ABSTRACT Background: Pressure ulcer is caused by pressure on the same skin area for a certain period of time, which causes a reduced blood circulation in the affected area and causes the tissue to die. Pressure ulcer is a major strain on healthcare, society and a big suffering for the patient. It contributes with high costs, extended care and pain. Aim: The aim was to describe the relationship between postoperative care and the appearance of pressure ulcer. Method: A literature study with 10 quantitative studies was used. Results: The intensive care department has an influence on the onset of pressure ulcers, and most of the pressure ulcers occur postoperatively in patients. The operating time is of no significance, but prolonged surgery may be a risk factor for pressure ulcer postoperatively. The majority of patients developing pressure ulcers in the postoperative process have underlying diseases such as diabetes, heart failure and renal failure. Other risk factors are patients who are older, underweight and have low Bradenpoints. Preventive measures such as air-changing mattresses are of great importance to counteract the onset of pressure ulcers, as well as saving large sums of money. Conclusion: Pressure ulcers are a contributing factor to patients having extended periods of suffering, which at the same time contribute to major costs for society and hospitals. In the postoperative stage, patients are more vulnerable due to reduced mobility and underlying diseases. Preventive measures such as mattresses help reduce the appearance of pressure ulcers and save big sums of money in the end. / SAMMANFATTNING Bakgrund: Trycksår uppkommer av att det blir tryck på samma hudområde under en viss tid, vilket leder till att det blir en nedsatt blodcirkulation i det drabbade området och att vävnaden tillslut dör. Trycksår är en stor belastning för sjukvård, samhälle och skapar ett stort lidande för patienten. Tryckskador bidrar med stora kostnader, förlängda vårdtider, smärta samt ett lidande för patienten. Syfte: Syftet var att beskriva sambandet mellan den postoperativa vården och uppkomsten av trycksår.Metod: En litteraturstudie med 10 kvantitativa artiklar. Resultat: Intensivvårdsavdelningen har en påverkan på uppkomsten av trycksår, och större delen av trycksåren uppkommer postoperativt hos patienter som är inneliggande på intensiven. Operationstiden har ingen signifikant betydelse, men en förlängd operation kan vara en riskfaktor för att trycksår uppkommer postoperativt. Majoriteten av patienterna som utvecklar trycksår i det postoperativa förloppet har bakomliggande sjukdomar som diabetes, hjärtsvikt och njursvikt. Andra riskfaktorer är patienter som är äldre, underviktiga och har låga Bradenpoäng. Förebyggande åtgärder som luftväxlande madrass har en stor betydelse för att motverka uppkomsten av trycksår, samt sparar in stora summor pengar. Slutsats: Trycksår är en bidragande faktor till att patienter får förlängda vårdtider med mycket lidande som samtidigt bidrar med stora kostnader för samhälle och sjukhus. I det postoperativa skedet är patienter extra utsatta på grund av nedsatt rörlighet och bakomliggande sjukdomar. Förebyggande åtgärder som madrasser bidrar till minskad uppkomst av trycksår och sparar stora summor pengar i slutändan

87f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-04T11:47:49Z No. of bitstreams: 1 Mirian%20Brito%20SEG.pdf: 499317 bytes, checksum: 31a297f2c4bcb53e6ac000dd5da64c5e (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-09T16:15:08Z (GMT) No. of bitstreams: 1 Mirian%20Brito%20SEG.pdf: 499317 bytes, checksum: 31a297f2c4bcb53e6ac000dd5da64c5e (MD5) / Made available in DSpace on 2013-04-09T16:15:08Z (GMT). No. of bitstreams: 1 Mirian%20Brito%20SEG.pdf: 499317 bytes, checksum: 31a297f2c4bcb53e6ac000dd5da64c5e (MD5) Previous issue date: 2008 / Este estudo buscou analisar o preparo recebido pelas famílias para cuidar de pessoas com úlcera por pressão no domicilio. Foi realizado nas clinicas médica (neurológica) e cirúrgica de um hospital público da cidade de Feira de Santana-Ba. Procedeu-se uma pesquisa com abordagem qualitativa utilizando a entrevista sem-estruturada