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Barnden R, Snowdon DA, Lannin NA, Lynch E, Srikanth V, Andrew NE. Prospective application of theoretical implementation frameworks to improve health care in hospitals - a systematic review. BMC Health Serv Res 2023; 23:607. [PMID: 37296453 DOI: 10.1186/s12913-023-09609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes. METHOD We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category. RESULTS Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results. CONCLUSIONS Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base. TRIAL REGISTRATION CRD42019119429.
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Affiliation(s)
- Rebecca Barnden
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia.
- National Centre for Healthy Ageing, Melbourne, VIC, Australia.
| | - David A Snowdon
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Elizabeth Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Velandai Srikanth
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
| | - Nadine E Andrew
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
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Ulrika K, Ami H, Madeleine BR, Lena G, Eva S, Carina B. Pressure ulcer prevalence and prevention interventions – A ten‐year nationwide survey in Sweden. Int Wound J 2022; 19:1736-1747. [DOI: 10.1111/iwj.13779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Källman Ulrika
- Södra Älvsborg Hospital Borås and Head Office, Departure of patient safety, Region Västra Götaland Borås Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Hommel Ami
- Department of Care Science Malmö University Malmö University Malmö Sweden
| | | | - Gunningberg Lena
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Sving Eva
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
- Departure of Patient Safety Region Gävleborg Gävleborg Sweden
- Centre for Research & Development Uppsala University, Region Gävleborg Gävle Sweden
| | - Bååth Carina
- Department of Health Sciences, Faculty of Health, Science and Technology Karlstad University Karlstad Sweden
- Faculty of Health, Welfare and Organisation Østfold University College Fredrikstad Norway
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Barakat-Johnson M, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Lai M, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Implementing best available evidence into practice for incontinence-associated dermatitis in Australia: A multisite multimethod study protocol. J Tissue Viability 2021; 30:67-77. [PMID: 33158742 DOI: 10.1016/j.jtv.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Abstract
AIMS Incontinence-associated dermatitis (IAD) is an insidious and under-reported hospital-acquired complication which substantially impacts on patients' quality of life. A published international guideline and the Ghent Global IAD Categorisation Tool (GLOBIAD) outline the best available evidence for the optimal management of IAD. This study aims to implement theguideline and the GLOBIAD tool and evaluate the effect on IAD occurrences and sacral pressure injuries as well as patient, clinician and cost-effectiveness outcomes. MATERIALS AND METHODS The study will employ a multi-method design across six hospitals in five health districts in Australia, and will be conducted in three phases (pre-implementation, implementation and post-implementation) over 19 months. Data collection will involve IAD and pressure injury prevalence audits for patient hospital admissions, focus groups with, and surveys of, clinicians, patient interviews, and collection of the cost of IAD hospital care and patient-related outcomes including quality of life. Eligible participants will be hospitalised adults over 18 years of age experiencing incontinence, and clinicians working in the study wards will be invited to participate in focus groups and surveys. CONCLUSION The implementation of health district-wide evidence-based practices for IAD using a translational research approach that engages key stakeholders will allow the standardisation of IAD care that can potentially be applicable to a range of settings. Knowledge gained will inform future practice change in patient care and health service delivery and improve the quality of care for patients with IAD. Support at the hospital, state and national levels, coupled with a refined stakeholder-inclusive strategy, will enhance this project's success, sustainability and scalability beyond this existing project.
