Knowledge and attitudes of nurses in a major public hospital in Cyprus towards pressure ulcer prevention

Assessing nurses' attitudes towards pressure ulcer prevention: an updated systematic review

OBJECTIVE

The aim of this systematic review was to critically appraise and synthesise the existing research literature pertaining to nurses' attitudes toward pressure ulcer (PU) prevention.

METHOD

The systematic review presented in our paper serves as an updated version of the definitive review conducted by Avsar et al. in 2019. Using systematic review methodology, we considered published quantitative studies focusing on nurses' attitudes toward PU prevention as measured using psychometric tests. The search was conducted in April 2022, using PubMed, CINAHL, Scopus, Cochrane and EMBASE databases, and returned 454 records, of which 35 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the evidence-based librarianship (EBL) appraisal checklist.

RESULTS

In most studies, distinct measurement instruments were used for measuring nurses' attitudes toward the prevention of PUs: the Moore and Price Attitude Scale and the Attitude towards Pressure Ulcer Prevention Instrument (APuP). In this first update, the mean attitude score was 69% (±14%, range: 33.6-89%). A separate analysis of the new studies alone included in this first update (n=14) indicated a mean attitude score of 62.25% (±17.9%; median: 14%), suggesting a 10.75% lower mean attitude score. In total, 46% (n=16) yielded a score ≥75%. Conversely, Avsar et al. in 2019, 86% (n=18) of studies yielded positive attitude results. Studies from the Middle East show the lowest mean attitude score (mean 55%; ±15%; median 53%; n=9), with studies from Europe displaying the highest mean attitude score (mean 79%; ±6%; median 79%; n=12).

CONCLUSION

The findings suggest that, overall, nurses are relatively positively disposed toward PU prevention. However, there are differences across continents. It is important to highlight also that the nurses have difficulties reflecting this positive attitude into actual preventative strategies.

Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review

OBJECTIVE

To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.

METHODS

A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.

RESULTS

A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences".

CONCLUSION

The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.

Is caring for pressure ulcers in the intensive care unit in Spain still a challenge? A qualitative study on nurses' perceptions

BACKGROUND

The incidence of pressure ulcers is an indicator of quality in intensive care units. Due to their frequency and severity, they are identified as a problem of great importance, where the well-being of patients and relatives is compromised, also generating a high healthcare cost. Nurses are primarily responsible for the care of pressure ulcers, however, the existing literature exposes a clear lack of knowledge regarding its prevention and treatment.

OBJECTIVES

To explore the attitudes, knowledge and perceived barriers by intensive care nurses regarding pressure ulcers treatment and prevention in a critical care setting.

DESIGN

A descriptive qualitative study has been carried out through semi-structured interviews with 22 intensive care nurses from two tertiary university hospitals in Spain. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to reinforce the methodological approach of the study.

FINDINGS

From the collected data, 4 main themes emerged: "lack of specific knowledge about pressure ulcers in intensive care", "continuity of care: the main problem to solve", "teamwork and pressure ulcers: gasping for improvement" and "Skin care as another vital sign".

CONCLUSION

Most intensive care nurses consider that they do not have sufficient knowledge regarding pressure ulcers. The nurses' attitudes are positive, however, an ineffective transmission of information and registration regarding ulcers is perceived. Regarding the treatment of pressure ulcers, the lack of continuity of care and updated knowledge/training have been the main barriers. In terms of prevention, the most mentioned barriers have been the clinical condition of the patient and the lack of personnel, despite the level of knowledge.

A Multicenter Assessment of Nurses' Knowledge Regarding Pressure Ulcer Prevention in Intensive Care Units Utilizing the PUKAT 2.0

Introduction

Pressure ulcer (PU) care is pivotal in the practice of nurses working in intensive care units (ICUs). Therefore, nurses must possess adequate knowledge about the potential risks leading to the development of PUs, as well as managing complications that worsen patient conditions.

Objective

To evaluate the level of knowledge of ICU nurses concerning PU prevention in tertiary hospitals in Saudi Arabia.

Methods

In this cross-sectional study, the researchers recruited 320 ICU nurses from four tertiary hospitals using convenience sampling. Nurses' knowledge regarding PU prevention was assessed using the revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data were collected between May and June 2022. The CROSS checklist was observed for reporting.

Results

The mean scores of nurses' level of knowledge regarding PU prevention according to the themes of the revised and updated version of the PUKAT 2.0 were as follows-etiology: 62.81  ±  23.77; classification and observation: 50.86  ±  23.28; risk assessment: 31.19  ±  24.26; nutritious diet: 46.04  ±  25.96; prevention: 22.36  ±  12.41; and specific patient groups: 14.84  ±  22.88. Furthermore, the score for nurses' overall level of knowledge of PU prevention was 39.55  ±  8.84 out of 100, interpreted as low based on the 60% cutoff; the minimum knowledge score was 0. Notably, knowledge of PU etiology, classification, observation, and specific patient groups differed based on the hospital of affiliation. Interestingly, gender was the only demographic characteristic based on which nurses' knowledge regarding specific patient groups differed.

Conclusion

This study identified insufficient knowledge among ICU nurses regarding PU prevention, which can lead to complications among patients. Simulation scenarios related to PU prevention and management will be an effective way to help nurses gain appropriate knowledge that can be applied in clinical practice.

Psychometric Properties of the Taiwanese Pressure Ulcer Management Self-Efficacy Scale in Nursing Practice

Self-efficacy strongly predicts clinical performance and competence. In Taiwan, there is no reliable method for assessing self-efficacy in the management of pressure injury. This study aims to establish psychometric properties of the Pressure Ulcer Management Self-Efficacy Scale (PUM-SES) translated for Taiwan and determine the validity and reliability of the Taiwanese version of the PUM-SES. Materials and methods: The PUM-SES was translated for use in Taiwan using Brislin’s method. The translation’s content validity, concurrent validity, predictive validity, internal consistency, and test−retest reliability were evaluated. The Pressure Ulcer Management Self-Efficacy Scale, Taiwanese version (PUM-SES-T), the Attitude toward Pressure Injury Prevention Scale (APIPS) and the Practice toward Pressure Injury Prevention Scale (PPIPS) of preventing pressure injury, and the General Self-Efficacy Scale (GSES) were tested using Pearson’s correlation. A cross-sectional survey with 330 RNs in Taiwan was conducted. The PUM-SES-T was used to predict the PPIPS, and a predictive regression model was constructed considering nursing demographic variables. Results: Seven experts evaluated the PUM-SES-T with a CVI value of 0.995. An internal consistency, using Cronbach’s α, of 0.762 and a test−retest reliability of 0.997 were obtained. The PUM-SES-T was positively correlated with the GSES (p < 0.001). Multiple regression revealed that the PUM-SES-T predicted practice with a strong predictive validity (F = 8.077, p < 0.001), had an adjusted R2 of 0.455, but collinearity was insignificant. In this study, PUM-SES-T is a valid instrument for intervention-related educational programs to measure self-efficacy with good reliability and validity. It can be employed when intervening in related education strategies or promoting policies.

Nurses' knowledge on pressure ulcer prevention: An updated systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool

Background

Pressure ulcers (PUs) are an indicator of the quality of nursing care and nurses can prevent PUs well if they have sufficient knowledge. Numerous studies in this field have reported different results. The aim of this study was to estimate the pooled score of nurses' knowledge about PU prevention based on the Pressure Ulcer Knowledge Assessment Tool (PUKAT).

Methods

In this systematic review and meta-analysis, databases including Web of Science, ScienceDirect, PubMed, and Scopus were searched. All studies published in English between 2011 and 2022 that reported the status of nurses' knowledge of PU prevention based on PUKAT were included in the analysis. Based on heterogeneity between the studies, the data were analyzed using a random effects model.

