Knowledge of the nursing team on pressure ulcer prevention

describe and analyze the nursing team's knowledge about classification, evaluation and measures to prevent pressure ulcers (PU) in patients hospitalized in the ICU of a teaching hospital in the city of Manaus.

Method:

a descriptive and exploratory study was conducted after approval by a research ethics committee. Data were collected using a validated instrument. The study sample was made up of 40 nursing staff members, of whom 14 were nurses and 26 were nursing technicians/aides. Data were analyzed through descriptive statistics and Student's t-test, with value of p<0.05.

Results:

the overall mean of hits was 63.4% for technicians/aides and 51.4% for nurses, with statistically significant differences between the groups only for the PU prevention category (p<0.001).

Conclusion:

a deficit of knowledge on PU prevention was found among nurses and nursing technicians/aides, demanding the training of these professionals.

Descriptors:
Pressure Ulcer; Prevention and Control; Nursing Team; Stomal Therapy; Hospital

Pressure ulcer evaluation and classification	Nurses		Nursing technicians/aides		Total
Pressure ulcer evaluation and classification	f	%	f	%	f	%
1 - Stage ^* * Stage: the current word for stage is category, according to the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel 2009. I pressure ulcers are defined as intact skin with hyperemia of a localized area and non-blanchable redness or different color from the surrounding area (T)	8	66.6	14	50.0	22	55.0
6 - Stage III pressure ulcers present partial tissue loss, involving the epidermis (F)	9	75.0	9	37.5	18	45.0
9 - Stage IV pressure ulcers present total tissue loss, with intensive destruction and necrosis of the tissue or damage to the muscles, bones, or supporting structures (T)	8	66.6	25	89.2	33	82.5
20 - Stage II pressure ulcers present loss of dermis in its total thickness (F)	4	33.3	13	46.4	17	42.5
31 - Pressure ulcers are sterile wounds (F)	8	66.6	17	60.7	25	62.5
32 - Lesions can develop faster on a region of the skin with pressure ulcer scar than on intact skin (T)	7	58.3	23	82.1	30	75.0
33 - A blister on the calcaneus region is not concerning (F)	11	91.6	24	85.7	35	87.5
38 - Stage II pressure ulcers can be extremely painful because of the exposure of nerve endings (T)	8	66.6	16	57.1	24	60.0