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Affiliation(s)
- Michelle Barakat-Johnson
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Jayne Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, Ground Floor, Officers Quarters, James Fletcher Campus, 72 Watt Street, Newcastle, New South Wales, 2300, Australia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2006, Australia; Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, New South Wales, 2050, Australia
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, 1 Reserve Road, St Leonards, New South Wales, 2065, Australia
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, Eastern Campus, Liverpool Hospital, Scrivener Street, Warrick Farm, New South Wales, 2170, Australia
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Level 4, Building 75, Hospital Road, Concord, New South Wales, 2139, Australia
| | - Michelle Lai
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, Building 3, Bloomfield Campus, Forest Road, Orange, New South Wales, 2800, Australia
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Level 7, King George V Building, 83-117 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Joan Walsh
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Kate White
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Fiona Coyer
- School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Clinical Outcomes, Safety and Implementation Research Program, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sengul T, Karadag A. Determination of nurses' level of knowledge on the prevention of pressure ulcers: The case of Turkey. J Tissue Viability 2020; 29:337-341. [PMID: 32800627 DOI: 10.1016/j.jtv.2020.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 11/15/2022]
Abstract
AIM OF THE STUDY Pressure ulcers (PUs) constitute a health issue that has a high prevalence and incidence rate in acute and long-term care, requiring long-term nursing care for treatment and prevention. Therefore, nurses should have adequate knowledge of the interventions and practices used to prevent PUs. MATERIALS AND METHODS This study employed a descriptive and cross-sectional design to assess the level of nurses' knowledge concerning preventive interventions for PUs. Based on data found in the literature, researchers developed a 16-question Participant Information Form (including age, gender, level of education, employed ward, and training on PUs) and used this form, along with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), to collect data. RESULTS A group of 471 nurses working in two foundation hospitals in 2018 participated in the study by completing a questionnaire. Among the participants, 44.2% worked in surgery, 21.2% in internal medicine, and 34.6% in other wards (such as intensive care, pediatrics, and the operating theater). Most of the nurses(73.5%) held a bachelor's degree, and their average work experience was 7.27 ± 7.00 years. It was determined that 69.4% of the nurses had not received in-service training relating to PUs, 55.6% did not attend lectures/conferences or read articles on the prevention of PUs, and 59.7% rated themselves as "adequate" in interventions used to prevent PUs. Based on the use of PUPKAI-T, 17 individuals (3.6%) scored equal to or more than the 60% cut-off value, and 454 individuals (96.4%) scored less than 60%. The mean level of knowledge on PUs was calculated as 11.1 ± 2.659 (range: 1-18) out of 26 questions. CONCLUSIONS Results of the study showed that the general level of knowledge of nurses in preventing PUs are extremely insufficient. Therefore, various strategies should be developed to increase nurses' level of knowledge on the etiology and development, classification and observation, and risk assessment of PUs, as well as on nutrition plans and preventive interventions.
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Affiliation(s)
- Tuba Sengul
- Koc University, Department of Fundamental Nursing, Koç University School of Nursing, İstanbul, Turkey.
| | - Ayişe Karadag
- Koc University, Department of Fundamental Nursing, Koç University School of Nursing, İstanbul, Turkey.
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Lorente-Granados MG, Quiñoz-Gallardo MD, Teixiné-Martín A, Arza-Alonso N, Suarez MD, Arias-Arias ÁJ. Implementation of the best practice guideline for pressure ulcer prevention: Development, results and sustainability. ENFERMERIA CLINICA 2020; 30:198-211. [PMID: 32418849 DOI: 10.1016/j.enfcli.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/05/2019] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
AIM To assess the impact of implementing the "Risk Assessment and Prevention of Pressure Injuries (PI)" guideline on adherence to its recommendations, the prevalence of PI and the sustainability of results, and to analyse the implementation strategies, sustainability and barriers detected. METHODS A retrospective observational study (June 2015 to December 2018). Two periods were studied (P1: Preparation and P2: Sustainability). The programme reports and data from the medical records of patients discharged from the 4participating hospitals were analysed with regard to adherence to preventive recommendations and health outcomes in terms of the presence of pressure injuries per centre. RESULTS A total of 13,515 patients were included, of whom 4,523 were at risk for PI and 722 had PI. Of the patients, 82.9% underwent a risk assessment for PI on admission. A decrease in this assessment on admission was observed between P1:89.1% vs. P2: 81% P<.001. Of the patients at risk, 42.1% were reassessed during their admission and a significant increase was observed between the periods P1: 30.7% vs. P2:46%; P<.001. 63.2% had a special pressure management surface, with a significant increase between P1:55.3% vs. P2: 65%; P<.001. The overall prevalence of PI was 5.5% and a significant decrease was observed on comparing P1: 6.6% vs. P2:5.1%; P=.003. The prevalence of nosocomial PI remained constant at 2.1%, P1:2% and P2:2.1%; P=.708. Institutional commitment, the appointment of leaders, drawing up of action plans, and training are outstanding strategies in all the centres. CONCLUSIONS This study shows that there is adequate adherence to the main recommendations of the guideline. A statistically significant improvement was observed in adherence to 2 out of the 3 recommendations assessed. The implantation and sustainability strategies implemented have been contributed to maintenance and/or improving results over time.
