Resumo: A prevenção de úlcera por pressão (UP) constitui uma das prioridades na busca da qualidade na assistência à saúde e a segurança do paciente no contexto do cuidado hospitalar. Trata-se de um estudo metodológico que teve por objetivos propor um protocolo de prevenção de úlcera por pressão (UP) para pacientes clínicos hospitalizados, com base na literatura científica; realizar a validação semântica por expertises e a análise empírica por enfermeiros assistenciais; e apresentar o protocolo de prevenção de UP para pacientes clínicos no contexto hospitalar. O estudo foi realizado em duas etapas, a primeira com Revisão Integrativa (RI) e a segunda de validação semântica e de análise empírica. Na etapa da RI sobre as recomendações para elaboração de protocolos para UP, foi realizado busca nas bases de dados LILACS (Literatura Latino-Americana do Caribe em Ciências da Saúde) e Medline (Index Medicus Eletrônico da National Library of Medicine), com a pergunta: \"Quais as recomendações da literatura científica para a elaboração de protocolo para prevenção de UP?\", obtivemos uma amostra final com 21 artigos científicos, que foram categorizados em dois temas: \"Protocolos\", que recomenda especificidades sociodemográficas e clínicas com adoção de instrumento e escalas para dimensionar as lesões de pele e UP, além de intervenções de enfermagem; e \"Estratégias de implementação do protocolo\" que valoriza liderança dos enfermeiros, apoio da gestão, educação permanente, previsão e provisão de recursos humanos e materiais como fundamentais para a implantação. Estes, subsidiaram a proposição do protocolo de UP para pacientes clínicos hospitalizados com os elementos constituintes Diagnóstico Situacional e Caracterização da Clientela, Definição das opções terapêuticas, Implementação do protocolo e Implantação do protocolo. Na segunda etapa foi realizada a validação semântica pelos enfermeiros expertises e a análise empírica pelos enfermeiros assistências, por meio de um questionário on-line (CEP/EERP-USP 1.564.471), sendo que não houve necessidade de modificações no conteúdo ou apresentação do protocolo, segundo os critérios estabelecidos previamente. O produto final deste estudo é a \"Cartilha de implementação estratégica do protocolo\", para subsidiar a sua implementação na prática clínica, focalizando etapas para assegurar a sua operacionalização. Acreditamos que este protocolo poderá contribuir efetivamente na prevenção de UP para a melhoria da assistência aos pacientes clínicos hospitalizados, oferecendo segurança e cuidado integral / Abstract: The prevention of pressure ulcers (PU) is one of the priorities in the search for quality in health care and patient safety in the context of hospital care. This is a methodological study that aimed to propose a pressure ulcer prevention protocol (PU) for hospitalized clinical patients, based on the scientific literature; to accomplish a semantic validation by experts and an empirical analysis by health care nurses; and to introduce the PU prevention protocol for clinical patients in the hospital context. The study was held in two steps: the first with Integrative Review (IR) and the second with semantic validation and empirical analysis. In the step of IR about the recommendations for the elaboration of protocols for PU, we conducted a search in the LILACS (Latin American and Caribbean Health Sciences) and Medline (Electronic Index Medicus of the National Library of Medicine) databases, with the question: \"What are the recommendations of the scientific literature for the elaboration of PU prevention protocols?\", through which we obtained a final sample of 21 scientific papers, which were categorized into two themes: \"Protocols\", which recommends sociodemographic and clinical specificities with adoption of an instrument and scales to measure the skin lesions and PU, besides nursing interventions; and \"Strategies for implementing the protocol\", which appreciates leadership of nurses, management support, continuing education, prediction and provision of human and material resources as essential elements for the deployment. These topics subsidized the proposition of the PU protocol for hospitalized clinical patients with the constituent elements: Situational Diagnosis and Characterization of Customers, Definition of therapeutic options, Protocol implementation and Protocol deployment. In the second step, a semantic validation was accomplished by expert nurses and an empirical analysis by health care nurses, through an online questionnaire (CEP/EERP-USP 1,564,471), and there was no need for changes in the protocol content or introduction, according to previously established criteria. The final product of this study is the \"Booklet on strategic implementation of the protocol\", in order to subsidize its implementation in clinical practice, highlighting the steps to ensure its operationalization. We believe that this protocol may effectively contribute in the PU prevention for the improvement of the care of hospitalized clinical patients, offering safety and comprehensive care

