Pressão”: application with guidelines for identification, staging and prevention of pressure injuries HOW TO CITE

Objective: develop an application with guidance on the identification, staging and prevention of pressure injuries in adults. Method: the descriptive method used started with the search for applications in the area of pressure injuries on the Google © and Apple © platforms. Afterwards, the content was developed, based mainly on the recommendations of the National Pressure Injury Advisory Panel. A prototype was created at www.fábricadeaplicativos.com.br and sent for evaluation of form and content. Six health professionals completed a questionnaire evaluating the application and two of them suggested changes. The application was adequate to the suggestions and reassessed by three stomatherapist nurses who did not suggest changes. Results: the application was developed on the “application factory” website and named “Sem Pressão” (No Pressure), with seven tabs. Conclusion: the application was created with guidelines on identification, staging and prevention of pressure injuries in adults, and made available for free download.


INTRODUCTION
Pressure injuries (PI) are defined as injuries located on the skin and/or underlying tissue, usually on bony prominence, resulting from isolated pressure or pressure combined with friction and/or shear. Numerous contributing factors may be associated with PI, but their meaning has yet to be elucidated 1,2 .These lesions can appear as intact or open skin and can be painful. Tolerance of the tissue to pressure can be influenced by microclimate, nutrition, tissue perfusion, comorbidities and the specific conditions of the tissue 1 .
PIs can also be related to the use of medical devices.
These are areas located on the underlying skin or tissue as a result of sustained pressure from a device 1 . Soft tissue injuries usually reproduce the shape of the device, which is usually rigid or fixed with tight dressings. These PIs can progress to full thickness lesions due to the lack of adipose tissue in many areas of ulceration 3,4 . Critical patients are susceptible to the development of PI related to devices for several reasons, such as edema, lack of sensitivity and peripheral vasoconstriction 3 .
Risk factors for the development of these injuries are related to mobility, humidity, activity, sensory perception, nutritional pattern, friction and shear1. The most susceptible patients are those who are immobile, both in bed and in a wheelchair, whether elderly or young people with some sensory impairment, such as trauma, coma, extensive surgical procedures, among others 5 .
PI are considered an important health problem for the general population, as they represent one of the main complications that affect hospitalized patients, prolonging hospitalization and increasing the overall costs of care6. They are also considered an indicator of quality of care in health services 5,7 and classified internationally as adverse events and represent a challenge, as they increase morbidity, mortality, duration and costs of treatment8, in addition to interfering with the quality of life of patients with PI9.

RESUMEN
Introducción: Lesiones por Presión representan una de las principales complicaciones en pacientes hospitalizados, prolongando la internación y aumentando los costos globales de la asistencia. Recursos para orientación de profesionales, como sitios web y directrices apoyan en la identificación, prevención y classificación. La aplicación para teléfonos inteligentes se presenta como una estrategia educativa para detener estos profesionales y la ausencia de esta tecnología libre y en portugués instigado este trabajo. Objetivo: Desarrollar aplicación con orientaciones sobre identificación, classificación y prevención de Lesiones por Presión en adultos. Método: El método descriptivo utilizado inició con la búsqueda de aplicaciones en el área de Lesiones por Presión en las plataformas Google © y Apple ©. Después, se desarrolló el contenido, baseado principalmente en las recomendaciones del National Pressure Injury Advisory Panel. Se creó un prototipo en www.fábricadeaplicativos.com.br y enviado para evaluación de forma y contenido. Seis profesionales de la salud llenaron un cuestionario evaluando la aplicación y dos de ellos sugirieron cambios. La aplicación fue adecuada a las sugerencias y reevaluado por 3 enfermeros estomaterapeutas, que no sugirieron cambios. Resultado: La aplicación fue desarrollada en el sitio "fabricadeaplicativos.com.br" y se denominó "Sem Pressão", con siete pestañas (http://app.vc/sem_pressao). Conclusión: Se creó la aplicación "Sem Pressão", con orientaciones sobre identificación, classificación y prevención de Lesiones por Presión en adultos y disponible para descarga gratuita. The introduction of computer technology and the emergence of sophisticated gadgets, such as computers, notebooks, palmtops, tablets, smartphones and portable phones with internet support, have brought many benefits to health care, allowing professionals access, anywhere, anytime, to a lot of information about the patient or their illness 12 . There are resources to guide health professionals on the topic, such as specific websites, classes, texts, guidelines. Among these features, the smartphone application (app) stands out, which is a type of software that allows the user to perform specific tasks. They exist for computers and for cell phones or smartphones, called mobileapps 13 .

DESCRIPTORES:
The smartphone is considered an easy-to-use tool that can reach a large portion of nurses and other professionals in the health staff 14  Thus, the objective of this study was to develop an application that can be used by health professionals, with guidelines for identifying, staging and preventing PI in adults. This category of professionals was chosen because it was the only one that suggested changes in the first phase of the assessment. All three participants submitted the form that agreed with all items. The application was, therefore, considered adequate in the form and content to be made available.

METHOD
From the prototype evaluated and updated, the end of the application was programmed and made available on the platforms for free download.

RESULTS
The application developed from the "fábrica de aplicativos" page was called "Sem Pressão" ('No Pressure') ( Fig. 1). When opening the application, the home screen presents the developed layout. Then automatically follows the page with the home menu. (Fig. 2).

DISCUSSION
Evidence suggests that PI can be prevented by implementing prevention guidelines that aim to identify known risk factors associated with PI development 19,20 .
Therefore, the identification and understanding of risk factors are necessary to provide adequate prevention interventions and make better use of resources in practice 10 .
The theme approach in the "Sem Pressão" application was  This allows a continental country like Brazil to reach this knowledge tool in the most distant places from large centers.
In addition, professionals carry their equipment with them, thus, access to information will happen anywhere, without the dependence of an office or fixed computer.
Providing up-to-date and accurate information is essential to support professionals when they are managing patient care 15 . A mobile app that allows for timely access without spending the internet band, supports the learning and practice of newly graduated professionals 25 . Agu and collaborators 24 mention that smartphones stay with their users 90% of the time. This advantage is even greater for home care nurses, as they can have access to information at any time, increasing the efficiency of their diagnostic and preventive actions 15 .
The prevention of the occurrence of PI brings benefits, such as cost reduction, better healing (in case of PI), reduced need for surgical intervention such as debridement or grafting, reduced hospital or home stay, among others 15 . Thus, "Sem Pressão" can assist institutions in reducing costs associated with assistance, in addition to reducing iatrogenic damage from hospitalization.
The individualization of care through the systematization of nursing care and the use of recommendations for evidencebased clinical practices can improve the quality of care and provide benefits to the patient 23 . The creation of an application in Portuguese and free for download is certainly a tool that will disseminate knowledge to professionals, mainly to non-specialists, who, thus, will be able to take initiatives to prevent PI.