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Publications

Publication Accepted :
Indian Journal of Dermatology Volume 60, Issue no: 6, November – December 2015.
 A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis

Elizebeth Thomas, Sudhaya Vinodkumar, Silvia Mathew, Maninder Singh Setia

Abstract

Background: Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross sectional, have used pooled data, or Cox regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data.

Aims and Objectives: The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time.

Materials and Methods: We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were:

(1) Score on the pressure risk assessment scale; and

(2) The proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data.

Results: The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01–12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16–1.86).

Conclusion: There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high risk score for PU on the monitoring scale, and these patients require active interventions.

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* Tag Team” Approach to care for critically ill patients. NURSING 2015, Vol. 45, 63. Published in issue: May 2015 by Sheena Binu, Asmita Garate, and Dr Maninder Singh Setia

Critically ill patients require intensive, well-coordinated interventions because they're at risk for developing complications such as extubation failures, mechanical ventilator weaning failures, malnutrition, and infections. Evidence-based nursing care, including frequent assessments, close monitoring, and timely communication of patient status to the multidisciplinary team are important when caring for these patients. However, ICU nurses are susceptible to burnout from the stress of caring for critically ill patients. To manage the specific requirements of these patients while simultaneously addressing the concerns of the nurses caring for them, we devised a new type of nursing care model—the "tag team" approach—to care for critically ill patients. This article takes a look at the tag team approach we used when caring for one critically ill patient who was admitted to our hospital in Mumbai, India, for over 3 months and discusses how the new care model improved the care the patient received.