[Incidence proportion estimation, prevalence and effective visiting nurse care of pressure ulcers].

PURPOSE: The purpose of this study are as follows: 1. To determine incidence proportion estimations and prevalence of pressure ulcers in home care settings. 2. To clarify the effective nursing care for prevention and treatments of pressure ulcers at visiting nursing service stations. 3. To show whether demographic characteristics are factors in pressure ulcer development. METHODS: This research is a part of the series of studies on prevalence of pressure ulcers in 934 visiting nursing service stations on October 1995 in Japan. This was followed in November 1, 1996 to October 31, 1997, by another investigation for incidence proportion estimation and prevalence of pressure ulcers and their relationship to nursing care facilities, in which questionnaires were mailed to 620 facilities that participated in the first research. Responses from 294 (47.4%) facilities and 1,208 subjects were received. We analyzed the responses from 215 facilities (73.1%) and 864 subjects to the two types of questionnaires. RESULTS: Prevalence of pressure ulcers was found to be 8.0% (95% CI: 7.5-8.6) on July 1, 1997 and incidence proportion estimation was 3.7% (95% CI: 3.3-4.1) from November 1, 1996 to October 31, 1997 for the 10,750 clients in 215 facilities. The number of prescriptions for turning of client sleep position (p = 0.044), and having a standard care assessment procedure (p = 0.015) were significantly higher for no-present pressure ulcer than in facilities with under 5% having present pressure ulcers and facilities with over 5% having present pressure ulcers. Subtracting the prevalence point in 1997 from 1995, the utilization of a primary nursing care plan (p = 0.021), and the number of part-time nurses (p = 0.008) were significantly higher in the groups that had a decrease or no-change compared to the increased groups. 45.6% of the ulcers identified were situated on the sacrum/buttocks and 39.4% of the ulcers were grade 2. The mean total score on the Braden Scale was 12.7. A score of 18 may be considered as the cut-off point in home care settings. DISCUSSION: Prevalence of pressure ulcers was found to be 8.0% and incidence proportion estimation was 3.7%. The present findings concerning incidence proportion estimation and prevalence of pressure ulcers and the practice of nursing care in visiting nursing service stations suggests possibility for improving outcomes for clients with pressure ulcers and for those at risk factors of developing them.