| BackgroundPressure ulcer is not a primary disease,it often appears as clinical complications of the disease.Pressure ulcer increases not only the suffering and economic burden of patients,but also the difficulty of diagnosis and treatment.It also leads to prolonged hospitalization and waste of medical resources.Pressure ulcer has long been considered as result of inappropriate nursing practice,but with more knowledge and research on pressure ulcer,it is discovered that surgery is also one of the important factors affecting the formation of ulcer.Nosocomial pressure ulcer incidence is 2.5-8.8%,23%of which was associated with surgery.The domestic incidence rate of surgical ulcer is 4.7-66%and 3.5%-29.5%abroad.Some researchers showed that evaluating and taking proper preventive measures accurately could decrease the incidence by 50%-60%.Most pressure ulcer risk assessment scales in clinical application focus on bedridden patients,the elderly and other hospitalized patients.There is no independent scales for surgery patients,other auxiliary means and tools for risk prediction are needed at the same time,which may result in prediction error and improper protection.Therefore,to establish a standard,efficient,independent pressure ulcer risk assessment scale to reduce the incidence of surgical pressure ulcer has become an important and urgent problem to be solved.ObjectiveTo develop an effective,reliable and easy-operating surgical pressure ulcer risk assessment scale for Chinese patients,and to examine the reliability and validity of the scale.MethodsWith the latest definition of pressure ulcer as theoretical framework,comprehensive literature search has been conducted for all standard and self-made pressure ulcer assessment scales both from home and abroad.Clinical case analysis results and interviews of clinical medical staff were collected to form the items pool.The research group made a screening by scoring method to gain an initial test scale.Using the initial test scale for 2 round of Delphi methods by experts and pre-investigation of 103 elective adult surgery patients by convenience sampling method,each scale items were tested and selected by Delphi method,data integrity,response's distribution,variance analysis,correlation coefficient method,factor analysis method and the Krone Bach coefficient method to form an initial scale.With convenience sampling method,118 elective adult surgery patients were assessed preoperatively with the initial scale.Data was gathered and analyzed with the use of Krone Bach coefficient,split half reliability,content validity,structure validity and predictive validity to evaluate the reliability and validity of the initial scale.The best diagnostic value of the scale was obtained by the analysis of the ROC curve,and the risk evaluation criteria were determined.ResultsThe initial test scale has 40 items for selection.7 numeric methods were used to evaluate if each of them were qualified for the final scale.Items denied by more than 4 methods were deleted,and those denied by 3 methods were retained for further evaluation.Eventually,16 items were retained in the final version of the scale,which was consistent with theoretical construction.The Krone Bach coefficient of the surgical pressure sore risk assessment scale was 0.662,split half reliability coefficient of total scale is 0.656.The area under the ROC curve(AUC)was 0.765,with sensitivity of 0.71 and specificity of 0.80.The best diagnostic cut-off score of the scale is 22.5.ConclusionThe surgical pressure ulcer risk assessment scale is reliable,effective,and has good predictive effect for surgical pressure ulcers.It can be used as a tool for risk assessment of pressure sores in patients undergoing elective surgery in clinical practice of surgical nursing. |
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