Reposicionamento no leito e prevenção da lesão por pressão: revisão sistemática e produção de tecnologia educacional em vídeo

Abstract

Introduction: Pressure Ulcer (PU) remain one of the most significant and costly challenges in both hospital and home healthcare settings. They are defined as localized damage to the skin and/or underlying tissues—typically occurring over bony prominences—resulting from prolonged pressure or a combination of pressure and shear (PAHO, 2018; Sardo et al., 2023). Prevention is recognized as a more efficient and less costly strategy than treatment, with an estimated 95% of PIs considered preventable (Araujo et al., 2019). Objective: To review the literature for original studies evaluating whether bed repositioning contributes to the prevention and treatment of pressure ulcer in bedridden individuals, and to develop guidance material for formal and informal caregivers on an appropriate strategy for positioning bedridden adults without the need for assistance. Methods: This project consisted of a rigorous systematic review and the development of a technical–technological product (TTP). The first stage was a systematic review (SR), designed as an evidence synthesis aimed at answering a research question structured using the PICO framework. The review protocol was registered in PROSPERO (Centre for Reviews and Dissemination, 2019). A comprehensive search was conducted with no language or date restrictions across eight databases, including grey literature sources. The strategy used MeSH and Emtree terms based on PICO and was refined using the PRESS tool. Eligibility criteria included bedridden adults in any care setting, focusing exclusively on original longitudinal studies. Title and abstract screening was conducted independently by two reviewers using the Rayyan application, with disagreements resolved by a third reviewer. Risk of bias was assessed using the Robvis tool (applying ROBINS-I, RoB 2.0, or RoB 2 CR, depending on study design). The certainty of the evidence was evaluated using the GRADE approach. Data analysis was performed using STATA® version 19, employing random-effects meta-analysis and assessment of publication bias. Product 2 consisted of a short instructional video developed as didactic material to guide formal and informal caregivers of bedridden adults on proper positioning techniques. The central aim of the TTP was to teach methods that could be performed independently, using only the basic features of a hospital bed. The script, written in plain language and grounded in the evidence identified, included an introduction, development, and conclusion, with full subtitles and narration by the researcher. Recordings were conducted in the Nursing Laboratory of FEPECS with support from a professional videographer to ensure high audio and video quality. A large male model, acting as a non-cooperative adult patient, was used to demonstrate the technique’s effectiveness regardless of patient size. Following production, the video underwent content validation by expert judges—nurses with at least five years of experience and a master’s or doctoral degree— selected through snowball sampling. Validation used the Content Validity Coefficient (CVC) proposed by Hernández-Nieto (2002), assessing clarity of language, practical relevance, and theoretical relevance on a 5-point Likert scale. The material will be disseminated through institutional channels and public platforms, including YouTube, and social media profiles of SES/DF, FEPECS, ESP/DF, and Cofen Play, as well as via QR Code access. Results: Product 1 – Systematic Review: Prevention of pressure injury and repositioning in bed: a systematic review. Results indicated that the intervention increased the probability of preventing pressure ulcer by 7% compared with the control group. When considering repositioning intervals of 3 or 4 hours versus 2 hours, the probability of prevention increased to 12%, based on clinical trial data. Despite statistical significance, findings should be interpreted cautiously due to high heterogeneity and very low certainty of evidence according to GRADE. Product 2 – Instructional Video: A didactic and accessible instructional video demonstrating how formal and informal caregivers can position a bedridden adult without the help of a second person, using the resources of a hospital bed. The technique is also adaptable for use on a standard bed. The results demonstrated high overall validity (total CVC = 0.88), with emphasis on the organization and sequencing of the material (0.91), indicating strong agreement regarding clarity, technical accuracy, and suitability for the target audience. The video proved to be a robust educational technology, grounded in best practices and capable of supporting caregivers in performing a critical intervention for patient safety. For initial product promotion, the official YouTube channel of the graduate program hosts the video link. In addition to this strategy, the program is being promoted via QR code at each bedside in the inpatient unit where the researcher works, with the aim of disseminating the information to other units within the network. The project is aligned with the research line Quality in Adult and Elderly Healthcare. Conclusion: Repositioning bedridden adults is a validated intervention for the prevention of pressure ulcer and serves as an adjunct treatment when performed correctly and according to established criteria. Evidence indicates that effective repositioning does not require strict adherence to a fixed two-hour schedule; instead, repositioning intervals should be individualized. The developed technical product demonstrates potential applicability for influencing care practices and contributing to scientific and social advancement in the field of nursing at a national level. It represents a high-complexity innovation that adapts existing knowledge and returns meaningful benefits to both the general public and the scientific community.