Trycksår : preventiva omvårdnadsåtgärder och bedömningsinstrumentens effektivitet : en systematisk litteraturstudie

Syftet med denna litteraturstudie var att beskriva vilka omvårdnadsåtgärder som kan förebygga uppkomsten av trycksår samt vilken förmåga att identifiera patienter som riskerar att utveckla trycksår sjuksköterskan har med de bedömningsinstrument som finns. De vetenskapliga artiklarna (n = 20) som ingick i studien söktes via Högskolan Dalarnas databaser Blackwell Synergy, PubMed och ELIN@Dalarna. Sökorden som användes i olika kombinationer var pressure sore, pressure ulcers, nursing, routines, treatment, knowledge, methods, management, measures, risk assessment, scales, risk patients och prevention/preventing. Inklusionskriterierna var att de skulle vara empiriska, skrivna på svenska eller engelska samt vara publicerade efter 1997. Resultatet visade att det finns många olika förebyggande åtgärder som vidtas. I preventivt syfte var evidensbaserade bedömningsinstrument ett bra och användbart verktyg. Även tryckreducerande underlag som luft- eller trögskumsmadrasser, fårskinn eller vattenfyllda handskar användes som trycksårspreventiva åtgärder. Lägesändringar med hjälp av vändscheman samt tidig mobilisering var också förebyggande åtgärder som vidtogs. Patienternas näringsstatus har stor betydelse i det preventiva arbetet. Resultat visade att det förekommer näringstillägg som en förebyggande strategi. Kontinuerlig inspektion av hud samt noggrann hygien var även något som utfördes i preventivt syfte. Det finns en mängd olika bedömningsinstrument och resultatet av litteraturstudien visar att resultaten vad gällde skalornas förmåga att förutse trycksår varierade mellan olika studier. Uppsatsförfattarna anser att trycksårsprevention är viktigt då trycksår orsakar lidande för patienten och är kostsamma för samhället. Preventiva rutinmässiga åtgärder borde utföras inom de flesta patientgrupper och då är bedömningsinstrumenten en viktig del i det arbetet.

Trycksår : – undersköterskors kunskaper om att förebygga trycksår

Background and aims: The population of older people in our society is increasing. Agerelated changes in the skin results in a diminished perception of pain and pressure and a decreased microcirculation in the skin affects its ability to adapt to injury. Occurrence of pressure sore on geriatrikal clinics are 5-10%, witch means that between five and ten thousand patients gets daily treat for pressure sores. When the patient gets a pressure sore the need for help increases. A common apprehension is that if the patient’s affects with pressure sores it’s because of deficiency in care. According to the law, all nursing interventions should be performed according to scientific and evidence and the nurse’s assistants are responsible for how they perform. The aim of this study was to examine how much knowledge the nurses assistants in community care services has about preventing, predicting and locate riskfactors for pressure sores and if they get the right education. Methods: A questionnaire based on 20 questions was maid and used for this purpose. Out of 99 persons the questionnaires was answered bye 65 nurses assistants working in community care service in a small town in Sweden. Results: The results shown that the nurses assistants don’t use risk assessment scales in attempt to identify patients vulnerable to pressure sores and they are not well associated with the riskfactors. The study even shows that they have little knowledge in how to prevent pressure sores from appearing. The nursing model are some times out of date and the nurses assistants personal view attends to decide witch care they will perform instead of scientific and evidenced based nursing.

Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).