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Affiliation(s)
- María Gloria Lorente-Granados
- Área Asistencial y Calidad, Hospital General La Mancha Centro, Gerencia de Atención Integrada de Alcázar de San Juan, Ciudad Real, España
| | | | - Anna Teixiné-Martín
- Unidad de Medicina Interna y Neumología, Hospital Universitari Arnau de Vilanova, Gerencia Territorial ICS Lleida, Lleida, España
| | - Nagore Arza-Alonso
- Unidad de Docencia, Formación e Investigación, Organización Sanitaria de Osidebarrena, Osakidetza, Mendaro, Gipuzkoa, España
| | - Marta Díaz Suarez
- Unidad Hospitalaria Otorrino-Digestivo UH1E, Hospital General La Mancha Centro, Gerencia de Atención Integrada de Alcázar de San Juan, Ciudad Real, España
| | - Ángel Jesús Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Gerencia de Atención Integrada de Alcázar de San Juan, Ciudad Real, España
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Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries: Translating Knowledge Into Practice. J Nurs Care Qual 2020; 35:51-57. [PMID: 30817407 DOI: 10.1097/ncq.0000000000000395] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes. PROBLEM One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change. APPROACH This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs. OUTCOMES Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies. CONCLUSION Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.
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Babamohamadi H, Ansari Z, Nobahar M, Mirmohammadkhani M. The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial. Complement Ther Med 2019; 47:102223. [PMID: 31780037 DOI: 10.1016/j.ctim.2019.102223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of peppermint gel on the prevention of pressure injuries in patients with head trauma admitted to neurosurgical intensive care units. DESIGN This double blind, randomized, controlled clinical trial study was conducted on 150 patients with head trauma admitted to the ICU. Using sealed envelopes, patients were assigned randomly into two intervention (n = 75) and control (n = 75) groups. SETTING The study was conducted in the ICUs of a university hospital and a general hospital in Shiraz, Iran. INTERVENTION The intervention group received peppermint gel three times a day up to 14 days during the skin care as a layer on the skin areas exposed to the risk of pressure injuries. The control group used a placebo gel. PRIMARY OUTCOMES The expected outcome in this study was the incidence of pressure injuries stage I, which once daily was evaluated by pairs of observers with the National Pressure Ulcer Advisory Panel. RESULTS The incidence rate of pressure injuries was 22.8% and 77% in the intervention and the control groups, respectively. The chi-square test result showed a significant deference between two groups (P < 0.001). Sacrum was the most common site for incidence of the pressure injuries. CONCLUSION The findings showed that the peppermint gel has a positive effect in the prevention of pressure injuries in the patients with head trauma admitted to ICUs. So, the use of this gel is suggested as an easy and low-cost method for prevention of pressure injuries in the patients admitted to ICUs.
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Affiliation(s)
- Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Zahra Ansari
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran, Iran.