e a observação não participante, no período de junho a agosto de 2008. Os sujeitos constituiriam-se de nove familiares cuidadoras dos pacientes que apresentavam úlcera por pressão. Para análise dos dados, foi usado a análise de conteúdo temático de Bardin, à luz dos pressupostos de Collière, e demais autores que abordam sobre o cuidar/cuidado.Os resultados mostraram que, a maioria dos sujeitos são preparados de forma inadequada, para dar continuidade aos cuidados após a alta hospitalar, e os que se consideram preparados, não se sentiam seguros para realizá-los em casa. Identificamos, também, que o cuidar/educar, como processo de trabalho acontece de forma precária nas unidades estudadas. Às famílias, são delegadas responsabilidades pelos cuidados, sem o devido preparo e/ou supervisão, o que acarreta o aparecimento de úlceras por pressão, ou aprofundamento das lesões, já existentes. Concluímos que o distanciamento da enfermeira e a delegação de cuidados, têm impedido que ações educativas, possam garantir aos familiares condições para realizarem, adequadamente, os cuidados de seu parente em casa. / Salvador

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A avaliaÃÃo do impacto de intervenÃÃes educativas surge para identificar a efetividade de programas, softwares, curso e treinamentos que envolvam profissionais e sujeitos com necessidades de capacitaÃÃo. O curso Ãlcera por PressÃo Online, utilizado nesta tese, trata-se de uma tecnologia de informaÃÃo e comunicaÃÃo desenvolvida para capacitar profissionais de enfermagem sobre a prevenÃÃo e tratamento de Ãlcera por pressÃo (UP) em pacientes nas diversas esferas de cuidado. A UP, alÃm de ser um problema de saÃde pÃblica mundial, provoca a realizaÃÃo de estudos que buscam formas de minimizar esse problema, alÃm de ser um indicador de qualidade da assistÃncia de enfermagem adotado em instituiÃÃes de saÃde. Foi objetivo desta tese avaliar o impacto de uma intervenÃÃo educativa a partir de uma tecnologia de informaÃÃo e comunicaÃÃo sobre prevenÃÃo e tratamento de UP em uma unidade de terapia intensiva de um hospital universitÃrio de Fortaleza/CE. Trata-se de um estudo quase experimental, com abordagem antes e depois, realizado no perÃodo de setembro de 2011 a junho de 2012. Participaram da pesquisa 94 pacientes (47 antes e 47 depois) e nove enfermeiras do setor. O estudo foi dividido em trÃs fases: prÃ-intervenÃÃo, intervenÃÃo e pÃs-intervenÃÃo. Foram utilizados para coleta de dados formulÃrios com variÃveis clÃnicas e sociais dos pacientes; dados referentes à assistÃncia de enfermagem na prevenÃÃo e tratamento de UP; a escala de avaliaÃÃo de risco de Braden; questionÃrio com variÃveis sociais das enfermeiras; e o questionÃrio de avaliaÃÃo de conhecimento sobre UP de Pieper e Mott (1995). Os dados foram organizados no Programa Excel e analisado no Programa estatÃstico SAS, com a utilizaÃÃo dos Testes t de Student, Exato de Fisher, Qui-quadrado corrigido de Yates, T de Wilcoxon e U de Wilcoxon-Mann-Whitney para anÃlise estatÃstica. A pesquisa obteve a aprovaÃÃo do Comità de Ãtica em Pesquisa da instituiÃÃo com protocolo n 098.09.11. Os resultados apontaram similaridade entre os grupos prà e pÃs-intervenÃÃo em relaÃÃo Ãs caracterÃsticas sociais e fatores clÃnicos avaliados (p&#706;0,05), exceto no item readmissÃo que sà esteve presente na primeira fase. A avaliaÃÃo de risco, a descriÃÃo da pele e a descriÃÃo de medidas preventivas apresentaram melhor porcentagem no grupo pÃs-intervenÃÃo, mas sem diferenÃa estatisticamente significante (p=0,839; p=0,865; p=0,723, respectivamente). A maioria dos pacientes do grupo prÃ-intervenÃÃo (53,19%) apresentou UP; essa superioridade tambÃm ocorreu em relaÃÃo à presenÃa de UP na admissÃo na UTI, com diferenÃa significante em relaÃÃo ao grupo pÃs-intervenÃÃo (p=0,046). A prevalÃncia de UP na UTI diminuiu de 36,23% para 27,36%; e a incidÃncia de 31,91% para 19,14% depois da intervenÃÃo educativa. A maioria dos pacientes do grupo prÃ-intervenÃÃo apresentou risco elevado de desenvolver UP (57,44%) e o grupo pÃs-intervenÃÃo, risco moderado (51,06%). Entre as nove enfermeiras, a maioria jà tinha realizado curso sobre UP (55,56%) e