Study On The Application Of Chain Management Of Perioperative Pressure Injury In Patients Undergoing Prone Position Surgery In Spinal Surgery

Objectives:(1)To know the management status of perioperative pressure injury in patients undergoing spinal surgery,nurses’ cognitive status and training needs.(2)To develop a chain management scheme for perioperative pressure injury in prone position of spinal surgery.(3)To explore the effect of chain management of perioperative pressure injury in patients undergoing spine prone position surgery.Methods:This study consists of two parts.The first part is qualitative research,the research method is phenomenological research,and the sampling method is purposeful sampling.Data were collected through semi-structured interview and analyzed by Colaizzi’s seven-step analysis method.Through the analysis,the existing problems of perioperative pressure injury management in patients undergoing spinal surgery,nurses’ cognitive status and training needs were obtained.The second part is quantitative research,the research method is quasi-experimental research.Under the framework of the pressure damage chain management model,a large number of relevant literatures were consulted.Based on the results of qualitative research and the characteristics of prone position surgery in spine surgery,we conducted multiple rounds of discussions with the clinical expert group to refine and supplement the perioperative part of the pressure injury chain management model,and finally formed a targeted perioperative pressure injury chain management plan for prone position surgery in spine surgery.This scheme was applied to patients in prone position of spine surgery to investigate the effect of prevention of perioperative pressure injury.Using the historical control method,114 patients undergoing spine prone position surgery from April 2019 to June 2019 were selected as the control group,and 114 patients undergoing spine prone position surgery from August 2019 to October 2019 were selected as the intervention group.The control group adopted the conventional pressure injury management scheme,and the intervention group adopted the perioperative pressure injury chain management scheme.The incidence of perioperative pressure injury and the reported rate of perioperative pressure injury in the two groups were compared.In this study,EpiData3.1 software was applied for data entry,SPSS22.0 software was used for data statistical analysis,chi-square test or Fisher exact probability method was used for comparison of two sample rates,and rank sum test was used for grade data.Results:1.Qualitative research: This study conducted semi-structured interviews with 15 respondents,and extracted 7 topics,including the cognitive level of nurses is different,lack of scientific supervision mechanism,lack of pertinence in skin contact,the attitude of nurses is lack of enthusiasm,lack of compliance with the implementation of nursing measures,lack of dynamic and continuous evaluation,lack of initiative in reporting adverse events.2.Quantitative study: A total of 228 patients were included in the study,including 114 in the control group and 114 in the intervention group.There was no significant difference between the general demographic data and baseline data between the two groups(P >0.05).In the control group,18 cases(15.8%)of intraoperative pressure injuries occurred,including 15 cases of stage 1(3 cases with 2 stage 1 pressure injuries),with a component ratio of 85.7%,and 3 cases of stage 2 with a component ratio of 14.3%.In the intervention group,there were 7 cases of intraoperative pressure injuries,with an incidence of 6.1%,all of which were stage 1,and the component ratio was 100%.No intraoperative pressure injuries of stage 3 or above occurred in either group.The incidence of perioperative pressure injury was compared between the two groups,and the difference was statistically significant(P<0.05).There was no significant difference in the stage of perioperative pressure injury between the two groups(P>0.05).The head and face were the sites of high incidence of pressure injury in prone position of spine surgery,with a composition ratio of 78.5%.The incidence of pressure injury in perioperative period of head and face was compared between the two groups,13% in the control group and 5.3% in the intervention group,with statistically significant differences(P < 0.05).Compared with the two groups,the reported rate of perioperative pressure injury was 27.8% in the control group and 100% in the intervention group,with statistically significant differences(P<0.05).Conclusion:(1)By conducting qualitative interviews with perioperative nurses,the existing problems of perioperative pressure injury management in patients undergoing spinal surgery were summarized as follows: the cognitive level of nurses is different,lack of scientific supervision mechanism,lack of pertinence in skin contact,the attitude of nurses is lack of enthusiasm,lack of compliance with the implementation of nursing measures,lack of dynamic and continuous evaluation,lack of initiative in reporting adverse events.(2)A chain management scheme for perioperative pressure injury in prone position of spinal surgery was developed.(3)Chain management of perioperative pressure injuries can effectively reduce the incidence of perioperative pressure injuries in patients undergoing prone spinal surgery,and improve the reporting rate of perioperative pressure injuries by nurses.