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Dimanopoulos TA, Chaboyer W, Plummer K, Mickan S, Ullman AJ, Campbell J, Griffin BR. Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis. J Adv Nurs 2023. [PMID: 38037540 DOI: 10.1111/jan.16002] [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: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI. DESIGN A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023. METHODS Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach. RESULTS Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence. CONCLUSION These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings. IMPACT Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.
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Affiliation(s)
- Tanesha A Dimanopoulos
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Karin Plummer
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Bronwyn R Griffin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Metallinou D, Nanou C, Tsafonia P, Karampas G, Lykeridou K. Investigation of Healthcare Professionals' Knowledge of Evidence-Based Clinical Practices for Preterm Neonatal Skin Care-A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1235. [PMID: 36010125 PMCID: PMC9406586 DOI: 10.3390/children9081235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Neonatal skin care practices are considered crucial for a neonate's survival and are closely related to healthcare professionals' (HPs) knowledge and skills in delivering scientifically valid neonatal care interventions. In this descriptive cross-sectional pilot study, conducted in 2022, we aimed to assess HPs' basic theoretical knowledge of neonatal vernix caseosa, skin microbiota, and bathing as well as knowledge regarding evidence-based clinical practices (referred to as "clinical knowledge") for preterm neonatal skin care. Eligible participants were neonatologists, pediatricians, obstetricians, midwives and nurses working in the Greek setting. The research instrument was an online questionnaire designed by the research team. Finally, 123 HPs took part in the study. The theoretical, clinical and total knowledge scores were all significantly associated with age, healthcare profession and the sources used for education. Participants' theoretical and clinical knowledge scores were compared and found not to differ significantly (p = 0.566). A significant and positive correlation was found between theoretical and clinical knowledge scores. Thus, it is concluded that HPs should be updated with the latest evidence-based knowledge and clinical guidelines in order to provide neonatal skin care with high-quality standards.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Panagiota Tsafonia
- Obstetrics and Gynaecology Clinic, General Hospital of Agrinio, 30133 Agrinio, Greece
| | - Grigorios Karampas
- Second Department of Obstetrics and Gynaecology, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Katerina Lykeridou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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Evaluation of the consistency of neonatal skin injury assessment using clinical images and the metric and graduated colour tool. J Tissue Viability 2022; 31:395-403. [DOI: 10.1016/j.jtv.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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August DL, Kandasamy Y, Ray R, Lindsay D, New K. Fresh Perspectives on Hospital-Acquired Neonatal Skin Injury Period Prevalence From a Multicenter Study: Length of Stay, Acuity, and Incomplete Course of Antenatal Steroids. J Perinat Neonatal Nurs 2021; 35:275-283. [PMID: 32826705 DOI: 10.1097/jpn.0000000000000513] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to explore neonatal skin injury period prevalence, classification, and risk factors. Skin injury period prevalence over 9 months and χ2, Mann-Whitney U, and independent-samples t tests compared injured and noninjured neonates, with P values less than .05 considered statistically significant. Injury prediction models were developed using Classification and Regression Tree (CART) analysis for the entire cohort and separately for those classified as high or low acuity. The study took place in 3 Australian and New Zealand units. Neonates enrolled (N = 501) had a mean birth gestational age of 33.48 ± 4.61 weeks and weight of 2138.81 ± 998.92 g. Of the 501 enrolled neonates, 206 sustained skin injuries (41.1%), resulting in 391 injuries to the feet (16.4%; n = 64), cheek (12.5%; n = 49), and nose (11.3%; n = 44). Medical devices were directly associated with 61.4% (n = 240) of injuries; of these medical devices, 50.0% (n = 120) were unable to be repositioned and remained in a fixed position for treatment duration. The strongest predictor of skin injury was birth gestation of 30 weeks or less, followed by length of stay of more than 12 days, and birth weight of less than 1255 g. Prediction for injury based on illness acuity identified neonates less than 30 weeks' gestation and length of stay more than 39 days were at a greater risk (high acuity), as well as neonates less than 33 weeks' gestation and length of stay of more than 9 days (low acuity). More than 40% of hospitalized neonates acquired skin injury, of which the majority skin injuries were associated with medical devices required to sustain life. Increased neonatal clinician education and improved skin injury frameworks, informed by neonatal epidemiological data, are vital for the development of effective prevention strategies.
