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- Beeckman, Dimitri, et al.
(författare)
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EPUAP classification system for pressure ulcers : european reliability study
- 2007
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Ingår i: Journal of Advanced Nursing. - 0309-2402 .- 1365-2648. - 0309-2402 ; 60:6, s. 682-691
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. Background. Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. Methods. A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. Results. Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. Conclusion. Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.
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| 2. |
- Beeckman, D., et al.
(författare)
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EPUAP classification system for pressure ulcers : European reliability study
- 2007
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 60:6, s. 682-691
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. BACKGROUND: Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. METHODS: A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. RESULTS: Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. CONCLUSION: Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.
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| 7. |
- Gunningberg, L., et al.
(författare)
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Accuracy in the recording of pressure ulcers and prevention after implementing an electronic health record in hospital care
- 2008
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Ingår i: Quality and Safety in Healthcare. - : BMJ. - 1475-3898 .- 1470-7934 .- 1475-3901. ; 17:4, s. 281-285
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the accuracy in recording of pressure-ulcer prevalence and prevention before and after implementing an electronic health record (EHR) with templates for pressure-ulcer assessment. Methods: All inpatients at the departments of surgery, medicine and geriatrics were inspected for the presence of pressure ulcers, according to the European Pressure Ulcer Advisory Panel -methodology, during 1 day in 2002 (n= 357) and repeated in 2006 (n= 343). The corresponding patient records were audited retrospectively for the presence of documentation on pressure ulcers. Results: In 2002, the prevalence of pressure ulcers obtained by auditing paper-based patient records (n= 413) was 14.3%, compared with 33.3% in physical inspection (n= 357). The largest difference was seen in the geriatric department, where records revealed 22.9% pressure ulcers and skin inspection 59.3%. Four years later, after the implementation of the EHR, there were 20.7% recorded pressure ulcers and 30.0% found by physical examination of patients. The accuracy of the prevalence data had improved most in the geriatric department, where the EHR showed 48.1% and physical examination 43.2% pressure ulcers. Corresponding figures in the surgical department were 22.2% and 14.1%, and in the medical department 29.9% and 10.2%, respectively. The patients received pressure-reducing equipment to a higher degree (51.6%) than documented in the patient record (7.9%) in 2006. Conclusions: The accuracy in pressure-ulcer recording improved in the EHR compared with the paper-based health record. However, there were still deficiencies, which mean that patient records did not serve as a valid source of information on pressure-ulcer prevalence and prevention.
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| 14. |
- Jangland, Eva, et al.
(författare)
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Patients’ experiences of interactions with health professionals in a surgical setting : implications for the advancement of person-centered medicine
- 2012
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Ingår i: International Journal of Person Centered Medicine. - 2043-7730. ; 1:4, s. 756-765
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the experiences of patients who complain about negative interactions with health professionals in a surgical setting. The study was based on interviews with patients (n = 15) who had contacted their local Patients’ Advisory Committee to report their negative interaction with health professionals in a large university hospital in Sweden. Exploring the experiences of patients who report negative interactions may be a starting point for learning about the patients’ views of the health care organisation, and this information may contribute to quality improvement. The interviews were analysed using qualitative content analysis. Patients’ experiences of negative interactions are described under three main themes: ‘having lost confidence’, ‘feeling like a nuisance’ and ‘feeling abandoned and lonely’. Negative interactions with health professionals caused long-term consequences for patients, including suffering, insecurity, and worry. It also reduced their confidence in upcoming consultations. From the patients’ perspective a caring relationship with health professionals and reliable, appropriate, and timely information are vital to high quality care. Patient access to information and positive interactions with health professionals should be routine quality indicators in the surgical care unit. In the process of quality improvement, all health professionals need to be involved in setting goals, making small tests of changes, and evaluating outcomes. Patients’ stories of negative interactions could provide the impetus for professional reflection sessions in the surgical care unit and for education for all health professionals to develop new competence in patient relations
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| 16. |
- Sving, E., et al.
(författare)
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The experiences of operating room teams working with real-time feedback of interface pressure to prevent pressure injuries : A feasibility study
- 2020
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Ingår i: Perioperative Care and Operating Room Management. - : Elsevier BV. - 2405-6030. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgical patients have an increased risk of sustaining a pressure induced injury. Novel technology has made it possible to objectively measure and visualize the interface pressure between the patient's tissue and the support surface in real time. The aim of this study was to describe operating room team members’ experiences of working with a pressure mapping system as a means to prevent intraoperative and postoperative recovery unit pressure injuries, and to describe the interface pressures and the incidence of observed pressure injuries. Methods: We used a descriptive design with a qualitative approach to investigate the operating room team members’ experiences of working with real-time feedback of interface pressure, and a quantitative approach to investigate the interface pressures and the incidence of observed pressure injuries. The technology was used during 49 surgeries. Results: The system increased clinician awareness and was considered beneficial in pressure injury prevention activities. There were wide variations in the interface pressures that measured from < 50 to 255 mmHg. Eight patients developed blanchable erythema during surgery and five other patients developed category 1 pressure injuries two hours postoperatively. Conclusions: This study shows that the new technology could play an important role in preventing pressure injuries during surgery in the future.
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| 17. |
- Wadensten, Barbro, et al.
(författare)
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Why is pain still not being assessed adequately? : Results of a pain prevalence study in a university hospital in Sweden
- 2011
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:5-6, s. 624-634
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Tidskriftsartikel (refereegranskat)abstract
- Aim.The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital.Background.Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients.Design.Quantitative and explorative.Method. Survey. Results.Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain > 3 and 42 center dot 1% rated their pain > 7. Of the patients who reported having experienced pain during the preceding 24 hours, 38 center dot 7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29 center dot 6% of the patients were completely satisfied, and 11 center dot 5% were not at all satisfied with their participation in pain management.Conclusions.The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups. Relevance to clinical practice. Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.
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