Cross-cultural adaptation and validation of the neonatal/infant Braden Q risk assessment scale

A scoping review and narrative synthesis of neonatal skin injury severity scales

BACKGROUND

Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment.

AIMS

The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates.

METHODS

This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment.

RESULTS

A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates.

CONCLUSION

Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.

Predictive validity and reliability of two pressure injury risk assessment scales at a neonatal intensive care unit

To compare the predictive ability and reliability of two pressure injury (PI) assessment tools, the Neonatal/Infant(N/I) Braden Q and Braden QD scale, in neonates. A prospective and cross-sectional study. This study was conducted in the neonatal intensive care unit (NICU) of a tertiary-level university hospital in China between April and June 2023. A total of 410 patients were included in this study. Risk assessment was performed with the N/I Braden Q scale, followed immediately with the Braden QD scale once daily. Risk assessment was terminated when the PI developed or the patient was discharged from the NICU or died. Each patient's final risk assessment was considered in the data analysis. The area under the curve (AUC) of the two scales was 0.879 and 0.857, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient of the N/I Braden Q Scale scores were 0.844, 0.833, 0.30, 0.984 and 0.806, respectively. The Braden QD scale scores were 0.938, 0.733, 0.229, 0.993 and 0.727, respectively. Both scales are valid and reliable in predicting the risk of PI in the NICU. The N/I Braden Q Scale was better to distinguish patients at PI risk and not at PI risk than the Braden QD scale. The literature is limited on this topic. This study provides insight into the comparison of different pressure injury risk assessment scales. The findings of this study may guide nurses to choose a suitable tool to assess the risk of pressure injury in neonates.

ADAPTAÇÃO TRANSCULTURAL E VALIDAÇÃO DO INSTRUMENTO BRADEN QD SCALE PARA USO EM NEONATOS NO BRASIL

RESUMO Objetivo: adaptar transculturalmente e validar o instrumento Braden QD Scale para uso em neonatos no Brasil. Método: estudo metodológico de adaptação transcultural e estudo transversal observacional de validação, realizado entre dezembro de 2017 a agosto de 2021. Participaram 10 especialistas, 38 enfermeiros e 105 recém-nascidos. O processo de adaptação transcultural envolveu a tradução inicial, síntese, retrotradução, comitê de especialistas, pré-teste e aprovação da versão adaptada pela autora do instrumento original. A validação verificou as propriedades psicométricas de validade, confiabilidade e consistência interna, a partir da aplicação do instrumento adaptado por dois avaliadores, de forma simultânea e independente, e avaliação temporal a partir de vídeo de cinco neonatos em dois momentos distintos. Os testes estatísticos foram o Índice de Validade de Conteúdo, alfa de Cronbach e coeficiente Kappa. Resultados: o processo de tradução da Braden QD scale resultou na versão em português adaptada para a cultura brasileira. O índice de validade de conteúdo do comitê de especialistas foi ≥0.90 e do pré-teste foi ≥0.80. Na confiabilidade interobservador todos os itens obtiveram coeficiente Kappa >0,90. O alfa de Cronbach do avaliador 1 foi de 0,773 e do Avaliador 2 foi de 0,769, sendo confiável o alfa de Cronbach >0,6. Na concordância intraobservador a média dos escores, na prática, não foram diferentes. Conclusão: o instrumento foi adaptado transculturalmente para uso em neonatos e crianças no Brasil. A versão brasileira apresentou níveis estatísticos de validade e confiabilidade, mostrando-se válida para uso em neonatos no Brasil.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE BRADEN QD SCALE FOR USE WITH NEONATES IN BRAZIL

ABSTRACT Objective: to cross-culturally adapt and validate the Braden QD Scale for use with neonates in Brazil. Method: a methodological study of cross-cultural adaptation and observational cross-sectional validation study, carried out between December 2017 and August 2021. The participants were 10 specialists, 38 nurses and 105 newborns. The cross-cultural adaptation process involved the initial translation, synthesis, back-translation, expert committee, pre-test and approval of the adapted version of the original instrument by the author. Validation verified the validity, reliability and internal consistency psychometric properties, from simultaneous and independent application of the adapted instrument by two evaluators, and based on time evaluation from the video of five neonates at two different moments. The statistical tests performed were Content Validity Index, Cronbach's alpha and Kappa coefficient. Results: the Braden QD scale translation process resulted in the Portuguese version adapted for the Brazilian culture. The expert committee's Content Validity Index was ≥0.90 and that of the pre-test was ≥0.80. In interobserver reliability, all items obtained Kappa coefficients > 0.90. Cronbach's alpha was 0.773 and 0.769 for Evaluators 1 and 2, respectively, with Cronbach's alpha > 0.6 considered as reliable. In intraobserver agreement, the mean scores were not different in the practice. Conclusion: the instrument was cross-culturally adapted for use with neonates and children in Brazil. The Brazilian version presented statistical validity and reliability levels, proving to be valid for use in neonates in Brazil.

