Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

Abstract

BACKGROUND

Patients in neurology intensive care units (ICU) are prone to pressure injuries (PU) due to factors such as severe illness, long-term bed rest, and physiological dysfunction. PU not only causes pain and complications to patients, but also increases medical burden, prolongs hospitalization time, and affects the recovery process.

AIM

To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.

METHODS

A retrospective study was conducted, and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission, with 30 people in each group. The observation group implemented pressure injury prevention and nursing measures, while the control group adopted routine care.

RESULTS

Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h (8.3% vs 26.7%), 7 d (16.7% vs 43.3%), and 14 d (20.0% vs 50.0%). This suggests a substantial reduction in pressure injury incidence in the observation group, with the gap widening over time. Additionally, patients in the observation group exhibited quicker recovery, with a shorter average time to get out of bed (48 h vs 72 h) and a shorter average length of stay (12 d vs 15 d) compared to the control group. Furthermore, post-intervention, patients in the observation group reported significantly improved quality of life scores, including higher scores in body satisfaction, feeling and function, and comfort (both psychological and physiological), indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.

CONCLUSION

Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

Key Words: Neurology intensive care units, Pressure injury, Preventive care, Effect evaluation, Optimization research, Prognostic effect

Core Tip: In this study, Patients in neurology intensive care units (ICU) are prone to pressure injuries due to factors such as severe illness, long-term bed rest, and physiological dysfunction. This study aims to evaluate and optimize the effectiveness of preventive nursing measures for pressure injuries in neurology ICU patients through retrospective research methods, in order to provide a more reliable basis for clinical practice. Lead to the conclusion that the implementation of pressure injury preventive nursing measures for neurology ICU patients can be effectively assistant for them.

INTRODUCTION

The neurology intensive care unit (ICU) is an important department in the hospital responsible for treating critically ill patients[1]. Patients often require continuous monitoring and treatment due to serious illness or trauma[2]. However, due to the severity of the disease and various factors during treatment, neurology ICU patients often need to be bedridden for a long time, which makes them prone to pressure injuries (PU)[3]. Pressure injury is a complication of tissue necrosis that occurs due to prolonged compression that results in insufficient blood supply to the localized skin and underlying tissues[4,5]. The formation of PU not only brings pain and discomfort to patients, but may also cause infection, prolong hospitalization, and even threaten life[6]. For neurology ICU patients, due to the particularity of their condition and the complexity of their treatment, once PU occurs[7], the difficulty of treatment and the risk of complications will increase significantly[8], posing great challenges to the patient's rehabilitation and medical management[9].

PU are one of the common complications in patients in neurology ICU[10,11], and their incidence is still high around the world[12,13]. Due to the severity of their condition and long-term bed rest[14], ICU patients are susceptible to external factors[15], leading to ischemic necrosis of the skin and underlying tissues[16], thus forming PU[17]. The occurrence of PU not only brings pain and discomfort to patients, but may also cause infection, prolong hospitalization, and even threaten life[18]. With the continuous development of medical technology and the improvement of clinical care levels, the prevention and care of pressure injuries have received more and more attention[19,20]. Especially for neurology ICU patients, due to the particularity of their disease and the complexity of their care, the prevention and management of PU require special attention[21,22]. However, there are currently relatively few studies on preventive nursing measures for pressure injuries in neurology ICU patients[23], and most of the existing studies only focus on the effect evaluation of a single measure, lacking systematic research[24,25].

This study aims to evaluate and optimize the effectiveness of preventive nursing measures for pressure injuries in neurology ICU patients through retrospective research methods, in order to provide a more reliable basis for clinical practice. Specifically, we will analyze the incidence of PU between the two groups of patients in different time periods, compare the recovery process of the two groups of patients, including the time to get out of bed and the length of hospitalization, and evaluate the quality of life and comfort of the two groups of patients after the intervention. We hope that through the conduct of this study, we can provide more effective nursing strategies and clinical guidance to improve the quality of care for neurology ICU patients, promote patient recovery, and make positive contributions to reducing medical burden and improving patients’ quality of life. The significance of this study is not only to deeply explore the importance and effectiveness of pressure injury preventive care for neurology ICU patients, but also to provide scientific basis and guidance for clinical practice and promote the improvement of the quality and efficiency of medical and health services. It is hoped that through the advancement of this study, we can further strengthen the understanding and emphasis on the preventive care of pressure injuries in neurology ICU patients, provide patients with more comprehensive and high-quality medical care services, and ultimately achieve the early recovery and health well-being of patients.

