Impaired wound healing in SCI patients contributes to the progression in severity of PIs. Best practice guidelines suggest that surgical flap reconstruction is an option for chronic stage 4 PIs that have failed to heal with more conservative measures, but little is known about the epidemiology of surgically reconstructed PIs in SCI patients. Rates of surgical wound complications are high, and cost of management is extensive. Accordingly, this study aims to establish a systematic approach for identifying SCI patients with surgically reconstructed PIs, to facilitate study of predictors of sustained wound closure, quantify costs of surgical reconstruction, and evaluate efficiency of treatment and recovery options. To address gaps in the literature, this study’s objectives were: (1) estimate surgical reconstruction hospital costs for stage 4 PIs in SCI patients and characterize the relationship of demographic, socioeconomic and lifestyle factors to cost at discharge, (2) explore a standardized method of identifying these cases in large databases, (3) identify and validate risk factors for complications at discharge from wound care follow-up, and (4) identify long-term cost and health care utilization of persons with SCI who have undergone surgical flap closure. It proved difficult to identify our own cohort of patients using administrative codes applied, making population-based study using administrative data less than ideal. Factors associated with open incision at three-to-six weeks post-index surgery included number of nursing visits in the previous year, and revision surgery within the six-week follow-up period. The cost of persons with SCI and PI was high one year prior to surgery (look-back) and almost double in the first year look-back. However, significant cost and health care utilization was demonstrated in Year 2 and 3 post-index surgery. Further prospective studies exploring models of health care delivery and addressing some of modifiable risk factors may improve cost-effectiveness and outcomes. / Thesis / Doctor of Philosophy (PhD) / Pressure ulcers, also known as pressure injuries (PI) or bedsores, are a common secondary complication in persons with spinal cord injury (SCI). While surgical closure is an option offered to patients, little is known about the long-term outcomes, including cost and use of health care services following the surgery. Risk factors for complications following surgery are known from a physical/co-morbidity/technique perspective, but environmental and behavioural factors have not been included these studies, and the use of health care administrative databases to accurately identify these patients for research has not been studied. A historical cohort study was conducted at one tertiary care centre in Toronto, Canada to identify known cases of SCI and PI reconstruction. Hospital codes were recorded in an algorithm used to evaluate the accuracy in identifying the known cases in the database. Health care usage and costs were also recorded, and risk factors for complications were also evaluated.

Nos últimos anos, a ciência e a tecnologia proporcionaram uma larga gama de ferramentas aos profissionais de saúde. Em especial, as Tecnologias da Informação, pois favorecem o aprimoramento considerável da qualidade dos serviços de saúde prestados à população, quando gerenciadas adequadamente. O objetivo deste estudo foi identificar a relação entre risco de desenvolvimento de lesão por pressão e complexidade assistencial em pacientes críticos internados na unidade de terapia intensiva de um hospital universitário por meio dos registros eletrônicos de saúde. Trata-se de estudo correlacional, longitudinal e descritivo, com abordagem quantitativa. A coleta de dados foi conduzida durante 120 dias, a amostra foi composta por 74 pacientes que atenderam aos critérios de inclusão da pesquisa. Em relação às características sociodemográficas e clínicas, foi observado maioria do sexo masculino (56,8%), brancos (73%), na faixa etária de 60 a 79 anos (40,5%) e o tempo médio de internação nessa unidade correspondeu a 10,5 dias. A maioria dos indivíduos apresentou risco elevado para a lesão por pressão com média de 11,7%, complexidade assistencial média foi de 84,7% e frequência média diária de 5,5% reposicionamentos, registrados no sistema de informação hospitalar. Quanto ao desfecho dos pacientes, 28 (37,8%) apresentaram lesão por pressão notificada no sistema de informação hospitalar, 27 (36,5%) evoluíram para óbito na Unidade de Terapia Intensiva e 15 (20,3%) evoluíram a óbito e desenvolveram lesão por pressão, mostrando uma associação estatisticamente significante (p= 0,017). Foi observado significância estatística (p<0,001) e relação inversa para a complexidade assistencial e risco para desenvolvimento. As variáveis