Ocorrência de lesão por pressão em pacientes internados em um hospital-escola

Objetivo: Avaliar a ocorrência e fatores de risco para o desenvolvimento de lesão por pressão (LP) em pacientes internados nas clínicas médica, cirúrgica e de observação do pronto-socorro de um hospital universitário. Métodos: Estudo transversal, descritivo- exploratório, de caráter epidemiológico. Os pacientes foram avaliados por meio de exame físico, três vezes por semana, durante dois meses consecutivos, entre junho e novembro de 2016. Resultados: A frequência de LP foi de 29% (n = 9) na clínica médica, 16% (n = 4) na clínica cirúrgica e 53,8% (n = 7) na observação do pronto-socorro. Segundo a escala de Braden, sete (30,4%) pacientes da clínica médica apresentaram risco elevado e dois (25%) risco moderado; três (27,3%) pacientes da clínica cirúrgica apresentaram risco elevado e um (7,1%) risco moderado; e sete (58,3%) pacientes na observação do pronto-socorro apresentaram risco elevado. Os fatores de risco associados aos participantes que desenvolveram LP foram: restrição no leito, o uso de cateteres ou dispositivos, droga vasoativa, fralda, ventilação mecânica, sedativos, inconsciência, jejum alimentar e tempo de internação acima de 10 dias. Conclusão: Houve alta frequência de LP nas clínicas médica e cirúrgica e na observação do pronto-socorro. A maioria dos pacientes apresentou risco elevado para desenvolver LP.

Occurrence of pressure injury in patients hospitalized in a school hospital

Objective: to evaluate the occurrence and risk factors for the development of pressure injury (PI) in patients admitted in medical and surgical clinics and in observation at the emergency room of a university hospital. Methods: Cross-sectional, descriptive-exploratory, epidemiological study. Patients were assessed by physical examination three times a week for two consecutive months between June and November 2016. Results: the frequency of PI was 29% (n = 9) in the medical clinic, 16% (n = 4) in the surgical clinic and 53.8% (n = 7) in observation at the emergency room. According to the Braden scale, seven (30.4%) patients in the medical clinic presented high risk and two (25%) moderate risk; three (27.3%) patients from the surgical clinic presented a high risk and one (7.1%) moderate risk; and seven (58.3%) patients in observation at the emergency room were high risk. The risk factors associated with the participants who developed PI were: restriction in the bed, use of catheters or devices, vasoactive drug, diaper, mechanical ventilation, sedatives, unconsciousness, food fasting and hospitalization time over 10 days. Conclusion: there was a high frequency of PI in the medical and surgical clinics and in observation at the emergency room. Most patients were high risk for developing PI.

Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis

Aims

Paediatric pressure ulcers are a serious problem to healthcare service. Thus, effective and early identification of the risk of developing pressure ulcer is essential. The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer, but its predictive power is controversial. Hence, we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.

Methods

Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese, including Medline, Cochrane Library, Embase, CINAHL, SinoMed, CNKI, Wangfang and VIP. The studies were screened by two independent reviewers. QUADAS-2 was used to assess the risk of bias of eligible studies. Demographic data and predictive value indices were extracted. The pooled sensitivity, specificity and receiver operating characteristics (ROC) were calculated by MetaDiSc 1.4 using random-effects models.

Results

Cochran Q = 26.13 (P = 0.0036) indicated the existence of heterogeneity; the I² for pooled DOR was 61.7%, suggesting significant heterogeneity among the included studies. The pooled sensitivity and specificity were 0.73 (95% CI: 0.67–0.78) and 0.61 (95% CI: 0. 59–0.63), respectively, yielding a combined DOR of 3.47 (95% CI: 2–6.01). The area under the ROC curve was 0.7078 ± 0.0421, and the overall diagnostic accuracy (Q*) was 0.6591 ± 0.0337. Sensitivity analysis showed the results were robust.

