Journal of Practical & Professional Nursing Category: Clinical Type: Integrative Review
Integrating Nursing with Biomedical Engineering: A Multidisciplinary Integrative Innovative Approach to Home-Base Care for Aging Society in Thailand
- Jinpitcha Mamom1*, Manyat Ruchiwit2, Debra Hain3
- 1 Faculty Of Nursing, Thailand
- 2 Faculty Of Nursing, Thammasat University, Thailand
- 3 Faculty Of Nursing, Christine E Lynn College Of Nursing, Florida Atlantic University, United States
*Corresponding Author:Jinpitcha Mamom
Faculty Of Nursing, Thailand
Received Date: Mar 05, 2019 Accepted Date: Mar 25, 2019 Published Date: Apr 02, 2019
Pressure ulcers constitute a significant public-health problem that is both dangerous and severe, impacting the multi-morbidity and mortality of the elderly person. Especially affected are elderly patients, as demographic changes in numerous countries have penetrated the society of the elderly. Health-care teams and the Public Health Ministry should maintain preparedness and readiness in providing care for the elderly.
This paper has as its objective a proposal for constructing an innovative repositioning bed that can adjust person into the appropriate position. The proposal applies principles and empirical evidence derived from an integration of medical knowledge and biomedical engineering for the management of mechanical loading, which is a significant cause of PUs, and from the interrelationship of mechanical loading with the impact it imposes upon the skin and tissues.
Conduct a literature review using the databases CINAHL, MEDLINE, DYNAMED, Web of Science, ISI and PubMed that focused on mechanical loading-related pressure ulcers. The key terms are: innovation, pressure ulcers, loadings and targeted studies published in Thai and English from January 2010 to December 2017.
Findings and discussion
It was discovered from research analysis and empirical evidence that an effective management method for mechanical-loading-related pressure ulcers is repositioning. In previous researches, it was found that a study had been conducted on the effects of many innovations. There were, however, gaps in practice, such as actually adopting them for use, the rather high prices involved and, importantly, the fact that they were never actually applied to the care of elderly patients who were in home-based care.
A new innovation which integrates a multidisciplinary knowledge base of health care and the engineering and architectural sciences will provide an alternative approach to lessening the burdens being borne by relatives administering the care. It will also assist the management and prevention of future PUs in the society of the elderly that are imminent.
The design and construction of innovative beds that can turn person that will reduce the forces imposed on the human tissues and skin (mechanical loading). The beds will be designed to adjust the head level upward and to adapt to the knee joint to allow it to bend. It must especially be capable of adjusting the position into 30 tilt lateral, as the pressure ulcer prevention guidelines [14-17].
Repositioning is considered to be an important strategy and is absolutely essential in the prevention of pressure ulcer of elderly patient . In a systematic review, it was suggested that repositioning must be performed at least every two hours , but the duration may vary according to the condition of the patient. Patients who are at high risk for developing PUs can be repositioned more frequently than every two hours if red marks have been found on the skin. In a study conducted by Bergstrom , it was found that there was no difference incidence over three weeks of observation between those turned at 2-, 3-, or 4-hour intervals in patients using high-density foam mattresses.
Lying positioning leads to minimum contact pressure upon the skin. Head elevating should not over than 30-degrees, with both knees raised of 0-30 degrees, as well as using a pillow to support the heels, help to prevent PUs, reduce problems from shearing and avoids muscular contraction and tension of the joints [15,24]. In lateral positioning, patients should be turned at a 30-degree lateral tilt. This position will reduce pressure on the coccyx and the shoulders, and will allow oxygen to nourish the tissues in the region of greater trochanter more effectively than when positioned to lie at angle of 60 or 90 degrees [22,24].
Accordingly, innovative repositioning beds that turn a patient on his side have been developed. These beds are capable of managing the mechanical loading that affects human tissues and skin; their function is to forestall occurrences of PUs and to lessen the burden being borne by caregivers. Use of these beds thus continues to improve the quality of life of both patient and caregiver, by applying physiological concepts to the development of pressure-injuries and managing interface pressures by properly repositioning.
Innovative repositioning beds, the In RB, were built and developed by researchers from beds that turned position by use of a remote control. The In RB, a new innovative structural steel bed, has 30-degrees of head-bed level, 30-45 degrees for the knee level, and 30-degrees lateral tilt to redistribute mechanical loadings on the bony prominences . They conducted pilot research studies on enhancing the quality of care for patients who are stoke victims through the use of beds that can turn someone, and the caregivers’ satisfaction. The goal is promoting the proper patients positioning, to reduce and distribute the interface pressure and to stimulate the blood flow so that the tissues can receive nourishment and oxygen. It is thus intended to help prevent and reduce the occurrences of PUs in the high risk of developing PUs when at home and also decreased workload of caregivers. Statistically significant results from the study have shown that this bed, which has been built to turn a patient by use of a manual crank, is safe and can prevent PUs. Also, care givers have a high level of satisfaction in the use of a bed that can turn the patient. Continued development has thus been directed toward achieving greater efficiency and effectiveness in the prevention of PUs. The quality of the instruments was sought through a proposal presented to five qualified specialists, among them a professor of medicine with expertise in the care of patients with injuries, a skilled nurse with experience in the care of injured patients (Advanced Practitional Nurse: APN) and a professor of mechanical engineering, to test for safety, sturdiness and functionality according to the objective, design and suitability of the invented product.