O desenvolvimento de úlceras de pressão em pacientes hospitalizados é um grande problema de saúde que envolve vários fatores relacionados com o paciente e com o meio externo. A prática baseada em evidências torna-se uma proposta eficaz na adoção de medidas para a prática clínica que promovam a melhoria da qualidade do cuidado. Esta pesquisa foi desenvolvida com os objetivos de avaliar os efeitos de intervenções educativas no conhecimento dos profissionais de enfermagem em Centro de Terapia Intensiva, nas medidas prevenção utilizadas em sua prática clínica e nas taxas de incidência de úlcera de pressão e avaliar os fatores de risco presentes nos pacientes e a adequação das ações realizadas pela equipe de enfermagem. Foi desenvolvida em um Centro de Terapia Intensiva de um hospital universitário, de nível terciário e de grande porte no interior do Estado de São Paulo. O caminho metodológico foi construído considerando as fases do processo de adoção de uma inovação proposta por Rogers. Foram realizadas intervenções educativas junto à equipe de enfermagem visando à persuasão para a adoção de inovações para prevenção de úlceras de pressão baseadas em evidências. Para avaliar os efeitos das intervenções educativas, foram conduzidos três estudos na fase pré-intervenção e repetidos na fase pós-intervenção. No primeiro estudo, buscou-se identificar o nível de conhecimento dos profissionais da equipe de enfermagem sobre a úlcera de pressão e medidas de prevenção por meio de instrumento que continha questões fechadas. No segundo estudo, foi identificada a prática clínica adotada pela equipe de enfermagem para a prevenção de úlcera de pressão, por meio de observação não participativa. O terceiro estudo tratou da identificação da taxa de incidência de úlcera de pressão em pacientes internados no CTI e dos fatores de risco relacionados a esses. Os resultados evidenciaram que a intervenção educativa influenciou no conhecimento dos profissionais da equipe de enfermagem e em alguns aspectos de suas práticas clínicas referentes aos cuidados de prevenção, porém, não influenciou na incidência de úlcera de pressão, que foi de 62,5% nas fases pré e pós-intervenção. As variáveis estudadas associadas desenvolvimento de úlceras de pressão foram os escores das Escalas de Braden e Glasgow tempo de internação do paciente. Destaca-se a pouca participação dos enfermeiros nos cuidados básicos de higiene e avaliação do paciente. Alguns pontos importantes devem ter maior atenção dos enfermeiros e ter maior enfoque em programas educacionais. São eles: cuidados básicos de higiene; intensificação dos cuidados de prevenção, especialmente mobilização do paciente; adoção de instrumentos para avaliação do risco para o desenvolvimento de úlcera de pressão; realização de programas educacionais periódicos, enfocando a prevenção e adoção de estratégias para monitoramento do problema. Considerando os aspectos da prevenção de úlceras de pressão, uma prática criteriosa e de qualidade deve ser prioritária, utilizando-se estratégias que possam envolver a instituição e a equipe multidisciplinar que atua no CTI. / The development of pressure ulcers in hospitalized patients is a large health problem that involves various patient and environment-related factors. Evidence-based practice is an effective proposal for the adoption of clinical practice measures that promote improvements in health care quality. This research aimed to evaluate the effects of educational interventions on nursing professionals’ knowledge at an intensive therapy center, on the prevention measures used in their clinical practice and on pressure ulcer incidence rates, as well as patients’ risk factors and the adequacy of the nursing team’s actions. The study was carried out at the Intensive Therapy Center (ITC) of a large tertiary-care university hospital in the interior of São Paulo State. The methodological course was constructed in view of the innovation adoption curve proposed by Rogers. Educational interventions were realized involving the nursing team, with a view to convincing them to adopt innovations to prevent pressure ulcers, based on evidences. In order to assess the effects of educational interventions, we conducted three studies in the pre-intervention phase, which were repeated after the intervention. In the first study, we aimed to identify nursing team professionals’ knowledge about pressure ulcers and prevention measures, using an instrument with closed questions. In the second study, we identified the clinical practice the nursing team adopted to prevent pressure ulcer, using non-participant observation. The third study was aimed at identifying pressure ulcer incidence levels in patients hospitalized at the ITC and related risk factors. Results demonstrated that the educational intervention influenced nursing team professionals’ knowledge and some clinical practice aspects related to preventive care, but did not affect pressure ulcer incidence levels, which corresponded to 62.5% in the pre- and post-intervention phases. We studied the Braden Score, the Glasgow Scale and hospitalization times as variables associated with the development of pressure ulcers. Nurses participated little in basic hygiene care and patient assessment. Both nurses and education programs should give more attention to some important points. These are: basic hygiene care; intensification of preventive care, especially patient mobilization; adoption of risk assessment instruments for the development of pressure ulcer; realization of periodical education programs focused on prevention and adoption of problem-monitoring strategies. In view of aspects of pressure ulcer prevention, a discerning and high-quality practice should be prioritized, using strategies that can involve the institution and the multidisciplinary team active at the institution.