curso na modalidade EAD (55,56%). O nÃmero de acertos de questÃes sobre prevenÃÃo foi superior no grupo pÃs-intervenÃÃo com 81,93%, sendo tambÃm esse grupo o que apresentou maior porcentagem de acertos nas questÃes relacionadas ao estadiamento da UP (93,20%). A diferenÃa no nÃmero de acertos e de pontos entre os grupos apresentou diferenÃa significante (p&#706;0,05). Concluiu-se que a intervenÃÃo educativa gerou impacto na diminuiÃÃo da prevalÃncia e incidÃncia de lesÃes na UTI e na aquisiÃÃo de conhecimento das enfermeiras, principalmente, relacionado ao estadiamento das lesÃes. / Educational interventions impact assessment appears to identify the effectiveness of programs, software, courses and trainings that involve professionals and individuals who present capacity needs. The Pressure Ulcer Online Course used in this thesis is an information and communication technology (ICT) developed to qualify nursing professionals to prevent and treat Pressure Ulcer (PU) in patients in all care situations. The PU, besides being a worldwide health problem, assembles studies that search ways of minimizing this problem, and it is a quality nursing assistance indicator adopted by health institutions. The objective of this thesis was to evaluate the impact of an educational intervention using an information and communication technology on prevention and treatment of pressure ulcer at an Intensive Care Unit of a Teaching Hospital in Fortaleza/CE. This is a quasi-experimental study with a before and after approach carried out from September 2011 to June 2012. 94 patients (47 patients before and 47 patients after) and 09 nurses from the ICU have participated in the research. The study has been divided into three phases: pre-intervention, intervention, and post-intervention. In order to collect data, we used questionnaires for patientsâ social and clinic variables; data regarding nursing assistance for PU prevention and treatment; Braden scale for assessing pressure ulcer risk; questionnaire for nursesâ social variables; and the Pieperâs and Mottâs (1995) questionnaires to evaluate the nursesâ knowledge of PU. Data was organized using Microsoft Excel and analyzed using the Statistic Software SAS. Statistical analyses were carried out using the Studentâs t-test, Fisherâs Exact test, and Yatesâ corrected Chi-square test, Wilcoxon T test, and Wicoxon-Mann-Whitney U test. The ethical committee of the institution has approved this research under protocol number 098.09.11. Results have pointed out similarity between the pre and post-intervention groups regarding social characteristics and clinical factors (p&#706;0.05) that have been analyzed, excepting the readmission item, which was present only in the first phase. Risk assessment, skin description and prevention measures description have shown better percentage in the post-intervention group, but there was no statistically significant difference (p=0.839; p=0.865; p=0.723, respectively). Most patients from the pre-intervention group (53.19%) have presented PU; this superiority has also happen regarding PU presence at the patientâs admission to hospital with significant difference related to the post-intervention group. PU prevalence at the IUC has decreased from 36.23% to 27.36% and incidence has reduced from 31.91% to 19.14 after the educational intervention. Most patients from the pre-intervention group have presented high risk for developing PU (57.44%) and the post-intervention group has present moderate risk (51.06%). Most of the nine nurses have already taken a course on PU (55.56%) and an online course (55.56%). Number of correct answers about prevention was higher in the post-intervention group, which showed a percentage of 81.93% correct answers. This group was also the one presenting the greatest percentage in questions about PU staging (93.20%). Difference on the number of correct answers and points between the groups have presented significant difference (p<0.05). We concluded that the educational intervention has impacted on the decrease of lesions prevalence and incidence at the IUC and on the nurses knowledge acquisition, mainly, regarding lesions staging.

