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Background Although Pressure ulcer is common in high and middle income countries it is rarely researched in low income countries. Evidence based interventions of pressure ulcer prevention are developed but the gap between the evidence and the clinical practice is wide. Aim Describe the nurses‟ knowledge about pressure ulcer prevention at a provincial hospital in Ghana. Design An empirical qualitative approached was used and semi-structured interviews were made with nurses at the Kwahu Governmental Hospital in Atibie, Ghana. A content analysis and a deductive content analysis were used to analyze the material. The evidence based interventions suggested by the North American Nurses Association (NANDA) was used as a theoretical framework. Result / Conclusion The themes Pressure ulcer prevention and Nurses‟ knowledge were found. Most of the evidence based interventions were mentioned by the participants. However, the participants explained massage as a preventive intervention although the evidence advice against massage. The participants did not mention any interventions considering documentation and nutrition. Further the nurses explained that they achieved their knowledge in school by practical demonstrations and examinations. The nurses‟ opinion was that their knowledge is enough to prevent pressure ulcers. / <p>Röda Korsets sjuksköterskeförening stipendium 2011</p>

Background: Pressure ulcers are related to reduced quality of life for patients and high costs for health care. Guidelines for pressure ulcer prevention have been available for many years but the problem remains. Aim: The overall aim of this thesis was to investigate hospital setting factors that are important to the performance of pressure ulcer prevention and to evaluate an intervention focused on implementing evidence-based pressure ulcer prevention. Methods: Four studies with a qualitative and quantitative approach were conducted.  Registered nurses’ performance of pressure ulcer prevention for patients at risk was investigated. Factors related to pressure ulcer prevention at different levels in hospital organizations were examined (hospital and ward type, workload, and nurse staffing) in two hospitals. A quasi-experimental study evaluated the effects of an intervention focusing on pressure ulcer prevention and a descriptive study with interviews examined nurses and first-line managers’ experiences of this intervention. Results: All of the studies show that quality improvement was needed for patients at risk of pressure ulcer. Registered nurses attention to pressure ulcer prevention was low and the caring culture of the wards ranged from organized work to unorganized work. Factors related to pressure ulcer prevention were patients’ age (risk and skin assessment) and patients’ risk (skin assessment, pressure reducing mattresses and planned repositioning), type of hospital (university and general), and ward (geriatric, medical, and surgical). Nurse staffing and workload played a minor role. Significantly more patients received pressure ulcer prevention after the intervention. Important factors for improvement were the support nurses and managers received by external and internal facilitators. Another important factor was interpersonal communication on the care provided by the nurses and first-line managers. Conclusion: Quality improvement regarding evidence-based pressure ulcer prevention was needed. Factors associated with pressure ulcer prevention were related to all levels in the hospital settings. A comprehensive intervention showed statistically significant improvement in the care. Interpersonal communication among the staff based on quality measurements was the key factor. Managers from the micro- to the macro-level have to know the conditions for pressure ulcer prevention and, given their position, ensure that the necessary prerequisites are in place.

