Validation of a comprehensive skin risk assessment and management instrument for hospitalized neonatal patients
DOI: https://doi.org/10.33024/minh.v8i9.1767
Neonate NSRAS Skin Injury SRAMT
Abstract
Background: Health services have increasingly shifted their focus from treating skin diseases and skin injuries to emphasizing preventive efforts through routine assessments. Various treatment equipment and neonatal conditions such as infant weight, gestational age, clinical status, and underlying diseases have been shown to have a strong association with the risk of skin injury. Early detection using valid assessment instruments is therefore essential in neonate care.
Purpose: To determine differences in skin injury risk levels in neonates using the SRAMT and NSRAS Plus instruments, and to examine the relationship between gestational age and birth weight with the risk of skin injury.
Method: This short cohort design involving a total of 66 neonates, divided into an exposed group and an unexposed group (historical control). Skin injury risk assessments were conducted using the SRAMT and NSRAS Plus instruments. Data were analyzed by comparing the first and last assessments within the exposed group, comparing exposed and unexposed groups, and testing correlations between gestational age, birth weight, and skin injury risk.
Results: The findings showed significant differences in skin injury risk levels between the first and last assessments in the exposed group (p = 0.001). There were also significant differences in skin injury risk levels between the exposed and unexposed groups (p = 0.001). However, no significant correlation was found between gestational age (p = 0.446) or birth weight (p = 0.821) and the level of skin injury risk.
Conclusion: The study concludes that preventive monitoring using the SRAMT and NSRAS Plus instruments effectively identifies changes in skin injury risk in neonates. Gestational age and birth weight were not found to have a significant relationship with the level of skin injury risk.
Suggestion: Researchers and health professionals are encouraged to integrate nurses’ knowledge regarding factors contributing to skin injury and to consistently re-monitor neonates using the SRAMT instrument. Modification of the instrument is also suggested to align it with current neonatal service conditions in Indonesia, enabling more effective prevention of skin injury, especially among preterm infants.
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References
Abkenar, M. J., Mojen, L. K., Shakeri, F., & Varzeshnejad, M. (2020). Skin injuries and its related factors in the neonatal intensive care unit. Iran J Neonatol, 11(4), 93-98.
August, D. L., Edmonds, L., Brown, D. K., Murphy, M., & Kandasamy, Y. (2014). Pressure injuries to the skin in a neonatal unit: fact or fiction. Journal of Neonatal Nursing, 20(3), 129-137.
August, D. L., New, K., Ray, R. A., & Kandasamy, Y. (2018). Frequency, location and risk factors of neonatal skin injuries from mechanical forces of pressure, friction, shear and stripping: a systematic literature review. Journal of Neonatal Nursing, 24(4), 173-180.
August, D., Hitchcock, I., Tangney, J., Ray, R. A., Kandasamy, Y., & New, K. (2019). Graduated colour tape measure: Development and demonstration of this tool in a case series of neonatal skin injuries. Journal of Tissue Viability, 28(3), 133-138.
Broom, M., Dunk, A. M., & E Mohamed, A. L. (2019). Predicting neonatal skin injury: the first step to reducing skin injuries in neonates. Health services insights, 12, 1178632919845630.
Cho, K. S., Ahn, H. C., Lee, J. H., Lim, S. Y., Lee, H. J., & Park, H. K. (2019). Extravasation wound care in the neonatal intensive care unit. Journal of Wound Management and Research, 15(1), 17-22.
Csoma, Z. R., Meszes, A., Ábrahám, R., Kemény, L., Tálosi, G., & Doró, P. (2016). Iatrogenic skin disorders and related factors in newborn infants. Pediatric Dermatology, 33(5), 543-548.
de Lima, E. L., de Brito, M. J. A., de Souza, D. M. S. T., Salome, G. M., & Ferreira, L. M. (2016). Cross-cultural adaptation and validation of the neonatal/infant Braden Q risk assessment scale. Journal of Tissue Viability, 25(1), 57-65.
Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J., Annemans, L., & Beeckman, D. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754–1774.
Edsberg, L.E., Black, J.M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing, 43 (6), 585.
Faria, T. F., & Kamada, I. (2018). Skin injuries in newborns in neonatal intensive care. Enferm Glob, 17(1), 211-36.
Foster, K. L., Bergerhofer, L. D., Smith, J. B., Fix, M. M., Olney, A., & Sherman, A. (2017). SIRA+ P: Development and testing. Journal of Pediatric Nursing: Nursing Care of Children and Families, 34, 65-71.
Grosvenor, J., & Dowling, M. (2018). Prevention of neonatal pressure injuries. Journal of Neonatal Nursing, 24(3), 122-125.
Huffines, B., & Logsdon, M. C. (1997). The neonatal skin risk assessment scale for predicting skin breakdown in neonates. Issues in comprehensive pediatric nursing, 20(2), 103-114.
Kalia, Y. N., Nonato, L. B., Lund, C. H., & Guy, R. H. (1998). Development of skin barrier function in premature infants. Journal of Investigative Dermatology, 111(2), 320-326.
Martins, C. O. A., & dos Santos Curado, M. A. (2017). Observation neonatal skin risk assessment scale: Statistical validation with newborns. Revista de Enfermagem Referência, 4(13), 43.
Oranges, T., Dini, V., & Romanelli, M. (2015). Skin physiology of the neonate and infant: clinical implications. Advances in wound care, 4(10), 587-595.
Smith, H. A., Moore, Z., & Tan, M. H. (2019). Cohort study to determine the risk of pressure ulcers and developing a care bundle within a paediatric intensive care unit setting. Intensive and Critical Care Nursing, 53, 68-72.
Vance, D. A., Demel, S., Kirksey, K., Moynihan, M., & Hollis, K. (2015). A Delphi study for the development of an infant skin breakdown risk assessment tool. Advances in Neonatal Care, 15(2), 150-157.
Willock, J., Habiballah, L., Long, D., Palmer, K., & Anthony, D. (2016). A comparison of the performance of the Braden Q and the Glamorgan paediatric pressure ulcer risk assessment scales in general and intensive care paediatric and neonatal units. Journal of tissue viability, 25(2), 119-126.
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