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Nancy Bergstrom

Publications and source records attributed to Nancy Bergstrom.

9 recordsLinked to original sources
PubMed2005

RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care.

OBJECTIVE: A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven't been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents. METHODS: In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents' medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time. RESULTS: More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes. CONCLUSIONS: The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There's an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.

Activities of Daily Living↗
PubMed2005

The National Pressure Ulcer Long-Term Care Study: outcomes of pressure ulcer treatments in long-term care.

OBJECTIVES: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long-term care residents. DESIGN: Retrospective cohort study with convenience sampling. SETTING: Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States. PARTICIPANTS: Eight hundred eighty-two residents, aged 18 and older, with length of stay of 14 days or longer, who had at least one Stage II to IV PrU. MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics, treatment characteristics, and change in PrU area. Data were obtained from medical records, Minimum Data Set, and other records. RESULTS: Two multiple regression models, one for each stage grouping (Stage II, Stage III and IV), were completed. The area of Stage II PrU was reduced more with moist (F=21.91, P<.001) than with dry (F=13.41, P<.001) dressings. PrUs cleaned with saline or soap showed less decrease in area (F=12.34, P<.001) than PrUs cleaned with other cleansers such as antiseptic, antibiotic, or commercial cleansers. Change in area of Stage III and IV PrUs was related to sufficient enteral feeding (F=5.23, P=.02), enteral feeding without higher acuity levels (F=3.94, P=.048), size of PrU (very large (F=120.89, P=.001) and large (F=27.82, P=.001)), and type of dressing (moist (F=14.70, P<.001) and dry (F=5.88, P=.02)). Stage III and IV PrUs increased in area when debrided (F=5.97, P=.02). The overall models were significant (Stage III and IV, F=20.30, coefficient of determination (R2)=0.06, P<.001; Stage II, F=40.28, R2=0.13, P<.001) but explained little of the variation in change in PrU area. CONCLUSION: In this sample of nursing facility residents, use of moist dressings (Stage II, Stage III and IV) and adequate nutritional support (Stage III and IV) are strong predictors of PrU healing.

Adolescent↗
PubMed2004

The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents.

OBJECTIVES: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long-term care residents. DESIGN: Retrospective cohort study with convenience sampling. SETTING: Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States. PARTICIPANTS: A total of 1,524 residents aged 18 and older, with length of stay of 14 days or longer, who did not have an existing PU but were at risk of developing a PU, as defined by a Braden Scale for Predicting Pressure Sore Risk score of 17 or less, on study entry. MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics (e.g., demographics, medical history, severity of illness using the Comprehensive Severity Index, Braden Scale scores, nutritional factors), treatment characteristics (nutritional interventions, pressure management strategies, incontinence treatments, medications), staffing ratios and other facility characteristics, and outcome (PU development during study period). Data were obtained from medical records, Minimum Data Set, and other written records (e.g., physician orders, medication logs). RESULTS: Seventy-one percent of subjects (n=1,081) did not develop a PU during the 12-week study period; the remaining 29% of residents (n=443) developed a new PU. Resident, treatment, and facility characteristics associated with greater likelihood of developing a Stage I to IV PU included higher initial severity of illness, history of recent PU, significant weight loss, oral eating problems, use of catheters, and use of positioning devices. Characteristics associated with decreased likelihood of developing a Stage I to IV PU included new resident, nutritional intervention (e.g., use of oral medical nutritional supplements and tube feeding for >21 days), antidepressant use, use of disposable briefs for more than 14 days, registered nurse hours of 0.25 hours per resident per day or more, nurses' aide hours of 2 hours per resident per day or more, and licensed practical nurse turnover rate of less than 25%. When Stage I PUs were excluded from the analyses, the same variables were significant, with the addition of fluid orders associated with decreased likelihood of developing a PU. CONCLUSION: A broad range of factors, including nutritional interventions, fluid orders, medications, and staffing patterns, are associated with prevention of PUs in long-term care residents. Research-based PU prevention protocols need to be developed that include these factors and target interventions for reducing risk factors.

Adolescent↗
PubMed2002

Description of the National Pressure Ulcer Long-Term Care Study.

OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long-Term Care Study (NPULS). DESIGN: Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling. SETTING: One hundred nine long-term care facilities throughout the United States. PARTICIPANTS: Two thousand four hundred twenty adult residents aged 18 and older, with a length of stay of 14 days or longer and who were at risk of developing a pressure ulcer, as defined by a Braden Scale for Predicting Pressure Sore Risk MEASUREMENTS: More than 500 characteristics were obtained for each resident over a 12-week period. This paper describes the NPULS database with respect to the resident (sex, age, diagnoses, severity of illness scores, Braden Scale score, activities of daily living, cognitive ability, mobility, bowel or bladder incontinence, laboratory values, nutritional assessment, and pressure ulcer assessment documentation), treatment (nutritional interventions, pressure relieving devices, incontinence interventions, protective devices, turning schedules, and pressure ulcer treatments), and outcome variables (pressure ulcer development and healing, pressure ulcer and systemic infection, changes in nutritional status, and discharge disposition) associated with pressure ulcers. Descriptive statistics and bivariate associations were used for preliminary analyses of resident, treatment, and outcome characteristics. RESULTS: The average age +/- standard deviation was 79.7 +/- 14.2; 70% of the residents were female. Fifty-three percent of residents (n = 1,293) were at risk of developing a pressure ulcer but never developed one during the study (Group 1), 19% developed a new pressure ulcer during the study (n = 457) (Group 2), 22% had an existing pressure ulcer (n = 534) (Group 3), and 6% had an existing pressure ulcer and developed a new ulcer during the study (n = 136) (Group 4). Residents who developed a new pressure ulcer (Group 2) were more likely to be female, older, cognitively impaired, and immobile than residents who had an existing pressure ulcer (Group 3). CONCLUSIONS: This baseline study describes the NPULS database with respect to the resident, treatment, and outcome variables associated with pressure ulcers. Future studies will focus on multivariate analyses for risk factor prediction of pressure ulcer development and pressure ulcer healing. Research-based pressure ulcer prevention and treatment protocols can then be developed.

Adolescent↗
PubMedDate not supplied

Predictive validity of the Braden Scale among Black and White subjects.

BACKGROUND: The Braden Scale for Predicting Pressure Sore Risk (Braden Scale) has been tested for predictive validity, but the cut-off scores for Blacks has not been compared to White populations. OBJECTIVES: The purpose of this brief report is to determine if the Braden Scale predicts pressure ulcer risk similarly for Blacks and Whites. METHOD: A multisite study of the predictive validity of the Braden Scale was conducted in nursing homes, tertiary care, and Veteran's Administration Medical Centers in three cities (Omaha, Chicago, and Raleigh) selected to maximize ethnic diversity. A total of 843 subjects, 666 (79%) White, 159 (12%) Black were studied. Two nurses independently rated each randomly selected subject on admission and every other day until discharge, using the Braden Scale or the Skin Assessment Tool. RESULTS: Whites had a higher incidence of pressure ulcers (15%) than did Blacks (5%), but there was no statistically significant difference in the mean Braden Scale score between groups ( 19.4, 2.8, White versus 19.8, 2.75, Black). A score of 18 best predicts risk for both groups (sensitivity 70%, specificity 77%, with 75% correct predictions for Whites and sensitivity 75%, specificity 76%, with percent correct 76% for Blacks). There was no difference in the area under the receiver-operator characteristic (ROC) curves (0.75, 0.03, White and 0.82, 0.07, Black subjects, =.005). CONCLUSIONS: A score of 18 can be used for identifying Black and White individuals at risk for pressure ulcers.

Adult↗
PubMedDate not supplied

Validation of the mobility subscale of the Braden Scale for predicting pressure sore risk.

BACKGROUND: The Braden Scale for Predicting Pressure Sore Risk has been tested extensively for reliability and validity, but the validity of each subscale has not been evaluated. Because subscale scores are intended to guide patient care decisions, validity is an important issue. OBJECTIVE: : To establish the convergent construct validity of the mobility subscale of the Braden Scale. METHODS: The study evaluated 16 members at a veterans' home (4 members representing each score on the mobility subscale). Movement, as recorded by a Motionlogger Actigraph, a wristwatch-sized accelerometer and microprocessor that measures physical movement (activity), was measured continuously. Each person wore an Actigraph on the nondominant ankle for 72 hours. RESULTS: The mean activity for each of the four subscale score groups was plotted, producing a histogram in which higher scores were associated with greater activity (F[3, 15] = 31.69;p <.001, one-way analysis of variance), as expected. Pair wise multiple comparisons between groups showed that only the subgroup with a score of 4 was significantly different in mean activity (p <.001) from the other three score groups. CONCLUSIONS: Convergent construct validity for the Braden mobility subscale was supported. A larger sample and establishment of a threshold to eliminate minor, ineffective movements from Motionlogger Actigraph measures may distinguish between significant and nonsignificant movement.

Aged↗