Previous literature showed weak and sometimes contradictory evidence regarding the best interventions to prevent pressure ulcers and the best factors that can serve as predictors for ulceration. The aim of this study was to explore effective interventions and associated risk factors in the area of pressure ulcer. A retrospective approach was used to explore such interventions and risk factors in a more natural clinical environment than found in a prospective study. While retrospective studies have their limitations, one problem of prospective studies, the Hawthorn effect, is not present. In order to meet the aims of the study, a matched case-controlled design was employed. A convenience sampling technique was used to select all patients who matched the study criteria. Two groups of patients were selected. The first group developed pressure ulcer during hospitalization, the other did not. In order to have a sound and robust comparison, each patient from the pressure ulcer groups was matched or at least nearly matched with another patient from the non-pressure ulcer group for a number Waterlow sub-scores. Further criteria for selection included a minimum of three days total length of stay in hospital and being initially free of any pressure ulcer on admission for both of the study groups. Electronic medical records for all patients were revised, and multidimensional data were extracted using a data extraction sheet. Data analyses were carried out using univariate analysis (t-test, Mann-Whitney, Chi-square and Fisher’s exact test) and multivariate analysis (binary logistic regression). In univariate analysis for preventive interventions, the following interventions were significantly associated with pressure ulcer prevention (P≤ 0.05): standard hospital bed, seating cushion, static pressure redistributing mattress, re-positioning every four hours and helping the patient to sit regularly in a chair. When the effect of all interventions was adjusted through the multivariate model, the following interventions were independently associated with prevention: draw sheet, re-positioning every four hours and helping patient to sit regularly in chair (odds ratio = 0.24, 0.06 and 0.13 respectively; P≤ 0.05). In univariate analysis for risk factors related to physical activity and mobility, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): moving in bed with help, the ability to take a bath only in bed, needing two helpers in performing activities of daily living and moving outside bed only by a hoist. When adjusting the effect of all variables related to physical activity and mobility through the multivariate model, only two factors were independently associated with developing pressure ulcer: moving in bed with help and the ability to take a bath only in bed (odds ratio = 7.69 and 3.67 respectively; P≤ 0.05). In univariate analysis for risk factors related to pressure ulcer intrinsic risk factors, the following factors were significantly associated with developing pressure ulcer (P≤ 0.05): presence of three underlying medical conditions, dehydration, depression, having a blood transfusion, serum albumin <32mg/dl, haemoglobin <130 g/l in males or <115 for females and systolic blood pressure <113 mmHg. When adjusting the effect of all variables related to intrinsic risk factors through the multivariate model, the following risk factors were independently associated with pressure ulcer: presence of two underlying medical conditions, presence of three underlying medical conditions, cognitive impairment, serum albumin <32mg/dl and haemoglobin <130 g/l in males or <115 for females (odds ratio = 13.3, 143, 4.3, 0.10 and 0.14 respectively; P≤ 0.05). Findings from this study suggest a number of interventions to be effective in PUs prevention, and a number of risk factors that can predict risk of PUs. Findings were based on statistical association between acquiring PUs and the independent variables (preventive interventions and risk factors). This cannot constitute a cause and effect relationship due to the retrospective nature of data analyzed; it only supports the association between a number of interventions and risk factors in preventing or predicting PUs. This can guide further research to investigate these interventions and risk factors by employing the same approach used, but in a prospective manner.

Proefschrift Rijksuniversiteit Limburg, Maastricht. / Met lit. opg. en een samenvatting in het Nederlands.

In the vast majority of cases, appropriate identification and mitigation of risk factors can prevent or minimize pressure ulcer (PU) formation. However, some PUs are unavoidable. Based on the importance of this topic and the lack of literature focused on PU unavoidability, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference in 2014 to explore the issue of PU unavoidability within an organ system framework, which considered the complexities of nonmodifiable intrinsic and extrinsic risk factors. Prior to the conference, an extensive literature review was conducted to analyze and summarize the state of the science in the area of unavoidable PU development and items were developed. An interactive process was used to gain consensus based on these items among stakeholders of various organizations and audience members. Consensus was reached when 80% agreement was obtained. The group reached consensus that unavoidable PUs do occur. Consensus was also obtained in areas related to cardiopulmonary status, hemodynamic stability, impact of head-of-bed elevation, septic shock, body edema, burns, immobility, medical devices, spinal cord injury, terminal illness, and nutrition.

