| 1. |
- Wåhlin, Ingrid, et al.
(författare)
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Development and validation of an ICU-specific pressure injury risk assessment scale
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:3, s. 769-778
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Tidskriftsartikel (refereegranskat)abstract
- Background Critically ill patients are at high risk for pressure injury (PI) due to critical illness combined with multiple interventions and therapies. It is hence important to gain more knowledge about the risk factors associated with pressure injury development and methods for decreasing its prevalence. Aims To develop and validate a clinical useful ICU-specific PI risk assessment scale based on the RAPS. Method The study was designed as a prospective instrument development and validation study. The Risk Assessment Pressure Ulcer Scale (RAPS), which in Sweden is a commonly used PI risk assessment scale, was used as a starting point. Development was then performed in different steps; adaption of items and response options to ICU care, discussion with ICU staff members to enhance clinical relevance and usability, test of interrater reliability, revision of instrument, a new test with 300 patients followed by statistical evaluation. Results The final version of the RAPS-ICU consists of six items: failure of vital organs, mobility, moisture, sensory perception, level of consciousness and special treatment in the form of mechanical ventilation, continuous dialysis and/or inotropic drugs. A total score was reached by summing all responses. Each of the items was found to be significant associated with PI development as well as the total score (p < 0.001). The total score also showed a high interrater reliability (ICC = 0.96), good sensitivity and acceptable specificity with AUC = 0.71 and ICU staff perceived the RAPS-ICU as relevant and easy to use in clinical practice. Conclusion The RAPS-ICU is a valid and clinically useful tool to identify patients at risk to develop pressure injury at ICU.
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| 2. |
- Björk, Elisabeth, et al.
(författare)
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Single-stage hydrocyclone fractionation of refined bleached softwood pulp
- 2017
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Ingår i: Paper Conference and Trade Show, PaperCon 2017: Renew, Rethink, Redefine the Future. - : TAPPI Press. ; , s. 878-905, s. 878-905
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Refined bleached chemical softwood was fractionated using a hydrocyclone in a fine and a coarse fraction. The trials were done at three inject concentrations, three coarse fraction volume ratios, and with pulps refined with two refining levels.A large difference in sheet properties between fine and coarse fraction was observed. Compared with the feed pulp, the relative change in the sheet properties increased more in the fine fractions than it decreased in the coarse fractions. Increased fines proportion had a positive effect on all properties up to a certain level when a further improvement could not be observed. Interestingly, the fine fractions of both refining levels reached the same absolute strength level, both for the tensile properties and z-strength. The fine fractions at the highest coarse fraction mass ratios contained more fines, and the mean fibre was shorter and narrower. This led to higher density but also a decrease of the stretch-at-break and z-strength values.When comparing these results with previous fractionation results for unrefined pulp, it was found that inject concentration did not have a large effect on thickening in the present study. As for the refined pulp, the tensile index increased with fines proportion for the unrefined pulp, however, only up to a certain fines proportion where a maximum values was reached. The increase was larger for the refined pulps which had higher fines proportion.
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| 3. |
- Källman, Ulrika, et al.
(författare)
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Blood flow responses over sacrum in nursing home residents during one hour bed rest
- 2016
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Ingår i: Microcirculation. - : WILEY-BLACKWELL. - 1073-9688 .- 1549-8719. ; 23:7, s. 530-539
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo describe individual BF responses in a nursing home resident population for one-hour periods of bed rest. MethodsBF was measured for one hour over the sacrum in 0 degrees supine position and 30 degrees supine tilt position in 25 individuals aged 65 y or older while lying on a pressure-redistributing mattress. Measurements were made at three tissue depths (1, 2, and 10 mm) using the noninvasive optical techniques, LDF and PPG. ResultsEleven participants had a PIV response at 1mm depth in both positions and seven participants had a lack of this response at this depth and positions. The BF response at 1mm depth appeared immediately and remained over, or below, baseline for the entire 60min of loading in both positions. These BF patterns were also seen in deeper tissue layers. ConclusionsThe cutaneous BF response among the nursing home residents was distinct, appeared early, and remained during the one hour of loading.
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| 4. |
- Källman, Ulrika, et al.
(författare)
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Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
- 2016
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Ingår i: International Wound Journal. - : Wiley-Blackwell. - 1742-4801 .- 1742-481X. ; 13:6, s. 1168-1175
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.
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| 5. |
- Bergstrand, Sara, et al.
(författare)
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Microcirculatory responses of sacral tissue in healthy individuals and in patients on different pressure-redistribution mattresses
- 2015
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Ingår i: Journal of Wound Care. - : Mark Allen Group. - 0969-0700 .- 2052-2916. ; 24:8, s. 346-358
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.
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| 6. |
- Harle, Karolina, et al.
