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  • 1.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses2015In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 24, no 8, p. 346-358Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.

    Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.

    Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.

    Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.

  • 2.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions2014In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, p. 761-771Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

    METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

    RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

    CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

  • 3.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Evaluation of Repositioning in Pressure Ulcer Prevention2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: To reduce the risk for pressure ulcers, repositioning of immobile patients is an important standard nursing practice. However, knowledge on how this preventive intervention is carried out among elderly immobile patients is limited and to what extent patients perform minor movements between nursing staff-induced repositionings is largely unknown, but these movements might have implications for the repositioning intervention. Different lying positions are used in repositioning schedules, but there is lack of evidence to recommend specific positions.

    Aim: The overall aim of this thesis was to describe and evaluate how repositioning procedures work in practice in the care of elderly immobile patients. The aim was also to compare the effects of different positions with regard to interface pressure, skin temperature, and tissue blood flow in elderly patients lying on a pressure-redistribution mattress.

    Methods: This thesis consists of four quantitative studies. In Study I, 62 elderly immobile patients were included. All movements the patients made, either with help from the nursing staff or spontaneously, were registered continuously over the course of three days. Study II served to pilot the procedure for Study III. Tissue blood flow and skin temperature were measured in hospital patients (n = 20) for 5 minutes in two supine, two semi-Fowler, and two lateral positions. In Study III, a new sample was recruited (n = 25) from three nursing homes. Measurement of interface pressure was added, and the measurements were extended from 5 minutes to 1 hour. The six positions were reduced to four by excluding the two semi-Fowler positions. Blood flow was measured using photopletysmography (Study II-IV) and laser Doppler flowmetry (Studies III and IV). In Study IV a deeper analysis of the individual pressure-induced vasodilation (PIV) responses was performed on the sample from Study III. An age of 65 years or older was an inclusion criterion in all studies.

    Results: Study I showed that there was a large variation in the extent to which the elderly immobile patients made spontaneous movements, and these movements were positively related to taking analgesics and negatively related to taking psycholeptics. Patients scored as high risk for pressure ulcer development were repositioned more frequently than patients scored as low risk. However, the spontaneous movement frequency was not associated with any risk scores. Study II showed that the different lying positions influenced the blood flow in different ways. In Study III, it was found that the overall blood flow response during one hour of loading was significantly higher in the 30° supine tilt position than in the 0° supine, 30° lateral, and 90° lateral positions. The overall blood flow in the 90° lateral position did not differ compared to the 30° lateral position, although the interface pressure was significant higher in the 90° lateral position. In patients lacking a PIV response (Study IV), the blood flow decreased immediately and remained below baseline during the one hour of loading.

    Conclusions: Although elderly and immobilized, some patients frequently perform minor movements while others do not. Patients who cannot perform minor movements are important for the nursing staff to identify because they very likely need more intensive repositioning interventions. The spontaneous movement frequency was not associated with the risk assessment score, and this implies that some immobile patients assessed as low risk might need to be repositioned as often as patients assessed as high risk. Of the positions evaluated, the 30° supine tilt position was concluded to be most beneficial. There was no great difference in how the blood flow was affected in the 90° lateral position compared to the 30° lateral position, which question the appropriateness of the recommendation to avoid the 90° lateral position. The patients with lacking a PIV response might be particularly vulnerable to  pressure, which also implies that these patients might need to be repositioned more frequently.

    List of papers
    1. Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
    Open this publication in new window or tab >>Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
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    2016 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1168-1175Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2016
    Keywords
    Nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-117445 (URN)10.1111/iwj.12435 (DOI)000387664400011 ()25779932 (PubMedID)
    Note

    Funding agencies: Research Council Sodra Alvsborg Boras Sweden; Research Council ostergotland Linkoping Sweden; SwedBank Sjuharad foundation for research at the Sodra Alvsborg Hospital Boras Sweden; Sodra Alvsborgs Hospital Boras Sweden; King Gustaf V and Queen Victorias F

    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2017-12-04Bibliographically approved
    2. Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
    Open this publication in new window or tab >>Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
    Show others...
    2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 1, p. 133-144Article in journal (Refereed) Published
    Abstract [en]

    Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

    Place, publisher, year, edition, pages
    Blackwell Publishing, 2013
    Keywords
    nursing, older adults, patient repositioning, pressure ulcer, prevention, skin temperature, tissue blood flow
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87459 (URN)10.1111/j.1365-2648.2012.06000.x (DOI)000312550600013 ()
    Note

    Funding Agencies|Research Council South Alvsborg||South Alvsborg Hospital and Dermatology Department Research Foundation||South Alvsborg Hospital, Boras||Swed Bank Sjuharads foundation for research at the hospital of South Alvsborg, Boras, Sweden||Swedish Research Council||Faculty of Health Sciences, Linkoping, Sweden||

    Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2017-12-06
    3. The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
    Open this publication in new window or tab >>The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
    Show others...
    2015 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 17, no 2, p. 142-151Article in journal (Refereed) Published
    Abstract [en]

    Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.

    Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

    Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.

    Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.

    Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

    Place, publisher, year, edition, pages
    Sage Publications, 2015
    Keywords
    nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
    National Category
    Clinical Medicine Nursing
    Identifiers
    urn:nbn:se:liu:diva-109318 (URN)10.1177/1099800414540515 (DOI)000349332300003 ()25037449 (PubMedID)
    Note

    The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research project was funded by the Research Council, Sodra Alvsborg Hospital, Boras, Sweden [VGFOUSA-318701]; the Research Council, Ostergotland, Linkoping, Sweden [LIO-197101]; the Dermatology Department Research Foundation at Sodra Alvsborg Hospital, Boras Sweden [April 01, 2010]; the SwedBank Sjuharad Foundation for Research at the Sodra Alvsborg Hospital, Boras, Sweden [October 10, 2011]; the Sodra Alvsborg Hospital, Boras, Sweden [April 01, 2011]; the King Gustaf V and Queen Victoria's Freemason Foundation [December 2011]; the NovaMedTech and European Union-European Regional Development Fund [September 29, 2011]; Faculty of Health Science Linkoping University, Linkoping, Sweden [LIO-200671].

    Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05
    4. Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
    Open this publication in new window or tab >>Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.

    Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.

    Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.

    Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.

    Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.

    Keywords
    Tissue blood flow, pressure-induced vasodilation, interface pressure, skin temperature, pressure ulcer, nursing home residents
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-117446 (URN)
    Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2015-04-27Bibliographically approved
  • 4.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 1, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

  • 5.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Södra Älvsborgs Sjukhus, Sweden.
    Bergstrand, Sara
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindgren, Margareta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Blood flow responses over sacrum in nursing home residents during one hour bed rest2016In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 23, no 7, p. 530-539Article in journal (Refereed)
    Abstract [en]

    ObjectivesTo describe individual BF responses in a nursing home resident population for one-hour periods of bed rest. MethodsBF was measured for one hour over the sacrum in 0 degrees supine position and 30 degrees supine tilt position in 25 individuals aged 65 y or older while lying on a pressure-redistributing mattress. Measurements were made at three tissue depths (1, 2, and 10 mm) using the noninvasive optical techniques, LDF and PPG. ResultsEleven participants had a PIV response at 1mm depth in both positions and seven participants had a lack of this response at this depth and positions. The BF response at 1mm depth appeared immediately and remained over, or below, baseline for the entire 60min of loading in both positions. These BF patterns were also seen in deeper tissue layers. ConclusionsThe cutaneous BF response among the nursing home residents was distinct, appeared early, and remained during the one hour of loading.

  • 6.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1168-1175Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

  • 7.
    Källman, Ulrika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Engström, Maria
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure ulcer prevention: The effect of different lying positions on tissue blood flow, temperature and interface pressure in elderly patients - an ongoing study2010In: Pressure ulcer prevention: The effect of different lying positions on tissue blood flow, temperature and interface pressure in elderly patients, 2010Conference paper (Refereed)
  • 8.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.

    Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.

    Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.

    Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.

    Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.

  • 9.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Södra Älvsborgs Sjukhus, Borås, Sweden .
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Cristina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents2015In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 17, no 2, p. 142-151Article in journal (Refereed)
    Abstract [en]

    Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.

    Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

    Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.

    Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.

    Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

  • 10.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting2014In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 2, p. 70-76Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    The aims of this study were to examine and compare the predictive validity of 4 risk assessment scales used for the prediction of pressure ulcer (PrU) development and to identify risk factors.

    DESIGN:

    Cross-sectional descriptive study.

    SETTING:

    A general hospital in Sweden.

    PARTICIPANTS:

    Patients (all aged ≥18 years) admitted to medical, surgical, orthopedic, oncology, and rehabilitation wards. Of 412 patients available, a total of 346 patients participated in the study.

    METHOD:

    Data were collected using the Swedish version of the European Pressure Ulcer Advisory Panel minimum data set as well as the Norton, Modified Norton, Braden, and Risk Assessment Pressure Sore (Ulcer) (RAPS) scales. The predictive validity was estimated by measuring sensitivity, specificity, positive predictive value, and negative predictive value. Multiple logistic regression analysis was used to determine risk factors associated with PrUs.

    RESULTS:

    The RAPS scale reached best balance between sensitivity and specificity at the recommended cutoff level of ≤29, followed by the Braden scale and the Norton scale at recommended cutoff levels ≤18 versus ≤16, respectively. The modified Norton scale also reached an acceptable balance between sensitivity and specificity but at the cutoff level of ≤23, which is a higher cutoff level than recommended. General physical condition, physical activity, moisture, friction, and shear emerged as significant risk factors.

    CONCLUSIONS:

    The results support that the recommended cutoff levels of the RAPS, Norton, and Braden scales are valid in a general hospital setting. However, the recommended cutoff level of the modified Norton scale (≤20) has to be increased when used in this care context.

  • 11.
    Wiklander, Kerstin
    et al.
    Chalmers, Sweden; University of Gothenburg, Sweden.
    Erichsen Andersson, Annette
    University of Gothenburg, Sweden.
    Källman, Ulrika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. South Alvsborg Hospital, Sweden.
    An investigation of the ability to produce a defined "target pressure using the PressCise compression bandage2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1336-1343Article in journal (Refereed)
    Abstract [en]

    Compression therapy is the cornerstone in the prevention and treatment of leg ulcers related to chronic venous insufficiency. The application of optimal high pressure is essential for a successful outcome, but the literature has reported difficulty applying the intended pressure, even among highly skilled nurses. The PressCise bandage has a novel design, with both longitudinal and horizontal reference points for correct application. In the current experimental study, the results for the general linear model, where the data set is treated optimally, showed that all 95% confidence intervals of the expected values for pressure were, at most, 5 mmHg from the target value of 50 mmHg, independent of the position on the leg and the state of activity. Moreover, even nurses with limited experience were consistently able to reach the targeted pressure goal. Future studies are needed to determine how well the bandage works on legs of different shapes, the optimal way of using the bandage (day only or both day and night) and whether the bandage should be combined with an outer bandage layer. In addition, special attention should be paid to subjective patient experiences in relation to the treatment as pain, discomfort and bulk are factors that can compromise patients willingness to adhere to the treatment protocol and thereby prolong the healing process.

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