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran; Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Statistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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Structure, Process, and Quality Indicators for Pressure Injury Prevention and Care in Austrian Hospitals. J Wound Ostomy Continence Nurs 2019; 46:479-484. [DOI: 10.1097/won.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention: A Qualitative Study in Older Orthopedic Patients. J Wound Ostomy Continence Nurs 2019; 46:383-389. [PMID: 31348431 DOI: 10.1097/won.0000000000000568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries. DESIGN Descriptive study. SUBJECTS AND SETTING A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older. METHODS Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULT The overall theme from 21 interviews was "A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care" from which 2 categories, "awareness" and "action," emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position. CONCLUSIONS It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
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Oliveira ACD, Rocha DDM, Bezerra SMG, Andrade EMLR, Santos AMRD, Nogueira LT. Qualidade de vida de pessoas com feridas crônicas. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Resumo Objetivo: Avaliar a qualidade de vida de pessoas com feridas crônicas. Métodos: Estudo transversal realizado com 176 pessoas com feridas crônicas em acompanhamento ambulatorial e domiciliar em um serviço público de saúde. Foram utilizados: formulário para a caracterização sociodemográfica, clínica e terapêutica e o questionário Cardiff Wound Impact Schedule para a mensuração da qualidade de vida. As análises foram descritivas e inferenciais empregando-se os testes t de Student, ANOVA, Mann Whitney e Kruskal-Wallis. Resultados: Dentre as pessoas acompanhadas em domicílio, predominaram lesões de origem vasculogênicas, com tempo de existência superior a 12 meses e área de até 25 cm2. No ambiente ambulatorial, prevaleceram feridas vasculogênicas e traumáticas, com tempo máximo de seis meses e extensão de até 25 cm2. Os fatores clínicos associados à qualidade de vida foram: tempo de duração da lesão, etiologia da lesão, grande extensão, aspecto do exsudato, presença de odor e de dor. O domínio de QV “bem-estar” apresentou maior impacto negativo decorrente da presença de lesão. Conclusão: Os fatores clínicos influenciaram diretamente os domínios de QV, sendo necessária a utilização de estratégias diferenciadas com o intuito de reduzir o impacto na QV por se tratarem de aspectos que poderiam ser atenuados ou evitados mediante a avaliação da lesão e a escolha do tratamento adequado.
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Santamaria N, Creehan S, Fletcher J, Alves P, Gefen A. Preventing pressure injuries in the emergency department: Current evidence and practice considerations. Int Wound J 2019; 16:746-752. [PMID: 30815991 DOI: 10.1111/iwj.13092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence-based PI prevention protocols for the high-risk emergency/trauma patient. The prevention of hospital-acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence-based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.
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Affiliation(s)
- Nick Santamaria
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Creehan
- Department of Nursing, Virginia Commonwealth University, Richmond, Virginia
| | | | - Paulo Alves
- Department of Nursing, Catholic University of Portugal, Lisbon, Portugal
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Koh SY, Yeo HL, Goh ML. Prevention of heel pressure ulcers among adult patients in orthopaedic wards: an evidence-based implementation project. Int J Orthop Trauma Nurs 2018; 31:40-47. [PMID: 30316760 DOI: 10.1016/j.ijotn.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/14/2018] [Accepted: 08/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels. AIMS The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel pressure ulcers. METHODS The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and involved a sample consisting of 30 adult patients. RESULTS Nurses' compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project resulted in more than 50% reduction in stage one heel pressure ulcers. CONCLUSION The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
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Affiliation(s)
- Siew Yi Koh
- University of Orthopaedic Cluster, National University Hospital, Singapore
| | - Hui Ling Yeo
- University of Orthopaedic Cluster, National University Hospital, Singapore
| | - Mien Li Goh
- Evidence Based Nursing Unit, National University Hospital, Singapore.
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Lala D, Houghton PE, Kras-Dupuis A, Wolfe DL. Developing a Model of Care for Healing Pressure Ulcers With Electrical Stimulation Therapy for Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 22:277-287. [PMID: 29339869 DOI: 10.1310/sci2204-277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Electrical stimulation therapy (EST) has been shown to be an effective therapy for managing pressure ulcers in individuals with spinal cord injury (SCI). However, there is a lack of uptake of this therapy, and it is often not considered as a first-line treatment, particularly in the community. Objective: To develop a pressure ulcer model of care that is adapted to the local context by understanding the perceived barriers and facilitators to implementing EST, and to describe key initial phases of the implementation process. Method: Guided by the Knowledge-to-Action (KTA) and National Implementation Research Network (NIRN) frameworks, a community-based participatory research (CBPR) approach was used to complete key initial implementation processes including (a) defining the practice, (b) identifying the barriers and facilitators to EST implementation and organizing them into implementation drivers, and (c) developing a model of care that is adapted to the local environment. Results: A model of care for healing pressure ulcers with EST was developed for the local environment while taking into account key implementation barriers including lack of interdisciplinary collaboration and communication amongst providers between and across settings, inadequate training and education, and lack of resources, such as funding, time, and staff. Conclusions: Using established implementation science frameworks with structured planning and engaging local stakeholders are important exploratory steps to achieve a successful sustainable best practice implementation project.