STUDART, Rita MÃnica Borges. A escala de Waterlow na Ãlcera por pressÃo em pessoas com lesÃo medular: uma tecnologia assistencial de enfermagem 2009.124f. DissertaÃÃo de Mestrado. Programa de PÃs-GraduaÃÃo de Enfermagem. Faculdade de FarmÃcia, Odontologia e Enfermagem. Universidade Federal do CearÃ.Fortaleza- Ce, 2009. A aplicaÃÃo da tecnologia assistencial na prÃtica profissional do enfermeiro para avaliar Ãlcera por pressÃo em pacientes com lesÃo medular deve ter uma abordagem holÃstica envolvendo a equipe multiprofissional. Este estudo teve como objetivo avaliar os fatores de risco para Ãlceras por pressÃo em pessoas hospitalizadas por lesÃo medular, utilizando a escala de Waterlow. Estudo transversal, com 60 pacientes internados em um hospital pÃblico municipal de emergÃncia de Fortaleza, cuja coleta de dados ocorreu no perÃodo de maio de 2008 a outubro de 2008. A populaÃÃo foi constituÃda pelos pacientes internados nas Unidades de InternaÃÃes: Neurocirurgia, UTI, Traumatologia e Cirurgia Geral, com o diagnÃstico mÃdico de lesÃo medular. Para a coleta de dados, utilizou-se dois instrumento, contendo dados de identificaÃÃo e fatores de risco, elaborado por meio de levantamento bibliogrÃfico utilizando a escala de Waterlow. Os dados foram coletados em duas etapas: no primeiro momento no mÃximo com 96 horas de internaÃÃo e no segundo momento foram coletados com dez dias de internaÃÃo. Os dados foram compilados no software Excel, em forma de planilhas e a anÃlise estatÃstica foi feita no programa SPSS versÃo 13.0. Para a anÃlise de associaÃÃo dos dados foram utilizados: Teste de KolmogorovâSmirnov, Coeficiente de correlaÃÃo de Pearson e Coeficiente de correlaÃÃo de Spearman. Todas as recomendaÃÃes Ãticas foram seguidas durante as etapas da pesquisa. No estudo, os pacientes afetados pela Ãlcera por pressÃo, em sua maioria, foram do sexo masculino, com faixa etÃria entre 18 a 33 anos com uma mÃdia de 37,12 anos procedentes da capital, com mÃdia salarial e nÃvel de escolaridade baixos. A aplicaÃÃo da escala de Waterlow, implementada neste estudo, revelou-se eficaz e sensÃvel para avaliar os fatores de risco para Ãlceras por pressÃo em pessoas hospitalizadas por lesÃo medular. Com base nos resultados obtidos, acredita-se que no primeiro momento da avaliaÃÃo pela escala de Waterlow pode ser dispensada a mensuraÃÃo do IMC, dada a dificuldade de aferir o mesmo. Ademais foi constatado que o paciente com lesÃo medular tem altÃssimo risco para desenvolver Ãlcera por pressÃo independente do IMC. O fator de risco mais significante para o desenvolvimento de Ãlcera por pressÃo no paciente com lesÃo medular foi à mobilidade fÃsica prejudicada associada ao longo tempo de internaÃÃo. A presenÃa de acompanhante foi outro achado importante, pois dos 19 pacientes que nÃo desenvolveram Ãlcera por pressÃo todos tinham acompanhantes. Foi constatado tambÃm que 90% dos pacientes nÃo receberam nenhum tipo de orientaÃÃo antes do advento da Ãlcera por pressÃo e que apenas 31% receberam orientaÃÃes depois do aparecimento da Ãlcera. Este estudo permitiu conhecer de forma aprofundada os riscos mais importantes para desenvolver Ãlcera por pressÃo nos pacientes com lesÃo medular com a utilizaÃÃo da escala de Waterlow / STUDART, Rita MÃnica Borges. Waterlowâs Scale on pressure ulcers on spinal cord injured persons: an assistance technology of nursing 2009. 