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McNichol L, Watts C, Mackey D, Beitz JM, Gray M. Identifying the right surface for the right patient at the right time: generation and content validation of an algorithm for support surface selection. J Wound Ostomy Continence Nurs 2015; 42:19-37. [PMID: 25549306 PMCID: PMC4845766 DOI: 10.1097/won.0000000000000103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Support surfaces are an integral component of pressure ulcer prevention and treatment, but there is insufficient evidence to guide clinical decision making in this area. In an effort to provide clinical guidance for selecting support surfaces based on individual patient needs, the Wound, Ostomy and Continence Nurses Society (WOCN®) set out to develop an evidence- and consensus-based algorithm. A Task Force of clinical experts was identified who: 1) reviewed the literature and identified evidence for support surface use in the prevention and treatment of pressure ulcers; 2) developed supporting statements for essential components for the algorithm, 3) developed a draft algorithm for support surface selection; and 4) determined its face validity. A consensus panel of 20 key opinion leaders was then convened that: 1.) reviewed the draft algorithm and supporting statements, 2.) reached consensus on statements lacking robust supporting evidence, 3.) modified the draft algorithm and evaluated its content validity. The Content Validity Index (CVI) for the algorithm was strong (0.95 out of 1.0) with an overall mean score of 3.72 (out of 1 to 4), suggesting that the steps were appropriate to the purpose of the algorithm. To our knowledge, this is the first evidence and consensus based algorithm for support surface selection that has undergone content validation.
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Affiliation(s)
- Laurie McNichol
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, Clinical Nurse Specialist and WOC Nurse, Cone Health, Wesley Long Hospital, Greensboro, North Carolina
- Carolyn Watts, MSN, RN, CWON, CBPN-IC, Senior Associate in Surgery, Clinical Nurse Specialist, WOC Nurse, Vanderbilt University Medical Center, Nashville, Tennessee
- Dianne Mackey, MSN, RN, CWOCN, Staff Educator, Chair, National Wound Management Sourcing and Standards Team, Home Health/Hospice/Palliative Care, Kaiser Permanente, San Diego, California
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, APN-C, FAAN, Professor of Nursing, School of Nursing – Camden, Rutgers University, Camden, New Jersey
- Mikel Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology and School of Nursing, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Carolyn Watts
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, Clinical Nurse Specialist and WOC Nurse, Cone Health, Wesley Long Hospital, Greensboro, North Carolina
- Carolyn Watts, MSN, RN, CWON, CBPN-IC, Senior Associate in Surgery, Clinical Nurse Specialist, WOC Nurse, Vanderbilt University Medical Center, Nashville, Tennessee
- Dianne Mackey, MSN, RN, CWOCN, Staff Educator, Chair, National Wound Management Sourcing and Standards Team, Home Health/Hospice/Palliative Care, Kaiser Permanente, San Diego, California
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, APN-C, FAAN, Professor of Nursing, School of Nursing – Camden, Rutgers University, Camden, New Jersey
- Mikel Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology and School of Nursing, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Dianne Mackey
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, Clinical Nurse Specialist and WOC Nurse, Cone Health, Wesley Long Hospital, Greensboro, North Carolina
- Carolyn Watts, MSN, RN, CWON, CBPN-IC, Senior Associate in Surgery, Clinical Nurse Specialist, WOC Nurse, Vanderbilt University Medical Center, Nashville, Tennessee
- Dianne Mackey, MSN, RN, CWOCN, Staff Educator, Chair, National Wound Management Sourcing and Standards Team, Home Health/Hospice/Palliative Care, Kaiser Permanente, San Diego, California
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, APN-C, FAAN, Professor of Nursing, School of Nursing – Camden, Rutgers University, Camden, New Jersey
- Mikel Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology and School of Nursing, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Janice M. Beitz
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, Clinical Nurse Specialist and WOC Nurse, Cone Health, Wesley Long Hospital, Greensboro, North Carolina
- Carolyn Watts, MSN, RN, CWON, CBPN-IC, Senior Associate in Surgery, Clinical Nurse Specialist, WOC Nurse, Vanderbilt University Medical Center, Nashville, Tennessee
- Dianne Mackey, MSN, RN, CWOCN, Staff Educator, Chair, National Wound Management Sourcing and Standards Team, Home Health/Hospice/Palliative Care, Kaiser Permanente, San Diego, California
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, APN-C, FAAN, Professor of Nursing, School of Nursing – Camden, Rutgers University, Camden, New Jersey
- Mikel Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology and School of Nursing, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Mikel Gray
- Correspondence: Mikel Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, PO Box 800422, Charlottesville, VA 22908 ()
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Stinson M, Gillan C, Porter-Armstrong A. A Literature Review of Pressure Ulcer Prevention: Weight Shift Activity, Cost of Pressure Care and Role of the Occupational Therapist. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13651610908371] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Pressure ulcers are a major concern for those who spend a prolonged period of time sitting. Weight shifts are one prevention strategy used to reduce the risk of tissue damage. Currently, the prevalence of pressure ulcers is high, suggesting that concordance with preventative methods is poor. Occupational therapy focuses on the use of functional activity to promote health and wellbeing. The aim of this literature review was to evaluate the role of functional activity in reducing seated interface pressure. Method: A comprehensive search of nine electronic databases (AMED, CINAHL, Ovid MEDLINE, SportDiscus, EMBASE, British Nursing Index, Cochrane Library, Google Scholar and OTDBASE) was conducted between January 2000 and October 2011. Findings: From the 24 articles included in the review, there is limited evidence evaluating the role of functional activity and weight shifts in reducing seated interface pressure. Limited evidence suggests poor concordance with weight shifts, with wheelchair users repositioning on average once every 1–2 hours. The cost of pressure ulcer care is considerable, with an average annual cost of £1.7 billion in the United Kingdom. Occupational therapists have a key preventative role. Conclusion: Further research is needed to explore the role of functional activity and to determine the effectiveness of weight shift activity in reducing seated interface pressure.
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Affiliation(s)
- May Stinson
- Lecturer in Occupational Therapy, School of Health Sciences, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland
| | - Catherine Gillan
- Formerly Research Assistant, School of Health Sciences, University of Ulster, Newtownabbey, Co. Antrim, and currently Occupational Therapist, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Alison Porter-Armstrong
- Senior Lecturer in Rehabilitation Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland
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