Introduktion: Trycksår är en vårdskada som kan uppstå i samband med kirurgiska ingrepp. Det medför ett stort lidande för patienten men även en kostnad för samhället. Alla patienter som opereras har en ökad risk att utveckla trycksår på grund av unika riskfaktorer som en operation medför. Därför har operationsteamet en särskild utmaning i att förebygga denna vårdskada.   Syfte: Syftet med studien var att undersöka vilka trycksårspreventiva åtgärder som operationsteamet använder.   Metod: Studien genomfördes som en observationsstudie med kvantitativ ansats. Operationsteam vid ett medelstort sjukhus i södra Sverige observerades.  Ett observationsprotokoll konstruerades för att fånga de åtgärder som operationsteamet använde. Totalt genomfördes 20 observationer.   Resultat: Operationsteamet tryckavlastade patientens hälar och bakhuvud. Patienten värmdes intraoperativt, personalen såg till att patienten inte låg med benen i kors eller låg på varmt underlag och anpassade  operationsbordet efter patientens behov. Flera möjliga trycksårsförebyggande metoder genomfördes inte alls eller i liten utsträckning. Operationsteamet repositionerade inte patienten varannan timme, instrument, personal och utrustning tilläts trycka på patienten och material fanns mellan patienten och den tryckavlastande madrassen.   Konklusion: Operationsteamet utnyttjade trycksårspreventiva åtgärder för att förhindra trycksår hos patienten. Dock fanns ett flertal trycksårsförebyggande åtgärder som sällan användes eller inte alls. / Introduction: Pressure ulcers are a common health problem that can be a complication in surgical procedures. It means a great suffering for the patient, but also a cost to society. The surgical team has a special challenge to prevent pressure ulcers that occur in the operating room. It´s because all patients who undergo surgery have an increased risk of developing pressure ulcers because of the unique risk factors that an operation means for the patient.   Aim: The purpose of this study was to investigate the methods that the surgical team use to prevent pressure ulcer in patients during surgery.   Method: The study was conducted as an observational study with quantitative approach. The study included 20 observations of surcial teams on a hospital in south Sweden. An observation protocol was created to capture the preventive methods the surgical team used.   Results: The surgical team depressurized the patients heels and occiput with pillows. The surgical team was warming the patient intraoperatively, made sure that the patient was not lying with legs crossed or laid on a warm surface. The staff adjusted the operating table to the patient's needs. Several possible methods to prevent pressure ulcers that was not used or rarely used, was also observed. The surgical team did not reposition the patient every two hours, equipment and staff were allowed to press against the patient and layers of material laid between the patient and the pressure ulcer preventing mattress.   Conclusion: The surgical team used pressure ulcer preventive methods to decrease the risks of pressure ulcer in the patients. However, there were a number of pressure ulcers prevention methods that were rarely used.

<p>Human motion monitoring is an important function in numerous applications. In this dissertation, two systems for monitoring motions of multiple human targets in wide-area indoor environments are discussed, both of which use radio frequency (RF) signals to detect, localize, and classify different types of human motion. In the first system, a coherent monostatic multiple-input multiple-output (MIMO) array is used, and a joint spatial-temporal adaptive processing method is developed to resolve micro-Doppler signatures at each location in a wide-area for motion mapping. The downranges are obtained by estimating time-delays from the targets, and the crossranges are obtained by coherently filtering array spatial signals. Motion classification is then applied to each target based on micro-Doppler analysis. In the second system, multiple noncoherent multistatic transmitters (Tx's) and receivers (Rx's) are distributed in a wide-area, and motion mapping is achieved by noncoherently combining bistatic range profiles from multiple Tx-Rx pairs. Also, motion classification is applied to each target by noncoherently combining bistatic micro-Doppler signatures from multiple Tx-Rx pairs. For both systems, simulation and real data results are shown to demonstrate the ability of the proposed methods for monitoring patient repositioning activities for pressure ulcer prevention.</p> / Dissertation

