The effect of a pressure ulcer prevention care bundle on nursing workload costs.

AIM: This study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. DESIGN, SETTING, AND PARTICIPANTS: This prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. METHODS: The study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018-30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018-15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. RESULTS: The pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). CONCLUSION: The pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.

Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units.

PURPOSE: The purpose of this study was to assess the effectiveness of a pressure injury prevention care bundle. DESIGN: Prospective interventional study. SUBJECTS AND SETTING: Participants were 13 nurses and 104 patients cared for in the intensive care unit for at least 24 hours in a university hospital in Ankara, Turkey. METHODS: The study was conducted in 2 stages: the pre-care and post-care bundle stages. In the pre-care bundle stage, the pressure injury incidence of the patients was followed by the nurses. At the end of the third month, the researcher held a 1-day training program for the nurses about the care bundle use to promote correct implementation. In the post-care bundle stage, the nurses provided care according to the bundle. Compliance with the care bundle was assessed. Pressure injury incidence rates in the pre- and post-care bundle stages were compared. RESULTS: The incidence of stage 1 pressure injury was 15.11 (1000 patient-days) in the pre-care bundle stage and 6.79 (1000 patient-days) in the post-care bundle stage; this reduction was not statistically significant. CONCLUSIONS: A pressure injury prevention bundle was implemented in an intensive care unit, resulting in a decline in stage 1 pressure injuries.

Effects of Information, Motivation, Behavioral Skills Model on Urinary Incontinence in Men With Overactive Bladder and Urge Incontinence: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the effect of an intervention based on and information, motivation, behavioral skills (IMB) model on urinary incontinence symptoms, impact on daily activities, and incontinence-specific quality of life in men with overactive bladder dysfunction (OAB) and urge incontinence. DESIGN: Parallel-group, open-label, randomized-controlled clinical trial. SUBJECTS AND SETTING: The sample comprised 60 male patients admitted to the urology clinic of a training and research hospital in Ankara, Turkey. Inclusion criteria were adult men older than 18 years and diagnosed with OAB and urge incontinence. METHODS: Data were collected from February 2018 to February 2019. Participants were randomized into 2 equal groups. The intervention group (n = 30) received a structured intervention based on the IMB model, and a control group (n = 30) received standard OAB management. The primary outcome was severity of urge incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes were mean scores on the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Urinary Incontinence Information Rating. All outcome measures were evaluated before and 6 months after the training. RESULTS: Following the intervention, mean ICIQ-SF scores were significantly lower in the IMB model group as compared to the control group. Analysis revealed a significant increase in knowledge scores in both groups when baseline scores were compared to postintervention scores (P = .000 for the intervention group and P = .004 for the control group). The intervention group participants also had a higher postintervention scores when compared to control group subjects (P = .000). CONCLUSIONS: A structured behavioral intervention based on the IMB model significantly alleviated the severity of bothersome lower urinary tract symptoms in adult males with OAB and urge incontinence when compared to standard care.

An Investigation of Pain Beliefs, Pain Coping, and Spiritual Well-Being in Surgical Patients.

This study investigated pain beliefs, pain coping, and spiritual well-being in surgical patients. The study adopted a cross-sectional, descriptive, and correlational research design. The sample consisted of 213 voluntary patients admitted to a surgery clinic between April and November 2019. Data were collected using a demographic characteristics questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 item (FACIT-Sp-12), the Pain Beliefs Questionnaire (PBQ), and the Pain Coping Questionnaire (PCQ). Number, percentage, mean, and Spearman's correlation were used for analysis. Participants had a total FACIT-Sp-12 score of 25.99 ± 8.43. They had a mean PBQ "organic beliefs" and "psychological beliefs" subscale score of 4.44 ± 0.64 and 4.96 ± 0.68, respectively. They had a mean PCQ "self-management," "helplessness," "conscious coping attempts," and "medical remedies" subscale score of 15.83 ± 6.15, 9.41 ± 4.63, 8.72 ± 3.66, and 7.46 ± 5.33, respectively. Spiritual well-being was weakly and positively (r = 0.445, p < 0.000) correlated with self-management and moderately and negatively correlated (r = - 0.528, p < 0.000) with helplessness. Participants with higher organic and psychological beliefs had lower spiritual well-being. The results indicate that nurses should evaluate both pain and spiritual well-being in patients.