The issue of pressure ulcers is related to limited mobility of P/Cs in bed, and is well known at present. With regard to the permanent increase of surviving P/Cs in critical conditions the prevention of pressure ulcers is a current nationwide topic. Nevertheless, statistical information admits the occurrence of pressure ulcers. The occurrence of pressure ulcers is a rapidly developing nursing problem. This problem has to be taken into account and its prevention has to start from the very beginning of the limited mobility of a P/C in bed.The theoretical part of the thesis is divided into three areas. The first one describes the quality of nursing care in general. The second area is directly focused on pressure ulcers. A chapter dealing particularly with the prevention of pressure ulcers at an ARD extends the last area of the theoretical part. Two goals were set for this thesis: 1. To map the roles of nurses (medical rescue workers) in the prevention of pressure ulcers at an ARD. 2. To map the factors affecting the occurrence of pressure ulcers at an ARD. Four research questions were formulated to achieve the goals: 1. What role does a nurse (a medical rescue worker) play in the prevention of pressure ulcers at an ARD? 2. What factors influence the occurrence of pressure ulcers at an ARD? 3. What information do nurses (medical rescue workers) working at an ARD miss? 4. What problems do nurses (medical rescue workers) working at an ARD have? The empiric part of the thesis was processed by a qualitative method in the forms of the semi-structured interview and involved observation. On the basis of the obtained data the research was extended by a chapter "The Occurrence of Pressure Ulcers", where the data obtained from the head nurses of the involved workplaces was processed and described to summarize the research. The elaboration and the processing of the research brought answers to all four research questions. The results of the research have revealed a number of roles that nurses play. The roles are: the provision of the prevention as such, detection of the first stage of a pressure ulcer, the care of a pressure ulcer already occurred and the prevention of complications. The internal and external factors influencing the occurrence of pressure ulcers are also describer here. The information on the issues of pressure ulcers prevention among nurses and medical rescue workers, the interest in the issues, where the results are surprising in the negative sense, where two thirds of the respondents showed disinterest. We have found that the respondents miss basic information like the classification of pressure ulcers, the information on modern prevention materials and on the healing and treatment of pressure ulcers. Problems in the prevention of pressure ulcers based on two sides were also found out, namely on the side of the management and on the side of the nursing care. On the basis of the circumstances ascertained within the research head nurses from the involved workplaces of the "X" region have been invited to participate in the organization of a seminar for nurses and medical rescue workers working at ARDs, focused on the topic: The issues of the prevention of pressure ulcers at an anaesthesiology and resuscitation department.

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.

<p>Syftet med denna litteraturstudie var att beskriva hur sjuksköterskor arbetar med preventiva åtgärder vid trycksårs uppkomst samt vilka omvårdnadsåtgärder som ges till patienter som utvecklat trycksår. Vetenskapliga artiklar söktes i databaserna Medline via Pubmed och Cinahl med sökorden nursing, pressure ulcer, prevention, treatment, therapy, intervention. Endast artiklar från år 2003- mars 2008 användes i studien. Både kvantitativa och kvalitativa artiklar användes, dessa artiklar granskades utifrån två modifierade granskningsprotokoll. Resultatet påvisade variationer av dessa preventiva insatser som sjuksköterskor använde sig av. Att tillföra kosttillskott som vitamin C, zink och proteiner som ett komplement till den vanliga sjukhusmaten visade ett positivt gensvar för läkning av trycksår. Tryckavlastning i form av tryckreducerande madrasser, vändscheman, speciella sittdynor, riskbedömningsinstrument i datasystem samt sjuksköterskornas kliniska blick används i hög grad till patienter som befann sig i riskzonen för att utveckla trycksår samt till patienter som hade utvecklat trycksår.</p> / <p>The aim of this literature review was to describe how nurses´ work with preventive measures for pressure ulcer and method of treatments to patients who have developed pressure ulcer. Scientific articles were searched for in Medline via Pubmed and Cinahl data base using the search terms: nursing, pressure ulcer, prevention, treatment, therapy, and intervention. Only articles that were published January 2003 to March, 2008 was used in the study. Both qualitative and quantitative articles were used and these articles were reviewed on the basis of two modified quality assessment instruments. The results showed a variation of preventive measures used by nurses. Adding nutritional supplements such as vitamin C, zinc and proteins gave a positive response for healing of pressure ulcers. Pressure-reducing techniques such as pressure-reducing mattresses, turning schedules, special cushions, pressure ulcer risk assessment scales and, last but not least, the nurses’ clinical flair was highly used for patients at risk of developing pressure ulcers and to patients who already had developed pressure ulcers.</p>

