危重患者压力性损伤预防的护理干预：系统评价

Abstract

Aim

To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients.

Background

Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings.

Design

A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.

Methods

Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis.

Results

The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low.

Conclusions

Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries.

Relevance to clinical practice

Nursing interventions should consist of evidence-based ‘bundles’ and be adapted to patients’ needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

摘要翻译（仅供参考）

目的

系统综合有关预防重症监护患者压力性损伤的最有效护理干预措施的证据。

背景

尽管压力损伤 (PI) 预防是重症监护病房护理的重点，但医院获得性压力损伤在这些环境中继续发生。

设计

以系统评价和 Meta 分析的首选报告项目 (PRISMA) 和无荟萃分析的综合 (SWiM) 指南为指导的文献系统评价。

方法

搜索了四个电子数据库以进行相关研究。纳入的研究经过筛选，然后使用适当的乔安娜布里格斯研究所评估工具进行严格评估。使用叙述性综合分析和报告数据。

结果

该评价包括 14 项研究。包括随机对照试验、准实验、病例系列和横断面研究。该审查确定了四大类对预防压力性损伤最有效的干预措施：(a) PI 预防包，(b) 重新定位和使用表面支撑，(c) 预防医疗器械相关的压力性损伤和 (d) ) 获得专业知识。所有纳入的研究都报告了干预后压力性损伤的减少；然而，证据的强度从中等到非常低。

结论

护士完全有资格领导重症监护病房的压力性损伤预防。每个危重病人都需要干预来预防压力性损伤，而 PI 的预防应被视为一项复杂的干预措施。护士必须计划和实施循证护理，以预防所有类型的压力性损伤，包括与医疗设备相关的压力性损伤。针对护士的 PI 预防教育和培训计划对于预防压力性损伤很重要。

与临床实践的相关性

护理干预应包括循证“包”并适应患者的需求。为防止危重患者发生压力性损伤，护士必须具备能力和受过高等教育，并确保常规实施基本策略以改善活动能力和减轻压力。

原文链接：

https://onlinelibrary.wiley.com/doi/10.1111/jocn.15709

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