The impact of standardized patient interactions on nursing students' preventive interventions for pressure ulcers.

AIM: This study was performed as a quasi-experimental study using a standardized patient simulation program in order to explore the effects of education on the performance and knowledge of undergraduate nursing students with respect to pressure ulcer prevention. METHODS: The study sample consisted of 38 students who completed the study. After the theoretical education portion, the students first knowledge and performance scores were evaluated with the standardized patient program. Demonstration education with the standardized patient and a second standardized patient practice were then performed. Afterwards, a debriefing session was held under the supervision of the researcher. After three months, the second knowledge and performance score evaluation was performed with the standardized patient. Knowledge and performance scores were compared after theoretical training and three months after simulation training. RESULTS: The mean score of 38 students were 43.68 ± 9.06 and 75.92 ± 16.84 on the pre- and post-tests, respectively. Preliminary points were significantly lower than post-test points (p < 0.001). The median performance score was 7.89 (min-max: 0-73.68) in the first simulation and 86.84 (min-max: 63.16-100.00) in the second simulation. There was a statistically significant change between the two performance scores (p < 0.001). CONCLUSION: In this study, it was determined that the level of knowledge and performance persisted in the evaluations after comprehensive training using standardized patient simulations. This study confirmed standardized patient practice as an efficient learning modality for nursing students in the long-term.

Evaluating the Effects of a Pressure Injury Prevention Algorithm.

OBJECTIVE: To evaluate the effect of a pressure injury prevention algorithm on pressure injury prevention. DESIGN, SETTING, AND PARTICIPANTS: This intervention study was conducted in the anesthesiology and reanimation ICU (ARICU) of a university hospital. The study included two sample groups (nurses and patients). All patients older than 18 years (prealgorithm, n = 80; postalgorithm, n = 74) in the ARICU who verbally consented were included in the study. All 15 nurses who worked in the ARICU during the postalgorithm period agreed to participate in the study. INTERVENTIONS: The study was performed in four phases. In the first phase, pressure injury incidence was evaluated in the ARICU (prealgorithm period; April 1 to September 30, 2016). At the same time, a pressure injury prevention algorithm was developed. In the second phase, ARICU nurses were provided education on how to prevent pressure injury and use the pressure injury prevention algorithm. In the third phase, the nurses provided care based on the pressure injury prevention algorithm (postalgorithm period; November 1, 2016, to April 30, 2017). In the fourth phase, the incidence of pressure injury in the pre- and postalgorithm periods was compared, and the effectiveness of the algorithm was evaluated. MAIN RESULTS: The pressure injury incidence was 46.10 per 1,000 patient-days in the prealgorithm period and 9.21 per 1,000 patient-days in the postalgorithm period. The decline was statistically significant (z = 9.590, P < .001). CONCLUSIONS: Nursing education and the evidence-based pressure injury prevention algorithm reduced pressure injury rates. Further study of this algorithm in other ICUs and among various care populations is recommended to fully establish its efficacy.

Care under the guidance of pressure injury prevention protocol: a nursing home sample.

Pressure injury is a healthcare problem frequently encountered in nursing homes. This study evaluated the effects of the care delivered under the guidance of a protocol for pressure injury prevention at a nursing home. It was implemented in four phases. In the pre-protocol period, the pressure injury incidence and nurses' care practices were evaluated. In the second phase, nurses were trained to use the protocol. In the third phase, the nurses provided care under the guidance of the protocol (post-protocol period). In the fourth phase, the incidence of pressure injury and nurses' care practices were compared between the pre- and post-protocol periods. The average age of the older residents was 78.40±7.12 years, and all were at high or very high risk of pressure injury according to the Braden scale scores. Some 30% were bed bound; 90% had faecal and urinary incontinence; and 70% had malnutrition. The results showed that the pressure injury incidence reduced from 17.39% in the pre-protocol period to 10.87% in the post-protocol period, while the nurses' care practices improved in the post-protocol period. Thus, use of pressure injury-prevention protocols can reduce the incidence of these injuries in vulnerable care home residents.