Results

The pooled scores of PU prevention knowledge in nurses and nursing students were (51.5%; 95% CI: 45.8-57.2%) and (48.9%; 95% CI: 42.5-55.2%), respectively. As the age of the participants increased, the pooled score of pressure ulcer prevention knowledge increased significantly (p = 0.028). The publication bias was not significant. The highest and lowest knowledge scores in nurses and nursing students were related to the fourth dimension (nutrition) and the fifth dimension (preventive measures to reduce the amount of pressure/shear), respectively.

Conclusion

Knowledge of nurses and nursing students about PU prevention is insufficient. Providing regular training to nurses and including the principles of PU prevention in the curriculum of nursing students to improve their knowledge seems necessary.

Critical care nurses' knowledge, attitudes, and practices of pressure injury prevention in China: A multicentric cross-sectional survey

Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen-item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low-level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation.

Nursing team knowledge assessment instruments about pressure injury: integrative review

Objectives: to identify in the scientific literature how the assessment of knowledge of the nursing team about pressure injuries is conducted, which instruments are used, and their psychometric properties. Methods: integrative review conducted with 44 scientific articles. The search was conducted between October and December 2021 in the following data sources: BDENF, Cinahl, Lilacs, MEDLINE, Scopus, Google Scholar, and Web of Science, using the strategy in Portuguese: ("lesão por pressão" OR "úlcera por pressão" OR "úlcera de decúbito" OR "escara de decúbito") AND enfermagem AND conhecimento, and, in English, ("pressure ulcer" OR "bed sore" OR "bed sores" OR bedsore OR bedsores) AND nursing AND knowledge. Articles published between 2012 and November 2021 were included, with text available in full, in open access, in English, Portuguese, or Spanish, resulting from original research related to care in the hospital area. Results: The most used knowledge assessment instrument was the P-PUKT and its versions, used in 50% of the studies, followed by the PUKAT and its versions. Three studies also used instruments constructed and validated by the authors, five qualitative studies, and four studies used non-validated instruments. Conclusion: Valid instruments to assess knowledge are essential to identify possible failures in patient care. Heterogeneity in the samples and in the classification criteria of the participants' level of knowledge made it impossible to compare the results obtained in the studies, constituting a limitation.

Knowledge, attitude, and practice of Iranian nurses towards pressure ulcer prevention: A systematic review

INTRODUCTION

Pressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review aimed to evaluate the knowledge, attitude, and practice of Iranian nurses towards PU prevention.

METHODS

A systematic search was conducted on PubMed, Web of Science, Scopus databases, Google Scholar Search Engine, as well as Magiran, Iranmedex, and Scientific Information Database (SID) Persian databases using the relevant keywords, from the earliest date available to August 21, 2020. Studies were appraised using the appraisal tool for cross-sectional studies (AXIS tool).

FINDINGS

Among a total of 1,543 Iranian nurses included in the 9 studies, 80.53% were female with a mean age of 31.14 (SD = 5.52) years. The mean work experience of the participants was 7.94 years (SD = 5.44). The knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. Also, the present study showed that nurses' attitudes toward PU prevention were contradictory. Age, gender, level of education, work experience, and participation in previous educational workshops were possible factors related to nurses' knowledge about PU prevention. Women with higher work experience had a more positive attitude.

CONCLUSION

This review found inappropriate knowledge, attitude, and practice of Iranian nurses toward PU prevention and highlights the importance of regular upgrading of nurses' knowledge and practice related to PU prevention.

Evaluating Nurses' Knowledge of Pressure Injury Prevention: A Descriptive Study

OBJECTIVE

To evaluate nurses' knowledge on pressure injury (PI) prevention.

