, a number of assumptions surround their use for nurse practice and for patient care. To date, there appears to be no research which actually examines how nurses use assessment tools to assess patient's needs and plan care, despite the emphasis placed on evidence based practice. Assessment is a fundamental activity when caring for an older person where multipathology and the potential for health state deterioration are likely. This study consists of 3 parts. Part 1 identified the number and type of assessment tools that are routinely used within continuing care settings using a postal survey, revealing that the Waterlow scale is the most routinely used tool to assess pressure ulcer risk. Part 2 examined how continuing care nurses assess pressure ulcer risk through the use of observation and interview. Part 3 involved a detailed examination of the cognitive processes used by nurses when assessing pressure ulcer risk and planning care using simulation and a technique known as `Think aloud'. The results of this study indicate there were no differences between continuing care nurses working in either hospital wards or nursing homes in how the assessment was carried out, as neither group based their assessment or plan of care solely on the Waterlow scale. However, the Waterlow scale was found to be used differently according to the nurses' experience with those with more than 2 years experience, less likely to base their assessment of pressure ulcer risk or plan of care on Waterlow derived information.

The problem this study addresses is the need for nurses to adhere to guidelines on pressure ulcer prevention and treatment, so patients best possible health outcomes. This study created and utilized a new tool to assess nurses’ training, attitudes, knowledge, and skill/ability for adhering to practice guidelines of the National Pressure Ulcer Advisory Panel. The study sought to identity significant predictors of Personal Knowledge Rating Scale (TPKRS-101) and Personal Skill/Ability Rating Scale (TPS/ARS-101). The online study’s convenience sample of nurses (n=190) was 80.5% (n=153) female, 59.5% (n=113) Black, and 18.4% (n=35) Asian—with mean age of 40.27 years (min 23, max 73, SD=10.95). Some 53.2% (n=101) were not born in the US, while 16.8% (n=32) were from Ghana, 7.9% (n=15) from Jamaica, and 7.4% (n=14) from Philippines. Annual household income mean was $50,000 to $99,999 (mean=4.43, category 4, min=2, max=10, SD=1.00). Mean years working in nursing was 8-10 years (mean=4.34, category 4, min=1, max=9, SD=2.14). Nurses rated themselves “good” for performing pressure ulcer care tasks, as follows: (a) Nursing Training Rating Scale (TNRS-101) with global mean of 4.11 (SD=0.60, min= 1.94, max=5.00), or good; (b) Personal Knowledge Rating Scale (TPKRS-101) with global mean of 4.15 (SD=0.57, min=2.79, max=5.00), or good; and, (c) Personal Skill/Ability Rating Scale (TPS/ARS-101) with global mean of 4.13 (SD=0.62, min=2.56, max=5.00), or good. Higher Personal Knowledge Rating Scale (TPKRS-101) scores were significantly predicted by: more positive Attitudes Regarding Practice Guidelines-Relevance Scale (ARPG-R-5) (b = .067, SEB = .029, p = .022); and, higher level of Social Desirability (13 items) (b = .030, SEB = .013, p =.023). For this regression model, R2=.063, and AdjR2=.053, meaning that 5.3% of the variance was explained by model. Personal Skill/Ability Rating Scale (TPS/ARS-101) scores were significantly predicted by: higher level of Social Desirability (13 items) (b = .051, SEB = .014, p = .000). For this regression model, R2=.064, and AdjR2=.059, meaning that 5.9% of the variance was explained by model. Finally, the quantitative data were augmented by qualitative findings for barriers nurses experience to pressure ulcer prevention and treatment, as follows: Category I-External Barriers; and, Category II-Internal Barriers.