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Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk

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  • Mariana F Cremasco
  • Fernanda Wenzel
  • Suely SV Zanei
  • Iveth Y Whitaker

Abstract

Aims and objective. To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background. Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design. Prospective descriptive study. Methods. Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results. The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion. Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice. Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs.

Suggested Citation

  • Mariana F Cremasco & Fernanda Wenzel & Suely SV Zanei & Iveth Y Whitaker, 2013. "Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk," Journal of Clinical Nursing, John Wiley & Sons, vol. 22(15-16), pages 2183-2191, August.
    • Handle: RePEc:wly:jocnur:v:22:y:2013:i:15-16:p:2183-2191
    DOI: 10.1111/j.1365-2702.2012.04216.x
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    Cited by:

    1. Seyma Adibelli & Fatos Korkmaz, 2019. "Pressure injury risk assessment in intensive care units: Comparison of the reliability and predictive validity of the Braden and Jackson/Cubbin scales," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(23-24), pages 4595-4605, December.
    2. Ahmad Tubaishat & Panos Papanikolaou & Denis Anthony & Laila Habiballah, 2018. "Pressure Ulcers Prevalence in the Acute Care Setting: A Systematic Review, 2000-2015," Clinical Nursing Research, , vol. 27(6), pages 643-659, July.
    3. Tove E Børsting & Christine R Tvedt & Ingrid J Skogestad & Tove I Granheim & Caryl L Gay & Anners Lerdal, 2018. "Prevalence of pressure ulcer and associated risk factors in middle‐ and older‐aged medical inpatients in Norway," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(3-4), pages 535-543, February.
    4. Dana Tschannen & Christine Anderson, 2020. "The pressure injury predictive model: A framework for hospital‐acquired pressure injuries," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(7-8), pages 1398-1421, April.
    5. Pedro Sardo & Cláudia Simões & José Alvarelhão & César Costa & Carlos J Simões & Jorge Figueira & João L Simões & Francisco Amado & António Amaro & Elsa Melo, 2015. "Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(21-22), pages 3165-3176, November.

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