Publication: Yoğun bakım hastalarında basınç yaralanması riskinin tanılanması : ölçüm aracı geliştirme
Abstract
Amaç: Bu araştırmada Türk toplumunda yoğun bakım hastalarına özgü basınç yaralanması riskini tanılama ölçeğinin geliştirilmesi, geçerlik ve güvenirliğinin incelenmesi amaçlandı. Gereç ve Yöntem: Tanımlayıcı ve metodolojik araştırma tipinde iki aşamalı tasarlanan bu araştırmada, Edirne’de bir devlet hastanesinde 3. Basamak Genel Yoğun Bakım Kliniği’nde tedavi gören yoğun bakım hastaları araştırmanın evrenini oluşturdu. Birinci aşamada 01 Mart -25 Mart, 24 Mayıs-30 Eylül 2021 tarihlerinde 104 yoğun bakım hastası araştırmaya dahil edildi. Yoğun Bakım Hastaları Bilgi Formu, Tıbbi Araçlara Bağlı Basınç Yaralanması Değerlendirme Formu ve Bates-Jensen Yara Değerlendirme Formu ile veri toplanarak basınç yaralanması risk faktörleri incelendi. İkinci aşamada belirlenen risk faktörleri ile taslak ölçek formu oluşturularak uzman görüşüne sunuldu. Kapsam geçerliliği analizi sonuçlarına dayanarak 16 madde içeren “Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama Ölçeği” oluşturuldu. 01 Kasım 2023 ve 29 Şubat 2024 tarihlerinde Braden, Norton, Waterlow, Jackson/ Cubbin ve Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama ölçekleri ile veri toplanarak 130 yoğun bakım hastası örnekleme dahil edildi. İlk 30 hasta araştırmacı hemşire ve ikinci hemşire tarafından gözlemlenerek Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama Ölçeği’nin gözlemciler arası uyumu incelendi. İstatistiksel analiz yapılarak veriler değerlendirildi. Bulgular: Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama Ölçeği’nin bütün maddelerin KGİ 0,80’den büyük olduğu, kesme noktası >7 (yüksek risk) puanda (duyarlılık: %93,3 ve özgüllük: %84,7) en yüksek duyarlılık ve özgüllüğü gösterdiği, Cronbach’s Alpha katsayısının 0,87, sınıf içi korelasyon katsayısının 0,987 olduğu saptandı. Ölçek ile aynı yönde puanlanan Waterlow Ölçeği arasında korelasyonun pozitif yönde güçlü (p<0,001), zıt yönde puanlanan Braden, Norton ve Jackson/ Cubbin ölçekleri arasında korelasyonun negatif yönde güçlü olduğu saptandı (p<0,001). Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama Ölçeği Jackson/ Cubbin Ölçeği’nden (duyarlılık: %95,6) sonra ikinci sırada en yüksek duyarlılığı, Waterlow Ölçeği (özgüllük: %84,7) ile eşit ve en yüksek özgüllüğü gösterdi. Sonuç: Türk toplumunda yoğun bakım hastalarında basınç yaralanması riskini tanılamada “Yoğun Bakım Hastalarında Basınç Yaralanması Riski Tanılama Ölçeği” geçerli, gözlemciler arası uyumu yüksek ve güvenir bir ölçek olduğu saptandı.
