Basınç yarası önlemede bakım paketi kullanımının basınç yarası insidansına etkisinin incelenmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu araştırma; basınç yarası önlemede bakım paketi kullanımının basınç yarası insidansına olan etkisini belirlemek amacıyla yapılmış olan, yarı deneysel bir araştırmadır. EPUAP/NPUAP/PPPIA 2014 rehberi doğrultusunda hazırlanmış olan bakım paketi; "risk değerlendirme, derinin değerlendirilmesi, deri bakımı, pozisyon verme, destek yüzeyler, beslenme ve sıvı alımı" parametrelerinden oluşmuştur. Araştırma kapsamına 1 Nisan- 30 Eylül tarihleri arasında Sağlık Bilimleri Üniversitesi (S.B.Ü) İzmir Bozyaka Eğitim ve Araştırma Hastanesi Genel Yoğun Bakım Ünitesinde (YBÜ) yatmakta olan en az 24 saat ve üzeri kalması beklenen, 18 yaş ve üzeri 73 hasta dahil edilmiş ve 431 hasta değerlendirilmesi yapılmıştır. Bu çalışmanın protokolü üç aşamadan oluştu. Birinci aşamada basınç yarası önlemede bakım paketi parametreleri doğrultusunda eğitim sunumu ve broşürü hazırlandı. İkinci aşamada YBÜ hemşirelerine basınç yarası önlemede bakım paketi konulu eğitim verildi. Üçüncü aşamada araştırma kapsamına alınan hastalara verilen hemşirelik bakımı bakım paketi parametreleri doğrultusunda değerlendirilmiş olup, basınç yarası önlemede bakım paketine uyumun basınç yarası insidansına olan etkisi incelendi. Araştırmada elde edilen veriler SPSS (Statistical Package for Social Sciences) for Windows 25.0 programı kullanılarak analiz edildi. Verileri değerlendirilmesinde sayı, yüzde, bağımsız örneklem t testi, Mann Whitney U testi kullanıldı. Çalışmada hemşirelerin uyum ortalamalarına bakıldığında; Nisan-Haziran (Nisan, Mayıs, Haziran) döneminde bakım paketi uyum ortalaması 91.39∓14.26, Temmuz-Eylül (Temmuz, Ağustos, Eylül) döneminde bakım paketi uyum ortalaması ise 93.77∓12.36 olduğu tespit edildi. Nisan-Haziran dönemi ile Temmuz-Eylül dönemi arasında bakım paketi uyumu puan sıra ortalamaları bakımından istatistiksel olarak anlamlı bir farklılığın olmadığı tespit edildi (p>0.05). Nisan-Haziran döneminde risk değerlendirme ve deri değerlendirme uyum %91.4 (n=191), deri bakımı uyum %93.8 (n=196), pozisyon verme uyum %90.4 (n=189), destek yüzey uyum 90.9 (n=190), beslenme ve sıvı alımı uyum %90.4 (n=189) bulundu. Temmuz-Eylül döneminde ise; risk değerlendirme ve deri değerlendirme uyum %92.3 (n=205), deri bakımı uyum %97.3(n= 216), pozisyon verme uyum %92.8 (n=206), destek yüzey uyum %94.6 (n=210), beslenme ve sıvı alımı uyum %94.1(n=209) olarak bulundu. Çalışmamızın eğitim aşamasının başladığı 1. periyotta basınç yarası insidansı %8.42'dir. Veri toplama aşaması olan 2. periyotta basınç yarası insidansı % 20,1 ve bakım paketi uyum ortalaması 91.39±14.26, 3. periyotta basınç yarası insidansı %6.81 ve bakım paketi uyum ortalaması 93.77±10.15'dir. Çalışma dönemindeki basınç yarası insidansı ve bakım paketi uyumu değerlendirildiğinde, basınç yarası uyum ortalaması artarken, basınç yarası insidansının düştüğü gözlendi. Nisan-Haziran tarihleri arasında bakım paketi uyum ortalaması ile basınç insidansı arasında istatistiksel olarak anlamlı bir farklılık olduğu tespit edildi (p<0.05). Temmuz-Eylül tarihleri arasında bakım paketi uyum ortalaması ile basınç insidansı arasında istatistiksel olarak anlamlı bir farklılık olduğu tespit edildi (p<0.05). Hastaların basınç yarası gelişme durumu incelendiğinde hastaların %87.7'sinde basınç yarası gelişmediği, %12.3'ünde ise basınç yarasının geliştiği görüldü. İzlemi sonlandırma nedenlerine bakıldığında ise; %12.3 (n=9) basınç yarası gelişme, %34.2 (n=25) eksitus, %47.9 (n=35) klinik sevk, %2.7 (n=2) ve taburcu olarak bulundu. Çalışma bitiminde %2.7(n=2) yatışı devam etmektedir. Sonuç olarak kanıta dayalı rehberler doğrultusunda hazırlanmış eğitim ile basınç yarası önlemede bakım paketi uygulamasının basınç yarası insidansını azalttığı belirlendi. Bu nedenle yoğun bakım hastalarında basınç yarası önlemede bakım paketinin kullanılması önerilmektedir.
