Cent Eur J Nurs Midw 2016, 7(2):428-436 | DOI: 10.15452/CEJNM.2016.07.0011
At risk of pressure ulcers - a nursing diagnosis
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Slovakia
Aim: The aim of the study was content validation of the nursing diagnosis of at Risk of Impaired Skin Integrity by a sample of Slovak nurse-experts. It focuses on identifying the major risk factors in pressure ulcer development.
Design: Retrospective study.
Methods: The Diagnostic Content Validity Model designed by Fehring was used for validation of the nursing diagnosis; we used it to establish the significance of the risk factors of the nursing diagnosis of at Risk of Impaired Skin Integrity in relation to pressure ulcer development. Correlation analysis was used for evaluation of the relationships between the risk factors. The sample consisted of 126 nurse-experts in accordance with modified Fehring criteria.
Results: Out of 23 items, the nurses rated nine as significant (the most frequently present) risk factors (the weighted scores are shown in brackets): physical immobilisation (0.92), skeletal prominence (0.9), imbalanced nutritional state (0.86), moisture (0.86), mechanical factors (e.g., shearing forces, pressure, restraint) (0.84), a Norton Scale score of 14 ≥ points (0.81), hyperthermia (0.81), excretions (0.77), and extremes of age (0.76). Statistically significant correlations, which are positive and range between 0.2 and 0.4, were found between some risk factors. The strongest correlations were found between moisture and mechanical factors (r = 0.4008) and moisture and physical immobilization (r = 0.3072).
Conclusion: Using the DCV model, the experts identified nine significant risk factors which can be predictors of pressure ulcer development.
Keywords: pressure ulcers, validation, potential nursing diagnosis, risk factors
Received: October 19, 2015; Accepted: December 17, 2015; Published: September 30, 2016 Show citation
References
- Allman RM, Goode PS, Patrick MM, Burst N, Bartolucci AA. Pressure ulcer risk factors among hospitalized patients with activity limitation. Journal of American Medical Association. 1995;273(11):865-870.
Go to original source...
Go to PubMed...
- Bavaresco T, Lucena Ade F. Nursing Intervention Classifications (NIC) validated for patients at risk of pressure ulcers. Revista latino-americana de enfermagem. 2012;20(6):1109-1116.
Go to original source...
Go to PubMed...
- Beeckman D, Van Lancker A, Van Hecke A and Verhaeghe S. A Systematic review and meta-analysis of incontinenceassociated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Research in Nursing & Health. 2014;37(3):204-218.
Go to original source...
Go to PubMed...
- Bóriková I. Predikcia rizika vzniku dekubitov. In: Dušová B, Jarošová D, Vrublová Y, editors. Trendy v ošetřovatelství IV. Ostrava: Ostravská univerzita v Ostrave; 2006. s. 19-26. (in Slovak)
- Bours GJ, De Laat E, Halfens RJ, Lubbers M. Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units. Results of a cross-sectional survey. Intensive Care Medicine. 2001;27(10):1599-1605.
Go to original source...
Go to PubMed...
- Casimiro C, García-de-Lorenzo A, Usán L. Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population. Nutrition. 2002;18(5):408-414.
Go to original source...
Go to PubMed...
- Coleman S, Nelson EA, Keen J, Wilson L, McGinnis E, Dealey C, Stubbs N, Muir D, Farrin A, Dowding D, Schols JM, Cuddigan J, Berlowitz D, Jude E, Vowden P, Bader DL, Gefen A, Oomens CW, Schoonhoven L, Nixon J. Developing a pressure ulcer risk factor minimum data set and risk assessment framework. Journal of Advanced Nursing. 2014;70(10):2339-2352.
Go to original source...
Go to PubMed...
- Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, Farrin A, Brown J, Sschoonhoven L, Nixon J. Patient risk factors for pressure ulcer development: systematic review. International Journal of Nursing Studies. 2013;50(7):974-1003.
Go to original source...
Go to PubMed...
- Demarre L, Verhaeghe S, Van Hecke A, Clays E, Grypdonck M, Beeckman D. Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. Journal of Advanced Nursing. 2015;71(2):391-403.
Go to original source...
Go to PubMed...
- Defloor T, Grypdonck MF. Pressure ulcers: validation of two risk assessment scales. Journal of Clinical Nursing, 2005;14(3):373-382.
Go to original source...
Go to PubMed...
- Fehring RJ. Validating diagnostic labels: standardized methodology. In: Hurley ME, editor. Classification of nursing diagnoses: Proceedings of the sixth Conference. Mosby: St. Louis; 1986. p. 183-190.
- Fúrová A. Manažment prevencie dekubitov. In: Krišková A et al., editors. Ošetrovateľské techniky: metodika sesterských činností. 1. vyd. Martin: Osveta; 2006. s. 167-178. (in Slovak)
- Grofová Z. Nutriční podpora - praktický rádce pro sestry. 1. vyd. Praha: Grada Publishing; 2007. (in Czech)
- Hyun S, Li X, Vermillion B, Newton C, Fall M, Kaewprag P, Moffatt-Bruce S, Lenz ER. Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients. American Journal of Critical Care. 2014;23(6):494-500.
Go to original source...
Go to PubMed...
- Kalvach Z, Kojanová M, Vohradníková O. Dekubity, proleženiny, otlaky (pressure sores, bedsores). In: Kalvach Z. et al. editors. Geriatrie a gerontologie. 1. vyd. Praha: Grada Publishing; 2004. s. 233-239. (in Czech)
- Källman U, Lindgren M. Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting. Advances in Skin and Wound Care. 2014;27(2):70-76.