122f. Masterâs Degree Dissertation. Program of Post Graduation on Nursing. Pharmacy, Odontology and Nursing College. Federal University of CearÃ. Fortaleza-Ce, 2009. The application of assistant technology in nursing professional practice to evaluate pressure ulcers in spinal cord injured patients must be an holistic approach, involving a multiprofessional team. This study purposed to evaluate the risk factors linked to pressure ulcers in persons hospitalized due to spinal cord injury, using the Waterlow scale. Transversal study, with 60 patients from a municipal public emergency hospital of Fortaleza, in which data were collected between May 2008 and October 2008. The population was constituted by patients interned in Infirmaries: Neurosurgery, UTI, Traumatology and General Surgery with spinal cord injury diagnosis. Two instruments were used for collecting the data, containing identification data and risk factors, elaborated by bibliographical consulting using the Waterlow scale. Data were collected at two stages: the first one the interview and physical exam in patients at the primary 72h of incoming, in the second one at 10 days of incoming. Data were summarized by the software Excel, based on plans, and the statistical analysis was made by SPSS program 13.0 version. Statistical test were performed to data association analysis: Kolmogorov-Smirnov Test, Pearsonâs Correlation Coefficient and Spearmenâs Correlation Coefficient. All ethical recommendations were followed during the research stages. In this study, most of all patients affected by pressure ulcers were male, between 18 and 33 years old, with an age average of 37,12 years, coming from the capital urban area, with salary average and scholar status low. The application of the Waterlow scale, performed in this study, demonstrated efficacy and sensibility to evaluate risk factors to pressure ulcers in spinal cord injured hospitalized persons. Supported by the results, it is believed that in the first moment of the evaluation using the Waterlow scale the Body Mass Index should be dismissed, due to the difficulty of measuring it. Besides, it was revealed that spinal cord injured patient has a great risk to developing pressure ulcers, not depending on Body Mass Index. The most significant risk factor to pressure ulcers in that patient was the physical mobility damaged linked to the time of hospitalization. The presence of a companion was other important evidence, so that all of the 19 patients that not developed pressure ulcers were accompanied. It was also showed that 90% of the patients did not receive any kind of information before pressure ulcer occurrence and that only 31% received information after the pressure ulcer occurrence. This study permitted to know deeply the most important risks to pressure ulcers in spinal cord injured patients using the Waterlow scale

