Using a text-mining survey of basic nursing textbooks published in Japan from 1951 to 2019, the present study aimed to identify the description and transition in pressure ulcer-related content in nursing textbooks. Descriptions of pressure ulcer were converted into text data which were then separated into components, categorized, and quantified to examine the ratio and changes per category. The Jonckheere-Terpstra test was conducted after dividing the category volume by the number of textbooks by publication period. Correspondence analysis was carried out using the publication period and category. The results of a trend test for the categories of quantity, evaluation, wound surface, rehabilitation, necrotic tissue, competence, and burns was significant and were classifiable into the following five items and percentages: movement support（51.4%）, skin and wound management（18.7%）, nursing（10.7%）, whole body management（9.8%）, and environmental maintenance （9.4%）. Correspondence analysis revealed that the textbook content in the period from the 1950s to the 1960s was characterized by a focus on observation and local irritation. In the 1950s, drying was emphasized. The 1970s to 1980s was characterized by a focus on the details of body parts, positional and postural change, and bedding whereas the focus in the 1990s to the 2010s was on multiple approaches to the wound healing process. More than 50% of the content related to pressure ulcers in nursing textbooks was movement support. Recently, multifaceted, and comprehensive content has been characterized with emphasis on evaluation.

View full abstract

　　Objective: To investigate factors and challenges related to establishing selfcare in gastrointestinal ostomy patients
　Methods: The patient demographics and stoma attributes of gastrointestinal ostomy patients were retrospectively investigated. Patients were classified into a “selfcare group,” “semi-selfcare group（emptying pouch only）,” and “full care group” in descending order of ostomy selfcare acquisition at discharge.
　Results: One hundred thirty-six patients were included. The characteristics of patients who did not demonstrate selfcare acquisition, including advanced age, delirium, dementia, end stoma, permanent stoma, and no episode of leakage stemming from a peristomal crease, were collected. Family and medical support status was extracted using multinomial logistic regression analysis.
　Conclusion: The key issues in promoting the acquisition of selfcare by ostomy patients may include having a support system containing a key person and primary caregiver early after the decision to perform surgery and providing early rehabilitation and individualized goal-setting for ostomy care.

View full abstract

　The present study examined the prevalence of medical device-related pressure ulcers (MDRPU) and care in the home care setting. In total, 1,800 facilities nationwide with designated home-visit nursing stations were surveyed for MDRPU cases. The response rate was 18.8% (252 MDRPU in 338 facilities). The mean patient age was 69.0±25.3 years (range: 0-101 years); 115 (45.6%) respondents were men; and 233 (79.8%) MDRPU occurred at home. The most commonly involved devices were the indwelling urethral catheter (n=68), transmucosal tube (n=56),and nasal oxygen cannula (n=30). Using DESIGN-R^®, depth was scored d1, d2, D3, D4, and D5 in 163 (55.8%), 85 (29.1%), 18 (6.2%), 9 (3.1%), and one (0.3%) patient, respectively. Skin care, contact site protection, and pressure reduction care were implemented through experimentation with available materials. The present study suggested that home care nurses' knowledge of wound management can lead to appropriate MDRPU care. Notably, however, home care and medical institutions differ in background. The findings of the present study indicated the need to combine visiting nurses' expertise with certified nurses' expertise in wound, ostomy, and continence nursing and to educate local medical personnel, nursing care professionals, home care recipients, and their families about the differences between MDRPU and conventional pressure ulcer as well as how to monitor and care for MDRPU to prevent exacerbation. Finally, this study suggested the need to determine patients' self-care ability and families' nursing care ability according to living conditions and changes in the patients and their families. MDRPU prevention and management methods should also be specifically considered.

View full abstract

Background
　It is not clear why pressure injuries （PIs） in the bedridden older dying from non-cancer causes are more prolonged than those in cancer patients. The objective of this study was to identify the characteristics and clinical processes of PIs in bedridden older patients dying from non-cancer causes.
Methods
　This was a chart review of ≥75-year-old patients who were admitted at a long-term care center of a Japanese general hospital and had a PI in the sacral region from 2015 to 2021.
　To consider factors not included in the DESING-R^® items, the morphological characteristics of PIs were analyzed in a qualitative descriptive method by qualitative sketching technique using photographs taken each examination. Furthermore, the factors that affect the healing process were differentiated from morphological characteristics and processes by comparing the healed and unhealed groups.
Results
　We investigated 46 PIs in 45 participants. Fourteen PIs（14 participants）were healed（DESIGN-R^® score, 0points）; 32 PIs（31 participants）were unhealed at death. Nineteen morphologies were identified. In the healed PIs, the wound surface closed by epidermalization due to infilling with granulation tissue or by contraction after pocket formation. In the unhealed PIs, the necrotic tissue persisted after pocket formation; the wound surface area either enlarged or repeatedly enlarged and contracted. There was no difference between the two groups in treatment for PIs.
Conclusion
　While the treatment options were limited, prevention and early removal of necrotic tissue and infection are important.

View full abstract