Introduction: Pressure ulcers are one of the most monitored indicators of nursing care. Thanks to a well-functioning interdisciplinary team, pressure ulcers can be effectively prevented. Main aims of the thesis: The aim of this work is to map the role of nurse in an interdisciplinary team, to describe how the interdisciplinary teams currently work and what the effectiveness of their work is in relation to the prevention of pressure ulcers and their healing. Methodology: A qualitative research survey was used to collect the data in the form of semi-structured interviews wtih nurses. The selection criterion was the fact that they encounter patients suffering from pressure sores. The informants were getting method Snow ball. The resulting set of informants consisted of 15 persons. The results of the interviews were processed using the open-coding technique of pencil and paper and then divided into six categories. Results of the thesis: Research shows that the nurse plays a key role in the interdisciplinary team in the care of a patient with pressure ulcers. Her role is to work with other team members, direct patient care, preventive work and family contact. The results show that the nurse is a full member of the team. The overall care effect of the interdisciplinary team is ineffective in some departments, because, as it happens that individual workers do not work together. In our research, we mainly come across the absence of a nutritional therapist. Also, nurses would welcome more cooperation from lower medical staff. Furthermore, nurses perceive the use of scales as a certain obligation, and in some cases report their incorrect evaluation. Last but not least, we are confronted with ignorance and non-compliance with the standards of pressure ulcers treatment. Conclusion: We would like to convey the results achieved by the necessity of cooperation of all workers who care for a patient with pressure ulcers. The provision of complex care is essential in this area, because pressure ulcers are multifactorial. The use of interdisciplinary teams in the care of a patient with pressure ulcers brings the possibility to use people with different expertise, knowledge and experience. Together, they effectively work towards the early recovery of the patient, shortening the hospitalization period and saving the cost of hospitalization.

A tomada de decisão do enfermeiro na sua prática diária necessita ser fundamentada em conhecimento científico. A prática baseada em evidências é uma abordagem que preconiza a utilização de resultados de pesquisas na prática clínica, sendo a revisão integrativa um de seus recursos. A presente investigação é uma revisão integrativa que teve como objetivo buscar e avaliar as evidências disponíveis sobre as intervenções eficazes de enfermagem para a prevenção de lesões de pele no paciente cirúrgico, no período transoperatório, ou em decorrência deste. Para a seleção dos artigos utilizamos duas bases de dados, Cinalh e Medline, e a amostra desta revisão constituiu-se em 14 artigos, referentes principalmente ao uso de superfícies de suporte. Após análise dos artigos incluídos na revisão , os resultados dos estudos apontaram que os dispositivos considerados mais eficazes na prevenção de lesões de pele foram o colchão de ar micropulsante, cobertura de colchão de polímero de visco elástico seco e almofadas de gel sucessivamente. / Nursing decision making in daily practice needs to be based on scientific knowledge. Evidence-based practice establishes the use of research results in clinical practice, with integrative literature review as one of its resources. This integrative review aimed to find and evaluate the available evidence on efficient nursing care interventions for the prevention of skin injuries in surgical patients, during or as a result of the perioperative period. To select the articles, we use two databases, Cinalh and Medline, resulting in a sample of 14 articles, which mainly dealt with the use of support surfaces. The results of this analysis indicated that the devices considered most efficient in the prevention of skin injuries were, in decreasing order, the multi-cell pulsating dynamic mattress system, a dry visco-elastic polymer pad and gel cushions.

The three goals of this research were to investigate how normal subjects move while seated, how paraplegic patients move while seated, and whether seated movements can be modeled using a hemi-ellipsoid shape. Pressure readings were recorded at 11 Hz using a 36 by 36 sensor pressure map by XSENSOR. Subjects were instructed to move or perform pressure relief as they normally would while seated. Analysis was performed using Microsoft Excel with Solver and Matrix.xla add-ins and automated with VBA code. Major movements and time intervals between movements were calculated by locating the area of maximum pressure on each hemi-buttock for 20 normal and 6 paraplegic subjects. Statistical analysis revealed movements followed a normal distribution while time intervals followed a lognormal distribution. For both the normal (p=0.041) and paraplegic groups (p=0.007) the number of movements significantly increased from the first hour of recording to the second hour. The time interval between major movements decreased but not significantly for neither the normal subjects nor the paraplegics. No significant differences were identified between the normal and paraplegic groups over the first hour or second hour for number of movements or time intervals. Time series analysis with plotting, trend lines, ARIMA, and periodograms did not reveal patterns in the data. Preference for a side was shown. Next, all areas of identified major movements for one subject and one frame for each of the paraplegic patients were modeled as a hemi-ellispoid shape using minimization with Solver. Eigenvalues were calculated in order to obtain the lengths of the x, y, and z axis of the hemi-ellipsoid with an average error of 39.87% for the normal subject and an error range of 5.10% to 2701.81% for the paraplegic patients.

