Trycksår är en vårdskada som orsakas av flera faktorer och skapar lidande för patienter. Årligen medför trycksår 50 000 extra vårddagar i Sverige och förlänger de redan belastade vårdköerna. Upp till 90 % av alla trycksår kan förebyggas med preventiva åtgärder. Trots riktlinjer och preventiva åtgärder mot trycksår uppstår fortfarande vårdskadan trycksår. Säker vård kännetecknas av att minimera riskerna för vårdskador. Syftet var att undersöka vilka faktorer som påverkar sjuksköterskors följsamhet till trycksårsprevention inom slutenvården. En kvantitativ litteraturöversikt har utförts med 12 artiklar, varav 10 inhämtade från Cinahl och Medline och två från manuell sökning. Litteraturöversiktens resultat visar att flera faktorer påverkar sjuksköterskors följsamhet till trycksårsprevention där kunskap var den största faktorn. Signifikanta skillnader sågs i att högre utbildning gav förbättrad trycksårsprevention och fördjupad kunskap medförde positiva attityder. Slutsatsen av litteraturöversikten ger en bild av hur kompetens, hög arbetsbelastning, organisationen och omvårdnadsarbetet påverkar sjuksköterskors följsamhet till trycksårsprevention. Studien ger en begränsad bild av hur dessa faktorer påverkar följsamheten, där kvalitativ forskning skulle kunna fastställa specifika problem sjuksköterskor upplever kring faktorerna mer djupgående. / Pressure ulcers is a care injury and is caused by several factors and cause patients suffering. Annually pressure ulcers entail 50 000 extra care days in Sweden and increases the already burdened care queues. Up to 90% of all pressure ulcers can be prevented with preventive measures. Despite guidelines and preventive measures the care injury pressure ulcers still occurs. Safe care is characterized by minimizing risks for care injuries. The aim was to examine factors that affect nurses’ compliance with pressure ulcer prevention in inpatient care. A quantitative literature review has been performed with 12 articles, 10 were collected from Cinahl and Medline and two with manual search. The result shows that several factors affected nurse’s compliance to pressure ulcer prevention where knowledge were the biggest factor. Significant differences were seen with that higher education gave better pressure ulcer prevention and higher education gave better attitude.  Conclusion of this literature review provides a picture of how competence, heavy workload, the organization and nursing work affects nurse's compliance with pressure ulcer prevention. This study provides a limited picture of how these factors affect compliance, where qualitative research could determine specific problems nurses experience around these factors more in depth.

Bakgrund: Trycksår är en skada i huden samt underliggande vävnad som kan uppstå efter tryck eller skjuv. Patienter som drabbas av trycksår uttrycker att det medför ett stort fysiskt, psykiskt och socialt lidande. Sjuksköterskan är ansvarig för omvårdnadsarbetet där trycksårsprevention är en del av det förebyggande arbetet och inbegriper riskbedömning, hudbedömning samt regelbunden repositionering. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors erfarenheter av trycksårsprevention inom slutenvården. Metod: Kvalitativ litteraturstudie baserad på 10 artiklar med kvalitativ studiedesign som inhämtats från databaserna Cinahl och Pubmed. De utvalda artiklarnas resultat analyserades genom konventionell innehållsanalys. Resultat: Genom innehållsanalysen utkristalliserades huvudkategorier och subkategorier ur artiklarnas resultat. Resultatet utformades i två huvudkategorier: Vårdteamet och Arbetsmiljö och sex subkategorier: Prevention, Kommunikation, Undersköterskan, Patienten, Organisatoriska faktorer och Hög arbetsbelastning. Konklusion: Sjuksköterskor hade erfarenhet av att vårdteamet och vårdgivarens organisatoriska ansvar hade en avgörande betydelse i arbetet med trycksårspreventionen. / Background: A pressure ulcer is an injury to the skin and underlying tissue that can occur after pressure or shear. Patients who suffer from pressure ulcers express that it causes great physical, psychological and social suffering. The nurse is responsible for the nursing work where pressure ulcer prevention is part of the preventive work and includes risk assessment, skin assessment and regular repositioning. Aim: The aim of the literature study was to shed light on nurses' experiences of pressure ulcer prevention in inpatient care. Method: Qualitative literature study based on 10 articles with a qualitative study design obtained from the databases Cinahl and Pubmed. The results of the selected articles were analyzed by conventional content analysis. Result: Through the content analysis, main categories and subcategories were crystallized from the results of the articles. The result was formed into two main categories: Care team and Work environment and six subcategories: Prevention, Communication, Nurse, Patient, Organizational factors and High workload. Conclusion: Nurses had experience that the care team and the caregiver's organizational responsibility had a decisive importance in the work with pressure ulcer prevention.