METHODS

Four hundred six nurses in Turkey participated in this descriptive study between January and February 2020. Participants completed an information form and the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI). The PUPKAI contains 26 items across six themes: (1) development, (2) classification and observation, (3) risk assessment, (4) nutrition, (5) interventions to reduce the amount of pressure/rupture, and (6) interventions to reduce the duration of pressure/rupture.

RESULTS

The mean age of the nurses was 26.93 ± 6.72 years. The mean total PUPKAI score was 11.80 ± 3.28. Almost all participants (91.6%) had insufficient knowledge on PI prevention. Male nurses scored higher on themes 1 and 2 than female nurses (P = .046, P = .029, respectively). Nurses with a postgraduate degree scored higher in total and on themes 2, 3, 5, and 6 (P = .001, P = .006, P = .011, P = .044, P = .029, respectively), and nurses with more than 10 years of service scored higher in total and on themes 4, 5, and 6 (P = .001, P = .002, P = .001, P = .026, respectively).

CONCLUSIONS

The nurses who participated in this study do not have enough knowledge on PI prevention.

Pressure injury prevention practice and associated factors among nurses at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia: a cross-sectional study

OBJECTIVE

The prevention of pressure injury is of great importance in providing quality care to patients, as it has been reported that approximately 95% of all pressure injury are preventable. Nurses working in clinical settings play a key role in identifying patients at risk and administering preventative care. Therefore, this study examines pressure injury prevention practices among nurses.

DESIGN

Cross-sectional study design.

SETTING

Wolaita Sodo University Teaching and Referral Hospital, Ethiopia.

PARTICIPANTS

240 nurses.

MAIN OUTCOME MEASURES

Pressure injury prevention practices among nurses.

RESULT

Among nurses, 37.9% had good pressure injury prevention practices. The factors associated with pressure injury prevention practices included having a bachelor's degree or higher (adjusted odds ratio (AOR)=2.18; 95% CI 1.12 to 4.25), having more than 10 years of nursing experience (AOR=3.44; 95% CI 1.41 to 8.37), lacking subject knowledge (AOR=0.49; 95% CI 0.27 to 0.91) and being over the age of 40 (AOR=0.55; 95% CI 0.09 to 0.35).

CONCLUSION

The majority of nurses reported having a limited level of pressure injury prevention practice. Since pressure ulcer prevention practice is majorly the role of nurses. Upgrading the educational level of the nurses through continuous professional development opportunities can improve the preventive practice of pressure ulcer injury by increasing the knowledge and skill gained during the vocational training.

CONHECIMENTO DA EQUIPE DE ENFERMAGEM SOBRE LESÃO POR PRESSÃO

Objetivo:avaliar o nível de conhecimentos da equipe de enfermagem da clínica médica de um hospital universitário sobre lesão por pressão. Método: estudo descritivo-exploratório, aprovado por Comitê de Ética em Pesquisa. Os dados foram coletados através de questionário validado. Participaram 50 indivíduos, sendo 35 técnicos de enfermagem e 15 enfermeiros. Resultados: os técnicos em enfermagem obtiveram média de 83,5% e os enfermeiros obtiveram média de 89,9%. Realizou-se um modelo de regressão para verificar variáveis que influenciam no nível de conhecimento, sendo identificado que possuir mais de 5 anos na profissão aumenta 1,61 vezes a chance de o profissional apresentar um conhecimento adequado. Conclusão: foi identificada uma fragilidade no conhecimento sobre lesão por pressão. Tendo em vista os custos envolvidos no tratamento e as complicações advindas dessas lesões, as instituições de saúde devem implementar ações educativas sobre esse agravo.

