背景:足跟压迫性溃疡可引起疼痛,减少流动性,导致更长的住院时间,在严重的情况下会导致败血症,截肢,和死亡。卸载靴作为脚跟压疮预防装置销售,通过消除脚后跟的压力来工作,然而,几乎没有关于其临床有效性的高质量证据。鉴于证据不能指导这些设备的使用,这项研究旨在探索,如何,when,以及为什么这些设备在医院使用。
目的:探讨如何使用卸载装置预防足跟压疮,为谁,在什么情况下。
方法:进行了现实主义评估,以探索背景,机制,以及可能影响如何在临床实践中实施和使用卸载装置以预防医院足跟压疮的结果。来自英国各地的八名组织活力护士专家(英格兰,威尔士,和北爱尔兰)接受了采访。问题试图引出,以及以什么方式,关于使用足跟压疮的初步理论与受访者的经验相吻合。
结果:关于护士如何“主动”使用卸载装置来预防足跟压疮,将13种初始理论细化为三种方案理论,反应性治疗和减少早期压疮的恶化,以及影响这些设备使用方式的患者因素。
结论:所有受访者都在临床实践中使用卸载装置。人们认为它们不适合每个病人使用,在他们住院的每一个时刻,它在财务上也不可行。然而,受访者认为,确定能够维持使用该器械的合适的“处于危险中”的患者群体可能会导致主动且具有成本效益地使用该器械.对影响卸载设备有效使用的背景和机制的理解对卸载设备的临床实践和临床试验的设计具有影响。
结论:如何,为谁,在什么情况下卸载装置可以防止足跟压力溃疡?组织活力护士的观点。
BACKGROUND: Heel pressure ulcers can cause pain, reduce mobility, lead to longer hospital stays and in severe cases can lead to sepsis, amputation, and death. Offloading boots are marketed as heel pressure ulcer prevention devices, working by removing pressure to the heel, yet there is little good quality evidence about their clinical effectiveness. Given that evidence is not guiding use of these devices, this study aims to explore, how, when, and why these devices are used in hospital settings.
OBJECTIVE: To explore how offloading devices are used to prevent heel pressure ulcers, for whom and in what circumstances.
METHODS: A realist evaluation was undertaken to explore the contexts, mechanisms, and outcomes that might influence how offloading devices are implemented and used in clinical practice for the prevention of heel pressure ulcers in hospitals. Eight Tissue Viability Nurse Specialists from across the UK (England, Wales, and Northern Ireland) were interviewed. Questions sought to elicit whether, and in what ways, initial theories about the use of heel pressure ulcers fitted with interviewee\'s experiences.
RESULTS: Thirteen initial theories were refined into three programme theories about how offloading devices are used by nurses \'proactively\' to prevent heel pressure ulcers, \'reactively\' to treat and minimise deterioration of early-stage pressure ulcers, and patient factors that influence how these devices are used.
CONCLUSIONS: Offloading devices were used in clinical practice by all the interviewees. It was viewed that they were not suitable to be used by every patient, at every point in their inpatient journey, nor was it financially viable. However, the interviewees thought that identifying suitable \'at risk\' patient groups that can maintain use of the devices could lead to proactive and cost-effective use of the devices. This understanding of the contexts and mechanisms that influence the effective use of offloading devices has implications for clinical practice and design of clinical trials of offloading devices.
CONCLUSIONS: How, for whom, and in what circumstances do offloading devices work to prevent heel pressure ulcers? Tissue viability nurses\' perspectives.