Impact of a new clinical mattress solution on interface pressure and comfort during supine lying.

OBJECTIVE: Effective pressure management for individuals is critical for hospital and community-based care, to prevent the occurrence of pressure ulcers. This study explores the impact of a new mattress and topper solution on interface pressure and comfort during supine lying. METHOD: In this quantitative, healthy cohort study, patient-surface interface pressures were calculated for three mattresses (a standard hospital mattress, a new mattress solution (Levitex Foams Ltd., UK) and a dynamic air flow mattress) with and without an innovative topper solution (Levitex Foams Ltd., UK). Subjective comfort, contact surface area, peak and mean pressure and peak pressure index (head, sacrum, heels) were calculated for all mattress conditions for a 21-minute period. RESULTS: A total of 27 healthy volunteers took part in this study. The new mattress solution decreased peak pressure significantly compared with the hospital and air mattresses (p<0.04). Lower peak pressures were observed for the hospital mattress compared with the dynamic air flow mattress. The new mattress solution improved comfort and significantly lowered (>30%; p≤0.005) heel and head pressure compared with the other surfaces. Both hospital and air mattresses significantly reduced pressure and improved comfort with the addition of the new topper solution (p<0.05). CONCLUSION: The new mattress solution used in this study offers a potentially improved pressure management solution for individuals. Implementation of the topper may also help to improve pressure management when used with existing standard or dynamic air flow mattresses.

Improving Competency in Safe Patient Handling Through Online Learning Beyond the Classroom: A Longitudinal Study.

IMPORTANCE: Safe patient handling is intrinsic in health care provision, yet education in the skills required for safe patient handling is inconsistently delivered, with limited evidence that traditional face-to-face training reduces risk. OBJECTIVE: To assess the long-term effectiveness of replacing annual practical handling updates with an online training system, combined with competency assessment of skill and safety. DESIGN: Quasi-experimental longitudinal 3-yr study to track practical people handling skill development among undergraduate occupational therapy students. All participants had access to a multimedia online training system (that replaced tutor-led practical training), used in combination with annual competency evaluations to measure skills and safety in four people handling tasks. SETTING: All competency assessment took place on site in the School of Health and Society, University of Salford (Salford, United Kingdom). PARTICIPANTS: Undergraduate BSc(Hons) occupational therapy students (N = 243). Outcomes and Measures: Participants attended individual 45-min competency evaluations at three data collection points: beginning of Years 2 and 3 and end of Year 3. Data were collected by trained assessors using a competency assessment tool. RESULTS: Results demonstrate significant increases in skill level for sit-to-stand and repositioning in the chair (p < .05) and for hoisting and slide sheet maneuvers (p < .0001). Participants achieved 100% safety scores for repositioning in the chair and hoisting. CONCLUSIONS AND RELEVANCE: Students using the online system performed significantly better than students receiving traditional annual practical updates, providing an evidence base to reduce tutor-led training hours while increasing skill and safety levels using a combination of the online system and competency assessment. What This Article Adds: This approach was found to reinforce safe handling techniques and increase independence, competency, and safety of service users and caregivers working in health and social care environments while reducing time spent delivering annual people handling updates. The findings support replacement of face-to-face training updates, particularly in the current climate of social distancing.

Are older people putting themselves at risk when using their walking frames?

BACKGROUND: Walking aids are issued to older adults to prevent falls, however, paradoxically their use has been identified as a risk factor for falling. To prevent falls, walking aids must be used in a stable manner, but it remains unknown to what extent associated clinical guidance is adhered to at home, and whether following guidance facilitates a stable walking pattern. It was the aim of this study to investigate adherence to guidance on walking frame use, and to quantify user stability whilst using walking frames. Additionally, we explored the views of users and healthcare professionals on walking aid use, and regarding the instrumented walking frames ('Smart Walkers') utilized in this study. METHODS: This observational study used Smart Walkers and pressure-sensing insoles to investigate usage patterns of 17 older people in their home environment; corresponding video captured contextual information. Additionally, stability when following, or not, clinical guidance was quantified for a subset of users during walking in an Activities of Daily Living Flat and in a gait laboratory. Two focus groups (users, healthcare professionals) shared their experiences with walking aids and provided feedback on the Smart Walkers. RESULTS: Incorrect use was observed for 16% of single support periods and for 29% of dual support periods, and was associated with environmental constraints and a specific frame design feature. Incorrect use was associated with reduced stability. Participants and healthcare professionals perceived the Smart Walker technology positively. CONCLUSIONS: Clinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence are placing the user at risk. Current guidance needs to be improved to address environmental constraints whilst facilitating stable walking. The research is highly relevant considering the rising number of walking aid users, their increased falls-risk, and the costs of falls.

