Reduced pressure for fewer pressure ulcers: can real‐time feedback of interface pressure optimise repositioning in bed?

Abstract

The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.

Facilitating student nurses' learning by real time feedback of positioning to avoid pressure ulcers--Evaluation of clinical simulation

“…For the student nurses as a group, the knowledge score was 55.7% and the attitude score was 86.9%, which are similar to the results of the earlier study by Gunningberg and Carli [12] investigating repositioning skills of RN and AN. Both studies reveal that for the same person using the same available pressurereducing equipment, peak pressure varied considerably.…”

“…[10][11][12] In particular, knowledge concerning the role of pressure and shear reduction was poor. This is interesting, since reduction of pressure and shear is recognised as the single most important intervention to avoid pressure ulcers.…”

“…Being able to see the effects of one's own attempts at repositioning patients upon levels of pressure helps to consolidate the understanding of the importance of pressure reduction. [12] A pressure mapping system has recently been tested by RNs and ANs in one Swedish university hospital. [12] The system allowed pressure ulcer prevention to be individualised, in contrast to routinely turning every 2 hours.…”

“…[12] A pressure mapping system has recently been tested by RNs and ANs in one Swedish university hospital. [12] The system allowed pressure ulcer prevention to be individualised, in contrast to routinely turning every 2 hours. Visualising the effects of repositioning lead to discussion and reasoning among the nurses about what they were actually doing and how it affected levels of pressure on the patient's body.…”

“…During the same period, student nurses with little or no previous practical experience of PU prevention also tested the mapping system using exactly the same procedure as in the aforementioned study. [12] The aim of the study was to assess whether student nurses' learning about optimal repositioning could be facilitated by real-time feedback in a simulated PU prevention scenario. Furthermore, students' level of theoretical knowledge about PU and PU prevention as well as their attitudes to PU was investigated since these are likely to impact upon PU management.…”