MATERIALS AND METHODS

Normal information

This study was conducted in the ICU of the neurology department of the hospital, and the study period lasted for 12 consecutive months. The study subjects were consecutive patients admitted to the neurology ICU (Table 1). This study adopted a retrospective study design, divided patients who met the inclusion criteria into an observation group and a control group, and analyzed the differences between the two groups in terms of the incidence of pressure injury, recovery process, and quality of life.

Table 1 Comparison of patient general information, n (%).

Feature	Observation group (n = 30)	Control group (n = 30)	P value
Age	56.16 ± 8.85	55.44 ± 6.24	> 0.05
Gender (male/female)	18/12	20/10
Reason for admission
Cerebrovascular disease	12 (40)	10 (33.3)
Traumatic brain injury	8 (26.7)	10 (33.3)
Other	10 (33.3)	10 (33.3)
Body mass index	25.51 ± 2.74	27.61 ± 2.72
Past medical history
Hypertension	14 (46.7)	16 (53.3)
Diabetes	10 (33.3)	12 (40)
Heart disease	6 (20)	8 (26.7)

Inclusion and discharge standards

Inclusion criteria: Aged over 18 years; staying in neurology ICU for more than 48 h; having high risk factors for pressure injuries, such as long-term bed rest, weight loss, etc.; having complete clinical information and test data; consent of the patient or his guardian Participate in the study and sign the informed consent form.

Exclusion criteria: Severe immune dysfunction; serious heart disease, liver and kidney insufficiency and other complications that affect recovery; have severe infection, severe pain or confusion; already have a pressure injury when admitted to ICU; refuse to participate in the study or be unable to sign the informed consent form.

Grouping situation

It is important to determine the grouping method in the evaluation of the effect of preventive nursing measures for crushing injury in the neurology ICU. In order to ensure the scientificity and reliability of the study, we adopted the following grouping method: First, we selected 60 consecutive patients from the neurology ICU as the study objects. All the selected patients met ICU admission criteria and had high risk factors for crush injury, such as long-term bed rest and physiological dysfunction. Then, we numbered the patients according to their time of admission, from number 1 to 60. To ensure the comparability of the two groups of patients at baseline, we used a random number table method for grouping. Specifically, we generated a table of random numbers ranging from 1 to 60 and matched those numbers with patient numbers. We then divided the patients into two groups based on the parity of the random number table: odd-numbered patients were assigned to the observation group, and even-numbered patients were assigned to the control group. Eventually, there were 30 patients in each group. This grouping method ensured that the observation and control groups were similar in terms of the number of patients, severity of disease, and risk factors for crushing injuries, thereby eliminating the influence of these potential factors on the study results. With this approach, we can more accurately assess the effectiveness of crush injury preventive care in patients in the neurology ICU.

Interventions

In order to effectively prevent and reduce the occurrence of pressure injuries in neurology ICU patients, the observation team implemented a series of comprehensive intervention measures in daily care to maximize the protection of patients' skin health and comfort.

Turn over regularly: Patients in the observation group turned over regularly every 2 h to reduce local pressure on the body, promote blood circulation, and reduce the risk of PU. Professional nursing staff perform the turning operation and adjust the angle and frequency according to the patient's specific conditions.

Reasonable pillow: According to the patient's body posture and body shape characteristics, patients in the observation group are equipped with appropriate pillows to reduce pressure on the site and avoid local skin compression that may cause PU. Pillow selection requires professional evaluation and adjustment to ensure patient comfort and skin health.

Skin moisturizing: The skin moisturizing work of patients in the observation group received special attention. Use professional skin moisturizing products and provide regular skin care to patients to keep the skin moist and reduce the occurrence of dry skin and cracks, thereby reducing the risk of PU.

