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.

This is a quantitative and correlational analysis of how staff perceptions of locus of control of pressure sore prevention relate to knowledge and prevalence rates of pressure sores. Reference is made to value of pressure sore prevention. The survey population consisted of nursing and assistant nursing staff in both hospital and community settings of a rural Health Service Trust. Surveys were performed of: prevalence of sores; equipment for pressure relief; knowledge and opinions of aetiology, recommended use of equipment, and risk assessment. A scale was constucted to measure locus of control of life, health, and pressure sore prevention. The hypothesis that higher belief in personal control of pressure sore prevention would be correlated with higher knowledge of the subject, and lower prevalence rates, was not upheld. It is concluded that there are associations between prevalence, knowledge levels, value of pressure sore prevention, and locus of control. Significant differences exist between community and hospital staff, and between trained and support staff. Spearman correlations and Mann-Whitney tests were mainly used. Knowledge and equipment levels were considered satisfactory for adequate preventive measures to be taken. Key personnel, such as Sisters, were significantly associated with prevalence, in that the more they believed they controlled pressure sore prevention, the higher the prevalence rate. This has been explained using typology in terms of the priority and importance they attach to pressure sore prevention relative to other demands. Higher belief that fate controls pressure sore prevention also correlates with lower prevalence rates, perhaps because more effort is invested in trying to stave off the presumed inevitable. Domain-specific beliefs may be less important to prevention than generalized beliefs about control. Recommendations include the following: that methodology is replicated and refined; that the value of pressure sore prevention needs raising; that organisational lines of control need to be clear. Certain types of attitudes amongst staff may be unhelpful in a broader range of conditions and outcomes. Selection processes for nurses should take attitudes and beliefs into account, and there may be an need to change control expectations of groups of personnel.

Although pressure ulcers appear to occur infrequently in children, they can have serious consequences such as infection, scarring and changes to body image. This thesis is an account of the development of an instrument to help nurses to identify children most at risk of pressure ulcers, and take preventative action. Prior to 1996, there were very few publications on the problem of pressure ulcers in children; these were mainly anecdotal, or concerned with specialised populations. The main aim of the research presented in this thesis was to develop an evidence-based pressure ulcer risk assessment tool for children. Initially, paediatric pressure ulcer incidence and prevalence studies were carried out at one children's hospital (project 1). This included collecting detailed data on the characteristics of children. The incidence of pressure ulcers in the sample (not including non-blanching erythema) was 3.7%, and the prevalence was 2.2%. A multicentre study was carried out (project 2) in which detailed data of the characteristics of 54 children with pressure ulcers in 11 hospitals were collected. This data set was amalgamated with the data set from project 1. Analysis indicated that the most significant characteristics associated with pressure ulcers were mobility, devices in contact with the skin, anaemia, pyrexia, peripheral perfusion, inadequate nutrition, hypoalbuminaemia, low weight and inappropriate incontinence. These factors were used to develop a pressure ulcer risk assessment (the Glamorgan Scale). An inter-rater agreement study (project 3) was carried out on the Glamorgan scale by collecting 27 sets of paired data. The Glamorgan scale is the first published paediatric pressure ulcer risk assessment scale developed from patient data using statistical analysis. It is being used in paediatric areas in many countries throughout the world, it has been translated into four other languages, and incorporated into paediatric pressure ulcer prevention policies in at least 6 countries.

[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.

No description available.

Thesis (doctoral)--München, 1934.

Thesis (M.S.)--University of Michigan, 1990.

Proefschrift--Utrecht. / Vita. Includes bibliographical references.