complexidade assistencial, risco para desenvolvimento de lesão por pressão, posições observadas foram registradas e também frequência de reposicionamento foram coletadas 776 vezes e observou-se que 605 (78%) da amostra em relação ao escore de complexidade assistencial foram registradas. Em 50% dos dias que os profissionais de enfermagem foram escalados com um paciente identificou-se que não foi atingida a capacidade máxima de trabalho do mesmo. No entanto, foi possível identificar que a capacidade máxima foi ultrapassada quando os profissionais assumiram o segundo paciente, ocorrendo uma possível sobrecarga de trabalho em 75% dos dias. Foi possível identificar diariamente os registros inexistentes dos escores relacionados à complexidade assistencial, risco para o desenvolvimento de lesão por pressão e reposicionamento. Portanto, esta pesquisa evidencia a relevância dos dados e informações produzidas pela equipe de enfermagem para identificar os pacientes em risco, estabelecer medidas preventivas para os mesmos e consequentemente melhorar os indicadores de qualidade por meio dos registros eletrônicos e, assim, superar os desafios relacionados a segurança, qualidade e efetividade da assistência de enfermagem / In recent years, science and technology have provided a wide range of tools to health professionals. In particular, information technology, because they favor the improvement of quality of considerable health care provided to the population, when properly managed. The aim of this study was to identify the relationship between risk of pressure injury development and complexity care in critically ill patients admitted to the intensive care unit of a university hospital through electronic records. This is a longitudinal and correlational descriptive study with quantitative approach. Data collection was conducted for 120 days; the sample was composed of 74 patients who met the inclusion criteria. In relation to the sociodemographic and clinical characteristics, it was observed mostly male (56.8%), white (73%), aged 60 to 79 years (40.5%) and the average time of staying in this unit was 10.5 days. The majority of individuals presented a high risk for pressure injury with an average of 11.7%, average complexity care was 84.7% and average daily frequency of replacement registered was 5.5%, on the hospital information system. As for the outcome of patients, 28 (37.8%) had notified pressure injury in the hospital information system, 27 (36.5%) evolved to death in the intensive care unit and 15 (20.3%) evolved to death and developed pressure injury, showing a statistically significant association (p=0.017). Statistical significance was observed (p < 0.001) and inverse relationship to the complexity and risk to development assistance. The variables care complexity, risk for pressure injury development, positions observed, recorded and also repositioning frequency were collected 776 times and it was observed that 605 (78%) of the sample in relation to the care complexity scores were recorded. In 50% of the days that the nursing professionals have been scaled with a patient identified that was not achieved the maximum working capacity of the same. However, it was possible to identify the maximum capacity was exceeded when the professionals took the second patient, a possible overload of work in 75% of the days. It was possible to identify daily non-existent records of scores related to complexity, risk for pressure injury development and repositioning. Therefore, this research highlights the importance of data and information produced by the nursing staff to identify patients at risk, establish preventive measures to the same and consequently improve the quality indicators by means of electronic records and thus overcome the challenges related to safety, quality and effectiveness of nursing care

Os registros no prontuário do paciente são ferramentas estratégicas para o gerenciamento da qualidade da assistência em saúde e enfermagem. A Lesão por Pressão caracteriza-se como um indicador de qualidade assistencial e gerencial, permitindo a implementação de ações preventivas, por meio da utilização de diretrizes e protocolos clínicos destinados a orientar os profissionais de saúde para o alcance de uma assistência livre de danos. O objetivo deste estudo foi analisar o conteúdo dos registros das ações de enfermagem relacionadas ao reposicionamento dos pacientes em uma unidade de terapia intensiva. Trata-se, portanto, de estudo quantitativo, longitudinal, correlacional e analítico. A coleta de dados foi conduzida após aprovação do Comitê de Ética em Pesquisa e a amostra foi composta por 37 pacientes que atenderam aos critérios de inclusão da pesquisa. Quanto às características sociodemográficas e clínicas, foi identificado como maioria, o sexo masculino (56,8%); brancos (78,4%), na faixa etária de 60 a 79 anos (48,6%) e o tempo médio de internação na unidade com predominância de até dez dias de permanência (57,9%). A maioria dos indivíduos (48,6%) apresentou risco elevado para a Lesão por Pressão, com média de 11,7%; escore médio de gravidade de 54% na admissão e 54% na alta. Do total, 35,1% apresentou Lesão por Pressão, notificada no sistema de informação hospitalar, e 43,2% evoluiu para óbito. Na análise dos escores de risco para Lesão por Pressão (Braden) e gravidade na entrada (APACHE-E) e na saída (APACHE-S) da UTI, segundo o sexo, LP notificada e evolução para óbito entre os participantes da pesquisa, foram identificados valores estatisticamente significantes, exceto, entre as variáveis Braden e Lesão por Pressão notificada. Na análise dos valores percentuais de registros de ações de reposicionamento dos pacientes, segundo Lesão por Pressão notificada e evolução para óbito, não foram identificados valores estatisticamente significantes. Foi identificada correlação negativa (-0,369) e significância estatística (p=0,024) entre o percentual de registros de ações de reposicionamento e o escore Braden, ou seja, os pacientes com maior risco para Lesão por Pressão apresentaram maior frequência de registros de ações de reposicionamento. Na análise do conteúdo dos registros realizados diariamente pela equipe de enfermagem no prontuário do paciente, foi verificada predominância de registros relacionados à descrição da posição do paciente no leito e reposicionamento do paciente sem especificar a posição adotada. Este estudo evidencia a importância das informações produzidas pela equipe de enfermagem para identificação de pacientes em risco de desenvolvimento de Lesão por Pressão e o estabelecimento de medidas preventivas que atendam às exigências contemporâneas de maior efetividade, qualidade e segurança na assistência hospitalar, em especial, na unidade de terapia intensiva. Finalmente, vale destacar a relevância da sistematização da assistência de enfermagem, pautada na adoção de linguagem padronizada e estruturada, em suporte de papel ou eletrônico, visando à disponibilização de informação precisa, oportuna, válida, comparável e compartilhável, fundamentada nos pressupostos éticos e legais, políticos e organizacionais que envolvem o processo de auditoria no gerenciamento da assistência em saúde e enfermagem / The records in the patient\'s chart are strategic tools for managing the quality of health and nursing assistance. The Pressure Injury is characterized as an indicator of welfare and management quality allowing the implementation of preventive actions, through the use of clinical protocols and guidelines intended to guide health professionals to achieve a damage-free assistance. The aim of this study was to analyze the contents of the records of nursing actions related to the repositioning of patients in an intensive care unit. It is a longitudinal, quantitative, correlational and analytical study. Data collection was conducted after approval by the Committee of ethics in research and the sample was comprised of 37 patients who met the inclusion criteria. With regard to socio-demographic and clinical characteristics, was identified most of the males (56.8%), whites (78.4%), aged 60 to 79 years (48.6%) and the average time of hospitalization in unit with up to ten days of stay (57.9%). The majority of individuals (48.6%) presented a high risk for Pressure Injury averaging 11.7%, average score for severity on admission of 54% and 54% on high. Of the total, 35.1% presented notified Pressure Injury in hospital information system and 43.2% evolved to death. In the analysis of the risk scores for Pressure Injury (Braden) and gravity at the entrance (APACHE-E) and outlet (APACHE-S) of the ICU second sex, notified PI and evolution to death among the participants of the survey, statistically significant values were identified, except between Braden and variables notified Pressure Injury. In the analysis the percentage values of stock records of repositioning of patients according to notified Pressure Injury and evolution to death were not identified statistically significant values. It was negative correlation (-0.369) and statistical significance (p = 0.024) between the percentage of stock records of repositioning and the Braden score, i.e., patients with increased risk for Pressure Injury presented a higher frequency of stock records of repositioning. In the analysis of the content of the records held daily by the nursing staff in patient records, was observed a predominance of records related to description of the position of the patient in the bed and repositioning of the patient without specifying the position adopted. This study highlights the importance of information produced by the nursing staff to identify patients at risk for developing Pressure Injury and the establishment of preventive measures that meet the contemporary requirements of greater effectiveness, quality and safety in the hospital, in particular, in the intensive care unit. Finally, it is worth highlighting the relevance of systematization of nursing care, based on the adoption of standardized and structured language, in paper or electronic support, aimed at the provision of accurate information, timely, valid, comparable and sharable, based on ethical and legal assumptions, organizational and political involving health assistance management and nursing

Os registros no prontuário do paciente são ferramentas estratégicas para o gerenciamento da qualidade da assistência em saúde e enfermagem. A Lesão por Pressão caracteriza-se como um indicador de qualidade assistencial e gerencial, permitindo a implementação de ações preventivas, por meio da utilização de diretrizes e protocolos clínicos destinados a orientar os profissionais de saúde para o alcance de uma assistência livre de danos. O objetivo deste estudo foi analisar o conteúdo dos registros das ações de enfermagem relacionadas ao reposicionamento dos pacientes em uma unidade de terapia intensiva. Trata-se, portanto, de estudo quantitativo, longitudinal, correlacional e analítico. A coleta de dados foi conduzida após aprovação do Comitê de Ética em Pesquisa e a amostra foi composta por 37 pacientes que atenderam aos critérios de inclusão da pesquisa. Quanto às características sociodemográficas e clínicas, foi identificado como maioria, o sexo masculino (56,8%); brancos (78,4%), na faixa etária de 60 a 79 anos (48,6%) e o tempo médio de internação na unidade com predominância de até dez dias de permanência (57,9%). A maioria dos indivíduos (48,6%) apresentou risco elevado para a Lesão por Pressão, com média de 11,7%; escore médio de gravidade de 54% na admissão e 54% na alta. Do total, 35,1% apresentou Lesão por Pressão, notificada no sistema de informação hospitalar, e 43,2% evoluiu para óbito. Na análise dos escores de risco para Lesão por Pressão (Braden) e gravidade na entrada (APACHE-E) e na saída (APACHE-S) da UTI, segundo o sexo, LP notificada e evolução para óbito entre os participantes da pesquisa, foram identificados valores estatisticamente significantes, exceto, entre as variáveis Braden e Lesão por Pressão notificada. Na análise dos valores percentuais de registros de ações de reposicionamento dos pacientes, segundo Lesão por Pressão notificada e evolução para óbito, não foram identificados valores estatisticamente significantes. Foi identificada correlação negativa (-0,369) e significância estatística (p=0,024) entre o percentual de registros de ações de reposicionamento e o escore Braden, ou seja, os pacientes com maior risco para Lesão por Pressão apresentaram maior frequência de registros de ações de reposicionamento. Na análise do conteúdo dos registros realizados diariamente pela equipe de enfermagem no prontuário do paciente, foi verificada predominância de registros relacionados à descrição da posição do paciente no leito e reposicionamento do paciente sem especificar a posição adotada. Este estudo evidencia a importância das informações produzidas pela equipe de enfermagem para identificação de pacientes em risco de desenvolvimento de Lesão por Pressão e o estabelecimento de medidas preventivas que atendam às exigências contemporâneas de maior efetividade, qualidade e segurança na assistência hospitalar, em especial, na unidade de terapia intensiva. Finalmente, vale destacar a relevância da sistematização da assistência de enfermagem, pautada na adoção de linguagem padronizada e estruturada, em suporte de papel ou eletrônico, visando à disponibilização de informação precisa, oportuna, válida, comparável e compartilhável, fundamentada nos pressupostos éticos e legais, políticos e organizacionais que envolvem o processo de auditoria no gerenciamento da assistência em saúde e enfermagem / The records in the patient\'s chart are strategic tools for managing the quality of health and nursing assistance. The Pressure Injury is characterized as an indicator of welfare and management quality allowing the implementation of preventive actions, through the use of clinical protocols and guidelines intended to guide health professionals to achieve a damage-free assistance. The aim of this study was to analyze the contents of the records of nursing actions related to the repositioning of patients in an intensive care unit. It is a longitudinal, quantitative, correlational and analytical study. Data collection was conducted after approval by the Committee of ethics in research and the sample was comprised of 37 patients who met the inclusion criteria. With regard to socio-demographic