This quasi-experimental study was performed to determine effects of using care bundle to prevent pressure ulcers on the incidence of these ulcers. The care bundle prepared in accordance with EPUAP/NPUAP/PPPIA 2014 guides was based on the parameters of risk assessment, skin assessment, skin care, positioning, support surfaces, nutrition and fluid intake. Out of 431 patients admitted to the general intensive care unit of University of Health Sciences İzmir Bozyaka Education and Research Hospital, 73 patients aged 18-73 years and planned to stay in the intensive care unit for at least 24 hours were included into the sample. The study protocol had three stages. At the first stage, an educational presentation and a brochure were prepared in accordance with the parameters for care bundles to prevent pressure ulcers. At the second stage, the nurses working in the intensive care unit were offered education about care bundles to prevent pressure ulcers. At the third stage, nursing care offered to the patients included in the study was evaluated according to the parameters for care bundles, and effects of adherence to care bundles to prevent pressure ulcers on the incidence of these ulcers were examined. Data obtained were analyzed with Statistical Package for Social Sciences for Windows 25.0 and numbers, percentages, t test for independent samples and Mann-Whitney U test. The mean adherence of the nurses with care bundles was 91.39∓14.26 between April and June, and 93.77∓12.36 between July and September without a significant difference (p>0.05). Between April and June, risk and skin assessment adherence was 91.4% (n=191), skin care adherence was 93.8% (n=196), positioning adherence was 90.4% (n=189), support surface adherence was 90.9% (n=190) and nutrition and fluid intake adherence was 90.4% (n=189). Between July and September, risk and skin assessment adherence was 92.3% (n=205), skin care adherence was 97.3% (n= 216), positioning adherence was 92.8% (n=206), support surface adherence was 94.6% (n=210) and nutrition and fluid intake adherence was 94.1% (n=209). At the first stage, when education started, the incidence of pressure ulcers was 8.42%. At the second stage, when data were collected, the incidence of pressure ulcers was 20.1% and the mean care bundle adherence was 91.39±14.26. At the third stage, the incidence of pressure ulcers was 6.81% and the mean care bundle adherence was 93.77±10.15. While the mean pressure ulcer adherence increased, the incidence of pressure ulcers decreased. There was a significant difference between the mean care bundle adherence and the incidence of pressure ulcers between April and June (p<0.05). The difference between the mean care bundle adherence and the incidence of pressure ulcers between July and September was also significant (p<0.05). Off all the patients, 12.3% developed pressure ulcers, but 87.7% did not develop pressure ulcers. Reasons for cessation of follow-up was pressure ulcer development in 12.3% of the patients (n=9), exitus in 34.2% (n=25), referral to the wards in 47.9% (n=35) and discharge in 2.7% (n=2). At the end of the study, 2.7% of the patients are still in hospital (n=2). In conclusion, using care bundles to prevent pressure ulcers through education designed according to evidence-based guides was found to reduce the incidence of pressure ulcers. Care bundles could be used to prevent pressure ulcers in intensive care patients.
This quasi-experimental study was performed to determine effects of using care bundle to prevent pressure ulcers on the incidence of these ulcers. The care bundle prepared in accordance with EPUAP/NPUAP/PPPIA 2014 guides was based on the parameters of risk assessment, skin assessment, skin care, positioning, support surfaces, nutrition and fluid intake. Out of 431 patients admitted to the general intensive care unit of University of Health Sciences İzmir Bozyaka Education and Research Hospital, 73 patients aged 18-73 years and planned to stay in the intensive care unit for at least 24 hours were included into the sample. The study protocol had three stages. At the first stage, an educational presentation and a brochure were prepared in accordance with the parameters for care bundles to prevent pressure ulcers. At the second stage, the nurses working in the intensive care unit were offered education about care bundles to prevent pressure ulcers. At the third stage, nursing care offered to the patients included in the study was evaluated according to the parameters for care bundles, and effects of adherence to care bundles to prevent pressure ulcers on the incidence of these ulcers were examined. Data obtained were analyzed with Statistical Package for Social Sciences for Windows 25.0 and numbers, percentages, t test for independent samples and Mann-Whitney U test. The mean adherence of the nurses with care bundles was 91.39∓14.26 between April and June, and 93.77∓12.36 between July and September without a significant difference (p>0.05). Between April and June, risk and skin assessment adherence was 91.4% (n=191), skin care adherence was 93.8% (n=196), positioning adherence was 90.4% (n=189), support surface adherence was 90.9% (n=190) and nutrition and fluid intake adherence was 90.4% (n=189). Between July and September, risk and skin assessment adherence was 92.3% (n=205), skin care adherence was 97.3% (n= 216), positioning adherence was 92.8% (n=206), support surface adherence was 94.6% (n=210) and nutrition and fluid intake adherence was 94.1% (n=209). At the first stage, when education started, the incidence of pressure ulcers was 8.42%. At the second stage, when data were collected, the incidence of pressure ulcers was 20.1% and the mean care bundle adherence was 91.39±14.26. At the third stage, the incidence of pressure ulcers was 6.81% and the mean care bundle adherence was 93.77±10.15. While the mean pressure ulcer adherence increased, the incidence of pressure ulcers decreased. There was a significant difference between the mean care bundle adherence and the incidence of pressure ulcers between April and June (p<0.05). The difference between the mean care bundle adherence and the incidence of pressure ulcers between July and September was also significant (p<0.05). Off all the patients, 12.3% developed pressure ulcers, but 87.7% did not develop pressure ulcers. Reasons for cessation of follow-up was pressure ulcer development in 12.3% of the patients (n=9), exitus in 34.2% (n=25), referral to the wards in 47.9% (n=35) and discharge in 2.7% (n=2). At the end of the study, 2.7% of the patients are still in hospital (n=2). In conclusion, using care bundles to prevent pressure ulcers through education designed according to evidence-based guides was found to reduce the incidence of pressure ulcers. Care bundles could be used to prevent pressure ulcers in intensive care patients.
Açıklama
Anahtar Kelimeler
Basınç Yarası, Bakım Paketi, Uyum, İnsidans, Pressure Ulcer, Care Bundle, Adherence, Incidence