看護と患者ケアのジャーナル

看護教育とコミュニケーションの最新の進歩を探る

インダージート・カウル

褥瘡は医療においてよく見られる問題であり、患者と介護者の両方にとって負担となることがあります。褥瘡の原因となる要因は、摩擦、湿度、温度、圧力の緩和不足、栄養不足、不動など多数あります。これらの要因により、外部圧力による閉塞や、せん断力に関連する循環の中断が起こります。

その位置により、外傷、日光、環境中の汚染物質によるツールの損傷を受けやすく、これらのさまざまな障害のうち、圧力などの一般的な、しかし潜在的に予防可能な状態が、高齢者や急性または慢性の全身性疾患による身体障害を持つ人々などの高リスク集団に最もよく見られます。

褥瘡は依然として約 300 万人の成人に影響を与える大きな健康問題です。褥瘡の疫学は、急性期ケアでは 0.04% と 38%、長期ケアでは 2.2% と 23.9%、在宅ケアでは 17% と、環境によって異なります。インドでの褥瘡の有病率は 5.2%、カナダでは急性期ケアでは 25%、非急性期ケアでは 30%、混合医療環境では 22%、地域では 15% です。

導入：

「予防は注意より価値がある」

皮膚は、体全体を覆っている、表面積と重量の両方で最大の器官です。外皮系は、体を保護し、体に形を与え、周囲の環境に関する感覚情報を提供します。体全体の器官の中で、皮膚ほど検査しやすく、感染、病気、怪我にさらされやすい器官はありません。

褥瘡は医療においてよく見られる問題であり、患者と介護者の両方にとって負担となることがあります。褥瘡の原因となる要因は、摩擦、湿度、温度、圧力の緩和不足、栄養不足、不動など多数あります。これらの要因により、外部圧力による閉塞や、せん断力に関連する循環の中断が起こります。

褥瘡は依然として約300万人の成人を悩ませている大きな健康問題です。褥瘡の疫学

 

潰瘍の発生率は、急性期ケアでは 0.04% と 38%、長期ケアでは 2.2% と 23.9%、在宅ケアでは 17% と、環境によって異なります。圧迫の発生率は、インドでは 5.2%、カナダでは急性期ケアでは 25%、非急性期ケアでは 30%、混合医療環境では 22%、地域では 15% です。

圧迫と運動不足により変性した皮膚の潰瘍が痛みを伴い、赤くなることも多い部位は、尿や刺激物質への皮膚の露出により悪化し、褥瘡と呼ばれます。一般的には、仙骨、肘、膝、足首などの体の突出部に発生します。褥瘡の症状は、赤み、圧痛、不快感、触ると冷たくなる部分、局所的な浮腫、壊疽です。

ステージ 1: 最も表面的な段階であり、漂白できない赤みが見られます。この段階では、皮膚が通常よりも熱くなったり冷たくなったり、古い質感になったり、患者に痛みを感じたりすることがあります。

Stage 2: In this stage epidermis is involved and ulcers are not extended to dermis. The ulcer referred as a blister or abrasion.

Stage 3: In this stage full thickness of the skin involved and ulcer may extend into the subcutaneous tissue. There may be undermining damage that makes the wound much larger than it may see on the surface.

Stage4: In this stage the ulcer become deepest, extending into the muscle tendon or even in bones. Changing positioning in bed often reduces pressure on any one spot. Care giver need to follow a schedule for turning and responsible after every 15 minute. Using support surface such as special cushions, pads, matters and beds that relieve pressure. It is essential to keep wounds clean to prevent infection.

Gupta N, Loong. B and Loong. (2011) stated Comparing and contrasting knowledge of pressure ulcer, assessment, prevention and management in people with spinal cord injury among nursing staff working into two metropolitan spinal unit and rehabilitation training specialist in a three way. The studies shows response was 79% and 71% from the two spinal cords injury units and 46% from doctors.

Knowledge and management of pressure ulcers was conducted in U.S to determine if a structure workshop on a knowledge and management of pressure ulcers for nurses let to an improvement knowledge in the participants. The result of the study was 28 nurses participated in the workshop. The scores of the control test were compared with scores after teaching a substantial and statically significant development was observed (mean 11.1[SD, 2.1] and mean 14.6 [SD]on 21 items before and after teaching respectively P<100. A Lecture base workshop on knowledge and management of pressure ulcers helped improve nurse's knowledge and allows them bed to overcome training deficiencies.