and clinical characteristics, was identified most of the males (56.8%), whites (78.4%), aged 60 to 79 years (48.6%) and the average time of hospitalization in unit with up to ten days of stay (57.9%). The majority of individuals (48.6%) presented a high risk for Pressure Injury averaging 11.7%, average score for severity on admission of 54% and 54% on high. Of the total, 35.1% presented notified Pressure Injury in hospital information system and 43.2% evolved to death. In the analysis of the risk scores for Pressure Injury (Braden) and gravity at the entrance (APACHE-E) and outlet (APACHE-S) of the ICU second sex, notified PI and evolution to death among the participants of the survey, statistically significant values were identified, except between Braden and variables notified Pressure Injury. In the analysis the percentage values of stock records of repositioning of patients according to notified Pressure Injury and evolution to death were not identified statistically significant values. It was negative correlation (-0.369) and statistical significance (p = 0.024) between the percentage of stock records of repositioning and the Braden score, i.e., patients with increased risk for Pressure Injury presented a higher frequency of stock records of repositioning. In the analysis of the content of the records held daily by the nursing staff in patient records, was observed a predominance of records related to description of the position of the patient in the bed and repositioning of the patient without specifying the position adopted. This study highlights the importance of information produced by the nursing staff to identify patients at risk for developing Pressure Injury and the establishment of preventive measures that meet the contemporary requirements of greater effectiveness, quality and safety in the hospital, in particular, in the intensive care unit. Finally, it is worth highlighting the relevance of systematization of nursing care, based on the adoption of standardized and structured language, in paper or electronic support, aimed at the provision of accurate information, timely, valid, comparable and sharable, based on ethical and legal assumptions, organizational and political involving health assistance management and nursing

Orientador: Paula Schimidt Azevedo Gaiolla / Resumo: A partir da década de 90, muito se discute sobre estratégias para melhorar a recuperação do paciente após a realização da cirurgia. Dentre elas está a redução do tempo de jejum no pré-operatório, com a administração de líquidos claros e a diminuição da infusão de fluidos no intra e pósoperatório. Essas medidas têm sido aplicadas em vários trabalhos e protocolos mostrando-se segura e influenciando no tempo de internação do paciente e em outras complicações. Portanto, os objetivos desse trabalho foram avaliar se o tempo de jejum e o volume infundido no perioperatório influenciam no tempo de internação e no aparecimento de lesão por pressão(LPP) de pacientes cirúrgicos.Para tanto, foram estudados pacientes submetidos a cirurgias do aparelho digestivo, vascular, ortopédica, uroló- gica e ginecológica. Foram avaliados dados demográficos, clínicos e laboratoriais, escalas de risco cirúrgico, de risco para LPP e risco nutricional. Após a cirurgia o paciente foi avaliado quanto ao aparecimento de LPP pela escala de Avaliação e Classificação da LPP e o tempo de internação. A comparação univariada entre os indivíduos que apresentaram ou não LPP ou que ficaram ou não internados por mais de 5 dias, foi realizada pelo teste t de student, Mann Whitnney para as variáveis numéricas, a depender da normalidade de distribuição. A comparação univariada entre as variáveis categóricas foram realizadas pelo teste de qui-quadrado. A regressão logística múltipla foi utilizada para pesquisar variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Since the 90’s, a lot has been discussed about strategies to improve the recovery of patients after surgery. One of them is the reduction of preoperative fasting time, with the administration of clear liquids and with the decrease of intra and postoperative fluid infusion. As a matter of fact, those measures have been applied in several studies and protocols proving to be safe and influencing hospitalization time and in other complications. Therefore, the objectives of this work were to evaluate if the fasting time and the volume infused in the perioperative, influencing in the hospitalization time and the appearance of pressure injury in surgical patients. Therefore, were studied patients submitted to the following surgeries: digestive, vascular, orthopedic, urological and gynecological. Demographic, clinical and laboratorial data were analyzed, surgical risk scale, risk for pressure injury and nutritional risk. After the surgery, the patient was evaluated for the appearance of pressure injury by the Evaluate Scale and Classification of Pressure injury and hospitalization time. The univariate comparison between the individuals who presented or not the pressure injury time of hospitalization lower than five days or higher than five days was performed by the tstudent test and Mann Whitnney for the numerical variables, depending on the normality of the distribution. The univariate comparison between the categorical variables were made through the qui-square test. The multiple l... (Complete abstract click electronic access below) / Mestre