Background: Many nursing home residents are at risk of developing a pressure ulcer, which is an area of localised damage to the skin and/or underlying tissue due to immobility, increasing age and co-morbidities. Whilst guidelines for the prevention of pressure ulcers exist, their implementation can be sub-optimal. Care bundles are a set of research-informed practices used to facilitate the implementation of evidence into practice and incorporating psychological theory within their development may enhance their effectiveness. I aimed to co-design and assess the feasibility of implementing a theory and research-informed pressure ulcer prevention care bundle intervention in a nursing home setting. Method: This thesis comprised four separate studies as part of an overall mixed methods research design. Firstly, I conducted a systematic review and meta-analysis to determine the effects of care bundles per se on patient outcomes. I then conducted theory-informed qualitative, semi-structured interviews with nursing home care staff and NHS community-based nurses to explore the context of, and the barriers and facilitators to, pressure ulcer prevention in nursing homes. Next I co-designed a pressure ulcer prevention care bundle with 13 healthcare workers during a four hour workshop and supplemental email consultation. Using the Nominal Group Technique, we reached a consensus about the content of the care bundle. Following the steps of the Behaviour Change Wheel, I finalised the care bundle intervention. The final study involved a before-after study design where one nursing home implemented the care bundle intervention. I collected and analysed quantitative and qualitative data to gain a more holistic understanding of the feasibility issues related to the implementation. Findings: Findings from the systematic review suggested that care bundles may reduce the risk of negative outcomes in patients. These findings were based on very low quality evidence and the original study authors rarely reported adherence to the care bundle interventions. The theoretical understanding of the complexities in the prevention of pressure ulcers in nursing homes suggested there were four barriers and six facilitators, which my final care bundle intervention addressed. The co-designed care bundle intervention comprised three elements: support surfaces, skin inspection, repositioning; alongside three intervention functions and seven behaviour change techniques. In the final feasibility study, during the baseline period, there were 462 resident bed days and 5 new pressure ulcers recorded and in the intervention phase there were 1,181 resident bed days and no new pressure ulcers. The care bundle intervention appeared to be acceptable to the nursing home care staff and we have identified specific issues relating to the feasibility of implementing the care bundle intervention. Conclusions: The current research evidence-base for care bundles is poor. However, it was possible to co-design and implement a pressure ulcer prevention care bundle intervention for a nursing home setting. Further feasibility research is necessary before we can assess whether the care bundle intervention is effective in preventing pressure ulcers in nursing homes.

Bakgrund:Trycksår är ett stort och kostsamt problem för samhället som orsakar lidande ochsmärta hos patienten. Sjuksköterskan ska främja hälsa, förebygga ohälsa ochlindra lidande samt har ansvaret att identifiera risker och ordinera åtgärderför trycksårsprevention. Syfte medstudien var att beskriva och jämföra kunskap om och attityd till preventionav trycksår hos distriktssköterskan och sjuksköterskan inom kommunala hälso-och sjukvård. Metod: Beskrivande ochjämförande design med kvantitativ ansats. Enkäter delades ut till distriktsköterskor och sjuksköterskor som arbetade påsärskilt boende och hemsjukvård i fem kommuner. Det var 67 av 150 tillfrågadesom deltog i studien. Resultat: Resultatetvisade det att distriktsköterskans och sjuksköterskans kunskaper omtrycksårsprevention brister. Specifikt i frågorna omschema för lägesändring som minskar trycksårsrisken mest, avlastning av hälarpå tryckavlastande madrass, rätt sätt att reducera tryckkraften när en patientglider ner i en stol samt att syrebrist orsakar trycksår. Ingen signifikant skillnad mellan grupperna fannsgällande kunskap om trycksårsprevention. Attityden hos både distriktsköterskanoch sjuksköterskan var positiv och en signifikant skillnad fanns mellangrupperna. Distriktsköterskans hade en positivare attityd jämfört medsjuksköterskan. Sjuksköterskorna kändes sig mindre säker på sin förmåga attförebygga trycksår och distriktsköterskorna svarade i högre grad atttrycksårsprevention är en viktig uppgift. Slutsats:I föreliggande studie har deltagarna bristande kunskap om prevention avtrycksår och attityden hos både distriktsköterskan ochsjuksköterskan var positiv till