Bakgrund: Trycksår uppkommer efter ett långvarigt tryck mot huden som leder till en syrebrist i vävnaden. Patienter som drabbad av trycksår i vården är ofta rullstolsburna eller sängliggande på grund av sjukdom eller smärta. Trycksår innebär ett stort lidande för patienten och det vardagliga livet påverkas i den mån att patienten isolerar sig och läkningsprocessen är lång och upplevs smärtsam. Utöver stort lidande för patienten innebär trycksår stora kostnader för sjukvården och samhället. Syfte: Syftet med litteraturstudien var att beskriva omvårdnadsåtgärder i sjuksköterskans arbete gällande trycksårsprevention. Samt beskriva urvalsmetoden i de inkluderade artiklarna. Metod: Beskrivande litteraturstudie. Artiklar söktes i Cinahl och PubMed mellan 2012-2017. Det slutgiltiga resultatet baserades på 11 artiklar. Resultat: Resultatet utformades efter tre underrubriker: 1) Tryckavlastande hjälpmedel: Åtgärder och material i omvårdnaden minimerar risken att uppkomsten av trycksår sker. Den dagliga preventiva omvårdnaden och olika luftmadrasser visade på bäst effekt. 2) Riskbedömning: Användandet av olika riskbedömningsinstrument i det dagliga arbetet minskade risken för trycksårsuppkomster. Det framkom att det bäst lämpade bedömningsinstrumentet var RAPS. Genom utbildning kunde sjuksköterskorna öka sin kunskap gällande identifiering och klassificering av trycksår. 3) Lägesändringar: Resultatet visade att 30 graders vinkling i en liggande position var bäst för att avlasta områden som lätt drabbas av trycksår. Metodologisk aspekt: Urvalsmetoden beskrevs på ett tydligt sätt i 11 av de inkluderade artiklarna. I en artikel var urvalsmetoden mindre tydlig. Slutsats: Litteraturstudien visar på att genom att använda sig av olika omvårdnadsåtgärder så som tryckavlastande hjälpmedel, riskbedömningar samt lägesändringar kan sjuksköterskan i sitt preventiva arbete minska uppkomsten av trycksår. / Background: Pressure ulcers occur after prolonged pressure against the skin which leads to an acid deficiency in the tissue. Patients who suffered from pressure ulcers in the ward are often wheelchair-borne or bedridden due to illness or pain. Pressure ulcers are a major disorder for the patient and everyday life is affected insofar as the patient isolates and the healing process is long and painful. In addition to suffering for the patient, pressure ulcers involve high costs for the healthcare and society. Aim: The aim of the literature study was to describe nursing measures in the nursing work regarding pressure ulcers prevention. As well as describe the sampling method in the included articles. Method: Descriptive literature study. Articles were searched in Cinahl and PubMed between 2012-2017. The final result was based on 12 articles. Findings: The result was designed according to three subheadings: 1) Pressure relief devices: Measures and materials in nursing minimize the risk of the occurrence of pressure ulcers. The daily preventive care and different air mattresses showed the best effect. 2) Risk assessment: The use of different risk assessment tools in daily work reduced the risk of pressure ulcer. It was found that the most suitable assessment tool was Raps. Through education, nurses could increase their knowledge regarding the identification and classification of pressure ulcers. 3) Position changes: The result showed that 30 degrees angulation in a lying position was best for relieving areas easily affected by pressure ulcers. Methodological aspect: The selection method was described clearly in 11 of the included articles. In one article, the selection method was less clear. Conclusion: The literature study shows that by using various care measures such as pressure relief devices, risk assessments and changes in position, the nurse in his preventive work can reduce the appearance of pressure ulcers.

