Establishment Of A Survey Tool On Pressure Ulcer Prevention And Cross-Sectional Study

[Objective]①Developing a survey tool for pressure ulcer prevention which has good reliability and validity to monitor and evaluate the effect of pressure ulcer prevention and management.②We implement a multi-center,cross-sectional study to obtain the epidemiological characteristics,the implementation of preventive nursing measures in hospitalized patients in 14 tertiary hospitals and to verify the feasibility and practicality of the survey tool in order to provide the bases for clinical pressure ulcer monitoring and prevention.[Methods]Through the literatures reading,brainstorming and task group discussing,an entry pool was built for pressure ulcer prevention.We analyzed and filtered the entries according to the importance of each item to develop the initial survey tool.26 experts were consulted every 14 days to obtain their opinions which used to modify and improve the survey tool.The consultation was stopped when the opinions were in agreement.We calculated the positive coefficient,the authority coefficient,the Kendall’s coefficient of concordance and the content validity of survey tool.A cross-sectional pilot study was conducted on 2047 patients from a tertiary hospital in Nanjing to analyze the consistency reliability,structural validity and feasibility(practicality,convenience and average research time for each patient)of the tool.After improving the survey tool further,926 nurses from 14 tertiary general and specialist hospitals in 9 provinces,1 autonomous region and 1 municipality of China used the uniform survey method and procedure to investigate pressure ulcer prevention of 19909 hospitalized patients.[Results]①Results of the survey tool construction:The content of tool:A survey tool for pressure ulcer prevention consisting of 4 first-level indicators and 21 secondary indicators was formed after 3 rounds of Delphi consultation.The tool has four parts which were general information,disease information,skin observations information and preventive nursing measures.Results of expert consultation:The positive coefficient were all 100%and the rates of opinions was 57.69%,38.46%and 0.00%.The authority coefficient was 0.830.The mean of each index in the 3 rounds of consultation was 4.115～5.000,4.346～5.000 and 4.346～5.000.The coefficient of variation was 0.000-0.241,0.000-0.235 and 0.000～0.234 respectively.The Kendall’s coefficient of concordance was 0.115,0.174 and 0.214(P<0.001).The content validity was 0.954.The result of pilot study:The consistency of the tool(Cronbach’s alpha)was 0.824 and the Cronbach’s alpha in different wards ranged from 0.731～0.913.The result of construct validity showed the exploratory factor analysis got two common factors which explained 75.351%of the total variance and the factor loading was 0.585-0.857 respectively.The result of tool feasibility evaluation showed that the practicability and convenience rate were all 99.8%.The average time spent on each survey was(4.16±2.54)min.②Results of cross-sectional survey:Study staff:The average score of 926 participants was(91.99±4.66)points and the pass rate was 97.52%.Patients’ condition:19706 valid questionnaires were obtained from 19909 patients and the effective rate was 98.98%.303 pressure ulcer locations on 215 patients were found.The total prevalence of pressure ulcers was 1.01%and it was 0.61%excluding the stage Ⅰ.Epidemiological characteristics:The most common stage of pressure ulcers was stage Ⅰ(37.62%)and the next was stage Ⅱ(34.32%).The most common site of pressure ulcers was sacrum(46.20%).The prevalence of pressure ulcers increased with age,the difference was statistically significant(P<0.05).The prevalence of pressure ulcers in hospitalized patients aged 18～39,40～59,60～69,70～79,80～89 and>89 was 0.38%,0.54%,0.95%,2.31%,4.51%and 10.71%respectively.The prevalence of pressure ulcers in different departments was follows:ICU 8.98%,emergency department 2.76%,neurology department 1.91%,rehabilitation department 1.12%,internal medicine department 1.07%,surgery department 0.99%,other departments 0.49%,gerontology department and obstetrics department 0%and its difference was statistically significant(P<0.05).Among the 215 patients with pressure ulcers,71.16%were using decompression devices,56.96%were using dressings,74.88%had repositioning planning,73.02%had pressure ulcer prevention signs.All the implementation rates of preventive nursing measures were over 50%.[Conclusion]①The survey tool for pressure ulcer prevention has good reliability and validity.It can be used to investigate pressure ulcer prevention of Chinese hospitalized patients.②The multi-center,cross-sectional study of 14 tertiary hospitals shows that the prevalence of pressure ulcers was still high in ICU,emergency department and neurology department where critical illness patients with limited activities stayed.The elderly patients should be worthy of attention particularly.Clinical nurses did well in the implementation of preventive nursing measures,but it can improve more.The survey tool developed in our study is practicable.