Schoonhoven L et al (2006) conducted a study on 13 patients to assess the pressure ulcer prevalence in different group during follow up. Result showed that weekly incidence rate was 0.006/week. Highest rate were observed for surgical patient and lower for geriatric and neurological patient.

Tom Defloor, et al (2005) was conducted study on knowledge and attitude of nurse on pressure ulcer prevention in Belgian and aim was the study is to assess the knowledge and attitude of nurses about pressure ulcer prevention in Belgian the result shows that prevalence was 13.55%.Approximately 30% of the patient were at risk .Only 13.9% of their patients received fully adequate preventive care. The mean knowledge and attitude scores were 49.7%-71.3% respectively.

As highlighted by Brown (2003) in systemic review about 33.3% of ICU patient died 30 days after the onset of full thickness pressure ulcer and 73.3% had died after 1 year.

 Skin care is a fundamental nursing skill. Nursing staff may see this as elementary and not feel the need to focus education energy on skin care. There are many nursing homes that do not have access to expert wound care consultation to stay current, especially in rural area.

Nursing staff face an immense challenge in caring for the skin of patients with bed ridden diseases but by treating them holistically and educating both parents and their care giver; worthy skin integrity can be achieved. The key to successful prevention and treatment of pressure ulcers is the administrative process of setting up proper care plan as well as hands on nursing work so that it ensures the provision of high and satisfactory quality care to the patient and contribute a lot in the reduction of hospital stays due to pressure ulcer eruption that is the common complication after any acute and chronic injury that are difficult to treat and cost more. Its mandatory nurses should have good knowledge and practices while they provide care to those patients at risk of development of pressure ulcer.

Lyder H.C et al studied that preventing pressure ulcers had been a nursing concern for many years. Infect Florence Nightingale in 1859 wrote "if she has a bedsore, it's generally not the fault of the disease, but of the nursing". Others view pressure ulcer as a "visible mark of care giver sin associated with poor nonexistent nursing care.

N Gupta et al (2011) was comparing and contrasting knowledge of pressure ulcer, assessment, prevention and management in people with spinal cord injury among nursing staff working into two metropolitan spinal units and rehabilitation training specialist in a three way. The studies shows response was 79% and 71% from the two spinal cord injury units and 46% from doctors. There is also difference in management knowledge among nurses based on work rather than years of experience.

Altum et al (2011) a study of knowledge and management of pressure ulcers was conducted in U.S. The aim of study was to determine if a structure workshop on knowledge and management of pressure ulcers for nurses let to an improvement knowledge in the participants. The results of the study were 28 nurses participated in the workshop. The scores of the control test were compared with the scores after teaching a substantial and statistically significant development was observed (mean 11.1[SD, 2.1] and mean 14.6 [SD 0.9] on 21 items before after teaching respectively P< 100). A lecture base workshop on knowledge and management of pressure ulcers helped improve nurse's knowledge and allows them bed to overcome training deficiencies.

ジャネット・ガディゲンら (2001) が米国で行った調査によると、床ずれの発生率は長期ケアでは 0.4% ～ 38%、在宅ケアでは 2.2% ～ 23.9% でした。有病率にも同様に大きなばらつきがあり、急性期ケアでは 10% ～ 18%、長期ケアでは 2.3% ～ 28%、在宅ケアでは 0% ～ 29% でした。集中治療室では免疫力が低下しているため床ずれの発生率がはるかに高く、ICU 患者の 8% ～ 40% に床ずれが発生しました。

経歴: Indrajeet kaur は、UAE の Filipino Awards による 2019 年プロフェッショナル オブ ザ イヤーを受賞した Beluga India の Gov. Senior Secondary Smart School で働いています。

 

第54回世界看護・ヘルスケア会議、2020年5月13日〜14日。

抄録引用:

インデルジート・カウル、「看護教育とコミュニケーションにおける最新の進歩を探る」、世界看護会議 2020、第 54 回世界看護・医療会議、2020 年 5 月 13 日〜14 日