A review of literature provides the concept to continue for the contemplated research, an understanding of the status of the research in the problem area includes research approach, method, instrumentation, and analysis. The literature review is organized under the following headings:
- Review related to the prevalence of pressure sore
- Review related to the etiology and risk factors of pressure sore
- Review related to the prevention of pressure sore
- Review related to the caregivers of pressure sore
Review Related to prevalence of pressure sore
Hendrichova.I et.al (2010) have done Retrospective analysis of 1414 clinical records of patients admitted over 6 months and found prevalence of pressure ulcers of 22.9 % and incidence of 6.7 %
Forni C et. al (2009), conducted study regarding cohort study of the incidence of heel pressure sores in patients with leg casts at the Rizzoli orthopedic hospital and also the associated risk factors at Italy. He found that out of 216 patients 17.6% (38) developed a pressure sore: 16/124 in orthopedic wards; and 22/92 in cancer care units. The related risk factors of pressure sore were noted are administration of anti neoplastic drugs (p = 0.033) OR = 2.61; skin redness before cast application (p = 0.001; OR = 4.44), reported symptoms after the application (p = 0.000; OR = 7.86). Most of the pressure sores were mainly in the stage 1 and stage II was 6/216 (2.4%).
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Voweden KR and Vowden.P (2009) conducted study regarding the prevalence of pressure ulcer, management, equipment provision and outcome for patients with pressure ulceration and identified in a wound care survey within one English health care district on 1000 population in the tertiary referrals and prevalence of 53.7 % were classed as grade 2 pressure ulcers, 48 % were grade I and only 35 % of grade 4. Pressure ulcers were identified through the critical incident form are only about 11 % of pressure ulcers at hospital setup and gives the current Epidemiology of pressure ulcers.
Harrow J.J et.al (2008) conducted study regarding pressure ulcers and occipital alopecia in operation Iraqi Freedom poly trauma casualties: retrospective review from 2004- 2006 to detect the prevalence and severity of pressure-related injuries and stated that 38% of admissions to this hospital had pressure-related injuries on the day of admission. In which Casualties from Iraq had a higher rate of pressure ulcers (53%) than other area (22%). Occipital lesions accounts 50% of non-stage I pressure ulcers and more severe than of the sacrum or in the extremities.
Review related to risk factors associated with the pressure ulcer:
Lahmann N.A.et. al (2010) done, study regarding impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute care hospitals, by the method of prevalence survey among 7377 residents in 60 nursing homes and also 28,102 clients with 82 acute-care hospitals at Germany by annual point prevalence surveys. Results noted are nosocomial prevalence rates in hospitals decreased from 26.3% during the first year to 11.3% in the last year (mainly in nursing homes from 13.7% to 6.4%). The usage of pressure ulcer-related structures conspicuous more during each repetition to more than 90%.
Fisher A.R et. al (2004) conducted cross sectional prevalence studies among 535 patients regarding f pressure ulcers in adults in acute care settings at university teaching hospital, Canada and found the prevalence of pressure ulcers was 27% (at 95% confidence interval, 23-31%). Total Braden score below 17 and increasing age were significantly associated with the presence of pressure ulcers and also found majority of the risk factors are increasing age, less activity level, friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, only increasing age, friction and shear were associated with the presence of pressure ulcers in the whole sample.
Silva M.S et.al (1998) conducted exploratory- descriptive study to identify, in the specialized literature, which predisposing conditions and risks factors would be related to the development of pressure ulcer, and to verify how often these predisposing conditions and risk factors would be present in bedridden patients, hospitalized in an institution and concluded that there is the need to construct an instrument to measure this risk must suit our reality and that incorporates risk factors identified with a significant frequency in this study and are not contemplated in most of the available scales in the literature.
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Review related to the prevention of pressure sore
Baldi et .al (2010) conducted study regarding Studying factors related to pressure ulcers prevention: a marginal scale model for modelling heterogeneity among hospitals. in patients referred to several Italian hospitals, with the method of prevalence survey co ordinate through the European Pressure Ulcer Advisory Panel among 12 000 hospitalized patients in Italy, and results shows that the prevention of pressure sore includes usage of Braden Scale, age and assistance- connected aspects, and usage of preventive equipment combined with a repositioning techniques.
Wann-Hansson C et .al (2008) conducted study in sweedish University regarding Risk factors and prevention among clients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present during admission with 535 clients and notified the prevalence rate of pressure ulcers were 27% (95% confidence interval, 23-31%).
Shahin E.S (2008) conducted study regarding prevalence of pressure ulcer among intensive care cltients: a cross sectional study at German with the sample of 1760 clients in order to assess the pressure ulcer prevalence among intensive care clients, and also found clients’ characteristics and preventive measures related to prevalence of pressure ulcer clients and to assess the most common sites of pressure ulcers. A result shows a mean prevalence rate was +/-30% from 2002 to 2005. The pressure sore prevalence was decreased to 16.2% in 2006 and half of the pressure ulcers were in grade 1. He has stated the significant association between the age and pressure ulcer (P <or= 0.022), Braden score (P <or= 0.01) and bowel incontinence (P <or= 0.01). He concluded that factors influencing pressure ulcers should be taken into account to prevent occurrence of further pressure ulcers.
Review related to caregivers of pressure sore
Meesterberends.E (2010) conducted study by Annual national prevalence survey method at Netherlands over the past 10 years regarding homes and notified high prevalence rates in Dutch nursing homes and found that the implementation of pressure ulcer guidelines were not to be successful in all nursing homes and need to give much attention. Providing adequate education for nursing home staffs to increase attention of pressure ulcer can the first steps in order to improve the implementation of pressure ulcer guidelines.
Kwiczala.S et.al (2005) conducted study regarding pressure ulcer prevention- evaluation of awareness in families of patients at risk among 62 caregivers over 4 month period and revealed Only 11% of interviewed person knew the meaning of pressure ulcer, 42% of caregivers were not aware of possible causes of pressure ulcer, and 54.8% were not able to mention any risk factor of pressure ulcer. Maximum of caregivers donâ€™t know the basic concepts of prevention of pressure ulcer, pressure reducing mattresses includes dressings used in pressure ulcers management. 53% of interviewed persons never received any kind of information regarding prevention of pressure ulcer, and only 23% got that information from nurses, which shows very less involvement of professional staff towards education of families of clients at risk in developing pressure sore.
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