<p>The aims of the present thesis were to survey the prevalence and incidence ofpressure ulcers in patients with hip fracture and to investigate nursing staffknowledge and documentation regarding pressure ulcer prevention for the samepatient group. Another aim was to test the effect of three preventive interventions:risk assessment and pressure ulcer grading, a pressure-reducing mattress and aneducational programme. Experimental, comparative and descriptive designs wereused and quality improvement philosophy guided the research. In 1997 and 1999, atotal of 124 and 101 patients > 65 years with hip fractures were included andfollowed with risk assessment and skin observation. Audit of patient records, aquestionnaire to nursing staff and a focus group interview were also employed.</p><p>The findings from the first studies showed that 20% of the patients hadpressure ulcers on arrival to the hospital. During the hospital stay, 55% developednew pressure ulcers. Nursing staff knowledge and documentation regardingpressure ulcer prevention was unsatisfactory. An extensive educational programmewas developed and conducted in 1998. Twenty-five registered nurses participatedfrom the hospital and the community setting.</p><p>There were no significant differences in the prevalence/incidence ofpressure ulcers between the experimental and control groups in the twoexperimental studies. However, there was a significant reduction of the incidence ofpressure ulcers between 1997 and 1999 (from 55% to 29%). The focus group indicatedthat there had been changes since 1997 in nursing and treatment routines in theAccident and Emergency Department and in the orthopaedic wards.</p>

The aims of the present thesis were to survey the prevalence and incidence ofpressure ulcers in patients with hip fracture and to investigate nursing staffknowledge and documentation regarding pressure ulcer prevention for the samepatient group. Another aim was to test the effect of three preventive interventions:risk assessment and pressure ulcer grading, a pressure-reducing mattress and aneducational programme. Experimental, comparative and descriptive designs wereused and quality improvement philosophy guided the research. In 1997 and 1999, atotal of 124 and 101 patients &gt; 65 years with hip fractures were included andfollowed with risk assessment and skin observation. Audit of patient records, aquestionnaire to nursing staff and a focus group interview were also employed. The findings from the first studies showed that 20% of the patients hadpressure ulcers on arrival to the hospital. During the hospital stay, 55% developednew pressure ulcers. Nursing staff knowledge and documentation regardingpressure ulcer prevention was unsatisfactory. An extensive educational programmewas developed and conducted in 1998. Twenty-five registered nurses participatedfrom the hospital and the community setting. There were no significant differences in the prevalence/incidence ofpressure ulcers between the experimental and control groups in the twoexperimental studies. However, there was a significant reduction of the incidence ofpressure ulcers between 1997 and 1999 (from 55% to 29%). The focus group indicatedthat there had been changes since 1997 in nursing and treatment routines in theAccident and Emergency Department and in the orthopaedic wards.

Syftet med denna litteraturstudie var att beskriva hur sjuksköterskor arbetar med preventiva åtgärder vid trycksårs uppkomst samt vilka omvårdnadsåtgärder som ges till patienter som utvecklat trycksår. Vetenskapliga artiklar söktes i databaserna Medline via Pubmed och Cinahl med sökorden nursing, pressure ulcer, prevention, treatment, therapy, intervention. Endast artiklar från år 2003- mars 2008 användes i studien. Både kvantitativa och kvalitativa artiklar användes, dessa artiklar granskades utifrån två modifierade granskningsprotokoll. Resultatet påvisade variationer av dessa preventiva insatser som sjuksköterskor använde sig av. Att tillföra kosttillskott som vitamin C, zink och proteiner som ett komplement till den vanliga sjukhusmaten visade ett positivt gensvar för läkning av trycksår. Tryckavlastning i form av tryckreducerande madrasser, vändscheman, speciella sittdynor, riskbedömningsinstrument i datasystem samt sjuksköterskornas kliniska blick används i hög grad till patienter som befann sig i riskzonen för att utveckla trycksår samt till patienter som hade utvecklat trycksår. / The aim of this literature review was to describe how nurses´ work with preventive measures for pressure ulcer and method of treatments to patients who have developed pressure ulcer. Scientific articles were searched for in Medline via Pubmed and Cinahl data base using the search terms: nursing, pressure ulcer, prevention, treatment, therapy, and intervention. Only articles that were published January 2003 to March, 2008 was used in the study. Both qualitative and quantitative articles were used and these articles were reviewed on the basis of two modified quality assessment instruments. The results showed a variation of preventive measures used by nurses. Adding nutritional supplements such as vitamin C, zinc and proteins gave a positive response for healing of pressure ulcers. Pressure-reducing techniques such as pressure-reducing mattresses, turning schedules, special cushions, pressure ulcer risk assessment scales and, last but not least, the nurses’ clinical flair was highly used for patients at risk of developing pressure ulcers and to patients who already had developed pressure ulcers.

