Design and participants
This was a retrospective and observational study. The data of hospital electronic medical records were retrospectively collected, with the consent of the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University, the patient's informed consent is waived. The study was approved by the human research ethics committee of the First Affiliated Hospital of Wenzhou Medical University. All methods were performed in accordance with the relevant guidelines and regulations. The study was conducted between 2017 and 2018. Patients who had HAPI during hospitalization were included in the study, except patients who already had HAPI on admission and remained in the department for less than 24 hours.
Instrument
In this study, a questionnaire was designed based on the existing literature about HAPI[1, 2, 5, 14–19]. The questionnaire contents comprised the following Sect. (1) General information, namely age, sex, height, weight, body mass index, chronic medical history, operation history, education level, smoking history, admission time, admission diagnosis, department, PI occurrence (outside the hospital/ hospital-acquired), and discharge time. (2) The Braden Scale score (performed on admission, on development of HAPI, and at discharge), a risk factor assessment tool for HAPI which consists of six subscales reflecting the degree of sensory perception, nutrition, mobility, activity, moisture, and shear/friction. The Braden Scale score ranges from 6 to 23, with a lower score indicating a greater risk of developing HAPI[14, 21]. (3) The HAPI assessment, including stage (HAPI stages I-IV, unstageable PI, deep tissue PI, medical device-related PI and mucosal membrane PI[1]) and location (sacrum, hip, buttock, heel, ischial tubercle, elbow, occipital eminence, scapula, internal and external ankles, and other areas). (4) HAPI prognosis (i.e. healing, not healing, dead).
Before the formal investigation, a research group was constructed, and the purpose, content, method, and considerations of the study were determined by this group. All members of the group had experience in the nursing care of HAPI. Two nurses in the group were responsible for data collection and completing HAPI questionnaires.
Statistical analysis
Statistical analyses were completed using IBM SPSS statistic 25.0 software (IBM Corporation, Chicago, IL, USA). A paired t-test was performed to determine the significance of differences between the Braden Scale scores at each time point. Statistical significance was considered at a level of p < 0.05.