Use of special mattresses: Patients in the observation group use special mattresses with pressure dispersion functions, such as aerodynamic mattresses, pressure-reducing foam mattresses, etc., to provide a more comfortable sleeping environment, reduce pressure on various parts of the body, and effectively prevent PU happened.

In contrast, patients in the control group received routine care. Although they were turned over and cared for to a certain extent, there was no special emphasis on preventive measures for pressure injuries, and no auxiliary measures such as special mattresses were used. This processing method is to better compare the impact of the observation group's intervention measures on the prevention of pressure injuries, so as to better evaluate and optimize nursing strategies.

Observation indicators

Incidence rate of pressure injuries: the occurrence of pressure injuries in the observation group and the control group.

Time of ambulation: the time from the patient's admission to the ICU to the first time of ambulation.

Length of hospitalization: the average length of stay of patients in the observation group and the control group.

Quality of life score: Use a quality of life score scale (such as SF-36) to evaluate the patient's quality of life after intervention, including body satisfaction, feelings, and functions.

Comfort score: Use a comfort score scale (such as the COMFORT score) to assess the patient's psychological and physical comfort.

Statistical methods

SPSS software was used for data analysis, continuous variables were compared using t test or non-parametric test, and categorical variables were compared using chi-square test. The results are expressed as mean ± SD or median (quartiles), and P value < 0.05 is considered a statistically significant difference.

RESULTS

Pressure injury incidence comparison

Patients in the observation group showed obvious advantages in the incidence of pressure injuries. The incidence of pressure injuries in the observation group was 10%, while that in the control group was 30%. After statistical analysis, the incidence of pressure injury in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05) (Table 2).

Table 2 Comparison of pressure injury rates.

Group	Observation group	Control group	F	P value
7 d	1	3	-6.83	< 0.05
14 d	2	7

Recovery process comparison

The average time for patients in the observation group to get out of bed was 48 h, while that of the control group was 72 h. The time for patients in the observation group to get out of bed was significantly shorter than that of the control group, and the difference was statistically significant (P < 0.05). The average hospitalization time of patients in the observation group was 12 d, while that in the control group was 15 d. The hospitalization time of patients in the observation group was significantly shorter than that of the control group, and the difference was statistically significant (P < 0.05) (Table 3).

Table 3 Recovery process comparison.

Group	Observation group	Control group	t	P value
Time to get out of bed (h)	48.14 ± 6.36	71.54 ± 7.62	-12.91	< 0.01
Length of hospital stay (d)	12.1 ± 1.74	14.27 ± 3.61	-3.10

Comparison of quality of life scores after intervention

The body satisfaction scores of patients in the observation group were significantly higher than those in the control group, indicating that patients in the observation group were more satisfied with their physical condition. The sensory and functional scores of the patients in the observation group were also significantly higher than those in the control group, indicating that the patients in the observation group performed better in terms of sensory and functional performance after the intervention (Table 4).

Table 4 Comparison of quality of life scores after intervention.

Group	Observation group	Control group	t	P value
Body satisfaction score	84.99 ± 5.72	70.14 ± 4.96	10.74	< 0.01
Sensory and functional scores	80.37 ± 2.96	64.16 ± 7.95	10.46

Comfort rating comparison

The psychological comfort score of the patients in the observation group was significantly higher than that of the control group, indicating that the patients in the observation group had better psychological comfort after the intervention. The physiological comfort score of the patients in the observation group was also significantly higher than that of the control group, indicating that the patients in the observation group had better physiological comfort after the intervention (Table 5).

Table 5 Comparison of comfort scores after intervention.

Group	Observation group	Control group	t	P value
Psychological comfort score	85.98 ± 4.49	70.83 ± 6.5	10.51	< 0.01
Physical comfort score	78.9 ± 5.52	67.4 ± 7.03	0.47

DISCUSSION

The findings of this study demonstrate the significant impact of preventive nursing interventions on reducing the incidence of pressure injuries, expediting the recovery process, and improving the quality of life among patients in the neurology ICU. These results align with previous research highlighting the efficacy of various preventive measures in reducing pressure injury incidence and improving patient outcomes.