A ocorrência de úlcera por pressão (UPP) nos pacientes atendidos nos serviços de saúde é um problema significante tanto para os indivíduos como para os familiares e instituições do mundo todo. Os pacientes com restrição de mobilidade são os que têm maior risco. A assistência domiciliária pode contribuir com o atendimento humanizado na promoção da saúde e prevenção da doença assim como para orientar e acompanhar os cuidadores domiciliares no atendimento das necessidades dos pacientes com condições crônicas que estão sujeitos a complicações como a UPP. Este estudo é do tipo descritivo e quantitativo e teve como objetivos identificar nos pacientes em assistência domiciliária em um Distrito de Saúde, as características sóciodemográficas e clínicas, o escore de risco para a UPP pela escala de Braden; a prevalência de pacientes com UPP; as características da lesão e as medidas utilizadas para prevenção e tratamento. A população foi 47 pacientes, com 76,7% na faixa etária de 60 a 80 anos, 51% do sexo feminino, 42,5% casados, 85% de cor branca; predominância de escolaridade no nível fundamental 1 incompleto; 48,9% recebiam entre 3 a 5 salários mínimos; 91,5% pacientes eram dependentes de cuidadores. As morbidades mais freqüentes foram as doenças do sistema circulatório (63,8%) e do sistema nervoso (48,9%). Para 48,9% dos pacientes a restrição da mobilidade ocorreu em decorrência da própria doença. O escore médio da Escala de Braden foi 17, mínimo 10 e máximo 23 e os idosos tinham escores mais baixos. Nove pacientes tinham UPP (prevalência 19,1%). A localização anatômica de maior freqüência foi a região do trocânter do fêmur (29,4%) e a região dos calcâneos (23,5%). Quanto a classificação das UPP, o maior percentual (35,3%) encontrado foi no estágio I e 29,4% no estágio IV. Quanto ao tempo da lesão, 58,8% das UPP haviam surgido há 4 meses. Quanto a dimensão, mais de 40% das lesões tinham mais de 8 cm2 . Em referência às características do leito das feridas, 11 apresentavam mostravam sinais de cicatrização e 6 apresentavam esfacelo ou necrose. Embora 70% da população tivesse risco para UPP a grande maioria não utilizava as medidas básicas para prevenção da UPP. Em relação ao tratamento 29,4% citaram o uso de pomadas com antibióticos, medida desnecessária e contra-indicada; 35,3% citaram o uso de coberturas industrializadas e em 4 úlceras, foram utilizados produtos sem qualquer evidência como hipoglós, óleo de amendoim e talco. Considerando as características de cada paciente que apresentou a UPP como a idade, morbidade referida e escore da Escala de Braden é possível compreender que os fatores agiram sinergisticamente para o desenvolvimento da lesão e que as medidas que poderiam diminuir o impacto do excesso de pressão como a redução do tempo em uma mesma posição e o uso de colchão adequado não foram utilizadas com freqüência. A articulação entre os níveis de atenção à saúde é fundamental para esta população para possibilitar o atendimento integral e contínuo. A construção de redes de apoio entre a família, comunidade e serviços poderá facilitar a resolução dos problemas encontrados. / The occurrence of pressure ulcers (PU) in patients seen at health services is a significant issue for the individuals as well as for their families and institutions across the world. Patients with restricted mobility are those at the highest risk. Home care should contribute with humanized care in health promotion and disease prevention, as well as with the process of instructing and following home caregivers in their meeting the needs of patients with chronic conditions subject to complications like pressure ulcers. The objectives of this descriptive quantitative study were to identify the sociodemographic and clinical characteristics of home care patients in a health district, as well as their risk score for PU according to the Braden scale; the prevalence of patients with PU; the characteristics of the wound, and the measures used for prevention and treatment. The population consisted of 47 patients, with 76.7% in the age range of 60 to 80 years, 51% were women, 42.5% were married, and 85% were white. Most patients had incomplete fundamental studies, 48.9% received between 3 and 5 minimum salaries, and 91.5% were dependent on their caregivers. The most common morbidities were circulatory system (63.8%) and nervous system (48.9%) diseases. The mobility of 48.9% of patients was restricted due to the disease itself. The average score on the Braden Scale was 17 (minimum 10 and maximum 23), and the elderly had the lowest scores. Nine patients had PU (19.1% prevalence). The most frequent anatomic location was the femur trochanter region (29.4%) and the calcaneus (23.5%). In terms of PU classification, the higher percentage (35.3%) found was in stage I, and 29.4% in stage IV. As for wound time, 58.8% of PU had appeared four months before. In terms of the wounds dimension, over 40% were bigger than 8 cm2. Regarding the characteristics of the wound beds, 11 presented signs of healing, and six presented slough or necrosis. Although 70% of the population were at risk of PU, the majority did not use any basic PU prevention measures. As for treatment, 29.4% stated using ointments with antibiotics, which is unnecessary and contraindicated. Other 35.3% reported using industrialized dressings, and products without any evidence were used on four ulcers, like hipoglós®, peanut oil, and talc. The characteristics of each patient with PU, like age, referred morbidity and score on the Braden Scale make clear that the factors act synergistically toward the development of the wound. In addition, this shows that measures that could reduce the impact from the excessive pressure, like reducing the time in the same position and using an appropriate mattress were not frequently used. The articulation between health care levels is essential for this population in order to make integral and continuous health care possible. Constructing support networks between families, the community, and services could facilitate solving the identified problems.