trycksårsprevention. En skillnad mellangrupperna fanns där distriktsköterskan hade en positivare attityd jämfört medsjuksköterskan. / Introduction: Pressure ulcer is a common and expensive problem for society which causes suffering and pain for the patient. Registered nurses should promote health, prevent illness and relieve suffering and is responsible for identifying risk and prescribing measures for pressure ulcer prevention. The purpose of this study was to describe and compare district nurses and registered nurses knowledge and attitude to pressure ulcer prevention in municipal health care. The method: Descriptive and comparative design with quantitative approach. A questionnaire was distributed to district nurses and registered nurses who worked in nursing homes and home healthcare in five municipalities. It was 67 out of 150 respondents who participated in the study. The result: The result showed that district nurse and registered nurse’s lack in knowledge about pressure ulcer prevention. Specific in the question about position change that reduces pressure ulcer risk the most, relief of heels on pressure-reducing mattress, the right way to reduce the pressure force when a patient slides down in a chair and that oxygen deficiency causes pressure ulcer. No significant difference between the groups knowledge on pressure ulcer prevention was found. The attitude of both the district nurse and the registered nurse was positive and a significant difference was found between the groups. The district nurse had a more positive attitude compared to the registered nurse. Nurses felt less confident of their ability to prevent pressure ulcer and district nurses responded to a greater extent that pressure ulcer prevention is an important task. Conclusion: In this study, participants have insufficient knowledge about pressure ulcers prevention and the attitude of both the district nurse and the registered nurse was positive to pressure ulcer prevention. A difference between the groups was where the district nurse had a more positive attitude compared to the registered nurse.

Bakgrund Trycksår som uppstår under vårdtiden kan förebyggas. Dock utgör de fortfarande ettpågående säkerhets- och kvalitetsproblem inom vården. Olika evidensbaserade preventivainsatser finns för att undvika skadan. Trots detta är implementering i klinisk praxisbegränsad. En förståelse för de möjligheter och hinder i genomförandet av dessa insatser urolika perspektiv är av stor betydelse, så att riktade strategier kan införlivas igenomförandeplaner. Syfte Syftet var att belysa möjligheter och hinder för att förebygga trycksår. Metod En icke-systematisk litteraturöversikt som baserades på 16 vetenskapliga originalartiklarmed både kvalitativ och kvantitativ metod från databaserna PubMed och CINAHL.Artiklarna kvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag förvetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades meden integrerad dataanalys. Resultat I sammanställningen identifierades hur olika faktorer påverkar implementeringen avtrycksårsförebyggande arbete. Dessa faktorer delades in i tre huvudkategorier:organisation, personal och patienter. Möjligheter som en stödjande organisation,regelbundna utbildningsmöjligheter, tillgång till utrustning, positiva attityder, kompetentpersonal och patientmedverkan kan underlätta implementeringen. Otillräckliga resurser,bristande kunskap och utbildning, bristande dokumentation, negativa attityder,patientmotstånd, medicinskt instabil patient samt patientens bristande förståelse förtrycksårsprevention utgör hinder för implementering. Slutsats Möjligheter och hinder för att förebygga trycksår identifieras inom flera områden.För ett framgångsrikt trycksårsförebyggande arbete som leder till en signifikant minskningav uppkomsten av trycksår behövs en stödjande organisation som är beredd att göraförbättringsåtgärder för att åstadkomma bra förutsättningar så att personalen kan jobbaaktivt och effektivt med implementering av trycksårsförebyggande åtgärder. / Background Pressure ulcers that occur during the period of care can be prevented. However, they stillrepresent an ongoing safety and quality problem in healthcare. Various evidence-basedpreventive measures are available to avoid the damage. Despite this, implementation inclinical practice is limited. An understanding of the possibilities and barriers in theimplementation of these efforts from different perspectives is of great importance, so thattargeted strategies can be incorporated into implementation plans. Aim The aim was to identify facilitators and barriers to prevent pressure ulcers. Method A non-systematic literature review based on 16 original scientific articles using bothqualitative and quantitative methods from the databases PubMed and CINAHL. Thequality of the articles was checked based on Sophiahemmet University's assessment basisfor scientific classification