Hospitalized children are vulnerable to pressure injuries. Multiple methods are available to decrease pressure injuries. One specific method is the pediatric pressure injury prevention bundle, which includes device rotation, moisture management, positioning, skin assessment, and support surface management. Although this prevention bundle is available nationwide, it is not known if this type of bundled methodology helps decrease pressure injuries in hospitalized children. Secondary data regarding nursing interventions implemented as a bundle and pressure injury rates from a large pediatric hospital consortium were used to address this gap in the literature. The research questions explored the impact of the pressure injury prevention bundle on pressure injury rates over time and further dissected the data to determine the significance of each intervention in the treatment bundle. Benoit and Mion's model for performance improvement along with the continuous quality improvement model used by the hospital consortium guided the study. The secondary data sample included 102 children's hospitals participating in the national initiative Solutions for Patient Safety. Pearson correlation statistics revealed a significant inverse relationship between nursing interventions and pressure injury rates for hospitalized children. The findings indicated a 57% reduction in rates of pressure injuries over 5 years with nursing participation in implementing the pediatric pressure injury prevention bundle. The impact of any one intervention over the bundle was inconclusive. Positive social change is seen in the ability to decrease pressure injuries in hospitalized children by nurses' implementation of a pediatric pressure injury prevention bundles.

Nos últimos anos, a ciência e a tecnologia proporcionaram uma larga gama de ferramentas aos profissionais de saúde. Em especial, as Tecnologias da Informação, pois favorecem o aprimoramento considerável da qualidade dos serviços de saúde prestados à população, quando gerenciadas adequadamente. O objetivo deste estudo foi identificar a relação entre risco de desenvolvimento de lesão por pressão e complexidade assistencial em pacientes críticos internados na unidade de terapia intensiva de um hospital universitário por meio dos registros eletrônicos de saúde. Trata-se de estudo correlacional, longitudinal e descritivo, com abordagem quantitativa. A coleta de dados foi conduzida durante 120 dias, a amostra foi composta por 74 pacientes que atenderam aos critérios de inclusão da pesquisa. Em relação às características sociodemográficas e clínicas, foi observado maioria do sexo masculino (56,8%), brancos (73%), na faixa etária de 60 a 79 anos (40,5%) e o tempo médio de internação nessa unidade correspondeu a 10,5 dias. A maioria dos indivíduos apresentou risco elevado para a lesão por pressão com média de 11,7%, complexidade assistencial média foi de 84,7% e frequência média diária de 5,5% reposicionamentos, registrados no sistema de informação hospitalar. Quanto ao desfecho dos pacientes, 28 (37,8%) apresentaram lesão por pressão notificada no sistema de informação hospitalar, 27 (36,5%) evoluíram para óbito na Unidade de Terapia Intensiva e 15 (20,3%) evoluíram a óbito e desenvolveram lesão por pressão, mostrando uma associação estatisticamente significante (p= 0,017). Foi observado significância estatística (p<0,001) e relação inversa para a complexidade assistencial e risco para desenvolvimento. As variáveis complexidade assistencial, risco para desenvolvimento de lesão por pressão, posições observadas foram registradas e também frequência de reposicionamento foram coletadas 776 vezes e observou-se que 605 (78%) da amostra em relação ao escore de complexidade assistencial foram registradas. Em 50% dos dias que os profissionais de enfermagem foram escalados com um paciente identificou-se que não foi atingida a capacidade máxima de trabalho do mesmo. No entanto, foi possível identificar que a capacidade máxima foi ultrapassada quando os profissionais assumiram o segundo paciente, ocorrendo uma possível sobrecarga de trabalho em 75% dos dias. Foi possível identificar diariamente os registros inexistentes