Background: Pressure ulcer are one of the most common healthcare injuries and is a challenge for healthcare professionals. A pressure ulcer occurs from pressure or shear or a combination of both and it is mainly the elderly who are at risk. Pressure-relieving aids are used to prevent the pressure ulcer. The patient's experience is important in the care in order to prevent the pressure ulcer. Not understanding the patient's experience can lead to missed care and actions which in turn can lead to serious consequences. Aim: To describe patient's experiences of living with pressure ulcers. Method: A literature study was performed. An analysis of eleven qualitative articles that focused on the patient's experiences of pressure ulcers were conducted. Results: Two main themes and six subthemes emerged. The result presents the two main theme: Physical impact and Mental impact. Physical impact describes that pressure ulcers are painful and limit patient's mobility, which leads to becoming dependent on nursing care. Mental impact describes that the pressure ulcer causes the patients to isolate themselves, become dependent of others and lead to feelings of hopelessness. Conclusion: Patients experienced that being dependent on others are difficult and they experienced feelings of worthless and incapable. The smell and pain of the pressure ulcer and its wound fluids impairs patient's self-esteem and wellbeing, resulting in social isolation and hopelessness. / Trycksår är en av de vanligaste vårdskadorna inom hälso- och sjukvården som leder till ett lidande hos patienterna. Lidande är något som patienten blir utsatt för och är tvungen att leva med. Syftet med studien är att beskriva patienters upplevelser av att leva med trycksår. Att ta hänsyn till patienters upplevelser och deras kunskap kan resultera till en minskad sjukhusvistelse. Sjuksköterskan har som ansvar att främja hälsa, förebygga sjukdom, återställa hälsa och lindra patienters lidande. En viktig del av sjuksköterskans ansvar i omvårdnaden är att förhindra tryckskador. För att förhindra tryckskador ska sjuksköterskan känna till faktorer som ökar risken för trycksår, vilka är inkontinens, nedsatt rörlighet, anemi, rökning, malnutrition, nedsatt känsel, ödem, övervikt, hypotoni, diabetes och ateroskleros. För att kunna ge en adekvat behandling krävs det först att genomföra en bedömning för att kunna avgöra vilken behandling som blir aktuell. Stödytor som till exempel madrasser och sittdynor är det mest effektiva tillvägagångsätt för att förebygga trycksår hos patienter som befinner sig i samma ställning under en längre tid. Stödytans funktion är att jämnt fördela kroppens tyngdpunkt över hela ytan. I litteraturstudiens resultat inkluderades elva artiklar med kvalitativansats för att beskriva patienters upplevelser av att leva med trycksår. Patienterna upplever att trycksår är smärtsamma och begränsar dem i deras dagliga liv. Att leva med trycksår innebär att leva ett liv i smärta. Smärtan förvärrades av rörelser och bidrog till en nedsatt rörelseförmåga. Patienter uttryckte en förlust av rörlighet i samband med sitt trycksår, vilket bidrog till minskad förmåga att fortsätta med sitt dagliga liv. Den begränsade rörligheten gjorde att de blev beroende av andra personer och hjälpmedel. Många upplevde att tryckavlastande stödytor var obekväma och smärtsamma. Att ha trycksår bidrog även till sociala begränsningari livet. Patienterna uppgav att på grund av lukten från trycksåret så valde de att isolera sig från sociala aktiviteter. Att vara beroende av andra upplevdes som påfrestande vilket försämrade deras självkänsla och självförtroende, vilket bidrog till att de kände sig värdelösa och otillräckliga som inte kunde klara sig själva. Att få hjälp med intimvård och hygien upplevdes av patienterna som hotande för deras värdighet och integritet. Läketiden och behandlingen av trycksår var lång och fick patienterna att uppleva nedstämdhet och hopplöshet. Slutligen påverkar trycksår patienterna båda fysisk och psykisk och inverkar på deras välbefinnande och hälsa.

Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. Median duration of NPWT was 31 days (range 3 to 169) for pressure ulcers and 27 days (range 5 to 119) for the surgical wound group. Median lengths of stay in the early treatment groups were 85 days (range 11 to 239) for pressure ulcers and 57 days (range 7 to 119) for the surgical group versus 166 days (range 60 to 657) and 87 days (range 31 to 328), respectively, for the late treatment pressure ulcer and surgical groups (P <0.0001). After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (β = 0.96, P <0.0001 [pressure ulcers]; β = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.