Objective: The aim of this study was to develop a diagnostic scale for pressure injury risk specific for intensive care patients in Turkish society and to examine its validity and reliability. Materials and Methods: In this two-phase, descriptive and methodological study, intensive care patients, who were treated in the third-line General Intensive Care Clinic of a healthcare institution located in Edirne constituted the universe of the study. In the first phase, 104 intensive care patients were included in the study between March 1-March 25 and May 24-September 30, 2021. Pressure injury risk factors were examined by collecting data with the Intensive Care Patient Information Form, Asessment Form for Pressure Injury Due to Medical Devices, and Bates-Jensen Wound Assessment Tool. In the second phase, a draft scale form was created with the identified risk factors and presented to expert opinion. Based on the results of content validity analysis, the “Pressure Injury Risk Assessment Scale for Intensive Care Patients” containing 16 items was created. Data were collected using the Braden, Norton, Waterlow, Jackson/ Cubbin and Pressure Injury Risk Assessment Scales for Intensive Care Patients on November 01, 2023 and February 29, 2024; and 130 intensive care patients were included in the sample. The first 30 patients were observed by the investigator nurse and a second nurse, and the agreement between observers on Pressure Injury Risk Assessment Scale for Intensive Care Patients was examined. Statistical analysis was performed to assess data. Results: It was found that all items of the Pressure Injury Risk Assessment Scale for Intensive Care Patients had a CVI greater than 0.80, the cut-off point showed the highest sensitivity and specificity at >7 (high risk) points (sensitivity: 93.3% and specificity: 84.7%), Cronbach's Alpha coefficient was 0.87, and the intraclass correlation coefficient was 0.987. The scale was found to have a positive and strong correlation with Waterlow Scale scored in the same direction (p<0.001), and negative and strong correlations with the Braden, Norton and Jackson/ Cubbin scales scored in the opposite direction (p<0.001). The Pressure Injury Risk Assessment Scale for Intensive Care Patients showed the second highest sensitivity after the Jackson/ Cubbin Scale (sensitivity: 95.6%) and showed equal and the highest specificity with Waterlow Scale (specificity: 84.7%). Conclusion: It has been determined that the “Pressure Injury Risk Assessment Scale for Intensive Care Patients” is a valid and reliable scale with high inter-observer agreement in diagnosing the risk of pressure injury among intensive care patients in Turkish society.
Objective: The aim of this study was to develop a diagnostic scale for pressure injury risk specific for intensive care patients in Turkish society and to examine its validity and reliability. Materials and Methods: In this two-phase, descriptive and methodological study, intensive care patients, who were treated in the third-line General Intensive Care Clinic of a healthcare institution located in Edirne constituted the universe of the study. In the first phase, 104 intensive care patients were included in the study between March 1-March 25 and May 24-September 30, 2021. Pressure injury risk factors were examined by collecting data with the Intensive Care Patient Information Form, Asessment Form for Pressure Injury Due to Medical Devices, and Bates-Jensen Wound Assessment Tool. In the second phase, a draft scale form was created with the identified risk factors and presented to expert opinion. Based on the results of content validity analysis, the “Pressure Injury Risk Assessment Scale for Intensive Care Patients” containing 16 items was created. Data were collected using the Braden, Norton, Waterlow, Jackson/ Cubbin and Pressure Injury Risk Assessment Scales for Intensive Care Patients on November 01, 2023 and February 29, 2024; and 130 intensive care patients were included in the sample. The first 30 patients were observed by the investigator nurse and a second nurse, and the agreement between observers on Pressure Injury Risk Assessment Scale for Intensive Care Patients was examined. Statistical analysis was performed to assess data. Results: It was found that all items of the Pressure Injury Risk Assessment Scale for Intensive Care Patients had a CVI greater than 0.80, the cut-off point showed the highest sensitivity and specificity at >7 (high risk) points (sensitivity: 93.3% and specificity: 84.7%), Cronbach's Alpha coefficient was 0.87, and the intraclass correlation coefficient was 0.987. The scale was found to have a positive and strong correlation with Waterlow Scale scored in the same direction (p<0.001), and negative and strong correlations with the Braden, Norton and Jackson/ Cubbin scales scored in the opposite direction (p<0.001). The Pressure Injury Risk Assessment Scale for Intensive Care Patients showed the second highest sensitivity after the Jackson/ Cubbin Scale (sensitivity: 95.6%) and showed equal and the highest specificity with Waterlow Scale (specificity: 84.7%). Conclusion: It has been determined that the “Pressure Injury Risk Assessment Scale for Intensive Care Patients” is a valid and reliable scale with high inter-observer agreement in diagnosing the risk of pressure injury among intensive care patients in Turkish society.