Aims and Scope
Recent Articles
The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review
Natalie A. Floyd, Karen A. Dominguez-Cancino, Linda G. Butler, Oriana Rivera-Lozada, Juan M. Leyva-Moral, Patrick A. Palmieri
Background:
Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.
Methods:
This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.
Results:
The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.
Conclusion:
Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
April 20, 2021
Articles
- March 17, 2021
Factors Affecting the Eating Behavior Disorders of Korean College Students
March 17, 2021Knowledge, Attitude, and Practice of Primigravida Women on Birth Preparedness
February 16, 2021Islamic-based Disaster Response Competencies: Perceptions, Roles and Barriers Perceived by Nurses in Aceh, Indonesia
February 16, 2021Factors Affecting Students’ Preference for Nursing Education and their Intent to Leave: A Cross-sectional Study
February 16, 2021Predictive Model for the Quality of Life of Infertile Men
March 17, 2021Burden and Depression among Jordanian Caregivers of Hemodialysis Patients: A Cross-sectional Study
Editor's Choice
Night-time Noise Levels and Patients’ Sleep Experiences in a Medical Assessment Unit in Northern England
Felicity Astin, John Stephenson, Jonathan Wakefield, Ben Evans, Priyanka Rob, Garside Joanna, Emma Harris
Background:
Hospital in-patients need sleep so that restorative process and healing can take place. However, over one third of in-patients experience sleep disturbance, often caused by noise. This can compromise patients’ perceptions of care quality and cause physical and psychological ill health.
Aims:
To assess 1) in-patients sleep quality, quantity, reported sources of sleep disturbance and their suggestions for improvement 2) objectively measure decibel levels recorded at night.
Methods:
This descriptive study conducted in a Medical Assessment Unit used multi-methods; a semi-structured ‘sleep experience’ questionnaire administered to a purposive sample of in-patients; recording of night-time noise levels, on 52 consecutive nights, using two calibrated Casella sound level meters.
Results:
Patient ratings of ‘in-hospital’ sleep quantity (3.25; 2.72 SD) and quality (2.91; 2.56 SD) was poorer compared to ‘home’ sleep quantity (5.07; 2.81 SD) and quality (5.52; 2.79 SD). The difference in sleep quality (p<0.001) and quantity (p<0.001) ratings whilst in hospital, compared to at home, was statistically significant. Care processes, noise from other patients and the built environment were common sources of sleep disturbance. Participants’ suggestions for improvement were similar to interventions identified in current research. The constant noise level ranged from 38-57 decibels (equivalent to an office environment), whilst peak levels reached a maximum of 116 decibels, (equivalent to banging a car door one metre away).
Conclusion:
The self-rated patient sleep experience was significantly poorer in hospital, compared to home. Noise at night contributed to sleep disturbance. Decibel levels were equivalent to those reported in other international studies. Data informed the development of a ‘Sleep Smart’ toolkit designed to improve the in-patient sleep experience.
June 18, 2020
Other Post
- February 28, 2019
Revisiting The Meaning of A Good Nurse
January 31, 2019
m-Health in the Surgical Context: Prospecting, Review and Analysis of Mobile Applications
April 24, 2018
Evaluating Pictures of Nature and Soft Music on Anxiety and Well-Being During Elective Surgery
January 22, 2018
Shared Decision-Making for Nursing Practice: An Integrative Review
November 30, 2017
A Systematic Review and Comprehensive Critical Analysis Examining the Use of Prednisolone for the Treatment of Mild to Moderate Croup
December 29, 2017
Challenges of Obtaining Informed Consent in Emergency Ward: A Qualitative Study in One Iranian Hospital