- Al Mutairi KB, Hendrie D (2018) Global incidence and prevalence of pressure injuries in public hospitals: A systematic review. Wound Medicine 22: 23-31.
- Jocelyn Chew HS, Thiara E, Lopez V, Shorey S (2018) Turning frequency in adult bedridden patients to prevent hospital?acquired pressure ulcer: A scoping review. Int Wound J 15: 225-236.
- Källman U, Bergstrand S, Ek AC, Engström M, Lindgren M (2016) Blood flow responses over sacrum in nursing home residents during one hour bed rest. Microcirculation 23: 530-539.
- Auiwattanakul S, Ungpinitpong W, Yutthakasemsunt S, Buranapin S, Chittawatanarat K (2017). Prevalence of Pressure Ulcer and Nutritional Factors Affecting Wound Closure Success in Thailand. Materia sociomed 29: 196-200.
- Amir Y, Lohrmann C, Halfens RJ, Schols JM (2017) Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. Int Wound J 14: 184-193.
- Boyko TV, Longaker MT, Yang GP (2018) Review of the current management of pressure ulcers. Adv Wound Care (New Rochelle) 7: 57-67.
- Kaur S, Singh A, Tewari MK, Kaur T (2018) Comparison of Two Intervention Strategies on Prevention of Bedsores among the Bedridden Patients: A Quasi Experimental Community-based Trial. Indian J of Palliat Care 24: 28-34.
- Lavallée JF, Gray TA, Dumville J, Cullum N (2018) Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. Inter J Nurs Stud 82: 79-89.
- Tong SF, Yip J, Yick KL, Yuen MCW (2016) Effects of different heel angles in sleep mode on heel interface pressure in the elderly. Clin Biomech (Bristol, Avon) 32: 229-235.
- Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, et al (2013) Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes. J Am Geriatr soc 61: 1705-1713.
- De Meyer D, Van Damme N, Van den Bussche K, Van Hecke A, Verhaeghe S, et al (2017) PROTECT–trial: a multicentre prospective pragmatic RCT and health economic analysis of the effect of tailored repositioning to prevent pressure ulcers–study protocol. J Adv Nurs 73: 495-503.
- Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA et al (2014) Repositioning for pressure ulcer prevention in adults. Cochrane Database of Syst Rev 4: CD009958.
- Suttipong C, Sindhu S (2012) Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities. J Clin Nurs 21: 372-379.
- Cogan AM, Blanchard J, Garber SL, Vigen CL, Carlson M, et al (2017) Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clin Rehabil 31: 871-880.
- EPUAP N, NPUAP N (2014) Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. International NPUAP/EPUAP Pressure Ulcer Classification System. Perth, Australia.
- Gunningberg L, Sedin IM, Andersson S, Pingel R (2017) Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. Int J Nurs Stud 72: 53-59.
- Mamom J (2017) The effects of a community-based discharge-planning model for continuing pressure ulcer care on wound healing rates, nutritional status, and infection rates of elderly patients in Thailand. Songklanakarin J Sci Technol 39: 341-346.
- Edger M (2017) Effect of a Patient-Repositioning Device in an Intensive Care Unit on Hospital-Acquired Pressure Injury Occurences and Cost. J Wound Ostomy Continence Nurs 44: 236-240.
- Engels D, Austin M, McNichol L, Fencl J, Gupta S, et al (2016) Pressure Ulcers: Factors Contributing to Their Development in the OR. AORN J 103: 271-281.
- Grap MJ, Munro CL, Wetzel PA, Schubert CM, Pepperl A, et al (2017). Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients. Intensive Crit Care Nurs 38: 1-9.
- Lachenbruch C, Ribble D, Emmons K, VanGilder C (2016) Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey. J Wound Ostomy Continence Nurs 43: 235-241.
- Oomens C, Broek M, Hemmes B, Bader D (2016) How does lateral tilting affect the internal strains in the sacral region of bed ridden patients?-A contribution to pressure ulcer prevention. Clin Biomech (Bristol, Avon) 35: 7-13.
- Wong H, Kaufman J, Baylis B, Conly JM, Hogan DB, et al. (2015) Efficacy of a pressure-sensing mattress cover system for reducing interface pressure: study protocol for a randomized controlled trial. Trials 16: 434.
- Lippoldt J, Pernicka E, Staudinger T (2014) Interface pressure at different degrees of backrest elevation with various types of pressure-redistribution surfaces. Am J Crit Care 23: 119-126.
- Yi CH, Kim HS, Yoo WG, Kim MH, Kwon OY (2009) The effects of different types of automated inclining bed and tilt angle on body-pressure redistribution. Adv Skin Wound Care 22: 259-264.
Citation:Mamom J, Winaiprasert P, Hain D (2019) Integrating Nursing with Biomedical Engineering: A Multidisciplinary Integrative Innovative Approach to Home-Base Care for Aging Society in Thailand. J Pract Prof Nurs: S1001.
Copyright: © 2019 Jinpitcha Mamom, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.