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Learning Objective 1: The learner will identify the need for developing a protocol for repositioning patients that are in an upright position.
Learning Objective 2: The learner will be able to discuss the findings of this study and apply them to their nursing practice.
Purpose: To evaluate and describe the skin integrity of mobility-challenged patients sitting upright.
Background: Skin breakdown can impact hospital length of stay, quality of life and healthcare costs. A large body of literature exists on impaired skin integrity in hospitalized patients, little research is available about the effects of upright positioning on skin integrity.
Research Question: Do mobility-challenged patients sitting in an upright position, for 20-45 minutes, show visible effects on skin integrity?
Methods: This quantitative research study used a pre-test/post-test design. Using a modified Comprehensive Admission Skin Assessment participants’ skin was assessed, they were placed in an upright position and reassessed after 20-45 minutes.
Results: Visible change in the color and size of impairment that occurred with intervention was statistically significant, p<0.001 and p=0.010 respectively. Nine impairments found on the initial assessment improved with intervention.
Conclusions: Guidelines are needed for re-positioning of patients when in an upright position. Particular attention is needed on the placement of the lower extremities. Education of direct care providers is needed on the effects of an upright position on skin integrity.
References:
Berlowitz, D. MD, MPH. (2008). Prevention of pressure ulcers. Retrieved March 5, 2009 from www.uptodate.com.
Defloor, T., Grypdonck, M. (1999). Sitting posture and prevention of pressure ulcers. Applied Nursing Research, 12 (3), 136-142.
Defloor, T., De Bacquer, D. & Grypdonck, M. (2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies, 42,37-46.
Gefen, A. (2008). How much time does it take to get a pressure ulcer? Integrated evidence from human, animal and in vitro studies. Ostomy Wound Management, 54 (10), 35.
Piloian B. (1992). Defining characteristics of the nursing diagnosis "High risk for impaired skin integrity". Decubitis 5 (4), 32-42.
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