Go to original source...
Go to PubMed...
- Krajčík Š, Bajanová E. Dekubity, prevencia a liečba v praxi. 1. vyd. Bratislava: Herba; 2012. (in Slovak)
- Kumari S, Sharma D, Rana A, Pathak R, Lal R, Kumar A, Biswal UC. Risk assessment tool for pressure ulcer development in Indian surgical wards. The Indian Journal of Surgery. 2015;77(3):206-212.
Go to original source...
Go to PubMed...
- Lepisto M, Eriksson E, Hietanen H, Lepisto J, Lauri S. Developing a pressure ulcer risk assessment scale for patients in long-term care. Ostomy Wound Manage. 2006;52(2):34- 46.
- Lindgren M, Unosson M, Fredrikson M, Ek AC. Immobility - a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scandinavian Journal of Caring Sciences. 2004;18(1):57-64.
Go to original source...
Go to PubMed...
- Lyder CH. Pressure ulcer prevention and management. The Journal of the American Medical Association. 2003;289(2):223-226.
Go to original source...
Go to PubMed...
- Margolis DJ, Bilker W, Knauss J, Baumgarten M, Strom BL. The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Annals of Epidemiology. 2002;12(5):321-325.
Go to original source...
Go to PubMed...
- NANDA International. Nursing Diagnoses: Definitions and Classification 2012-2014. Herdman TH, editor. 9th ed. Chichester: Wiley Blackwell; 2012.
- NANDA International. Ošetřovatelské diagnózy: Definice a klasifikace 2012-2014. Herdman TH, editor. 1. vyd. Praha: Grada Publishing; 2013. (in Czech)
- NANDA International. Nursing diagnoses: Definitions and Classification 2015-2017. Herdman TH, Kamitsuru S, editors. 10th ed. Chichester: Wiley Blackwell; 2014.
- Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing. 2006;54(1):94-110.
Go to original source...
Go to PubMed...
- Papanikolaou P, Lyne PA, Lycett EJ. Pressure ulcer risk assessment: application of logistic analysis. Journal of Advanced Nursing. 2003;44(2):128-136.
Go to original source...
Go to PubMed...
- Pattanshetty RB, Prasade PM, Aradhana KM. Risk assessment of decubitus ulcers using four scales among patients admitted in medical and surgical intensive care units in a tertiary care set up: a crosssectional study. International Journal of Physiotherapy and Research. 2015;3(2):971-977.
Go to original source...
- Perneger TV, Raë AC, Gaspoz JM, Borst F, Vitek O, Héliot C. Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale. Journal of Clinical Epidemiology. 2002;55(5):498-504.
Go to original source...
Go to PubMed...
- Pereira de Melo R, Venícios de Oliveira Lopes M, Leite de Araujo T, de Fatima da Silva L, Aline Arrais Sampaio Santos F, Moorhead S. Risk for decreased cardiac output: validation of a proposal for nursing diagnosis. Nursing in Critical Care. 2011;16(6):287-294.
Go to original source...
Go to PubMed...
- Pokorná A, Mrázová R. Kompendium hojení ran pro sestry. 1. vyd. Praha: Grada Publishing; 2012. (in Czech)
- Riebelová V, Válka J, Franců M. Trendy soudobé chirurgie. Svazek 3. 1. vyd. Praha: Galén; 2000. (in Czech)
- Saleh M, Anthony D, Parboteeah S. The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients. Journal of Clinical Nursing. 2009;18(13):1923- 1929.
Go to original source...
Go to PubMed...
- Schulz CE, Lopes CT, Herdman TH, Lopes Jde L, de Barros AL. Construction and validation of an instrument for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery. International Journal of Nursing Knowledge. 2014;25(2):94-101.
Go to original source...
Go to PubMed...
- Suriadi AS, Sanada H, Sugama J, Kitagawa A, Thigpen B, Kinosita S, Murayama S. Risk factors in the development of pressure ulcers in an intensive care unit in Pontianak, Indonesia. International Wound Journal. 2007;4(3):208-215.
Go to original source...
Go to PubMed...
- Šáteková L, Žiaková K, Zeleníková R. Predictive validity of the Braden scale, Norton scale and Waterlow scale in Slovak Republic. Central European Journal of Nursing and Midwifery. 2015;6(3):283-290.
Go to original source...
- Šáteková L, Žiaková K. Validity of pressure ulcer risk assesment scales: review. Central European Journal of Nursing and Midwifery. 2014;5(2):85-92.
- The National Pressure Ulcer Advisory Panel (NPUAP). Pressure ulcer stages/categories. 2007 [cited 2015 Sep 4]. Available from: http://www.npuap.org/resources/educationaland-clinical-resources/npuap-pressure-ulcer-stagescategories/
- Trachtová E, Fojtová G, Mastiliaková D. Potřeby nemocného v ošetřovatelském procesu. 1. vyd. Brno: NCONZO; 1999. (in Czech)
- Vanderwee K, Grypdonck M, Defloor T. Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial. Journal of Clinical Nursing. 2007;16(2):325-335.
Go to original source...
Go to PubMed...
- Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation in Clinical Practice. 2007;13(2):227-235.
Go to original source...
Go to PubMed...
- Vörösová G et al. Interné ošetrovateľstvo. 2. vyd. Martin: Osveta; 2005. (in Slovak)
- Zeleníková R, Žiaková K, Čáp J, Jarošová D, Vrublová Y. Návrh kritérií výberu expertov pre validizáciu ošetrovateľských diagnóz v ČR a SR. Kontakt. 2010;12(4):407-413. (in Slovak)
Go to original source...
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.