Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Evaluation of Repositioning in Pressure Ulcer Prevention
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2027-1663
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: To reduce the risk for pressure ulcers, repositioning of immobile patients is an important standard nursing practice. However, knowledge on how this preventive intervention is carried out among elderly immobile patients is limited and to what extent patients perform minor movements between nursing staff-induced repositionings is largely unknown, but these movements might have implications for the repositioning intervention. Different lying positions are used in repositioning schedules, but there is lack of evidence to recommend specific positions.

Aim: The overall aim of this thesis was to describe and evaluate how repositioning procedures work in practice in the care of elderly immobile patients. The aim was also to compare the effects of different positions with regard to interface pressure, skin temperature, and tissue blood flow in elderly patients lying on a pressure-redistribution mattress.

Methods: This thesis consists of four quantitative studies. In Study I, 62 elderly immobile patients were included. All movements the patients made, either with help from the nursing staff or spontaneously, were registered continuously over the course of three days. Study II served to pilot the procedure for Study III. Tissue blood flow and skin temperature were measured in hospital patients (n = 20) for 5 minutes in two supine, two semi-Fowler, and two lateral positions. In Study III, a new sample was recruited (n = 25) from three nursing homes. Measurement of interface pressure was added, and the measurements were extended from 5 minutes to 1 hour. The six positions were reduced to four by excluding the two semi-Fowler positions. Blood flow was measured using photopletysmography (Study II-IV) and laser Doppler flowmetry (Studies III and IV). In Study IV a deeper analysis of the individual pressure-induced vasodilation (PIV) responses was performed on the sample from Study III. An age of 65 years or older was an inclusion criterion in all studies.

Results: Study I showed that there was a large variation in the extent to which the elderly immobile patients made spontaneous movements, and these movements were positively related to taking analgesics and negatively related to taking psycholeptics. Patients scored as high risk for pressure ulcer development were repositioned more frequently than patients scored as low risk. However, the spontaneous movement frequency was not associated with any risk scores. Study II showed that the different lying positions influenced the blood flow in different ways. In Study III, it was found that the overall blood flow response during one hour of loading was significantly higher in the 30° supine tilt position than in the 0° supine, 30° lateral, and 90° lateral positions. The overall blood flow in the 90° lateral position did not differ compared to the 30° lateral position, although the interface pressure was significant higher in the 90° lateral position. In patients lacking a PIV response (Study IV), the blood flow decreased immediately and remained below baseline during the one hour of loading.

Conclusions: Although elderly and immobilized, some patients frequently perform minor movements while others do not. Patients who cannot perform minor movements are important for the nursing staff to identify because they very likely need more intensive repositioning interventions. The spontaneous movement frequency was not associated with the risk assessment score, and this implies that some immobile patients assessed as low risk might need to be repositioned as often as patients assessed as high risk. Of the positions evaluated, the 30° supine tilt position was concluded to be most beneficial. There was no great difference in how the blood flow was affected in the 90° lateral position compared to the 30° lateral position, which question the appropriateness of the recommendation to avoid the 90° lateral position. The patients with lacking a PIV response might be particularly vulnerable to  pressure, which also implies that these patients might need to be repositioned more frequently.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 82 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1455
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-117447DOI: 10.3384/diss.diva-117447ISBN: 978-91-7519-095-2 (print)OAI: oai:DiVA.org:liu-117447DiVA: diva2:808220
Public defence
2015-06-04, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research CouncilÖstergötland County Council
Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2015-04-30Bibliographically approved
List of papers
1. Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
Open this publication in new window or tab >>Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
Show others...
2016 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, 1168-1175 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
Nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-117445 (URN)10.1111/iwj.12435 (DOI)000387664400011 ()25779932 (PubMedID)
Note

Funding agencies: Research Council Sodra Alvsborg Boras Sweden; Research Council ostergotland Linkoping Sweden; SwedBank Sjuharad foundation for research at the Sodra Alvsborg Hospital Boras Sweden; Sodra Alvsborgs Hospital Boras Sweden; King Gustaf V and Queen Victorias F

Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2017-12-04Bibliographically approved
2. Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
Open this publication in new window or tab >>Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
Show others...
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 1, 133-144 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

Place, publisher, year, edition, pages
Blackwell Publishing, 2013
Keyword
nursing, older adults, patient repositioning, pressure ulcer, prevention, skin temperature, tissue blood flow
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87459 (URN)10.1111/j.1365-2648.2012.06000.x (DOI)000312550600013 ()
Note

Funding Agencies|Research Council South Alvsborg||South Alvsborg Hospital and Dermatology Department Research Foundation||South Alvsborg Hospital, Boras||Swed Bank Sjuharads foundation for research at the hospital of South Alvsborg, Boras, Sweden||Swedish Research Council||Faculty of Health Sciences, Linkoping, Sweden||

Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2017-12-06
3. The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
Open this publication in new window or tab >>The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
Show others...
2015 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 17, no 2, 142-151 p.Article in journal (Refereed) Published
Abstract [en]

Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.

Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.

Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.

Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keyword
nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:liu:diva-109318 (URN)10.1177/1099800414540515 (DOI)000349332300003 ()25037449 (PubMedID)
Note

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research project was funded by the Research Council, Sodra Alvsborg Hospital, Boras, Sweden [VGFOUSA-318701]; the Research Council, Ostergotland, Linkoping, Sweden [LIO-197101]; the Dermatology Department Research Foundation at Sodra Alvsborg Hospital, Boras Sweden [April 01, 2010]; the SwedBank Sjuharad Foundation for Research at the Sodra Alvsborg Hospital, Boras, Sweden [October 10, 2011]; the Sodra Alvsborg Hospital, Boras, Sweden [April 01, 2011]; the King Gustaf V and Queen Victoria's Freemason Foundation [December 2011]; the NovaMedTech and European Union-European Regional Development Fund [September 29, 2011]; Faculty of Health Science Linkoping University, Linkoping, Sweden [LIO-200671].

Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05
4. Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
Open this publication in new window or tab >>Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
Show others...
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.

Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.

Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.

Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.

Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.

Keyword
Tissue blood flow, pressure-induced vasodilation, interface pressure, skin temperature, pressure ulcer, nursing home residents
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-117446 (URN)
Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2015-04-27Bibliographically approved

Open Access in DiVA

fulltext(1563 kB)7276 downloads
File information
File name FULLTEXT01.pdfFile size 1563 kBChecksum SHA-512
187cf98a0619ad5eb47d1cac916431a9726a72330b81a6a5f59ff66d9af88167573cc9f79d9f02ef3cee4031e98ca9ecd316a51a8ebc14f2c6d6d7cfbb0295aa
Type fulltextMimetype application/pdf
omslag(65 kB)40 downloads
File information
File name COVER01.pdfFile size 65 kBChecksum SHA-512
75c26bdaaf54ca8d7c05f274e50de72ade7f02ebc313f6f6a75d8566fc20af36392cc7436988950a2a9be2d0e0a59c5896a9017d333ab232bf772f9cc7686b5b
Type coverMimetype application/pdf

Other links

Publisher's full text

Authority records BETA

Källman, Ulrika

Search in DiVA

By author/editor
Källman, Ulrika
By organisation
Division of Nursing ScienceFaculty of Health Sciences
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 7276 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
isbn
urn-nbn

Altmetric score

doi
isbn
urn-nbn
Total: 5000 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf