Effect of Preventive Bundle Guidelines on Reducing Iatrogenic Pressure Injuries among Critically Ill Neonates

Abstract

Background:There is an emerging awareness that acutely ill and immobilized neonates are at risk for iatrogenic pressure injury. Therefore, it is crucial for nurses to understand the physiologic indices of pressure injury development and their interventions should be based on evidence-based information to reduce neonatal morbidity and mortality while increasing quality of care in the neonatal care setting.The aim of this study was to evaluate the effectiveness of preventivebundle guidelineson reducing iatrogenic pressure injuries among critically ill neonates.Research design: A quasi-experimental design was used. Settings:This study was conducted at the neonatalintensive care units in Benha Specialized Pediatric Hospital.Sample:A Convenient sample of nurses' (n=50) and critically ill neonates(n=60) were included from the above thementioned setting.Those neonateswere divided equally into two groups(study and control).Tools of data collection:Four tools were used namely; structured interviewing questionnaire format,pressure injury preventive bundle compliance checklist,Braden Q Risk Assessment Scales, andnurses opinion likert scale. Results:High percentage of the neonates (76.7%& 83.3%), in the study group were not at risk of pressure injury in the first and second week of admission respectively;this increased to 90.0%before discharge. While around (40%) of neonates in the control group were at high risk of pressure injury from the first week of admission till before discharge. Moreover. The result revealed that there was a significant improvement in nurses knowledge regarding pressure injuries as well as their compliance with preventive bundle guidelines after bundle implementation.Conclusion:The implementation of preventive bundle guidelines proved to be effective in improving nurses' knowledge and their compliance, with a positive impactontheincidence of pressure injury among critically ill neonates. Recommendation: Preventive bundle guidelines should be implemented in all hospitals caring for children to reduce the harm associated with hospital-acquired pressure injuries.

Effect of Preventive Bundle Guidelines on Nurses’ Knowledge and Compliance Regarding Pressure Ulcer Among Critically Ill Children at Pediatric Intensive Care Unit

“…On the same line, Sabaq &Amer [29] in the study about the effect of preventive bundle guidelines on reducing iratogenic pressure injury among critically ill neonates and found that, there was a positive correlation between nurses knowledge and their compliance after bundle implementation (r=.657, P<0.001). Moreover, Riccioni et al, [30] stated that pressure ulcer prevention continues to be a hot topic in pediatric hospitals.…”

Literatur Review: Intervensi Untuk Mencegah Dekubitus Pada Anak

“…Analisis kritis terhadap 7 artikel hasil penelitian yang menjadi sampel dalam literature review ini dituangkan dalam tabel berikut Artikel penelitian yang ditelaah berjumlah tujuh, setiap penelitian menggunakan desain penelitian yang berbeda-beda, diantaranya ada 5 penelitian dengan quasi eksperimental dengan pendekatan pre-post with control [14]- [16], [18], [20] dan selebihnya menggunakan pra eksperimen [17] [19].…”

“…Sabaq [20] melakukan penelitian dengan tujuan untuk mengetahui efek dari pencegahan dekubitus dalam menurunkan dekubitus pada neonatus kritis. Sampel sebanyak 60 anak yang dirawat di NICU dibagi menjadi dua kelompok antara lain 30 anak kelompok intervensi dan 30 anak kelompok kontrol.…”

“…Pada kelompok kontrol, sebagian besar responden berusia rata-rata 28-33 hari sebanyak 16(53,3%), berjenis kelamin perempuan sebanyak 18 (60%) dengam diagnosa RDS yaitu 12 anak (40%). Intervensi yang diberikan yaitu preventive bundle guideline meliputi pengkajian resiko, pengkajian kulit, manajemen kelembaban, pengkajian nutrisi, alih baring dan perawatan alat medis yang terpasang di anak [20].…”

“…Selain itu, lapisan korneum yang sedikit pada bayi antara usia 3 dan 12 bulan akan mengakibatkan kapasitas penahanan air berkurang [24]. Sebanyak 4 artikel menunjukkan bahwa sebagian besar sampel mengalami masalah gangguan pernapasan dan menggunakan ventilasi mekanik seperti pneumonia dan RDS [14]- [16], [20]. Menurut pendapat peneliti anak yang mengalami masalah gangguan pernapasan yang dirawat di perawatan kritis membutuhkan ventilasi mekanik sehingga anak mengalami immobilisasi yang beresiko komplikasi ulkus dekubitus bila tidak dilakukan perawatan dengan baik.…”