Conclusion

The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children. Further development and modification of this tool for use in paediatric population are warranted.

Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale

AIM

To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability.

BACKGROUND

Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants.

METHOD

The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed. For the second stage, the inter-rater/intra-rater agreement and construct validity were evaluated using a cross-sectional design. Finally, in the third stage, a cohort study to analyse pressure ulcers' incidence, diagnostic tests and the cut-off points of the scale was performed.

RESULTS

In the first phase, the content validity index was 0.93. In the second phase (336 neonates), the intra-rater reliability was 0.93 and the inter-rater reliability was 0.97. The construct validity has shown a two-dimensional model that fits better, representing "pressure duration and intensity" and "skin immaturity." In the third phase (268 neonates) the best values were those presented by the score 17: receiver operating characteristic curve was 0.84, showing a sensitivity of 91.18%, specificity of 76.50%, positive predictive value of 36.05% and negative predictive value of 98.35%.

CONCLUSION

The scale has shown evidence of validity and reliability to measure the neonatal risk of pressure ulcers in the Spanish context.

IMPLICATIONS FOR NURSING MANAGEMENT

Pressure ulcers are an adverse event recognised in paediatric units and specifically in neonatal units. The intent of the Spanish Neonatal Skin Risk Assessment Scale is to identify hospitalised neonates requiring prevention measures and their specific risk factors, to provide useful diagnostic information to improve the neonatal skin care into Spanish speaking countries. The Neonatal Skin Risk Assessment Scale could ensure the efficient and effective allocation of limited preventive resources, support clinical and management decisions, allow risk-adjusted cases in epidemiological studies, facilitate the development of risk assessment protocols and serve as evidence in litigation cases. All these features could facilitate developing best practice in nursing management and improve the quality and safety of neonatal care.

Developing a Mobile App for Prevention and Treatment of Pressure Injuries

OBJECTIVE

This descriptive study describes the planning and development of a mobile application (app) for prevention and treatment of pressure injuries for use by providers in a university research center. The app delineates risk factors for pressure injury development, provides an evaluation of the wound, recommends wound cleansing procedures, performs pressure injury staging, and recommends treatment interventions.

METHODS

A mobile app was developed using a contextualized instructional design, which involves a constructivist proposal and planning, developing, and applying specific didactic situations, thus incorporating mechanisms that favor contextualization. A literature search was conducted to identify relevant studies for the construction of the mobile app. The development process involved the selection of app tools, definition of the navigation structure, and planning of the environment configuration. The environment for downloading the app software on the Internet and installing it on the mobile device was created.

MAIN RESULTS

The literature search yielded 18 articles, 2 books, and 1 master's degree thesis. A mobile app was created with an easy-to-use graphic interface. The app stores the patient's demographic characteristics and provides an evaluation of his/her wound, a list of risk factors for pressure injury development, wound cleansing procedures, and treatment interventions.

CONCLUSIONS

The developed app may be useful in clinical practice, helping to prevent pressure injuries and promote select nursing interventions for the treatment of patients with pressure injury.

Short Mood and Feelings Questionnaire for screening children and adolescents for plastic surgery: cross-cultural validation study

CONTEXT AND OBJECTIVE

Patient-reported outcome measurements assessing the emotional state of children and adolescents who seek plastic surgery are important for determining whether the intervention is indicated or not. The aim of this study was to cross-culturally adapt and validate the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) for Brazilian Portuguese, test its psychometric properties and assess the emotional state of children and adolescents who seek plastic surgery. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic at a public university hospital.

METHODS

A total of 124 consecutive patients of both sexes were selected between September 2013 and February 2014. Forty-seven patients participated in the cultural adaptation of the questionnaire. The final version was tested for reliability on 20 patients. Construct validity was tested on 57 patients by correlating the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) with the Strengths and Difficulties Questionnaire and the Rosenberg Self-Esteem scale.

RESULTS

The child/adolescent and parent versions of the Short Mood and Feelings Questionnaire showed Cronbach's alpha of 0.768 and 0.874, respectively, and had good inter-rater reliability (intraclass correlation coefficient, ICC = 0.757 and ICC = 0.853, respectively) and intra-rater reliability (ICC = 0.738 and ICC = 0.796, respectively).

CONCLUSIONS

The Brazilian-Portuguese version of the Short Mood and Feelings Questionnaire is a reproducible instrument with face, content and construct validity.The mood state and feelings among children and adolescents seeking cosmetic surgery were healthy.