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Affiliation(s)
- Deanne L August
- College of Medicine and Dentistry (Ms August and Drs Kandasamy and Ray) and College of Public Health, Medical and Vet Sciences (Dr Lindsay), James Cook University, Townsville, Queensland, Australia; The Townsville Hospital and Health Service, Neonatology, Townsville, Queensland, Australia (Dr Kandasamy); and School of Nursing, Midwifery; and Social Work, University of Queensland, Brisbane, Queensland, Australia (Dr New)
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Behr JH, Wardell D, Rozmus CL, Casarez RL. Prevention Strategies for Neonatal Skin Injury in the NICU. Neonatal Netw 2020; 39:321-329. [PMID: 33318228 DOI: 10.1891/0730-0832/11-t-623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this article was to determine specific skin injury prevention interventions for neonates in the NICU. DESIGN The design was a systematic review. SAMPLE PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, and Scopus were systematically searched to identify quantitative studies identifying skin injury preventions for neonates in the NICU. OUTCOMES The outcomes included skin integrity or skin condition. RESULTS Nineteen studies were included in the review. Twelve studies included a randomized design. Barriers were the main interventions for the prevention of pressure injury, medical adhesive skin injury, diaper dermatitis, and general skin condition. The types of barriers included hydrocolloids, polyurethane-based dressings, film-forming skin protectant, or emollients. Nonbarrier interventions included rotation between a mask and nasal continuous positive airway pressure (NCPAP) interfaces, utilization of prescribed guidelines to decrease pressure injuries, and use of a lower concentration of chlorhexidine gluconate as a disinfectant.
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August DL, Ray RA, Kandasamy Y, New K. Neonatal skin assessments and injuries: Nomenclature, workplace culture and clinical opinions-Method triangulation a qualitative study. J Clin Nurs 2020; 29:3986-4006. [PMID: 32702143 DOI: 10.1111/jocn.15422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVE To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. BACKGROUND Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. DESIGN Qualitative enquiry including applied discourse analysis and between-method triangulation, within a larger exploratory mixed-methods study. METHODS Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. RESULTS A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness." Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. CONCLUSIONS The variety of unique terms, locations and risks for injury indicate the need for updated neonatal skin injury frameworks. If frameworks and policies continue to be created without the empirical knowledge of neonatal clinicians, misrepresentation of neonatal skin injury locations and risk will continue to dominate the literature. RELEVANCE TO CLINICAL PRACTICE The recognition and management of neonatal skin injuries are related to language used to describe assessments in the absence of diagnostic confirmation, which has implications for both the neonate and the healthcare team.
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Affiliation(s)
- Deanne L August
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Robin A Ray
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Yoga Kandasamy
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia.,The Townsville Hospital and Health Service, Neonatology Townsville Hospital Townsville, Townsville, Qld, Australia
| | - Karen New
- School of Nursing, Midwifery and Social Work Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Qld, Australia
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Ahn YM, Lee SM, Cho JA. Development of a Nursing Guideline for Improving Skin Integrity in High-Risk Infants. J Contin Educ Nurs 2020; 51:238-244. [PMID: 32347961 DOI: 10.3928/00220124-20200415-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND High-risk infants are highly susceptible to skin impairment caused by invasive procedures, radiant warmers, and phototherapy, in addition to their intrinsic vulnerability. This leads to a vicious cycle that aggravates the risk of skin infections. Concerns have been raised that neonatal nurses may lack knowledge regarding feasible guidelines to improve skin integrity of high-risk newborns. METHOD A clinical guideline was developed for neonatal skin care practices based on skin physiology, and its educational effects on the knowledge and confidence of neonatal nurses was evaluated. A booklet was developed on skin care practice guidelines divided into topics determined through a nationwide survey. RESULTS Using a quasi-experimental design with 46 neonatal nurses, education with this booklet improved nurses' knowledge of skin care practices but not their confidence. CONCLUSION These findings highlight the importance of implementing a tailored systematic program rather than a single educational session on skin care in high-risk infants for neonatal nurses. [J Contin Educ Nurs. 2020;51(5):238-244.].
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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Ahn YM, Sohn M, Lee S. Hydration and pH of the Stratum Corneum in High-risk Newborns in the First 2 Weeks of Life. CHILD HEALTH NURSING RESEARCH 2018. [DOI: 10.4094/chnr.2018.24.3.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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