Nursing actions before and after a protocol for preventing pressure injury in intensive care

Vasconcelos, Josilene de Melo Buriti; Caliri, Maria Helena Larcher

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RESEARCH • Esc. Anna Nery 21 (1) • 2017 • https://doi.org/10.5935/1414-8145.20170001 copy

Nursing actions before and after a protocol for preventing pressure injury in intensive care^a a Extracted from doctoral thesis "Construction, use and assessment of the effects of a pressure ulcer prevention protocol at an Intensive Care Unit" presented to Ribeirão Preto School of Nursing, University of Sao Paulo, WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil, in 2014.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the actions of nursing professionals before and after using a protocol for preventing pressure injuries in an intensive care unit.

Methods:

An observational, prospective, before and after comparative study, using a quantitative approach, was carried out in a teaching hospital in Paraíba. Nursing actions were observed during 38 bed baths before the protocol and 44 afterwards.

Results:

After using the protocol, a greater frequency of actions was noted: assessment of risk for pressure injuries on days following admission (p < 0.001), observation of bony prominences (p < 0.001) and application of moisturizer in all body regions (p < 0.001), lifting the patient from the bed during repositioning (p < 0.001), protection of knee bone prominences (p = 0.015), and elevation of the calcaneus (p < 0.005).

Conclusion:

The higher frequency of preventive actions after using the protocol demonstrates the importance of this tool in the adoption of evidence-based recommendations by professionals.

Keywords:
Pressure Ulcers; Nursing Care; Intensive Care Units; Patient Safety

Body region	Pre-protocol (n = 38)		Post-protocol (n = 44)		p-value^* * To calculate the association tests, the values for the item that does not apply were not considered.
Body region	n	%	n	%
Head
Hygiene
Yes	20	52.6	20	45.5	p = 0.517
No	18	47.4	24	54.5	p = 0.517
Observes bony prominences
Yes	1	2.6	18	40.9	p < 0.001
No	37	97.4	26	59.1	p < 0.001
Anterior trunk
Hygiene
Yes	37	97.4	44	100.0	p = 0.463
No	1	2.6	-	-	p = 0.463
Applies moisturizer
Yes	7	18.4	35	79.5	p < 0.001
No	31	81.6	8	18.2
Not applicable (skin lesions)	-	-	1	2.3
Observes bony prominences
Yes	2	5.3	38	86.4	p < 0.001
No	36	94.7	6	13.6	p < 0.001
Posterior trunk
Hygiene
Yes	36	94.7	44	100.0	p = 0.212
No	2	5.3	-	-	p = 0.212
Applies moisturizer
Yes	10	26.3	41	93.2	p < 0.001
No	28	73.7	2	4.5
Not applicable (skin lesions)	-	-	1	2.3
Observes bony prominences
Yes	21	55.3	44	100.0	p < 0.001
No	17	44.7	-	-	p < 0.001

Body region	Pre-protocol (n = 38)		Post-protocol (n = 44)		p-value^* * To calculate the association tests, the values for the item that does not apply were not considered.
Body region	n	%	n	%
Upper limbs
Hygiene front part
Yes	34	89.5	43	97.7	p = 0.327
No	3	7.9	1	2.3
Not applicable (skin lesions with bandaged member)	1	2.6	-	-
Hygiene back part
Yes	24	63.2	36	81.8	p = 0.083
No	13	34.2	8	18.2
Not applicable (skin lesions with bandaged member)	1	2.6	-	-
Applies moisturizer
Yes	7	18.4	30	68.2	p < 0.001
No	30	78.9	13	29.5
Not applicable (skin lesions)	1	2.6	1	2.3
Observes bony prominences
Yes	2	5.3	21	47.7	p < 0.001
No	36	94.7	23	52.3	p < 0.001
Lower limbs
Hygiene front part
Yes	34	89.5	44	100.0	p = 0.042
No	4	10.5	-	-	p = 0.042
Hygiene back part
Yes	25	65.8	42	95.5	p = 0.001
No	13	34.2	2	4.5	p = 0.001
Applies moisturizer
Yes	6	15.8	35	79.5	p < 0.001
No	31	81.6	6	13.6
Not applicable (skin lesions)	1	2.6	3	6.8
Observes bony prominences
Yes	5	13.2	42	95.5	p < 0.001
No	33	86.8	2	4.5	p < 0.001

Patient’s positioning and mobilization	Pre-protocol (n = 38)		Post-protocol (n = 44)		p-value^* * To calculate the association tests, the values for the item that does not apply were not considered.
Patient’s positioning and mobilization	n	%	n	%
Head of the bed positioned at an angle of 30° or less
Yes	27	71.1	36	81.8	p = 0.340
No	10	26.3	8	18.2
Not applicable (patient in Fowler’s position due to clinical condition)	1	2.6	-	-
Lifting patient from bed during movement
Yes	18	47.4	38	86.4	p < 0.001
No	16	42.1	3	6.8
Not applicable (patient assisted in movement)	4	10.5	3	6.8
Body’s lateralization at a 30° angle
Yes	4	10.5	12	27.3	p = 0.294
No	1	2.6	-	-
Not applicable (patient in supine position)	33	86.8	32	72.7
Use of support to reduce pressure on the dorsal region
Yes	4	10.5	12	27.3	p = 0.294
No	1	2.6	-	-
Not applicable (patient in supine position)	33	86.8	32	72.7
Protection of bone prominences - knee
Yes	2	5.3	12	27.3	p = 0.015
No	3	7.9	-	-
Not applicable (patient in supine position)	33	86.8	32	72.7
Elevation of the calcaneus
Yes	-	-	7	15.9	p = 0.005
No	33	86.8	25	56.8
Not applicable (patient in lateral decubitus)	5	13.2	12	27.3

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[1] Corresponding author: Maria Helena Larcher Caliri. E-mail: josilenedemelo@gmail.com