A tomada de decisão do enfermeiro na sua prática diária necessita ser fundamentada em conhecimento científico. A prática baseada em evidências é uma abordagem que preconiza a utilização de resultados de pesquisas na prática clínica, sendo a revisão integrativa um de seus recursos. A presente investigação é uma revisão integrativa que teve como objetivo buscar e avaliar as evidências disponíveis sobre as intervenções eficazes de enfermagem para a prevenção de lesões de pele no paciente cirúrgico, no período transoperatório, ou em decorrência deste. Para a seleção dos artigos utilizamos duas bases de dados, Cinalh e Medline, e a amostra desta revisão constituiu-se em 14 artigos, referentes principalmente ao uso de superfícies de suporte. Após análise dos artigos incluídos na revisão , os resultados dos estudos apontaram que os dispositivos considerados mais eficazes na prevenção de lesões de pele foram o colchão de ar micropulsante, cobertura de colchão de polímero de visco elástico seco e almofadas de gel sucessivamente. / Nursing decision making in daily practice needs to be based on scientific knowledge. Evidence-based practice establishes the use of research results in clinical practice, with integrative literature review as one of its resources. This integrative review aimed to find and evaluate the available evidence on efficient nursing care interventions for the prevention of skin injuries in surgical patients, during or as a result of the perioperative period. To select the articles, we use two databases, Cinalh and Medline, resulting in a sample of 14 articles, which mainly dealt with the use of support surfaces. The results of this analysis indicated that the devices considered most efficient in the prevention of skin injuries were, in decreasing order, the multi-cell pulsating dynamic mattress system, a dry visco-elastic polymer pad and gel cushions.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-27T09:30:10Z No. of bitstreams: 1 flaviacostademoraes.pdf: 2039869 bytes, checksum: 7b19ea9061dc6cf6cc6631ae358dfd87 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-27T11:07:50Z (GMT) No. of bitstreams: 1 flaviacostademoraes.pdf: 2039869 bytes, checksum: 7b19ea9061dc6cf6cc6631ae358dfd87 (MD5) / Made available in DSpace on 2016-01-27T11:07:50Z (GMT). No. of bitstreams: 1 flaviacostademoraes.pdf: 2039869 bytes, checksum: 7b19ea9061dc6cf6cc6631ae358dfd87 (MD5) Previous issue date: 2014-07-24 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Úlceras de decúbito são lesões que desenvolvem-se nas interfaces das proeminências ósseas de sustentação do corpo. As lesões favorecem a colonização microbiana, dificultando a cicatrização e podendo estabelecer uma infecção. Os óleos essenciais de plantas medicinais têm demonstrado ser uma importante fonte para obtenção de novos compostos antimicrobianos. Neste estudo, foi avaliado o potencial antimicrobiano dos óleos essenciais de O. americanum, O. gratissimum e O. selloi. A atividade antibacteriana foi determinada pelo método de difusão em ágar e microdiluição, frente a bactérias aeróbias Gram-positivas (Staphylococcus aureus e Staphylococcus epidermidis) e Gram-negativas (Escherichia coli e Pseudomonas aeruginosa) prevalentes nas lesões. As variações na concentração e presença de biocompostos nos óleos essenciais influenciaram diretamente na capacidade antibacteriana. As espécies foram identificadas através da análise das composições químicas dos óleos pelo método de Cromatografia Gasosa acoplada a Espectrometria de Massas CG-MS. Os quimiotipos identificados foram: O. americanum linalol-1,8cineol-cânfora; O. gratissimum eugenol e O. selloi metil-chavicol, tendo como referência os quimiotipos descritos em artigos científicos. O óleo essencial de O. selloi não apresentou atividade antibacteriana significativa; o óleo de O. americanum apresentou atividade contra S. aureus, com CIM de 625 μg/mL; o óleo de O. gratissimum exibiu atividade antibacteriana promissora – apresentando CIM 625 μg/mL – para S. aureus, S. epidermidis e E. coli podendo constituir um antisséptico para úlceras de decúbito. / Decubitus ulcers are lesions developed on interfaces of bony prominences of the body support, reaching bedridden or immobilized patients. Lesions favor microbial colonization, difficult healing, and may establish an infection. The essential oils of medicinal plants have been shown to be an important source for obtaining new antimicrobial compounds. In this study, we evaluated the antimicrobial activity of essential oils of O. americanum, O. gratissimum, and O. selloi. The antibacterial activity was determined by the method of agar diffusion and microdilution against Gram-positive aerobic bacteria (Staphylococcus aureus and Staphylococcus epidermidis) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) prevailing in lesions. The variations in concentration and presence of biocompounds in essential oils have directly influenced the antibacterial capacity. Species were identified by analyzing the chemical composition of the oils by the method of Gas Chromatography coupled to Mass Spectrometry GC-MS. There were identified the chemotypes: O. americanum linalool-1, 8cineol-camphor; O. gratissimum eugenol and O. selloi methyl-chavicol, with reference in chemotypes described in scientific articles. The essential oil of O. selloi did not show significant antibacterial activity; the oil of O. americanum showed activity against S. aureus with MIC of 625 μg/mL; the oil of O. gratissimum exhibited promising antibacterial activity, with MIC 625 μg/mL for S. aureus, S. epidermidis and E. coli. which may constitute an antiseptic for decubitus ulcers.

