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Sardo PMG, Moreira IF, Mouta LFDP, Santos MS, Ramos RC. Pressure ulcers/injuries prevention in emergency services: A scoping review. J Tissue Viability 2024:S0965-206X(24)00116-5. [PMID: 39068087 DOI: 10.1016/j.jtv.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/26/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
AIM OF THE STUDY To map the available evidence on nursing care provided to prevent the development of pressure ulcers/injuries in emergency services. MATERIAL AND METHODS Scoping review that follows the Preferred Reporting Items for Systematic reviews and the Meta-Analyses extensions for Scoping Reviews and the Joanna Briggs Institute guidelines. The inclusion criteria were based on the PCC mnemonic. The main variables of interest were the nursing care provided to prevent the development of pressure ulcers/injuries (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The scoping review protocol was registered on the OSF platform. RESULTS During the selection process, 175 articles were identified in different databases. Applying the inclusion and exclusion criteria, 20 studies were included in this scoping review. The preventive measures for the development of pressure ulcers/injuries were grouped into 9 categories: "risk factors and risk assessment", "support surfaces", "dressings for pressure ulcer/injury prevention", "skin and tissue assessment", "repositioning and early mobilization", "preventive skin care", "nutrition in pressure ulcer/injury prevention", "health education" and "vital signs management". The instruments for assessing the risk of developing pressure ulcers/injuries mentioned in the studies are the Braden, Waterlow and Norton scales. The most documented tool for assessing the risk of developing pressure ulcers/injuries in hospital emergency services was the Braden Scale. CONCLUSION International literature identified several preventive interventions that could be implemented in emergency services to avoid pressure ulcers/injuries development. However, is crucial that those preventive interventions were systematic implemented (in combination) since hospital admission.
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Affiliation(s)
- Pedro Miguel Garcez Sardo
- School of Health Sciences, University of Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Portugal.
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Wei L, Lv H, Yue C, Yao Y, Gao N, Chai Q, Lu M. A machine learning algorithm-based predictive model for pressure injury risk in emergency patients: A prospective cohort study. Int Emerg Nurs 2024; 74:101419. [PMID: 38432045 DOI: 10.1016/j.ienj.2024.101419] [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: 09/11/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To construct pressure injury risk prediction models for emergency patients based on different machine learning algorithms, to optimize the best model, and to provide a suitable assessment tool for preventing the occurrence of pressure injuries in emergency patients. METHODS A convenience sampling was used to select 312 patients admitted to the emergency department of a tertiary care hospital in Tianjin, China, from May 2022 to March 2023, and the patients were divided into a modeling group (n = 218) and a validation group (n = 94) in a 7:3 ratio. Based on the results of one-factor logistic regression analysis in the modeling group, three machine learning models, namely, logistic regression, decision tree, and neural network, were used to establish a prediction model for pressure injury in emergency patients and compare their prediction effects. The optimal model was selected for external validation of the model. RESULTS The incidence of pressure injuries in emergency patients was 8.97 %, 64.52 % of pressure injuries occurred in the sacrococcygeal region, and 64.52 % were staged as stage 1. Serum albumin level, incontinence, perception, and mobility were independent risk factors for pressure injuries in emergency patients (P < 0.05), and the area under the ROC curve of the three models was 0.944-0.959, sensitivity was 91.8-95.5 %, specificity was 72.2-90.9 %, and the Yoden index was 0.677-0.802; the decision tree was the best model that The area under the ROC curve for the validation group was 0.866 (95 % CI: 0.688-1.000), with a sensitivity of 89.8 %, a specificity of 83.3 %, and a Yoden index of 0.731. CONCLUSIONS The decision tree model has the best predictive efficacy and is suitable for individualized risk prediction of pressure injuries in emergency medicine specialties, which provides a reference for the prevention and early intervention of pressure injuries in emergency patients.
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Affiliation(s)
- Li Wei
- Tianjin Medical University General Hospital Airport Site, Tianjin, China.
| | - Honglei Lv
- Tianjin Medical University General Hospital, Tianjin, China
| | - Chenqi Yue
- Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Yao
- Tianjin Medical University General Hospital, Tianjin, China
| | - Ning Gao
- Tianjin Medical University General Hospital, Tianjin, China
| | - Qianwen Chai
- Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Minghui Lu
- Tianjin Medical University General Hospital Airport Site, Tianjin, China
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [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: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Chary AN, Brickhouse E, Torres B, Santangelo I, Carpenter CR, Liu SW, Godwin KM, Naik AD, Singh H, Kennedy M. Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening. Appl Clin Inform 2023; 14:478-486. [PMID: 37054983 PMCID: PMC10284630 DOI: 10.1055/a-2073-3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening. METHODS We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data for common themes across dimensions of the sociotechnical model. RESULTS Three themes emerged about how the EHR could be used to address challenges in implementation of delirium screening: (1) staff adherence to screening, (2) communication among ED team members about a positive screen, and (3) linking positive screening to delirium management. Participants described several HIT-based strategies including visual nudges, icons, hard stop alerts, order sets, and automated communications that facilitated implementation of delirium screening. An additional theme emerged about challenges related to the availability of HIT resources. CONCLUSION Our findings provide practical HIT-based strategies for health care institutions planning to adopt geriatric screenings. Building delirium screening tools and reminders to perform screening into the EHR may prompt adherence to screening. Automating related workflows, team communication, and management of patients who screen positive for delirium may help save staff members' time. Staff education, engagement, and access to HIT resources may support successful screening implementation.
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Affiliation(s)
- Anita N. Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Elise Brickhouse
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Beatrice Torres
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Christopher R. Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine, Emergency Care Research Core, St. Louis, Missouri, United States
| | - Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Kyler M. Godwin
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
- University of Texas Health Consortium on Aging, Houston, Texas, United States
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
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Redley B, Taylor N, Hutchinson AM. Barriers and enablers to nurses' use of harm prevention strategies for older patients in hospital: A cross-sectional survey. J Adv Nurs 2022; 78:3710-3720. [PMID: 35451523 PMCID: PMC9790359 DOI: 10.1111/jan.15269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse-led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. AIM The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. DESIGN Anonymous, online, cross-sectional survey. METHODS The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight-factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. RESULTS Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9-10/10) (p = .024), and awareness of strategies for the eight-factor framework (p = .019) were significant enablers of comprehensive harm prevention. CONCLUSION Targeted evidence-based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery and Centre for Quality and Patient Safety, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Natalie Taylor
- Implementation Science and Health Systems, School of Population HealthUniversity of New South WalesSydneyNSWAustralia
| | - Alison M. Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
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Zhang J, Qian S, Su G, Deng C, Reid D, Curtis K, Sinclair B, Yu P. Emergency department presentations of patients with alcohol use disorders in an Australian regional health district. Subst Abus 2022; 43:1126-1138. [DOI: 10.1080/08897077.2022.2060427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jingxiang Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Guoxin Su
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Chao Deng
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Kate Curtis
- Illawarra Health and Medical Research Institute, Wollongong, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Barbara Sinclair
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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