Basınç Yaralanmalarının Önlenmesinde Daha İyi Sonuçlara Doğru: Kanıta DayalıUygulamalar

Deri bütünlüğünü bozan, enfeksiyon riskini arttıran, hastanın yaşam kalitesini azaltan ve tedavi süresini uzatan basınç yaralanmalarınınönlenmesi, dünyada ve ülkemizde bakım kalitesinin indikatörlerinden biri olarak kabul edilmektedir. Uzun yıllardır üzerinde yoğunçalışmalar yapılan basınç yaralanmalarının önlenmesinde kanıta dayalı birçok uygulama olduğu görülmektedir. Bu kanıtlar; risk tanılamada ölçeklerin uygulanabilirliğini, cildin gözlemlenmesi ve bakımında hemşirelik yaklaşımın önemini, beslenmenin yaraiyileşmesindeki etkilerini, pozisyon değişikliğinin yara oluşumunu engellediğini ve eğitimin hemşirelik bakımındaki yerini göstermiştir.Teknolojinin de gelişmesiyle birçok yeni yöntem ve aracın basınç yaralanmalarını nasıl önleyebileceği araştırılmaktadır. Yayınlananuluslararası kılavuzlarda basınç yaralanmalarının önlenmesi için temel noktalar risk tanılama, cilt bakımı, beslenme, pozisyon değiştirme,mobilizasyon ve eğitim olarak belirtilmiştir. Bu derlemede basınç yaralanmalarının önlenmesine yönelik hemşirelik yaklaşımının güncelliteratür ışığında incelenmesi amaçlanmıştır.

Towards Better Results in Preventing Pressure Injuries: Evidence-Based Practices

Prevention of pressure injuries that disrupt skin integrity, increase the risk of infection, decrease the patient's quality of life and prolongthe treatment period is considered as one of the indicators of care quality in the world and in our country. It has been observed that thereare many evidence-based practices in the prevention of pressure injuries that have been studied intensively for many years. Theseevidences are; showed the applicability of the scales in risk diagnosis, the importance of nursing approach in the observation and care ofthe skin, the effects of nutrition on wound healing, the change of position prevents wound formation and the place of education in nursingcare. With the development of technology, many new methods and how the vehicle can prevent pressure injuries are investigated. In thepublished international guidelines, the main points for the prevention of pressure injuries are specified as risk identification, skin care,nutrition, position change, mobilization and education. In this review, it is aimed to examine the nursing approach to prevent pressureinjuries in the light of current literature.

