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KMID : 1190620050010010015
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Journal of the Korean Wound Care Society
2005 Volume.1 No. 1 p.15 ~ p.31
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Development of a Decision-Making Tree for the Prevention of Pressure Ulcer
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Park Sung-A
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Abstract
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The purpose of this study was to develop a decision-making tree to produce a comprehensive pressure ulcer prevention program. The risk factors for pressure ulcers were drawn from a review of the literature. An expert team examined them in order to select the factors to be used in developing a decision-making tree. The final factors chosen were those with an index of validity above 83% agreement. The detailed composition for preventive care was based on a literature review, and guidelines from the AHCPR (Agency for Health Care Policy and Research) and RCN (Royal College Nursing). These were used to form the decision-making tree. An expert team examined the content validity. User validity was tested by nurses who had more than 2 years clinical experience. The decision making tree was completed after modifications from the expert and user validity testing. The results of this study are summarized as follows : 1. The ten significant risk factors for pressure ulcer included; immobility, friction/shear, decreased mental status, nutritional deficit, sensory deficit, moisture (urinary/stool incontinence), impaired activity, decreased peripheral circulation, knowledge deficit in the caregiver and old age. 2. The framework was composed of interventions for the effect of risk factors on pressure which were set up first, then the decision-making tree for each risk factor influencing tissue tolerance was developed. 3. Preventive intervention were prepared to reduce intensity and duration of pressure for the conditional factors such as decreased mental status, sensory deficit, immobility and impaired activity. Each decision-making tree was developed with the factors influencing tissue tolerance such as friction/shear, urinary or stool incontinence, decreased peripheral circulation, and nutritional deficit. Knowledge deficit of the caregiver and old age were excluded from the decision- making tree. 4. As the results of the expert validity test, the content and decision making process were partially modified. 5. The utility of the decision-making tree was found to be its ability to provide standardized preventive care and to verify risk factors for pressure ulcers. Also the guidebook was evaluated as useful, but, there was less than 70% agreement on convenience of use and easiness of understanding. The reasons were analyzed and it was revealed that education about the preventive interventions of pressure ulcer are necessary. 6. Because the decision-making tree has the benefit of giving information about up-to-date interventions as well as usefulness in problem solving, it can be utilized as a tool for preventive pressure ulcer care education. In conclusion, the decision-making tree which was developed in this study provides standardized preventive pressure ulcer care. Also it has significance in providing an opportunity to learn up-to-date preventive interventions. (J Korean Wound Care Soc 2005;1:15-31)
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KEYWORD
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Pressure ulcer prevention, Decision making tree
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Listed journal information
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