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Affiliation(s)
- D Lala
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - P E Houghton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,School of Physical Therapy, Western University, London, Ontario
| | | | - D L Wolfe
- Parkwood Institute, London, Ontario, Canada
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Smith SK, Ashby SE, Thomas L, Williams F. Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings. Int Wound J 2018; 15:95-105. [PMID: 29115004 PMCID: PMC7949924 DOI: 10.1111/iwj.12840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/02/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e-learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital-acquired pressure injuries and the percentages of each stage of pressure of injury 1-4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure-relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice.
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Affiliation(s)
| | - Samantha E Ashby
- School of Health SciencesUniversity of NewcastleCallaghanNSWAustralia
| | - Lynette Thomas
- Professional DevelopmentNursing and Midwifery Services, Hunter New England Local Health DistrictNewcastleNSWAustralia
| | - Felicity Williams
- Professional DevelopmentNursing and Midwifery Services, Hunter New England Local Health DistrictNewcastleNSWAustralia
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Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. J Wound Ostomy Continence Nurs 2017; 44:142-147. [PMID: 28267120 DOI: 10.1097/won.0000000000000301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of a pressure mapping system with real-time feedback of pressure points in elderly care, with specific focus on pressure injury (PI) knowledge/attitudes (staff), interface pressure, and PI prevention activities (residents). DESIGN Descriptive, 1-group pretest/posttest study. SUBJECTS AND SETTING A convenience sample of 40 assistant nurses and aides participated in the study; staff members were recruited at daytime, and 1 nighttime meeting was held at the facility. A convenience sample of 12 residents with risk for PI were recruited, 4 from each ward. Inclusion criteria were participants older than 65 years, Modified Norton Scale score 20 or less, and in need of help with turning in order to prevent PI. The study setting was a care facility for the elderly in Uppsala, Sweden. METHODS A descriptive, comparative pretest/posttest study design was used. The intervention consisted of the use of a pressure mapping system, combined with theoretical and practical teaching. Theoretical and practical information related to PI prevention and the pressure mapping system was presented to the staff. The staff (n = 40) completed the Pressure Ulcer Knowledge and Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcer (APuP) before and following study intervention. Residents' beds were equipped with a pressure mapping system during 7 consecutive days. Peak pressures and preventive interventions were registered 3 times a day by trained study nurses, assistant nurses, and aides. RESULTS Staff members' PUKAT scores increased significantly (P = .002), while their attitude scores, which were high pretest, remained unchanged. Peak interface pressures were significantly reduced (P = .016), and more preventive interventions (n = 0.012) were implemented when the staff repositioned residents after feedback from the pressure mapping system. CONCLUSIONS A limited educational intervention, combined with the use of a pressure mapping system, was successful as it improved staff members' knowledge about PI prevention, reduced interface pressure, and increased PI prevention activities. As many of the staff members lacked formal education in PI prevention and management, opportunities for teaching sessions and reflection upon PI prevention should be incorporated into the workplace. More research is needed to evaluate the effect of continuous pressure mapping on the incidence of PI.
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Moya-Suárez AB, Morales-Asencio JM, Aranda-Gallardo M, Enríquez de Luna-Rodríguez M, Canca-Sánchez JC. Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU). J Tissue Viability 2017; 26:260-270. [PMID: 28911962 DOI: 10.1016/j.jtv.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/29/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
AIM OF THE STUDY The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers. MATERIAL AND METHODS An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016. RESULTS From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054). CONCLUSIONS The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers.