Bakgrund: Trycksår är vanligt förekommande inom vården. En koppling har gjorts mellan försämrad nutritionsstatus och ökad risk för trycksår. Ett sätt att påverka näringsstatusen kan vara att ge näringstillskott och genom detta indirekt påverka läkningen av trycksår, detta omvårdnadsansvar ligger hos sjuksköterskan. Ett problem kan dock vara att kunskapen hos sjuksköterskor gällande näringstillskott kan variera. Syfte: Syftet var att beskriva näringstillskotts effekt på läkningen av trycksår. Metod: Studien gjordes som en litteraturöversikt (n=10) baserade på kvantitativa artiklar. Resultat: Studiens resultat visade att de flesta näringstillskott hade positiv effekt på läkningen av trycksår. Tillskott i form av arginin, vitamin C och zink i kombination och hydrolyserat protein gav en förbättrad sårläkning. Tillskott i form av fiskolja visade ingen signifikant förbättring. Slutsats: Näringstillskott innehållande arginin, vitamin C och zink och i kombination har visat sig kunna påverka läkningsprocessen vid trycksår positivt. Studier visar dock att kunskapen hos sjuksköterskor gällande näringens roll i vården är bristande. Skulle detta bero på att informationen är svårförståelig, hoppas vi att den föreliggande studien kan bidra till ökat intresse och kunskap kring näringstillskotts effekt på läkningen av trycksår. / Background: Pressure ulcers are common in health care. A connection has been made between poor nutritional status and pressure ulcers. One way of affecting the nutritional status could be by giving nutritional supplements and by this affect the healing of pressure ulcers positively. The registered nurse is responsible of providing this care. An issue could be the lack of knowledge regarding nutritional supplements. Aim: The purpose of this study was to describe the nutritional supplements effect on pressure ulcer healing. Method: The study was executed as a literature review (n=10) based on quantitative studies. Result: The result of the study showed that most of the nutritional supplements have had a positive effect. Supplements such as arginine, vitamin C and zinc in combination and hydrolysated protein gave an improved wound healing. The supplement containing fish oil showed no significant improvements. Conclusion: Nutritional supplements containing arginine, vitamin C and zinc showed a positive effect on the healing of pressure ulcers. Studies show that nurses’ knowledge regarding nutrition in ulcer care is incomplete. If the reason behind this is that the information is difficult to understand our hope is that this study will make it easier to learn more about nutritional supplements, what supplements that should be used and its role in pressure ulcer care.

Syftet med denna systematiska litteraturstudie var att ta reda på vilka mätinstrument som används för att identifiera patienter med risk att utveckla trycksår samt beskriva vilka omvårdnadsåtgärder som har betydelse för trycksårsprevention och sårläkning. De vetenskapliga artiklarna (n=16) som ingick i denna studie söktes i databasen Elin@dalarna. Sökorden som användes var pressure ulcer i olika kombinationer med nutrition, activity, skin, Norton, treatment och hydrocolloid. Inklusionskriterierna var att artiklarna skulle vara publicerade mellan åren 1999-2006 och vara i fulltext samt svensk och/eller engelskspråkig. Resultatet visade att patienter borde riskbedömas för trycksår så snart som möjligt efter att de anlänt till vårdinrättningen. Bedömningen kunde göras med ett flertal olika evidensbaserade mätinstrument såsom Norton, modifierad Norton, Braden, modifierad Braden, och RAPS skalorna samt bedömning av BMI, serum albuminvärde och hudtemperatur. Sjuksköterskans omvårdnadsåtgärder gällande prevention och sårläkning var att snabbt mobilisera patienter. Hos immobiliserade patienter var det viktigt att dessa vändes varannan timme samt att sjuksköterskan använde kuddar, fårskinn eller anti- decubitus madrasser för att tryckavlasta huden i denna patientgrupp. Resultatet visade även att kosttillägg hade stor betydelse för trycksårsprevention och sårläkning. Det var viktigt att sjuksköterskan rengjorde såret med tvål/vatten eller natriumklorid och använde hydrocolloida förband för att få en optimal sårläkning.