Multidisciplinary approaches to moving and handling for formal and informal carers in community palliative care.

Health professionals such as nurses, physiotherapists and occupational therapists provide a wealth of support in the community to patients and their carers receiving palliative care. Moving and handling is one such support that needs careful consideration and assessment including risk, by appropriately qualified professionals. A combination of skills are required as well as knowledge of up to date equipment to assist the health professional in deciding how to formulate safe moving and handling interventions in a timely way. Patients with palliative care needs and their carers should be given the appropriate care and support necessary using a holistic, flexible and patient-centred approach to service delivery.

A blueprint for genomic nursing science.

PURPOSE: This article reports on recommendations arising from an invitational workshop series held at the National Institutes of Health for the purposes of identifying critical genomics problems important to the health of the public that can be addressed through nursing science. The overall purpose of the Genomic Nursing State of the Science Initiative is to establish a nursing research blueprint based on gaps in the evidence and expert evaluation of the current state of the science and through public comment. ORGANIZING CONSTRUCTS: A Genomic Nursing State of the Science Advisory Panel was convened in 2012 to develop the nursing research blueprint. The Advisory Panel, which met via two webinars and two in-person meetings, considered existing evidence from evidence reviews, testimony from key stakeholder groups, presentations from experts in research synthesis, and public comment. FINDINGS: The genomic nursing science blueprint arising from the Genomic Nursing State of Science Advisory Panel focuses on biologic plausibility studies as well as interventions likely to improve a variety of outcomes (e.g., clinical, economic, environmental). It also includes all care settings and diverse populations. The focus is on (a) the client, defined as person, family, community, or population; (b) the context, targeting informatics support systems, capacity building, education, and environmental influences; and (c) cross-cutting themes. It was agreed that building capacity to measure the impact of nursing actions on costs, quality, and outcomes of patient care is a strategic and scientific priority if findings are to be synthesized and aggregated to inform practice and policy. CONCLUSIONS: The genomic nursing science blueprint provides the framework for furthering genomic nursing science to improve health outcomes. This blueprint is an independent recommendation of the Advisory Panel with input from the public and is not a policy statement of the National Institutes of Health or the federal government. CLINICAL RELEVANCE: This genomic nursing science blueprint targets research to build the evidence base to inform integration of genomics into nursing practice and regulation (such as nursing licensure requirements, institutional accreditation, and academic nursing school accreditation).

Pressure distribution analysis of X-Ray table mattresses.

BACKGROUND: There is a risk of developing pressure ulcers from lying on an X-ray table mattress, if the mattress pressure redistribution properties are poor. AIM: To assess the pressure redistribution properties of 'new' and 'in current clinical use' X-ray table mattresses. METHODS AND MATERIALS: Twenty one X-ray table mattresses, each of 2.5 cm thickness, were evaluated. An anthropomorphic human phantom of adult stature with five different weights (minimum, first quartile, mean, third quartile and maximum) was used to simulate human head, pelvis and heels (pressure ulcer jeopardy areas). Using Xsensor technology, peak pressure was measured and Interface Pressure Ratio was calculated for the three pressure ulcer jeopardy areas 'with' and 'without' an X-ray table mattress. RESULTS: For all mattresses, statistically significant differences (p < 0.05) were found between the peak pressure values with and without using an X-ray table mattress for the three pressure ulcer jeopardy areas; similarly, for all mattresses, statistically significant differences (p < 0.05) were found between the Interface Pressure Ratio values with and without using x-ray table mattress. The type and age of the mattress was observed to have an impact on peak pressure values and Interface Pressure Ratios, with older mattresses performing worse. CONCLUSION: Peak pressure values and Interface Pressure Ratios are reduced significantly when using newer X-ray table mattresses. This could be because newer mattresses use more appropriate materials in their construction and/or older mattresses have lost their pressure redistribution properties. Radiology departments should consider assessing mattresses pressure redistribution properties, perhaps on an annual basis.

A Phantom-Based Method to Assess X-Ray Table Mattress Interface Pressures.