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Affiliation(s)
- Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071, Málaga, Spain.
| | - Marta Aranda-Gallardo
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | | | - José Carlos Canca-Sánchez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
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Gunningberg L, Bååth C, Sving E. Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. J Nurs Manag 2017; 26:140-147. [DOI: 10.1111/jonm.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology; Department of Health Sciences; Karlstad University; County Council of Värmland; Värmland Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Region Gävleborg; Gävle Sweden
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Gunningberg L, Sedin IM, Andersson S, Pingel R. Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. Int J Nurs Stud 2017; 72:53-59. [DOI: 10.1016/j.ijnurstu.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/05/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Ayello EA, Zulkowski K, Capezuti E, Jicman WH, Sibbald RG. Educating Nurses in the United States about Pressure Injuries. Adv Skin Wound Care 2017; 30:83-94. [PMID: 28106637 DOI: 10.1097/01.asw.0000511507.43366.a1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
GENERAL PURPOSE To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. ABSTRACT Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.
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Affiliation(s)
- Elizabeth A Ayello
- Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN • Faculty • Excelsior College School of Nursing • Albany, New York • Senior Advisor • Hartford Institute for Geriatric Nursing • New York, New York • Course Director • IIWCC-New York University • New York, New York • President • Ayello, Harris and Associates, Inc, • Copake, New York • Clinical Editor, Advances in Skin & Wound Care • Philadelphia, Pennsylvania Karen Zulkowski, DNS, RN • Executive Editor • WCET Journal • Associate Professor (ret) • Montana State University • Bozeman, Montana Elizabeth Capezuti, PhD, RN, FAAN • Hearst Chair • Gerontology • Hunter-Bellevue School of Nursing • Hunter College of the City University of New York • New York Wendy Harris Jicman, BSN, BSHS, RN • Staff Nurse • Temple University Medical Center • Philadelphia, Pennsylvania R. Gary Sibbald, MD, FRCPC (Med, Derm), MACP, FAAD, Med, MAPWCA • Faculty • School of Public Health Sciences and Faculty of Medicine • University of Toronto • Ontario, Canada • Director • International Interprofessional Wound Care Course and Masters of Science in Community Health • Dalla Lana School of Public Health • University of Toronto • Toronto, Ontario, Canada • Clinical Editor, Advances in Skin & Wound Care • Philadelphia, Pennsylvania
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Manderlier B, Van Damme N, Vanderwee K, Verhaeghe S, Van Hecke A, Beeckman D. Development and psychometric validation of PUKAT 2·0, a knowledge assessment tool for pressure ulcer prevention. Int Wound J 2017; 14:1041-1051. [PMID: 28547752 DOI: 10.1111/iwj.12758] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to develop a tool to measure the knowledge of nurses on pressure ulcer prevention. PUKAT 2·0 is a revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) developed in 2010 at Ghent University, Belgium. The updated version was developed using state-of-the-art techniques to establish evidence concerning validity and reliability. Face and content validity were determined through a Delphi procedure including both experts from the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) (n = 15). A subsequent psychometric evaluation of 342 nurses and nursing students evaluated the item difficulty, discriminating power and quality of the response alternatives. Furthermore, construct validity was established through a test-retest procedure and the known-groups technique. The content validity was good and the difficulty level moderate. The discernment was found to be excellent: all groups with a (theoretically expected) higher level of expertise had a significantly higher score than the groups with a (theoretically expected) lower level of expertise. The stability of the tool is sufficient (Intraclass Correlation Coefficient = 0·69). The PUKAT 2·0 demonstrated good psychometric properties and can be used and disseminated internationally to assess knowledge about pressure ulcer prevention.
