Adaptação e validação de protocolo para prevenção de úlcera por pressão em idosos assistidos no domicílio

Abstract

This is an experimental randomized study which aimed: to verify the validity of a nursing protocol for the prevention of pressure ulcers in elderly bedridden at home, whose care is performed by family caregivers with the supervision of nurses working in the primary care of the Brazilian Health System; to review the protocol for the prevention of pressure ulcers according to the opinion of experts in stomal therapy; to apply the Braden scale for predicting pressure ulcer risk in elderly bedridden at home and to evaluate the expected results according to the protocol for the prevention of pressure ulcers . This study was divided into two phases: content validation and clinical validation. It was used as reference the Nursing Standard of Practice Protocol developed by an American nurse named Elizabeth Ayello, as part of the Nurses Improving Care for Health System Elders (NICHE) project. The protocol was submitted to sixteen nurses expert in stomal therapy living in the city of Fortaleza, Ceara. Data collection was conducted between June and August 2010, the study population consisted of 520 elderly patients admitted to public and private hospitals, being recruited only 40 subjects. Recruitment was done using eligibility criteria such as: being ranked in the Braden scale; being unable to walk; being above 60 years old and living in Fortaleza or in its metropolitan area. The evaluation and adjustments proposed by the experts concerning the validation of content consisted of inclusions in similar items as well as exclusion of others; therefore, after the experts reaching a consensus, the protocol had a total of 15 items out of the 26 suggested preventive measures. From the 15 preventive measures, 6 or 40% of the total were performed according to the protocol by more than 70% caregivers in the three home visits. The analysis of repeated measures showed a violation of the principle of sphericity of variances between the days of the protocol application. The groups showed homogeneity of variances both for days of intervention and globally. In the analysis using the Greenhouse-Geisser correction it was found statistically significant difference in the scores of the Braden scale per day (p <0.001). It was observed in the first, second and third assessments that the experimental group had significantly more patients with high risk. The control group showed a greater concentration of patients in the classification "At risk" in the third and fourth assessments. In the fourth assessment a subject in the experimental group was readmitted. The results indicate that 13 (65%) of subjects in the control group showed no ulcer and 7 (35%) showed. However, 18 (90%) of the experimental group showed no ulcer, and only 2 (10%) showed. The control group showed a relative risk for ulcer of 3.5 compared to the experimental group. This value shows statistical significance at the level of 10%. The study concluded that the language of the protocol was clear and that such protocol feasible in its preventive measures.