Pressure ulcer prevention	Nurses		Nursing technicians/aides		Total
Pressure ulcer prevention	f	%	f	%	f	%
2 - The factors of risk to develop pressure ulcers are: immobility, incontinence, inadequate nutrition and change on consciousness level (T)	6	50.0	17	60.7	23	53.4
3 - All patients in risk for pressure ulcer should have their skin systematically inspected, at least once a week (F)	7	58.3	13	46.4	22	51.1
4 - The use of warm water and soap may dry the skin and increase the risk for pressure ulcer (T)	4	33.3	19	67.8	24	55.8
5 - It is important to massage the regions of bone prominence, if these have hyperemia (F)	7	58.3	5	17.8	13	30.2
7 - At the time of admission, all patients should be evaluated regarding the risk of developing pressure ulcer (T)	10	83.3	24	85.7	37	86.0
8 - Creams, transparent bandages and extra-thin hydrocolloid bandages help protecting the skin against the effects of friction (T)	4	33.3	7	25.0	13	30.2
10 - Proper intake of proteins and calories should be maintained during the disease/hospital stay (T)	9	75.0	23	82.1	35	81.4
11 - Patients restricted to the bed should be repositioned every three hours (F)	7	58.3	22	78.5	32	74.4
12 - A schedule with times to change the decubitus should be used to each patient with or in risk of pressure ulcer (T)	6	50.0	20	71.4	29	67.4
13 - Water or air gloves relief pressure on the calcaneus (F)	7	58.3	14	50.0	24	55.8
14 - Water or air ring cushions can help preventing pressure ulcers (F)	6	50.0	6	21.4	15	34.8
15 - On the position of lateral decubitus, patients with pressure ulcer, or in risk of pressure ulcer, should stay on a 30º angle in relation to the bed mattress (T)	7	58.3	17	60.7	26	60.4
16 - For patients with pressure ulcer, or in risk of pressure ulcer, the bed headboard should not be lifted in an angle higher than 30º if there is no medical contraindication (T)	5	41.6	14	50.0	20	46.5
17 - Patients that cannot move by themselves must be repositioned every two hours, when sitting in a chair (F)	5	41.6	8	28.5	15	34.8
18 - Patients with limited mobility and who can change their body position without help must be instructed to relieve pressure every 15 minutes, when sitting in a chair (T)	4	33.3	15	53.5	20	46.5
19 - Patients with limited mobility that can stay in a chair should have a cushion on the seat to protect the region of bone prominences (T)	8	66.6	23	82.1	32	74.4
21 - The skin of patients in risk of pressure ulcer should remain clean and free of moisture (T)	9	75.0	27	96.4	38	88.3
22 - Measures to prevent new lesions do not need to be continuously taken when a patient already has pressure ulcer (F)	8	66.6	28	100	38	88.3
23 - Mobile sheets or linings should be used to transfer or move patients that cannot move by themselves (T)	7	58.3	20	71.4	29	67.4
24 - The mobilization and transfer of patients that cannot move by themselves should be always made by two or more persons (T)	5	41.6	26	92.8	33	76.7
25 - For patients with a chronic condition that cannot move by themselves, rehabilitation must be started and include guidance about prevention and treatment of pressure ulcer (T)	7	58.3	24	85.7	32	74.4
26 - Any patient that cannot walk should be submitted to evaluation of risk for developing pressure ulcer (T)	11	91.6	27	96.4	40	93.0
27 - Patients and family members should be instructed regarding the causes and factors of risk for developing pressure ulcer (T)	10	83.3	28	100	40	93.0
28 - Regions of bone prominences can be in direct contact with each other (F)	8	66.6	26	92.8	37	86.0
29 - Every patient in risk of developing pressure ulcer should have a mattress that redistributes pressure (T)	6	50.0	25	89.2	33	76.7
30 - When macerated by moisture, the skin is more easily damaged (T)	10	83.3	23	82.1	34	79.0
34 - A good way to reduce pressure on the calcaneus region is to keep it lifted from the bed (T)	5	41.6	22	78.5	29	67.4
35 - No care provided to prevent or treat pressure ulcer needs to be recorded (F)	9	75.0	24	85.7	36	83.7
36 - Shearing is the force that occurs when the skin adheres to a surface and the body slides (T)	7	58.3	20	71.4	27	62.7
37 - Friction may happen when the patient is moved on the bed (T)	4	33.3	27	96.4	34	79.0
39 - For patients with incontinency, the skin must be cleaned at the time of elimination and in routine intervals (T)	6	50.0	28	100	36	83.7
40 - The development of educational programs in the institution could reduce the incidence of pressure ulcer (T)	12	100	26	92.8	40	93.0
41 - Hospitalized patients should be evaluated regarding the risk for pressure ulcer just once during hospital stay (F)	10	83.3	27	96.4	40	93.0

Instrument categories	Professional group		Stat. test	p value
	Nurses	Technicians/aides
	(n = 14)	(n = 26)
	Mean and SD (%) of hits
PU evaluation and classification	44 (20.6)	55.1 (16.4)	t-test (38 df) = 1.81	0.0780
PU preventive measures	52.9 (8.7)	65.1 (8.9)	t-test (38 df) = 4.01	< 0.001
All questions	51.4 (9.7)	63.4 (8.0)	t-test (38 df) = 4.08	< 0.001

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[1] CORRESPONDING AUTHOR Nariani Souza Galvão E-mail: narigalvao@ufam.edu.br