Authored by Nasira Hassan*
Abstract
Background: A communal health problem amongst immobilized patients is pressure ulcer that extend their period of hospitalization.
Objective: The objective of this study was to assess the effect of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan.
Research Methodology: A quasi experimental with non-equivalent control group design was used to assess the effect of body repositioning among immobilized patients to prevent pressure ulcer.
Results: A major difference between the interventional (1.35±.520) and control group (1.73±.790) mean of body repositioning to reduce the pressure ulcer among immobilized patients. P value is 0.000 which was less than .001 shows an important difference in mean of interventional and control group.
Keywords: Intensive care units (ICU); Pressure ulcer (PU)
Introduction
A communal health problem amongst immobilized patients is pressure ulcer that extend their period of hospitalization [1]. Pressure ulcer is confined impairment to the underlying tissues or skin above bony notorieties resulting from continued pressure [2]. Pressure ulcer start from mild reddening of skin to the damage of tissues and infection spread to muscles and bone [3]. Elbow, hip, back of head, heels, toes, shoulders, knees and thighs are body areas which are commonly predispose to pressure ulcer [4].
Pressure ulcer is a common community health problem. High mortality rate among immobilized patients is because of pressure ulcer [5]. It was one of the health care harm which lengthen the hospital stay and increase twenty percent of the total cost for the health care treatment [6]. In intensive care units more than 6000000 patients suffered from pressure ulcer, cost of 6 million patients treatment was 2.17 billion dollars. Moreover, pressure ulcer can harm to patients like pain, expensive treatment, Elongated hospitalization [7], physical and emotional problem, adverse social and psychosomatic impression lead to premature mortality [8].
The incidence of pressure ulcer among immobilized patients is not clear to determine because there are several epidemiological studies with different methodologies which present different prevalence and incidence rate [9]. However, international rate of PU in UK is 4.5%-25.2%, in Spain is 2.9%- 8.34%, in England is 14.8% and in USA is 19.1% [10]. Repositioning has long been vital constituent of pressure ulcer prevention (PUP). Repositioning (supine, lateral position) is one approach used along other protective strategies to release pressure and so preclude pressure ulcer. Repositioning schedules are used to dispense the pressure amongst the body and support surfaces [11]. Two hourly repositioning schedules is a standard care to the immobilized patients that must be applied, but in practice these standards were not regularly implemented [12].
Furthermore, 80% to 95% pressure ulcer are preventable from severe harm or even death [13]. It is the vital part of nursing care because all nurses are remaining forefront in the care of atrisk patients and subsequent provision of preventive measure to minimize the bedsore among immobilized patients [14]. To reduce the rate of bedsore among immobilized patients, there is need of special care and need to be educated [15]. Repositioning, skin care, nutrition and education of health care workers are preventive interventions of pressure ulcer among immobilized patients.
A prospective randomized control trial was conducted at western Ontario university, includes all physician of medicine on evaluation of a particular repositioning maneuver web-based teaching module consist of small group particular repositioning maneuver (PRM), standard classroom instruction and web-based module. The results were web-based module is very effective than SG and CI [16]. Another study was conducted to reduce the HAPU among bedridden patients by implementing novel care-based guidelines and preventive intervention (2 hourly repositioning, balanced and planned nutrition, pressure reducing beds, timely surgical interventions, education to care givers and wound/ skin checked by specialist nurse). Sample size was 9,755 patients. A paired sample t-test was used. Chi-square analysis was done. Only 89 patients were developed PU. Incidence rate of PU was reduced from 1.36% to 0.39% (p=0.002) in three years [17].
Study Objective
The objective of this study was to assess the effect of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan.
Methods
Research design
A quasi experimental with non-equivalent control group design was used to assess the effect of body repositioning among immobilized patients to prevent pressure ulcer.
Study Settin
Intensive care units of Neurosurgery department at public hospital, Pakistan.
Population
Study population was all immobilized patients who were admitted in intensive care unit.
Sampling
All immobilized patients were recruited through convenient sampling. Here two groups were formed. Intervention group is the one group on whom the nurses were performed repositioning preventive measure. Control group was for comparison purpose. The data collection procedure for patients was such that on day three of admission patients was assessed and 10 patients each group was followed for ten days. Then at day ten prevalence of pressure was observed in both groups and compared. Similarly, in this way 100 intervention group patients and 100 control group patients were followed over a period of 100 days in 10 10 groups for 10 days period each subgroup. After completing 100 patient’s assessment in intervention group and in control group the mean prevalence pressure ulcer score was assessed.
Research Instrument
The research instrument was consisting of following segments:
Socio-Demographic Data
It was utilized for collecting relevant data characteristics such as patients’ age 18-50 years, both genders; degree of pressure ulcer at 3rd and 10th day of assessment, abdominal circumference (inches) and co-morbidities.
Braden risk assessment scale
Braden risk assessment scale was used to evaluate the risk of pressure ulcer among ICUs patients by nurses
Repositioning of immobilized patients
Repositioning practices were done by nurses to minimize the risk of pressure ulcer among ICUs patients. Repositioned the immobilized patients 2 hours in supine position, 2 hours in a right lateral position 30° and 2hours in a left lateral position and continue the repositioning cycle in 24hour.
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