<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.

Bakgrund: En kombination av olika riskfaktorer och ett yttre tryck bidrar till att patienter drabbas av trycksår. Sjuksköterskor i samarbete med undersköterskor ansvarar för att förhindra risken för trycksår hos patienter. Tidigare studie påvisar att femton procent av inneliggande patienter på sjukhus drabbas av trycksår. Syfte: Syftet med studien är att belysa varför patienter får trycksår trots att sjuksköterskan i samarbete med undersköterskan bör ha kunskaper för att förebygga vårdrelaterade trycksår. Metod: Författarna använder sig av metoden allmän litteraturöversikt. Tolv artiklar med både kvalitativ och kvantitativ ansats ligger till grund för resultatet. Resultat: Resultatet påvisar tre huvudteman som påverkar det förebyggande arbetet av vårdrelaterade trycksår. Dessa teman är kunskaper angående trycksårsprevention, hinder i trycksårspreventionen och personalrelaterade faktorer. Diskussion: De huvudteman och subteman som framkommer i resultatet är bidragande faktorer till att patienter i dag utvecklar vårdrelaterade trycksår. Faktorerna bidrar även till ett ökat vårdlidande för patienten. Ett lidande som kan undvikas om ett gott förebyggande arbete utförs. / Background: A combination of risk factors and external pressure might cause a patient suffering from pressure ulcer. Health-care professionals who work close to patients are responsible for preventing the risk of pressure ulcer. A study found that fifteen percent of hospitalized patients suffer from pressure ulcer. Aim: The aim of this study is to highlight why patients have pressure ulcers even though the nurse in collaboration with the assistant nurse should have the knowledge to prevent health care associated pressure ulcer. Method: This study is a literature review. Twelve articles, of both quantitative and qualitative approach, was found and included in the results. Results: The result shows three main themes that seems to influence the pressure ulcer prevention. These themes are knowledge in pressure ulcer prevention, barriers in pressure ulcer prevention and personnel-related factors. Discussion: The main themes and subthemes that emerged from the results are contributing factors to patients today are developing healthcare associated pressure ulcers. These factors also contribute to an increased care associated suffering for the patient. A suffering that can be avoided if a good preventive work are performed.

A ocorrência de úlcera por pressão (UPP) nos pacientes atendidos nos serviços de saúde é um problema significante tanto para os indivíduos como para os familiares e instituições do mundo todo. Os pacientes com restrição de mobilidade são os que têm maior risco. A assistência domiciliária pode contribuir com o atendimento humanizado na promoção da saúde e prevenção da doença assim como para orientar e acompanhar os cuidadores domiciliares no atendimento das necessidades dos pacientes com condições crônicas que estão sujeitos a complicações como a UPP. Este estudo é do tipo descritivo e quantitativo e teve como objetivos identificar nos pacientes em assistência domiciliária em um Distrito de Saúde, as características sóciodemográficas e clínicas, o escore de risco para a UPP pela escala de Braden; a prevalência de pacientes com UPP; as características da lesão e as medidas utilizadas para prevenção e tratamento. A população foi 47 pacientes, com 76,7% na faixa etária de 60 a 80 anos, 51% do sexo feminino, 42,5% casados, 85% de cor branca; predominância de escolaridade no nível fundamental 1 incompleto; 48,9% recebiam entre 3 a 5 salários mínimos; 91,5% pacientes eram dependentes de cuidadores. As morbidades mais freqüentes foram as doenças do sistema circulatório (63,8%) e do sistema nervoso (48,9%). Para 48,9% dos pacientes a restrição da mobilidade ocorreu em decorrência da própria doença. O escore médio da Escala de Braden foi 17, mínimo 10 e máximo 23 e os idosos tinham escores mais baixos. Nove pacientes tinham UPP (prevalência 19,1%). A localização anatômica de maior freqüência foi a região do trocânter do fêmur (29,4%) e a região dos calcâneos (23,5%). Quanto a classificação das UPP, o maior percentual (35,3%) encontrado foi no estágio I e 29,4% no estágio IV. Quanto ao tempo