An evidence‐based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project
An evidence‐based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project
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老年社区环境中皮肤撕裂预防和初步管理的循证方法：最佳实践实施项目
DOI：
10.11124/jbisrir-2015-2073
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Clint Moloney
中科院分区：
文献类型：
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作者：
R. Beechey;L. Priest;M. Peters;Clint Moloney
背景 在社区环境中保持皮肤完整性是一个持续存在的问题，因为研究表明社区内皮肤撕裂的发生率高于机构环境。虽然这些环境中皮肤撕裂的预防和管理原则与急症护理环境中的相似，但考虑客户的环境和心理因素对于社区环境中的预防至关重要。有证据表明，家庭环境评估、对客户和护理人员的教育以及积极改善社区环境中的日常生活活动可以显着降低持续皮肤撕裂的风险。目标 该实施项目的目的是评估和审查社区环境中当前的皮肤撕裂预防和管理实践，并据此在对客户和工作人员进行预防皮肤撕裂的教育中实施循证方法。也是如此。该项目旨在实施循证原则，指导与皮肤撕裂初始管理相关的临床实践，并确定克服障碍和不合规的策略。方法 该项目利用乔安娜·布里格研究所的临床证据系统实际应用 (PACES) 审核工具来促进社区卫生环境的变化。该特定项目的实施地点是 Anglicare 昆士兰州南部的一个地区。成立了一个小团队并进行了基线审核。由此，实施了多种策略来解决不合规问题，其中包括为客户和护理人员提供教育资源、员工教育课程以及创建皮肤完整性套件以使员工能够避免皮肤撕裂，并由此进行后续审核。结果 基线审核结果略有不同，合规性从良好到低。由此，强调了对员工和客户教育的必要性。经过客户和员工教育课程以及员工自主学习包（附录一、二和三）后，审核标准有了许多改进。持续改进实践并取得进一步进展所需的未来策略是向护理人员引入现成的 Anglicare 皮肤完整性评估工具，用于 65 年以上的新客户入院，并向工作人员、客户和护理人员提供持续教育，以减少社区环境中皮肤撕裂的发生率。结论 该实施项目证明了在社区环境中对个人护理人员、客户及其护理人员进行教育以预防皮肤撕裂的重要性。这反过来又创造了自主权，使客户能够控制自己的健康。
Background Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. Objectives The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence‐based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence‐based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non‐compliance. Methods The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System (PACES) audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non‐compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow‐up audit undertaken. Results Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and staff education sessions and staff self‐directed learning packages (Appendix I, II and III). Future strategies required to sustain improvements in practice and make further progress are to introduce a readily available Anglicare Skin Integrity Assessment Tool to the nursing staff for undertaking new client admissions over 65 years, and to provide ongoing education to staff members, clients and care givers in order to reduce the prevalence of skin tears in the community setting. Conclusions This implementation project demonstrated the importance of education of personal care workers, clients and their caregivers for prevention of skin tears in the community setting. This in turn created autonomy and empowered clients to take control of their health.