dos escores relacionados à complexidade assistencial, risco para o desenvolvimento de lesão por pressão e reposicionamento. Portanto, esta pesquisa evidencia a relevância dos dados e informações produzidas pela equipe de enfermagem para identificar os pacientes em risco, estabelecer medidas preventivas para os mesmos e consequentemente melhorar os indicadores de qualidade por meio dos registros eletrônicos e, assim, superar os desafios relacionados a segurança, qualidade e efetividade da assistência de enfermagem / In recent years, science and technology have provided a wide range of tools to health professionals. In particular, information technology, because they favor the improvement of quality of considerable health care provided to the population, when properly managed. The aim of this study was to identify the relationship between risk of pressure injury development and complexity care in critically ill patients admitted to the intensive care unit of a university hospital through electronic records. This is a longitudinal and correlational descriptive study with quantitative approach. Data collection was conducted for 120 days; the sample was composed of 74 patients who met the inclusion criteria. In relation to the sociodemographic and clinical characteristics, it was observed mostly male (56.8%), white (73%), aged 60 to 79 years (40.5%) and the average time of staying in this unit was 10.5 days. The majority of individuals presented a high risk for pressure injury with an average of 11.7%, average complexity care was 84.7% and average daily frequency of replacement registered was 5.5%, on the hospital information system. As for the outcome of patients, 28 (37.8%) had notified pressure injury in the hospital information system, 27 (36.5%) evolved to death in the intensive care unit and 15 (20.3%) evolved to death and developed pressure injury, showing a statistically significant association (p=0.017). Statistical significance was observed (p < 0.001) and inverse relationship to the complexity and risk to development assistance. The variables care complexity, risk for pressure injury development, positions observed, recorded and also repositioning frequency were collected 776 times and it was observed that 605 (78%) of the sample in relation to the care complexity scores were recorded. In 50% of the days that the nursing professionals have been scaled with a patient identified that was not achieved the maximum working capacity of the same. However, it was possible to identify the maximum capacity was exceeded when the professionals took the second patient, a possible overload of work in 75% of the days. It was possible to identify daily non-existent records of scores related to complexity, risk for pressure injury development and repositioning. Therefore, this research highlights the importance of data and information produced by the nursing staff to identify patients at risk, establish preventive measures to the same and consequently improve the quality indicators by means of electronic records and thus overcome the challenges related to safety, quality and effectiveness of nursing care

Pressure ulcers are a serious health condition that have negative consequences for patients and organizations. The primary cause of pressure ulcers is intense and/or prolonged pressure or pressure in combination with shear that results in damage to the skin and underlying soft tissue. Early identification of patients at risk for pressure ulcers and 2-hour repositioning to off-load pressure are key components in reducing pressure ulcer development. Despite ongoing efforts to prevent pressure ulcers, the incidence and prevalence of hospital-acquired pressure ulcers (HAPUs) at the practicum site exceeded the benchmark for Magnet hospitals and the health system's goal of 1%. Patient mobility sensor technology will be implemented on all patients who are at risk for pressure ulcers and who require caregiver-assisted turns to reduce the incidence and prevalence of HAPUs and increase turn-schedule compliance. At risk patients are those with a Braden Scale score of 18 or less; however, nurses often score patients higher than actual. An educational activity, Braden Scale for Predicting Pressure Sore Risk: It's only as effective as the scores suggest, will be presented to nurses to provide them with the knowledge and skills necessary to accurately perform a Braden assessment and correctly identify patients at risk for pressure ulcers. A pretest/posttest design will be used to evaluate the effectiveness of the program in improving the nurses' accuracy when performing the Braden assessment. This project will help with the early identification of patients who will benefit from the patient mobility sensor technology and ultimately in decreasing HAPUs.

