PREVENTION OF PRESSURE INJURIES: ACTIONS PRESCRIBED BY INTENSIVE CARE UNIT NURSES

Mendonça, Paula Knoch; Loureiro, Marisa Dias Rolan; Frota, Oleci Pereira; Souza, Albert Schiaveto de

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Brasil

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Original Article • Texto contexto - enferm. 27 (4) • 2018 • https://doi.org/10.1590/0104-07072018004610017 copy

PREVENTION OF PRESSURE INJURIES: ACTIONS PRESCRIBED BY INTENSIVE CARE UNIT NURSES¹ 1 Artigo extraído da dissertação - Lesões por pressão: ocorrências, fatores de risco e prática clínica preventiva dos enfermeiros em centros de terapia intensiva, apresentada ao Programa de Pós-Graduação em Enfermagem (PPGENF) - Mestrado Acadêmico em Enfermagem da Universidade Federal de Mato Grosso do Sul (UFMS), em 2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to describe the nursing actions prescribed by nurses for the prevention of pressure injuries and their occurrence in intensive care units.

Method:

a cross-sectional, descriptive, analytical, quantitative study was conducted in two teaching hospitals in Campo Grande, Brazil. The collection occurred between March and June 2016, with 104 participants. The data were submitted to statistical analysis.

Results:

a statistical association was found between the actions of change of decubitus, application of hydrocolloid dressings on the sacral region, performance of external hygiene, change of the orotracheal catheter and/or nasoenteral catheter fixation device and inspection of the skin without pressure injuries. The occurrence of pressure injuries was found in 49% of the clients in both institutions.

Conclusion:

the elaboration and implementation of procedures and the monitoring of reports and of higher risk groups are strategies that direct the prescription of appropriate preventive actions for pressure injuries.

DESCRIPTORS:
Nursing care; Patient safety; Pressure ulcer; Patient care planning; Nursing

Sociodemographic characteristics / Risk factors	Pressure Injury				p-value^* * Chi-square test or Fisher's exact test. P -value in bold indicates a significant association (p<0.05).	Total
	Yes		No			Total
	n	%	n	%		n	%
Gender					1.000
Female	24	47.1	27	52.9		48	46
Male	27	52.9	29	54.7		56	54
Age group					0.032
Up to 59 years	17	33.3	29	54.7		46	44
Over 59 years	34	66.7	24	45.3		58	56
Body Mass Index classification (kg/m2)					0.594
Underweight (<18.5)	1	4.2	1	4.8		2	4.4
Eutrophic (adults: 18.5-24.9 or older adults: 22-27)	15	62.5	15	71.4		30	67
Overweight (≥25 and <30)	6	25	5	23.8		11	24
Obese (≥30)	2	8.3	-	-		2	4.4
No information							59
Temperature					0.029
Normothermia	23	45.1	36	67.9		59	57
Hyperthermia	28	54.9	17	32.1		45	43
Use of vasoactive drugs					0.246
No	21	41.2	28	52.8		49	47
Yes	30	58.8	25	47.2		55	53
Skin conditions					0.012
Without edema	18	35.3	32	60.4		50	48
With edema	33	64.7	21	39.6		54	52
Mechanical ventilation					0.610
Yes	41	80.4	45	84.9		86	83
No	10	19.6	8	15.1		18	17

Occurrence/Location	Institution				P-value^* * Fisher's exact test	Odds Ratio (95% CI)
	1		2
	n	%	n	%
Occurrence of pressure injury					0.435	1.38 (0.64-3.02)
Yes	20	44.4	31	52.5
No	25	55.6	28	47.5
Calcaneus					1.000	1.08 (0.32-3.65)
Yes	5	11.1	7	11.9
No	40	88.9	52	88.1
Pinna					0.288	0.43 (0.10-1.90)
Yes	5	11.1	3	5.1
No	40	88.9	56	94.9
Gluteal					0.773	1.26 (0.38-4.13)
Yes	40	88.9	51	86.4
No	5	11.1	8	13.6
Malleolus					0.504	0.56 (0.47-0.66)
Yes	-	-	2	3.4
No	45	100	57	96.6
Trochanter					0.235	0.28 (0.05-1.52)
Yes	5	11.1	2	3.4
No	40	88.9	57	96.6
Sacral					0.666	1.31 (0.55-3.08)
Yes	12	26.7	19	32.2
No	33	73.3	40	67.8
Labial commissure					0.433	0.43 (0.34-0.53)
Yes	1	2.2	-	-
No	44	97.8	59	100
Dorsal					1.000	0.76 (0.47-2.47)
Yes	1	2.2	1	1.7
No	44	97.8	58	98.3
Tibial					0.433	0.43 (0.34-0.53)
Yes	1	2.2	-	-
No	44	97.8	59	100
Scapular					1.000	0.56 (0.48-0.67)
Yes	-	-	1	1.7
No	45	100	58	98.3

Nursing action prescriptions	Pressure Injury				p-Value^ * Fisher's exact test and Odds Ratio*	Odds Ratio
	Yes		No			(IC 95%)
	n	%	n	%
Change of decubitus
Prescribed	42	82,4	44	83	0,005	1,05 (0,38-2,90)
Not prescribed	9	17,6	9	17
Application of hydrocolloid dressing on the sacral region
Prescribed	-	-	1	1,9	<0,001	1,98 (1,64-2,40)
Not prescribed	51	100	52	98,1
Use of emollients for skin hydration
Prescribed	41	80,4	39	73,6	0,488	0,68 (0,27-1,71)
Not prescribed	10	1,6	14	26,4
Comfort cushions
Prescribed	22	43,1	20	37,7	0,69	0,80 (0,37-1,76)
Not prescribed	29	56,9	33	62,3
External hygiene
Prescribed	32	62,7	38	71,7	<0,001	1,50 (0,66-3,43)
Not prescribed	19	37,3	15	28,3
Change orotracheal catheter and/or nasoenteral catheter fixation device
Prescribed	11	21,6	13	24,5	<0,001	1,18 (0,47-2,95)
Not prescribed	40	78,4	40	75,5
Air mattress
Prescribed	3	5,9	1	1,9	0,358	0,31 (0,03-3,06)
Not prescribed	48	94,1	52	98,1
Skin Inspection
Prescribed	7	13,7	12	22,6	<0,001	1,84 (0,66-5,13)
Not prescribed	44	86,3	41	77,4
Dry and clean perineum
Prescribed	3	5,9	2	3,8	<0,001	0,63 (0,10-3,92)
Not prescribed	48	94,1	51	96,2
Rotate oximeter sensor
Prescribed	21	41,2	13	24,5	<0,001	0,46 (0,20-1,07)
Not prescribed	30	58,8	40	75,5
Observation of positioning and fixation of orotracheal catheter
Prescribed	11	21,6	10	18,9	<0,001	0,85 (0,32-2,20)
Not prescribed	40	78,4	43	81,1
Bed headboard raised to 30 degrees
Prescribed	5	9,8	5	9,4	0,043	0,96 (0,26-3,53)
Not prescribed	46	90,2	48	90,6

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Paula Knoch Mendonça Rua Marco Pólo, 342- casa 08 79005-650 - Vila Carvalho, Campo Grande, MS, Brazil E-mail: paulaknoch@hotmail.com