Incidência de úlcera por pressão e ações de enfermagem

Abstract

Objectives: To estimate the cumulative incidence (IC up ) and density incidence (DI up ) of pressure ulcer (PU) and to describe the implementation of nursing interventions in two hospitals in the State of Bahia before (phase 1) and during an educational intervention (phase 2). Methods: A prospective design was used. The sample consisted of inpatients of medical/surgical units. Data were collected through skin integrity assessment, reviewing of medical records, interviewing patients, family members, and health care team. Results: The cumulative incidence before and during the educational intervention was 31.4% and 13.6% in hospital 1, and 21.4% and 15% in hospital 2, respectively. The density incidence in hospital 1 before and during the educational intervention was 14.3 days and 43.5 days, respectively. The density incidence in hospital 2 before and during the educational intervention was 31.3 days and 37 days, respectively. Conclusion: There was a statistically significant reduction of density incidence in hospital 1. Preventive nursing interventions were effective in both before and during the educational intervention in both hospitals. Keywords: Pressure ulcers/epidemiology; Quality assurance nursing care; Nursing care RESUMO Objetivos: Estimar a incidência cumulativa (IC up ) e a densidade de incidência (DI up ) de úlcera por pressão (UP) e descrever a ocorrência de ações de enfermagem em dois hospitais do Estado da Bahia, antes (fase 1) e durante (fase 2) intervenção educativa. Métodos: Estudo de coortes prospectivo com pacientes médico-cirúrgicos, utilizando avaliação da integridade cutânea, consulta a registros no prontuário, e entrevista com paciente, família e equipe. Resultados: IC up,, fase 1 e fase 2 foi, respectivamente, no hospital 1 de 31,4% e 13,6%, e no hospital 2, de 21,4% e 15%; DI up aponta tempo médio de exposição para aparecimento de UP no hospital 1 de 14,3 dias na fase 1 e de 43,5 na fase 2; no hospital 2, de 31,3 dias na fase 1 e 37 na fase 2. Conclusão: Redução estatisticamente significante da DI up no hospital 1; cuidados de enfermagem preventivos para UP comprometidos em ambos os hospitais nas duas fases. Descritores: Úlcera por pressão/epidemiologia; Avaliação da qualidade dos cuidados de enfermagem; Cuidados de enfermagem RESUMEN Objetivos: Estimar la incidencia acumulativa (IC up ) y la densidad de incidencia (DI up ) de úlcera por presión (UP) y describir la ocurrencia de acciones de enfermería en dos hospitales del Estado de la Bahia, antes (fase 1) y durante (fase 2) la intervención educativa. Métodos: Se trata de un estudio de cohortes prospectivo realizado con pacientes médico-quirúrgicos, utilizando una evaluación de la integridad cutánea, consulta a registros en la historia clínica, y entrevista con el paciente, la familia y el equipo. Resultados: IC up, fase 1 y fase 2 fue, respectivamente, en el hospital 1 de 31,4% y 13,6%, y en el hospital 2, de 21,4% y 15%; DI up apunta un tiempo medio de exposición para la aparición de UP en el hospital 1 de 14,3 días en la fase...

Incidence of pressure ulcer in regional hospitals of Mato Grosso, Brazil

“…Nos demais estados brasileiros, identificamos apenas um estudo do Rio de Janeiro com incidência de 26,8% em UTI (16) e um na Bahia, que estudou os setores de internação inclusive UTI, em dois hospitais, com incidência de 31,4% e 21,4%, respectivamente (17) . Na análise estatística sobre associação de idade, sexo, cor e tabagismo com presença de UP, nenhum resultado significativo foi encontrado, pois todos apresentaram p > 0,005.…”

“…Os resultados de pesquisas apontam que a influência da idade tem apresentado diferença estatística significante e não significante dependendo do grupo estudado (11,13,17) , o que nos leva a crer que mesmo conhecendo a susceptibilidade de desenvolvimento de UP em idosos, não se deve avaliar esse fator isoladamente.…”

Análise das subescalas de Braden como indicativos de risco para úlcera por pressão

“…These data are corroborated in similar studies performed in Brazilian hospitals. 2,6 Furthermore, it was found inadequate nutrition in more than 60% of the patients, and 50% of them had problems of friction and/or shear, very limited sensory perception and very moist skin. The patients´ sample was homogenous with respect to the risk of PU, since all of them had a total score <13.…”

“…Other studies also point out similar data. 6,16,[23][24] Patients who were hospitalized with cerebral vascular diseases showed good scores about nutrition. There are many reasons for this, including the fact that the cerebral vascular event is usually acute, reaching individuals who were previously with good health and nutrition conditions.…”

“…[4][5] PU increases hospitalization time, treatment cost and worsens the life quality of hospitalized patients. 6 Most of the times, it is a preventable problem and, therefore, it became imperative the reassessment of care processes provided by the staff of a University Hospital in southern Brazil, which uses an assistance protocol for PU prevention and treatment. This is based on the risk assessment through the Braden Scale, which consists of six subscales: sensory perception (ability for responding to the pressure -related to discomfort); moisture (level at which the skin is exposed to humidity); activity (degree of physical activity), mobility (ability to control the position of the body); nutrition (usual pattern of food consumption); friction (when two surfaces come into friction with one another) and shear (the patient slides into bed -skeleton and closer tissues move, but the skin remains motionless).…”