(författare)
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Experience of living with an enterocutaneous fistula
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley: 12 months. - 0962-1067 .- 1365-2702. ; 24:15-16, s. 2175-2183
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The purpose of this study was to describe patients experiences of living with an enterocutaneous fistula. Background. An enterocutaneous fistula is a complex and serious illness that usually occurs as a complication from surgery or spontaneously as a result of an underlying disease. The illness is demanding both physically and mentally and causes substantial medical and nursing problems for the afflicted individual. Design. A descriptive design with a qualitative approach. Methods. In-depth interviews were performed with nine participants who had experiences of living with an enterocutaneous fistula. The analysis was conducted using descriptive phenomenology according to Giorgi. Results. The essence of this study was that living with an enterocutaneous fistula is about handling an illness that causes several limitations in daily life and the following five themes emerged from the data: restrictions in daily life, approaches to illness, emotions, dependence and need of support. A constant fear of leakage from the fistula appliance, being dependent on intravenous fluids and being dependent on health care professionals caused isolation and social restriction. Conclusions. The participants had many strategies for handling their illness. By being well trained, engaged and having a positive and understanding approach, health care professionals can encourage hope, motivation and self-care. This can lead to decreased dependence and help the patient to better handle their illness. Relevance to clinical practice. The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.
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| 7. |
- Källman, Ulrika, 1968-
(författare)
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Evaluation of Repositioning in Pressure Ulcer Prevention
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: To reduce the risk for pressure ulcers, repositioning of immobile patients is an important standard nursing practice. However, knowledge on how this preventive intervention is carried out among elderly immobile patients is limited and to what extent patients perform minor movements between nursing staff-induced repositionings is largely unknown, but these movements might have implications for the repositioning intervention. Different lying positions are used in repositioning schedules, but there is lack of evidence to recommend specific positions.Aim: The overall aim of this thesis was to describe and evaluate how repositioning procedures work in practice in the care of elderly immobile patients. The aim was also to compare the effects of different positions with regard to interface pressure, skin temperature, and tissue blood flow in elderly patients lying on a pressure-redistribution mattress.Methods: This thesis consists of four quantitative studies. In Study I, 62 elderly immobile patients were included. All movements the patients made, either with help from the nursing staff or spontaneously, were registered continuously over the course of three days. Study II served to pilot the procedure for Study III. Tissue blood flow and skin temperature were measured in hospital patients (n = 20) for 5 minutes in two supine, two semi-Fowler, and two lateral positions. In Study III, a new sample was recruited (n = 25) from three nursing homes. Measurement of interface pressure was added, and the measurements were extended from 5 minutes to 1 hour. The six positions were reduced to four by excluding the two semi-Fowler positions. Blood flow was measured using photopletysmography (Study II-IV) and laser Doppler flowmetry (Studies III and IV). In Study IV a deeper analysis of the individual pressure-induced vasodilation (PIV) responses was performed on the sample from Study III. An age of 65 years or older was an inclusion criterion in all studies.Results: Study I showed that there was a large variation in the extent to which the elderly immobile patients made spontaneous movements, and these movements were positively related to taking analgesics and negatively related to taking psycholeptics. Patients scored as high risk for pressure ulcer development were repositioned more frequently than patients scored as low risk. However, the spontaneous movement frequency was not associated with any risk scores. Study II showed that the different lying positions influenced the blood flow in different ways. In Study III, it was found that the overall blood flow response during one hour of loading was significantly higher in the 30° supine tilt position than in the 0° supine, 30° lateral, and 90° lateral positions. The overall blood flow in the 90° lateral position did not differ compared to the 30° lateral position, although the interface pressure was significant higher in the 90° lateral position. In patients lacking a PIV response (Study IV), the blood flow decreased immediately and remained below baseline during the one hour of loading.Conclusions: Although elderly and immobilized, some patients frequently perform minor movements while others do not. Patients who cannot perform minor movements are important for the nursing staff to identify because they very likely need more intensive repositioning interventions. The spontaneous movement frequency was not associated with the risk assessment score, and this implies that some immobile patients assessed as low risk might need to be repositioned as often as patients assessed as high risk. Of the positions evaluated, the 30° supine tilt position was concluded to be most beneficial. There was no great difference in how the blood flow was affected in the 90° lateral position compared to the 30° lateral position, which question the appropriateness of the recommendation to avoid the 90° lateral position. The patients with lacking a PIV response might be particularly vulnerable to pressure, which also implies that these patients might need to be repositioned more frequently.
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| 8. |
- Källman, Ulrika, et al.
(författare)
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Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.
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| 9. |
- Källman, Ulrika, et al.
(författare)
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The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
- 2015
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Ingår i: Biological Research for Nursing. - : Sage Publications. - 1099-8004 .- 1552-4175. ; 17:2, s. 142-151
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.
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| 10. |
- Bergstrand, Sara, et al.
(författare)
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Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions
- 2014
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Ingår i: Microcirculation. - : John Wiley & Sons. - 1073-9688 .- 1549-8719. ; 21:8, s. 761-771
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.
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