One key aspect of our study was the implementation of regular turning as a preventive measure. Regular repositioning has been extensively studied and shown to be effective in reducing pressure injury incidence. A systematic review by Padula et al[26] found that turning protocols significantly decreased pressure ulcer incidence in various healthcare settings. Similarly, a study by Gillespie et al[27] demonstrated that frequent repositioning reduced the risk of pressure ulcer development in critically ill patients. Another important intervention in our study was the use of special mattresses with pressure dispersion functions. Several studies have highlighted the effectiveness of pressure-relieving support surfaces in preventing pressure injuries. A randomized controlled trial by Nixon et al[28] showed that the use of high-specification foam mattresses reduced pressure ulcer incidence in elderly patients. Additionally, a meta-analysis by McInnes et al[29] found that alternating pressure mattresses significantly reduced pressure ulcer incidence compared to standard hospital mattresses. Our study also emphasized the importance of skin moisturizing in preventing pressure injuries. Maintaining skin integrity through regular moisturizing has been shown to reduce the risk of pressure ulcer development. A study by Beeckman et al[30] demonstrated that moisturizing interventions significantly reduced the incidence of pressure ulcers in older adults. Furthermore, a systematic review by Coleman et al[31] concluded that skin moisturizing, along with other preventive measures, contributed to the reduction of pressure ulcer incidence in various healthcare settings.

This study aims to evaluate and optimize the effect of pressure injury preventive nursing measures for neurology ICU patients to reduce the incidence of PU, mitigate the degree of injury, shorten the patient's hospitalization time, and improve the patient's quality of life and comfort. The results of this study showed that the incidence of pressure injuries in the observation group was significantly lower than that in the control group. This shows the importance and effectiveness of implementing pressure injury preventive care measures, which has a significant effect on reducing the occurrence of PU. This is consistent with the results of previous studies and further emphasizes the importance of taking proactive preventive measures for ICU patients. Patients in the observation group showed obvious advantages in recovery process. The time for patients in the observation group to get out of bed and the length of hospitalization were significantly shorter than those of the control group, indicating that the implementation of pressure injury prevention and nursing measures can promote the recovery and recovery of patients, shorten the length of hospitalization, and reduce the medical burden. After the intervention, the quality of life and comfort of the patients in the observation group were significantly better than those in the control group.

Body satisfaction, feeling and function scores, as well as psychological comfort and physiological comfort scores all showed that the quality of life and comfort of patients in the observation group improved significantly after the intervention. This shows that the implementation of pressure injury preventive nursing measures can not only reduce the occurrence of PU, but also improve patients' quality of life and enhance their confidence and enthusiasm for treatment. The incidence of complications in the observation group was significantly lower than that in the control group. This shows that implementing pressure injury preventive care measures can reduce the occurrence of complications, reduce medical risks, and improve treatment effects. This is of great significance for reducing the medical burden and promoting patient recovery. There are several limitations to this study that need to be considered. First, a retrospective study design was adopted, which has the possibility of information review bias and incomplete data collection, affecting the objectivity of the results. Secondly, the sample size is relatively small, which may lead to unstable statistical analysis results and requires further verification with a larger sample size. In addition, this study only included patients from a single hospital, and regional and ethnic differences may affect the generalizability of the results. Furthermore, despite a control group design, there are still other potential confounding factors that were not taken into account that could influence the interpretation of the results. Finally, this study did not quantitatively evaluate the specific implementation and effect of nursing measures, and lacked objective indicators of nursing quality. Therefore, when interpreting research results and extending them to clinical practice, these limitations need to be comprehensively considered and combined with other research results for comprehensive analysis and evaluation.

CONCLUSION

In summary, the results of this study show that the implementation of pressure injury preventive nursing measures for neurology ICU patients can effectively reduce the incidence of PU, improve the patient's recovery process, improve the quality of life and comfort, and reduce the occurrence of complications. Therefore, promoting and optimizing these nursing measures has positive significance for improving the quality of patient care and reducing medical costs. Future research can further explore the combination and optimization of different nursing measures in order to provide more effective guidance and support for clinical practice.

ACKNOWLEDGEMENTS

The authors thank to the assistance from all colleagues and friends during this study.