Comparing demographics, treatments, and outcomes of patients with COVID-19 lesions versus hospital-acquired pressure ulcers/injuries during the first year of COVID-19.

BACKGROUND: As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment. OBJECTIVE: To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic. METHODS: A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is. RESULTS: Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I. CONCLUSION: This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.

American Association of Nurse Practitioners Research Agenda, 2023-2028.

ABSTRACT: This report highlights the 2023-2028 American Association of Nurse Practitioners Research Agenda (AANP-RA), which focuses on the research goals of AANP as an organization and is based on its mission and strategic plan. The purpose of the AANP Research Agenda is to outline research priorities that advance the AANP Strategic Plan and concurrently address gaps in nursing science. American Association of Nurse Practitioners supports research studies that are rigorously designed and conducted using quantitative, qualitative, and mixed-methods approaches, as well as implementation science with the potential to positively impact both NP practice and patient health outcomes. The AANP-RA strategy is guided by the PEARL acronym: examining NP Practice, Education, policy Advocacy, Research, and Leadership. A discussion of each area is presented along with suggested topics.

Training and practice of wound ostomy continence nurse specialists in China.

BACKGROUND: In China, with chronic wound patients increasing by 10% per year and more than 1 million stoma patients, there is an increasing demand for wound ostomy continence care. Accordingly, specialized wound care in China is developing rapidly and the gap with developed countries is narrowing. PURPOSE: This paper aims to describe the status of training, practice, and management of wound nurses in China. METHODS: Data on the training and practice of wound specialist nurses in the Chinese Mainland were collected through literature review and hospital surveys. RESULTS: The training system of Chinese Wound, Ostomy and Continence (WOC) specialist nurses is developing rapidly, but lacks a unified access standard, curriculum, teaching materials, and assessment system. Specialist nurses play an important role in education, clinical practice, and scientific research, but home care and independent nursing practices are still in their infancy. CONCLUSION: The developing momentum of wound care in China is encouraging, but it is necessary to unify and standardize WOC nurses' qualification certification, scope of practice, level-to-level administration, and other aspects to cultivate higher-quality specialized wound nurses.

Measuring Pressure Redistribution Properties of 4 Hospital Bed Surfaces: A Quality Improvement Project.

BACKGROUND: Pressure ulcers/injuries are not only prevalent in the long-term care facilities but also in the acute care setting. Pressure ulcer development has many contributing factors, including prolonged high surface interface pressure between the skin and mattress surface. PURPOSE: The purpose of this quality improvement project was to measure the pressure redistribution properties of 4 hospital surfaces. METHODS: Pressure measurements were performed on 8 participants lying on 1) standard mattress; 2) standard mattress with a static, air-filled bed overlay placed on top of it; 3) mattress with pulsing technology; and 4) mattress with immersing technology. Participants were volunteers measured while lying in the supine position and, in one instance, in the prone position. Pressures were measured with a full-body interface pressure mapping system. RESULTS: Of the 4 surfaces evaluated, the surface that provided the most effective pressure redistribution properties was the combination of the standard viscoelastic mattress with the static, air-filled overlay. CONCLUSION: These results can help guide surface choice for providing the best pressure redistribution properties in order to help prevent pressure ulcers/injuries.

Cutaneous Anomalies of the Critically Ill Patient.

Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.

Caring for Aging Skin: Preventing and managing skin problems in older adults.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Teaching Wound Care to Family Caregivers: An overview of methods to use to promote wound healing.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes.

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3-6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8-32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

Use of Pressure Mapping to Compare Two Operating Room Surfaces in the Supine With Bent Knees Position and the Supine in Lithotomy Position.