Bakgrund: Ett trycksår orsakar fysiskt, mentalt, emotionellt och socialt lidande för patienten. Även behandlingar som patienten behöver vara med om innefattar ett lidande och en rädsla för den smärta de upplever vid dessa. En rädsla för att såret inte ska läka och att få infektioner eller behöva amputera. Sjuksköterskan har en viktig uppgift vad gäller förebyggande åtgärder vid risk för trycksår, att ge en god omvårdnad och behandling. Detta trots att patienten upplever smärta vid omläggningen av såret. Syfte: Syftet med studien var att beskriva hur patienter som lever med svårläkta trycksår upplever sin situation och att kategorisera upplevelserna utifrån WHOQOL-instrumentets fyra dimensioner av livskvalitet. Metod: En litteraturstudie baserad på nio kvalitativa artiklar som kategoriserats utifrån WHOQOL-BREF:s fyra kategorier som referensram. Resultat: Patienter som lever med svårläkta trycksår upplever att deras liv påverkas på grund av fysiska, psykiska, sociala och miljörelaterade faktorer som smärta, oro/ångest, minskad social kontakt och att vara beroende av vården. Slutsats: Patienternas livskvalitet påverkas både fysiskt av att ha ett sår vilket gav konsekvenser för det psykiska välmåendet och den sociala kontakten. Detta beskrevs inte bara påverka patienterna själva utan även deras anhöriga och närstående. Mötet med vården beskrevs som påfrestande och med brist på förtroende vilket medförde att patienterna inte kände sig delaktiga. Klinisk betydelse: Uppsatsen vill visa att patienter påverkas på flera olika plan så som fysiskt, psykiskt och socialt och därmed vikten av att omvårdnadsåtgärder i form av att preventiva åtgärder vidtas för att förhindra att trycksår uppstår. Kunskap om förebyggande åtgärder finns beskrivna i PM/vårdprogram och behöver implementeras i undervisning och efterföljas inom vårdverksamheten. / Background: A pressure ulcer causes physical, mental, emotional and social suffering for the patient. Even treatments that the patient needs to go through includes a suffering and a fear of the pain they experience during treatment, but also a fear the wound won’t heal and to get infections or to have to amputate. Nurses have an important role in terms of prevention at risk for pressure ulcers, to give a good care and treatment. This despite the fact that the patient is experiencing pain during the bandaging. Purpose: The aim of this study was to describe how patients that are living with slow-healing pressure ulcers experience their situation and to categorize their experiences by using the four categories of the WHOQOL-instrument´s dimensions of quality of life. Method: A literature review based on nine qualitative articles with WHOQOL-BREF’s categories as reference. Results: Patients living with slow-healing wounds experience that their lives are effected because of physical, mental, social and environmental factors such as pain, worry/anxiety, reduced social contact and being dependent on the healthcare. Conclusion: The patients’ qualities of life are affected physically by having a wound, resulting in consequences for the mental health and the social contacts. This was described not only to affect the patients themselves but also their families and friends. Nursing care was described as distressing and with lack of confidence that led to that the patients didn’t feel involved. Clinical significance: This essay want to show that patients are affected on many levels such as physically, mentally and socially, and thereby the importance of nursing interventions through preventive measures to prevent pressure ulcers to occur. Knowledge of preventive measures are described in the PM/treatment programs and needs to be implemented in teaching and complied in the healthcare settings.

No / Wounds arising from various conditions are painful, embarrassing and often requires treatment plans which are costly. A crucial task, during the treatment of wounds is the measurement of the size, area and volume of the wounds. This enables to provide appropriate objective means of measuring changes in the size or shape of wounds, in order to evaluate the efficiency of the available therapies in an appropriate fashion. Conventional techniques for measuring physical properties of a wound require making some form of physical contact with it. We present a method to model a wide variety of geometries of wound shapes. The shape modelling is based on formulating mathematical boundary-value problems relating to solutions of Partial Differential Equations (PDEs). In order to model a given geometric shape of the wound a series of boundary functions which correspond to the main features of the wound are selected. These boundary functions are then utilised to solve an elliptic PDE whose solution results in the geometry of the wound shape. Thus, here we show how low order elliptic PDEs, such as the Biharmonic equation subject to suitable boundary conditions can be used to model complex wound geometry. We also utilise the solution of the chosen PDE to automatically compute various physical properties of the wound such as the surface area, volume and mass. To demonstrate the methodology a series of examples are discussed demonstrating the capability of the method to produce good representative shapes of wounds.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.