BACKGROUND: Pressure redistribution performance of x-ray table mattresses can influence the development of pressure ulcers in at-risk populations. Interface pressure analysis, with human participants, is a common method to assess mattresses. This approach has limitations that relate to the lack of standardisation between and within humans. AIM: This study aimed to develop and validate an anthropomorphic phantom-based method to assess x-ray table mattress interface pressures as an index of mattress performance. METHODS: A three dimensional phantom simulating an adult's head, pelvis, and heels was printed from x-ray computed tomography image data and attached to a metal frame 175 cm in length. Dry sand was added to the phantom head, pelvis, and heels to represent a range of human weights. Pressure distribution was assessed using XSensor. Phantom validation was achieved by comparing phantom mattress interface pressure characteristics, for five human equivalent weights, against 27 sets of human mattress interface pressure data. RESULTS: Using the correlation coefficient R, phantom and human pressure data showed good correlation for the five phantom weights (R values: head = 0.993, pelvis = 0.997, and heels = 0.996). CONCLUSION: A novel method to test x-ray mattresses for interface pressure was developed and validated. The method could have utility in the testing of x-ray mattresses that are in routine use and for new mattress development. Phantom interface pressure data could be provided by manufacturers to help inform procurement decisions when matching mattress characteristics to medical imaging demands and the underlying patient populations.

A narrative review on pressure ulcer (PU) studies relevant to medical imaging.

Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or pressure together with shear. PUs present significant health implications to patients; costing billions to manage and/or treat. The burden of PU prevention in hospitals must be the concern of all healthcare professionals, including radiographers. The purpose of this narrative review article was to identify and critically evaluate relevant literature and research conducted into pressure ulcers (PUs) relevant to medical imaging. It is expected that this review article will increase the level of awareness about PUs amongst radiographers and help to develop appropriate interventions to minimise the risk of PUs. A literature search was conducted in PubMed/Medline, Scopus, CINAHL, and Google Scholar to retrieve relevant articles. Also, books, professional body guidelines, magazines, grey and unpublished literatures were also searched. The search was limited to English Language articles. Only five articles were retrieved and reviewed. There are limited studies on PUs relevant to medical imaging. Available studies provide some evidence that radiographic procedures and settings subject patients attending for radiographic procedures to the risk of PUs. Further studies are needed into PU risk assessment, minimisation and management in medical imaging to help raise awareness and address the problem of the potential for PU development.

From pamphlets to podcasts: health information at Great Ormond Street Hospital for Children NHS trust.

This paper outlines the development of information for children and families at Great Ormond Street Hospital for Children NHS Trust. Starting in 1995, guidelines for producing written information have been developed and a regular audit programme carried out, resulting in information of consistently high quality being produced. The 'rules' set out for the provision of written information have now been developed to cover multimedia information, so that technology can be harnessed to develop podcasts and other non-written information materials. Technical processes are explained both for production and delivery. Future plans for multimedia information are also outlined.

An Investigation of Pressure Ulcer Risk, Comfort, and Pain in Medical Imaging.

INTRODUCTION: Pressure ulcers present significant trauma to patients and are expensive to manage. In medical imaging (MI), no study has been conducted to rigorously investigate interface pressure (IP) risk on MI table surfaces. IP is defined as the pressure between human body and a supporting surface. The aims of this research were to investigate whether IP risks exist on MI table surfaces and to assess pain and comfort when lying on MI table surfaces. METHODS: A calibrated XSENSOR mat was used to measure IP for three jeopardy areas (head, sacrum, and heels) in healthy volunteers on an x-ray table surface with no mattress, an x-ray table surface with a thin radiolucent mattress, and a computed tomography table surface, after which they completed a pain and comfort questionnaire. RESULTS: The sample consisted of 26 females and 23 males aged 18-59 years (mean = 34.6; standard deviation [SD] = 10.5). Analysis of variance identified statistically significant differences in the mean IP for the jeopardy areas across the three MI table surfaces (P ≤ .001). Results also indicated high mean IP value for the head (75.9 mmHg; SD = 6.9) on the x-ray table with no mattress. Seventy percent of the volunteers found lying on the x-ray table with no mattress to be very uncomfortable. Sixty-seven percent experienced most pain whilst lying on the x-ray table with no mattress and over 81% of the pain occurred at the head. CONCLUSION: IP risk exists on x-ray tables with no mattress. This could increase the risk of developing pressure ulcers in patients accessing prolonged radiography/radiology procedures.

The value of the political action committee: dollars and influence for nurse leaders.

Nurse leaders play an important role in the shaping of healthcare policy and the care delivery models of the future. It is vital for nurse leaders to understand the role of money in politics and how donations to a candidate's campaigns can be beneficial in getting one's concerns addressed by Congress. The political action committee (PAC) is a major vehicle for campaign contributions for candidates from any party. This article will detail the following related to PACs: history and background information, government regulations, and why PACs are an important vehicle for nurse leaders to gain access and influence in Congress.