INTRODUCTION: Hospital-acquired pressure ulcer/injury (HAPU/I) often occurs postoperatively despite preventative interventions. The authors recently found an increasing incidence of HAPU/I in patients having prolonged operating room (OR) procedures in both the bent knee and lithotomy positions. OBJECTIVE: The aim of this study was to measure and compare 2 different OR surfaces in both the supine with bent knees position and the supine in lithotomy position. The authors sought to identify the most effective pressure redistribution surface in different positions to prevent HAPU/I in surgical patients. MATERIALS AND METHODS: Using a pressure mapping device, the authors measured and compared 5 volunteers on the standard OR surface and on the standard surface with the static, air-filled cushion on top. RESULTS: Use of the static, air-filled seat cushion placed on top of the standard OR surface resulted in lower peak pressures and higher skin contact surface area than the standard OR surface alone. CONCLUSIONS: This study showed that use of the static, air-filled seat cushion on top of the standard OR surface resulted in superior pressure redistribution properties in both the supine with bent knees position and supine in lithotomy position compared with the standard OR surface alone.

Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries- To Be or Not To Be?

BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

The nurse practitioner role in treating the homeless and rough-sleeper population.

Homelessness has always existed worldwide and it presents challenges to society. Delivering health care can be challenging but relationships can be built by starting with wound care, a common problem. Often, the homeless and rough-sleepers need expert attention from caring individuals. However, this population does not have access to expert care, advice, or supplies. This column presents techniques for assessment, treatment, and engagement for better health outcomes in a low resource setting.

An international consensus on device-related pressure ulcers: SECURE prevention.

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com.

The Origin of Present-on-admission Pressure Ulcers/Injuries Among Patients Admitted from the Community: Results of a Retrospective Study.

Research about community-acquired pressure ulcer/injuries (CAPU/I) remains limited. PURPOSE: The aim of this descriptive, retrospective study was to quantify the number of patients with pressure ulcers/injuries (PU/Is) present on admission (POA), with particular attention to patient residence (home or skilled/long-term care facility [SNF]). METHODS: Data from the electronic medical records (EMR) and the incident reporting system of a 620-bed integrated health system in northern California from January 1, 2017, to December 31, 2017, were examined and used to create a registry that included patient demographics, length of stay (LOS), source of admission (home versus SNF), co-existing conditions, and documentation on end of life and death. A manual chart review was conducted to confirm the accuracy of data entered into the registry. All patients at least 18 years old and with a nurse-reported incident and EMR-documented PU/I that was listed as POA were included; pediatric, pregnant, or incarcerated patients were excluded. Extracted variables included demographic data, stage of PU/I on admission, and major diagnosis (or co-existing condition) by groups (spinal cord injuries [tetraplegia, paraplegia], neurological conditions, end-stage renal disease, cardiac and vascular disease, end of life [EOL], and death while in hospital during the year 2017). Descriptive analysis was used to examine the data. RESULTS: Of the 2340 records of patients with an PU/I POA, 477 were complete and analyzed. The majority (336, 70.4%) originated from home. Patients admitted from home were younger than those admitted from SNF (average age 62.9 and 71.5 years, respectively) and had a higher proportion of co-existing paraplegia/tetraplegia (24.4% vs 12.8%). More than 60% of all patients had a stage 3, stage 4, or unstageable PU/I. CONCLUSION: The majority of patients with a PU/I POA were admitted from home. Additional research and improved efforts to help high-risk individuals living at home prevent and manage PU/Is are needed.

The Use of Pressure Mapping: An Educational Report.

A pressure ulcer/injury (PU/I) is caused by multiple factors with sustained pressure being the major contributor to its development. This pressure may be measured by a health care provider using a pressure mapping device in order to assess pressure distribution properties of surfaces used. This educational article describes a general overview, the value, how to perform, and how to incorporate pressure mapping into clinical practice. Also included is an exemplar of a nurse and a physical therapist using pressure mapping to identify the best surface and position for a wheelchair-bound patient in order to minimize PU/I risk.

Ostomy Care at Home.

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Teaching Wound Care to Family Caregivers.

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Caring for Aging Skin.

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.