Risk factors of medical device-related pressure injury in intensive care units.

OBJECTIVES: Intensive care unit (ICU) patients are at high risk of medical device related pressure injury (MDRPI). This study aims to ascertain the MDRPI prevalence in ICU patients and analyse the risk factors of MDRPI. BACKGROUND: The occurrence of MDRPI not only increases hospitalisation time with pain and economic burden, but also causes medical disputes. A better understanding of this condition will increase knowledge and facilitate the ability to recognise and prevent MDRPI for clinical nursing staff. However, there are few multicentre studies of MDRPI prevalence in ICU patients in China. DESIGN: A cross-sectional study design was employed. METHODS: Data from 694 patients in 66 adult ICU at 30 hospitals in China were included between October 2018 and March 2019. The stage of each MDRPI was determined according to the definitions of National Pressure Ulcer Advisory Panel. The study methods were followed by the STORBE guidelines. RESULTS: The overall prevalence rate of MDRPI was 13.1% (91/694), with 98 anatomic locations in total. The most common stages of MDRPI were stage 1 (54.1%, 53/98), stage 2 (15.3%, 15/98) and mucosal membrane pressure injury (15.3%, 15/98). MDRPI mainly occurred in the finger (32.7%, 32/98), followed by nose (18.4%, 18/98). The prevalence rate of MDRPI caused by CPAP or BiPAP masks (25%) was highest. Lower Braden scores and having skin oedema were risk factors for MDRPI in adult ICU patients. CONCLUSION: The prevalence of MDRPI in this study was still high. Nurses should take these related factors into consideration when taking care of ICU patients, and appropriate prevention measures should be adopted to decrease the prevalence of MDRPI. RELEVANCE TO CLINICAL PRACTICE: The study can help to improve the PI prevention efforts in ICU patients specific to medical device related PI.

The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study.

OBJECTIVE: To ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers. BACKGROUND: Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals. DESIGN: A cross-sectional study design was used. METHODS: Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China. The investigators were divided into two groups. The investigators in group 1 examined the patients' skin. When a pressure ulcer was found, a pressure ulcer assessment form was completed. The investigators in group 2 provided guidance to the nurses, who assessed all patients and completed another questionnaire. A multivariate logistic regression analysis was used to analyse the relationship between the possible risk factors and pressure ulcer. RESULTS: The overall prevalence rate of pressure ulcers in the 25 hospitals ranged from 0%-3.49%, with a mean of 1.26%. The most common stage of the pressure ulcers was stage II (41.4%); most common anatomical locations were sacrum (39.5%) and the feet (16.4%). Braden score (p < .001), expected length of stay (p < .001), incontinence (p < .001), care group (p = .011), hospital location (p < .001), type of hospitals (p = .004), ages of patients (p < .001) were associations of pressure ulcers from the multivariate logistic regression analysis. CONCLUSIONS: The overall prevalence rate of pressure ulcers in Chinese hospitals was lower than that reported in previous investigations. Specific characteristics of pressure ulcer patients were as follows: low Braden score, longer expected length of stay, double incontinence, an ICU and a medical ward, hospital location in the Pearl River Delta, a university hospital and an older patient. RELEVANCE TO CLINICAL PRACTICE: The survey could make managers know their prevalence level of pressure ulcers and provide priorities for clinical nurses.

Relationship among self-concept clarity, social support, and psychological resilience in Chinese patients with an enterostomy: A cross-sectional study and structural equation model analysis.

PURPOSE: This study was to explore the relationship between self-concept clarity, social support, and psychological resilience in Chinese enterostomy patients. METHODS: A cross-sectional, descriptive study was conducted from October 2019 to April 2020 among enterostomy patients visiting the stoma clinic and inpatients with an enterostomy in general surgery of three tertiary grade A hospitals in Guangzhou, China. Patients (n=201) were required to complete paper questionnaires, including sociodemographic information, the 10-Item Resilience Scale Specific to Cancer, Self-concept Clarity Scale, and Social Support Rating Scale. Multiple linear regression analyses and structural equation modeling were conducted to explore the effect of self-concept clarity and social support on psychological resilience. RESULTS: Psychological resilience was at a median level among enterostomy patients, with a mean score of 38.21 (SD, 7.24). Education level (ß = 1.032, P = .004), own acceptance of stoma (ß = 2.445, P < .001), social support (ß = 206, P = .001) and self-concept clarity (ß = 0.285, P < .001) were factors related to psychological resilience, explaining 33.1% of the variance of psychological resilience. It was also shown that self-concept clarity exerted its direct positive effect on social support (ß = 0.098, SE = 0.025, BC 95%CI = 0.047/0.143), and it also had an indirect positive effect on psychological resilience through mediating social support (ß = 0.193, SE = 0.033, BC 95%CI = 0.121/0.245). CONCLUSIONS: This study suggests that self-concept clarity has an indirect positive effect on psychological resilience by influencing social support in enterostomy patients. Medical staff should strive to improve the self-concept clarity as a new means to enhance patients' psychological resilience, especially focusing on patients' social support, education level and own acceptance of enterostomy.