PDF

___

Guideline. The National Pressure Injury Advisory Panel (NPUAP) (2019) https://npiap.com/page/2019Guideline Erişim tarihi: 17 Aralık 2019.
Artico, M., Dante, A., D’angelo, D., Lamarca, L., Mastroianni, C., Petitti, T., ... De Marinis, M.G. (2018). Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. Palliat Med, 32(1), 299-307.
Atkinson, R. A., & Cullum, N.A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56, 186–198.
Black, J.M., Edsberg, L.E., Baharestani, M.M., Langemo, D., Goldberg, M., McNichol, L., Cuddigan, J. (2011). Pressure ulcers: avoidable or unavoidable? Results of the national pressure ulcer advisory panel consensus conference. Ostomy Wound Manage, 57(2), 24.
Chang, M.C., Yu, T., Luo, J., Duan, K., Tu, P., Zhao, Y., ... Stachura, M. (2018). Multimodal sensor system for pressure ulcer wound assessment and care. IEEE Trans Industr Inform, 14(3), 1186-1196.
Çınar, F., Şahin, S.K., Aslan, F.E. (2018). Yoğun bakım ünitesi’nde basınç yarasının önlenmeye yönelik Türkiye’de yapılmış çalışmaların incelenmesi; sistematik derleme. BAUN Sağ Bil Derg, 7(1), 42-50.
Demarre, L., Verhaeghe, S., Van Hecke, A., Clays, E., Grypdonck, M., Beeckman, D. (2015). Factors predicting the development of pressure ulcers in an at‐risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs, 71(2), 391-403.
Eglseer, D., Hödl, M., Lohrmann, C. (2019). Nutritional management of older hospitalised patients with pressure injuries. Int Wound J, 16(1), 226-232.
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. (Çev. Yara Ostomi İnkontinans Hemşireleri Derneği). Basınç Ülserlerini Önleme: Hızlı Başvuru Kılavuzu. Aralık 2010, Ankara.
Gage, W. (2015). Preventing pressure ulcers in patients in intensive care. Nursing Standard, 29(26):53-61.
García-Fernández, F.P., Agreda, J.J.S., Pancorbo-Hidalgo, P.L., Verdu-Soriano, J., Casanova, P.L., Rodríguez-Palma, M. (2016). Classification of dependencerelated skin lesions: a new proposal. J. Wound Care, 25, 26–32.
García‐Mayor, S., Morilla‐Herrera, J.C., Lupiáñez‐Pérez, I., Kaknani Uttumchandani, S., Leon Campos, A., Aranda‐ Gallardo, M., et al. (2018). Peripheral perfusion and oxygenation in areas of risk of skin integrity impairment exposed to pressure patterns. A phase I trial (POTER Study). Journal of Adv. Nurs., 74(2), 465-471.
Grap, M.J., Schubert, C.M., Burk, R.S., Lucas, V., Wetzel, P.A., Pepperl, A., et al. (2017). High frequency ultrasound sacral images in the critically ill: tissue characteristics versus visual evaluation. Intensive Crit. Care Nurs. 42, 62–67.
Grap, M.J., Munro, C.L., Wetzel, P.A., Schubert, C.M., Pepperl, A., Burk, R.S., et al. (2017). Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients. Intensive Crit. Care Nurs, 38, 1–9.
Griswold, L.H., Griffin, R.L., Swain, T., Kerby, J.D. (2017). Validity of the Braden Scalein grading pressure ulcers in trauma and burn patients. J. Surg. Res, 219, 151–157.
Jocelyn Chew, H.S., Thiara, E., Lopez, V., Shorey, S. (2018). Turning frequency in adult bedridden patients to prevent hospital‐acquired pressure ulcer: A scoping review. Int Wound J, 15(2), 225-236.
Joyce, P., Moore, Z.E., Christie, J. (2018). Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Syst Rev, 12:1-71.
Kalite İndikatörleri ve Sağlıkta İndikatör Yönetim Sistemi (SİYÖS) Projesi. T. C. Sağlık Bakanlığı, Sağlık Hizmetleri Genel Müdürlüğü, Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı. Ocak 2014, Ankara
Kim, C.G., Park, S., Ko, J.W., Jo, S. (2018). The relationship of subepidermal moisture and early stage pressure injury by visual skin assessment. J Tissue Viability, 27(3), 130-134.
Kim, J.K., Yoo, S.H., Nho, J.H., Ju, J.K. (2019). Performance and Influencing Factors of Evidence‐Based Pressure Ulcer Care Among Acute Care Hospital Nurses. Worldviews Evid Based Nurs, 16(1), 29-35.
Lin, F., Wu, Z., Song, B., Coyer, F., Chaboyer, W. (2020). The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. Int J Nurs Stud, 102, 103483.
López, M., Jiménez, J.M., Fernández, M., Martín, B., Cao, M.J., Castro, M.J. (2019). Relationship between pressure ulcer risk based on Norton Scale and on the “Eating/Drinking” need assessment. J Nurs Manag, 27(1), 117-124.
Moore, Z.E., Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev, 1: 1-43.
Nedergaard, H.K., Haberlandt, T., Toft, P., Jensen, H.I. (2018). Pressure ulcers in critically ill patients - preventable by non-sedation? A substudy of the NONSEDA-trial. Intensive Crit. Care Nurs, 44, 31–35.
Oozageer Gunowa, N., Hutchinson, M., Brooke, J., Jackson, D. (2018). Pressure injuries in people with darker skin tones: A literature review. J Clin Nurs, 27(17-18), 3266-3275.
Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). Int J Nurs Stud, 80, 12-19.
Porter‐Armstrong, A.P., Moore, Z.E., Bradbury, I., McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. Cochrane Database Syst Rev, 5:1-48.
Pressure Injury Prevention Points. The National Pressure Injury Advisory Panel (NPUAP), 2016. https://npiap.com/ Erişim tarihi: 17 Nisan 2019
Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. The National Pressure Injury Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA) https://cdn.ymaws.com/npiap.com/resource/resmgr/2014 _guideline.pdf Erişim tarihi: 17 Aralık 2019
Saghaleini, S.H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., Ostadi, Z. (2018). Pressure ulcer and nutrition. Indian J Crit Care Med, 22(4):283-289.
Suva, G., Sharma, T., Campbell, K.E., Sibbald, R.G., An, D., Woo, K. (2018). Strategies to support pressure injury best practices by the inter‐professional team: A systematic review. Int Wound J., 15(4), 580-589.
Tanrıkulu, F., & Dikmen, Y. (2017). Yoğun bakım hastalarında basınç yaraları: risk faktörleri ve önlemler. J Hum Rhythm, 3(4), 177-182.
Tomova‐Simitchieva, T., Lichterfeld‐Kottner, A., Blume‐Peytavi, U., Kottner, J. (2018). Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross‐over trial. Int Wound J, 15(3), 429-437.
Zhou, Q., Yu, T., Liu, Y., Shi, R., Tian, S., Yang, C., ... Wu, Z. (2018). The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross‐ sectional study. J Clin Nurs, 27(3-4), 694-704.