Bakgrund: Sjuksköterskan har ett ansvar att förebygga ohälsa och förhindra vårdskador. Trycksår är den vanligaste vårdskadan och tidig identifiering krävs för att förhindra livshotande komplikationer. Trycksår förekommer mer frekvent hos patienter med svart hud på grund av svårigheten att identifiera trycksår i ett tidigt skede. Syfte: Syftet var att beskriva sjuksköterskans särskilda omvårdnadsåtgärder för att identifiera trycksår i ett tidigt stadie hos patienter med svart hud. Metod: Studien genomfördes som en litteraturstudie. Sökningar i omvårdnadsinriktade databaser resulterade i åtta artiklar som analyserades genom latent innehållsanalys. Resultat: Tre kategorier identifierades: 1) Bedömning av hudfärg, 2) Bedömning av blanchering och hyperpigmentation, 3) Bedömning av hudtemperatur. Användning av Munsell Color Chart tillät en objektiv bedömning av patientens hudfärg. Bristen på kliniska bedömningsverktyg ledde till ett ökat behov av tydliga rutiner gällande hudbedömning. Alternativ ljuskälla och infraröd termometer samt palpering möjliggjorde trycksårsidentifiering innan visuella tecken uppstod. Slutsats: Litteraturstudien visade att sjuksköterskan behöver ökad kunskap och medvetenhet gällande trycksårsidentifiering på patienter med svart hud. Fortsatt forskning behövs för att utveckla specifika bedömningsverktyg anpassade för svart hud och möjliggöra tidig identifiering. / Background: Nurses have a responsibility to prevent illness and avoid care injuries. Pressure injuries are the most common care injury and early identification is needed to prevent complications. Pressure injuries occur in higher frequency in patients with black skin due to the difficulties in identification in an early stage. Aim: The aim was to describe specific nursing measures to help identify pressure injuries in an early stage in patients with black skin. Method: The study was conducted as a literature review. Searching in nurse-oriented databases resulted in eight articles that were analyzed through latent content analysis. Results: Three categories were identified: 1) Evaluation of skin color, 2) Evaluation of blanching and hyperpigmentation, 3) Evaluation of skin temperature. The use of the Munsell Color Chart allowed an objective assessment of the patient’s skin color. The lack of clinical assessment tools lead to an increased need for clear procedures regarding skin assessment. An alternative light source, infrared thermography and palpation allowed pressure injury identification before visual signs appeared. Conclusion: The literature review showed that nurses need increased knowledge and awareness regarding pressure injury identification in patients with black skin. Further research is needed to develop specific assessment tools adapted for black skin and enable early identification.

The aim of this study was to explore the knowledge, practices, and the sources of knowledge that certified prosthetists/orthotists (CPOs) have experienced regarding early pressure injury assessment for different skin tones. This was examined across different contexts of skin tone demographics using qualitative semi-structured interviews with CPOs from different contexts. Seven participants from six different clinics were recruited using purposive sampling. Of the interviewed participants, five were from Scandinavia, one from South Africa, and one from Nigeria. The interviews were conducted to explore the participants’ own experience of this phenomenon using a phenomenological approach and an interpretivist paradigm. Qualitative content analysis was used to analyse the transcribed interviews inductively. The results consisted of five main categories: Assessment, Standardized Methods, Perceptions of Assessment regarding Skin Tones, Sources of Knowledge regarding Skin Tones, and Relevance of Knowledge Improvement, each with a number of subcategories. There were two main findings. Firstly, CPOs lack systematized knowledge of early pressure injuries irrespective of skin tones. Secondly, many CPOs lack assessment knowledge for darker skin tones as it is only learned from experience and is not taught in education or literature. In conclusion, the field of prosthetics and orthotics must develop to improve systematic early pressure injury knowledge and assessment differences between skin tones.