and quality. The results were compiled and analyzed in anintegrated data analysis. Results In the compilation, identified how various factors affect the implementation of pressureulcer prevention work. These factors were divided into three main categories: organization,health care professionals and patients. Opportunities such as a supportive organization,regular educational opportunities, access to equipment, positive attitudes, competent staff,and patient involvement can facilitate the implementation. Insufficient resources, lack ofknowledge and training, lack of documentation, negative attitudes, patient resistance,medically unstable patients, and the patient's lack of understanding of the pressure ulcerprevention measures are barriers to implementation. Conclusions Possibilities and barriers to prevent pressure ulcers were identified in several areas. For asuccessful pressure ulcer prevention that leads to a significant reduction in the occurrenceof pressure ulcers, a supporting organization is needed to prepare to make improvementmeasures to create good conditions so that the staff can work actively and efficiently withthe implementation of pressure ulcer prevention measures.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

Bakgrund Trycksår definieras som ett sår orsakat av ischemi i vävnaden och kan indelas i olika kategorier. I Sverige beräknades omkring 11% av alla patienter utveckla sjukhusförvärvade trycksår och beräknas kosta runt 450 miljoner svenska kronor avseende förlängda vårdtider inom somatisk specialistvård. Förutom förlängda vårdtider skapar även trycksår ett stort lidande och sänkt livskvalitet för den drabbade. Kunskapen om trycksårsprevention och möjligheten till utbildning gällande trycksår tycks skilja sig runt om i världen. Säker vård handlar om att förebygga vårdskador och risk för vårdskador, säker vård är en del sjuksköterskans kärnkompetenser. Syfte Syftet med litteraturstudien är att identifiera hinder i det preventiva arbetet av trycksår inom sjukhusvård Metod En strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Resultat Hindren som identifierats för trycksårsförebyggande arbete var kunskapsbrist, organisatoriska faktorer, patienter och det praktiska utförandet. Kunskapsbrist identifierades av majoriteten av de länder som ingick i studien. Organisatoriska problem som fanns var bristen på riktlinjer, teamarbete, materialbrist, arbetsmiljö och utbildning. Patienter kunde även ses som ett hinder i arbetet med trycksårsprevention, det kunde då handla om exempelvis sjukdomstillstånd. Utförandet av trycksårsprevention sågs som bristfällig i flertalet studier där personal inte utförde riskbedömningar på patienter i riskzonen, det framkom även att all personal inte utför trycksårsprevention av oklar anledning vilket är ett hinder. Slutsats Denna litteraturstudie beskriver hinder i det trycksårsförebyggande arbetet. En stor del av problemen berör organisationer, det finns potential till förbättring inom området trycksårsprevention. / Background Pressure ulcer is defined as a wound caused by ischemia in the tissue and can be seperated into different categories. In Sweden around 11% of all patients were estimated to develop hospital aquired pressure ulcers, these were estimated to cost around 450 million swedish crowns in regard somatic specialty care. Disregarding length of care pressure ulcers also casues great patient suffering and lowers quality of life. The knowledge about pressure ulcer and the possibility to recieve training about pressure ulcers seems to vary between different countries. Safe care is used to prevent healthcare injuries and near miss healthcare injuries. Safe care i one of the core competencies for registered nurses. Aim The aim of the study is to identify barriers of pressure ulcer prevention in hospital care. Method A structured litterature review with elements of the methodology used in systematic reviews. Results The barriers wich were identified to pressure ulcer prevention were lack of knowledge, organisational factors, patients and in the practical work. Lack of knowledge were identified in the majority of studies included in the review. Organisational barriers were lack of guidelines, flaws in teamwork, lack of material, working environment and in education. Patients could be seen as a barrier to pressure ulcer prevention, such barrier could for example be the patients condition. The practical use of pressure ulcer prevention was viewed as flawed, in mulitple studies the personel did not use risk assessement tools on patients with a risk of pressure ulcer development, in some cases there appeared to be no reason as to why some personel did not use any risk assesment tools. Conclusions This litterature review describes barriers to pressure ulcer prevention. A large part of the problem is located in organizations, there is room for improvement in the field.