da lesão, 58,8% das UPP haviam surgido há 4 meses. Quanto a dimensão, mais de 40% das lesões tinham mais de 8 cm2 . Em referência às características do leito das feridas, 11 apresentavam mostravam sinais de cicatrização e 6 apresentavam esfacelo ou necrose. Embora 70% da população tivesse risco para UPP a grande maioria não utilizava as medidas básicas para prevenção da UPP. Em relação ao tratamento 29,4% citaram o uso de pomadas com antibióticos, medida desnecessária e contra-indicada; 35,3% citaram o uso de coberturas industrializadas e em 4 úlceras, foram utilizados produtos sem qualquer evidência como hipoglós, óleo de amendoim e talco. Considerando as características de cada paciente que apresentou a UPP como a idade, morbidade referida e escore da Escala de Braden é possível compreender que os fatores agiram sinergisticamente para o desenvolvimento da lesão e que as medidas que poderiam diminuir o impacto do excesso de pressão como a redução do tempo em uma mesma posição e o uso de colchão adequado não foram utilizadas com freqüência. A articulação entre os níveis de atenção à saúde é fundamental para esta população para possibilitar o atendimento integral e contínuo. A construção de redes de apoio entre a família, comunidade e serviços poderá facilitar a resolução dos problemas encontrados. / The occurrence of pressure ulcers (PU) in patients seen at health services is a significant issue for the individuals as well as for their families and institutions across the world. Patients with restricted mobility are those at the highest risk. Home care should contribute with humanized care in health promotion and disease prevention, as well as with the process of instructing and following home caregivers in their meeting the needs of patients with chronic conditions subject to complications like pressure ulcers. The objectives of this descriptive quantitative study were to identify the sociodemographic and clinical characteristics of home care patients in a health district, as well as their risk score for PU according to the Braden scale; the prevalence of patients with PU; the characteristics of the wound, and the measures used for prevention and treatment. The population consisted of 47 patients, with 76.7% in the age range of 60 to 80 years, 51% were women, 42.5% were married, and 85% were white. Most patients had incomplete fundamental studies, 48.9% received between 3 and 5 minimum salaries, and 91.5% were dependent on their caregivers. The most common morbidities were circulatory system (63.8%) and nervous system (48.9%) diseases. The mobility of 48.9% of patients was restricted due to the disease itself. The average score on the Braden Scale was 17 (minimum 10 and maximum 23), and the elderly had the lowest scores. Nine patients had PU (19.1% prevalence). The most frequent anatomic location was the femur trochanter region (29.4%) and the calcaneus (23.5%). In terms of PU classification, the higher percentage (35.3%) found was in stage I, and 29.4% in stage IV. As for wound time, 58.8% of PU had appeared four months before. In terms of the wounds dimension, over 40% were bigger than 8 cm2. Regarding the characteristics of the wound beds, 11 presented signs of healing, and six presented slough or necrosis. Although 70% of the population were at risk of PU, the majority did not use any basic PU prevention measures. As for treatment, 29.4% stated using ointments with antibiotics, which is unnecessary and contraindicated. Other 35.3% reported using industrialized dressings, and products without any evidence were used on four ulcers, like hipoglós®, peanut oil, and talc. The characteristics of each patient with PU, like age, referred morbidity and score on the Braden Scale make clear that the factors act synergistically toward the development of the wound. In addition, this shows that measures that could reduce the impact from the excessive pressure, like reducing the time in the same position and using an appropriate mattress were not frequently used. The articulation between health care levels is essential for this population in order to make integral and continuous health care possible. Constructing support networks between families, the community, and services could facilitate solving the identified problems.