Syftet med denna studie var att klargöra eventuellt samband mellan nutrition och trycksår genom att söka svar på de tre frågorna: Har nutritionen någon betydelse för uppkomst och läkning av trycksår? Vilka näringsämnen behövs för att förhind-ra uppkomsten och främja läkningen av trycksår? Finns de något samband mellan malnutrition och/eller ätsvårigheter och trycksår? Metoden för denna litteraturstu-die innefattade systematisk databassökning och manuell sökning av artiklar från referenslistor. Tio vetenskapliga artiklar med kvantitativ forskning i ämnet har analyserats och sammanställts. Resultatet presenteras i följande fyra tema: Nutri-tionens betydelse, energiintagets betydelse, vitaminers och mineralers betydelse samt bifynd. Analysen indikerar på samband mellan förbättrad nutrition och både minskad incidens och förbättrad läkning av trycksår. / The purpuse of this study is to elucidate the relationship between nutrition and pressure ulcer by seeking the answers to the following three questions: Does nutri-tion have any implication on the appearance and healing of pressure ulcers? What nutrients are needed to prevent appearance and promote healing of pressure ul-cers? Is there a connection between malnutrition and/or eating-difficulties and pressure ulcers? The method for this literature review consisted of a systematic searches in databases and searching through references. Ten scientific quantitative research articles in this subject have been analysed and concluded. The result is presented in four themes: The significance of nutrition, the significance of energy intake, the significance of vitamins and minerals and sub findings. The result of this analysis shows a connection between improved nutritional status and both lower incidence and improved healing of pressure ulcers.

Decubitus innebär onödigt lidande för patienter som drabbas. Genom att använda sig av rekommenderade behandlings- och omvårdnadsåtgärder kan detta lidande förhindras. Syftet med litteraturstudien är att undersöka sjuksköterskors attityder, kunskaper och kunskapsinhämtning, hur ny kunskap implementeras samt i vilken utsträckning EPUAP:s rekommendationer för prevention följs. Metoden som används är databassökning. Tio artiklar har granskats och ligger till grund för resultaten som besvarar frågeställningarna. Resultatet visar att sjuksköterskornas kunskaper är varierande, men överlag bristfälliga. Föråldrade och inte vetenskapligt förankrade metoder används i relativt stor utsträckning. Vid riskbedömning används inte alltid mätinstrument, såsom Nortonskalan och Bradenskalan, inte heller utförs riskbedömningen enligt gällande riktlinjer. Slutsatsen är att det behövs mer kunskap om decubitus samt uppdaterade metoder, vilka måste göras tillgängliga för vårdpersonalen. För att minska och förhindra prevalensen och vårdlidandet krävs det först och främst att vårdpersonalen lär sig identifiera tidiga tecken på decubitus och riskbedömer enligt ett mätinstrument. / Decubitus causes a lot of unnecessary suffering for the patients. This suffering could be prevented with the usage of recommended treatment- and nursingmethods. The purpose with this review is to examine nurses´ attitudes, knowledge and the gathering of knowledge, how this knowledge is implemented into clinical work and to what extend EPUAP´s recommendations for prevention are applied. The method consists of database searches. Ten articles have been studied and our result is based on the findings in these articles. The result shows that nurses´ degree of knowledge varies, however is on the whole lacking. Old and non-scientific methods are used a great deal. When risk assessing neither the Nortonscale nor the Bradenscale are widely used. The risk assessment is in many cases not performed in accordance with guidelines. The conclusion is that more knowledge about decubitus is needed, along with updated methods. It is of great importance that these methods are made available for staff. In order for there to be a decrease in the prevalence of decubitus every member of staff needs to be able to identify the early stages and perform risk assessment with the use of either the Nortonscale or the Bradenscale.