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Affiliation(s)
- Bénédicte Manderlier
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Nele Van Damme
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Katrien Vanderwee
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,O.L.V. van Lourdes Ziekenhuis Waregem, Waregem, Belgium
| | - Sofie Verhaeghe
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Galvão NS, Serique MAB, Santos VLCDG, Nogueira PC. Knowledge of the nursing team on pressure ulcer prevention. Rev Bras Enferm 2017; 70:294-300. [DOI: 10.1590/0034-7167-2016-0063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: describe and analyze the nursing team's knowledge about classification, evaluation and measures to prevent pressure ulcers (PU) in patients hospitalized in the ICU of a teaching hospital in the city of Manaus. Method: a descriptive and exploratory study was conducted after approval by a research ethics committee. Data were collected using a validated instrument. The study sample was made up of 40 nursing staff members, of whom 14 were nurses and 26 were nursing technicians/aides. Data were analyzed through descriptive statistics and Student's t-test, with value of p<0.05. Results: the overall mean of hits was 63.4% for technicians/aides and 51.4% for nurses, with statistically significant differences between the groups only for the PU prevention category (p<0.001). Conclusion: a deficit of knowledge on PU prevention was found among nurses and nursing technicians/aides, demanding the training of these professionals.
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Sving E, Fredriksson L, Gunningberg L, Mamhidir AG. Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting. J Clin Nurs 2017; 26:3200-3211. [DOI: 10.1111/jocn.13668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Eva Sving
- Department of Patient Safety; Region Gävleborg Sweden
- Centre for Research & Development; Uppsala University/Region Gävleborg; Uppsala Sweden
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
| | - Lennart Fredriksson
- Centre for Research & Development; Uppsala University/Region Gävleborg; Uppsala Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
- Faculty of Health and Occupational Studies; University of Gävle; Gävle Sweden
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Muntlin Athlin Å, Engström M, Gunningberg L, Bååth C. Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study. Scand J Trauma Resusc Emerg Med 2016; 24:134. [PMID: 27842564 PMCID: PMC5109774 DOI: 10.1186/s13049-016-0326-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain. Trial registration ISRCTN85296908. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0326-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Entrance 40, 751 85, Uppsala, Sweden. .,Department of Medical Sciences, Uppsala University, Uppsala, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. .,School of Nursing, University of Adelaide, Adelaide, Australia.
| | - Maria Engström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.,Nursing Department, School of Medicine and Health, Lishui University, Lishui, China
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Quality Department, Uppsala University Hospital, Uppsala, Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Karlstad, Sweden
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Tulek Z, Polat C, Ozkan I, Theofanidis D, Togrol RE. Validity and reliability of the Turkish version of the pressure ulcer prevention knowledge assessment instrument. J Tissue Viability 2016; 25:201-208. [DOI: 10.1016/j.jtv.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 11/27/2022]
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Swafford K, Culpepper R, Dunn C. Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit. Am J Crit Care 2016; 25:152-5. [PMID: 26932917 DOI: 10.4037/ajcc2016963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hospital-acquired pressure ulcers (HAPUs) are a costly and largely preventable complication occurring in a variety of acute care settings. Because they are considered preventable, stage III and IV HAPUs are not reimbursed by Medicare. OBJECTIVES To assess the effectiveness of a formal, year-long HAPU prevention program in an adult intensive care unit, with a goal of achieving at least a 50% reduction in 2013, compared with 2011. METHODS Planning for the prevention program began in 2012, and the program was rolled out in the first quarter of 2013. Program components included use of Braden scores, a revised skin care protocol, fluidized repositioners, and silicone gel adhesive dressings. Efforts were made to educate and motivate staff and encourage them to be more proactive in detecting patients at risk of HAPUs. RESULTS Incidence of HAPUs in the unit was reduced by 69% (n = 17; 3% of patients in 2013 vs n = 45, 10% of patients in 2011), despite a 22% increase in patient load. The potential cost saving as a result of this decrease was approximately $1 million. CONCLUSIONS A comprehensive, proactive, collaborative ulcer prevention program based on staff education and a focus on adherence to protocols for patient care can be an effective way to reduce the incidence of HAPUs in intensive care units.
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Affiliation(s)
- Katie Swafford
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
| | - Rachel Culpepper
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
| | - Christina Dunn
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
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Balzer K, Kottner J. Evidence-based practices in pressure ulcer prevention: Lost in implementation? Int J Nurs Stud 2015; 52:1655-8. [DOI: 10.1016/j.ijnurstu.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 11/17/2022]
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