NURSING TEAM KNOWLEDGE ABOUT PRESSURE INJURIES

Objective: to assess the level of knowledge of the nursing staff of the medical clinic of a university hospital about pressure injuries. Method: descriptive-exploratory study, approved by the Research Ethics Committee. Data were collected through a validated questionnaire. Fifty individuals participated, 35 nursing technicians and 15 nurses. Results: nursing technicians had an average of 83.5% and nurses had an average of 89.9%. A regression model was carried out to verify variables that influence the level of knowledge, and it was identified that having more than 5 years in the profession increases 1.61 times the chance that the professional has adequate knowledge. Conclusion: a weakness in knowledge about pressure injuries was identified. In view of the costs involved in the treatment and complications arising from these injuries, health institutions must implement educational actions about this condition.

Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework

A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross-sectional study

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence‐based pressure ulcer prevention practices should be promoted.

Knowledge and Attitude of Community Nurses on Pressure Injury Prevention: A Cross-sectional Study in an Indonesian City

The objectives of this study were to examine the knowledge and attitude of Indonesian community nurses regarding Pressure Injury (PI) prevention. A cross‐sectional design was used and included the community nurses permanently working in the Public Health Center (Puskemas) in Bandung, West Java Indonesia. Knowledge was measured using the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). Attitudes were measured using a predesigned instrument which included 11 statements on a five point Likert scale. All data were collected using paper‐based questionnaires. The response rate was 100%. Respondents (n = 235) consisted of 80 community nursing program coordinators (34.0%) and 155 community nurses (66.0%). Regarding knowledge, the percentage of correct answers in the total group of community nurses on the PUKAT 2.0 was 30.7%. The theme “Prevention” had the lowest percentage of correct answers (20.8%). Community nurses who had additional PI or wound care training had a higher knowledge score compared with community nurses who did not have additional PI training (33.7% vs 30.3%; Z = −1.995; P = 0.046). The median attitude score was 44 (maximum score 55; range 28–55), demonstrating a positive attitude among participants towards PI prevention. Further, the higher the education status of participants, the more positive the attitudes (H = 11.773; P = 0.003). This study shows that community nurses need to improve their basic knowledge of PI prevention. Furthermore, research should be performed to explore what community nurses need to strengthen their role in PI prevention.

Factors determining nurses' knowledge of evidence-based pressure ulcer prevention practices in Finland: a correlational cross-sectional study

BACKGROUND

Pressure ulcers cause economic burden, human suffering, pain and decreased health-related quality of life in patients. Pressure ulcers are preventable in most cases, and nursing staff knowledge is a key factor in successful pressure ulcer prevention. Further evidence is needed to better tailor pressure ulcer prevention training programmes to the nursing staff.

AIM

To evaluate the level of nursing staff knowledge about evidence-based pressure ulcer prevention practices in both primary and specialised care, and to identify what factors determine nurses' knowledge levels.

METHODS

A correlational, cross-sectional study was conducted from 2018 to 2019 in two hospital districts in Finland. The Pressure Ulcer Prevention Knowledge test was used to collect data, and the Attitude towards Pressure ulcer Prevention (APuP) instrument was used as a background variable. The data were statistically analysed with Wilcoxon and Kruskal-Wallis tests, Spearman correlations and multiple linear regression.

RESULTS

The pressure ulcer prevention knowledge of the participating registered nurses, practical nurses and ward managers (N = 554) was on average 24.40 (max. 35.00). There was no difference in the participants' knowledge based on the type of unit in which they were working (primary or specialised care). The participants' attitudes (p < 0.0001), current position (p = 0.0042), frequency of taking care of patients with pressure ulcers (p = 0.0001) and self-evaluated training needs (p < 0.0001) independently explained the variation in the knowledge scores.

CONCLUSIONS

Special attention needs to be paid to the knowledge of those nurses working in positions that require lower levels of education and those who rarely take care of patients with pressure ulcers. Supporting nurses' positive attitudes towards pressure ulcer prevention should be an essential part of pressure ulcer prevention training. Nurses' self-evaluations of their training needs can be used to target training. The limitations of the study should be considered when generalising the results.

Nurses' Knowledge and Attitudes towards Prevention of Pressure Ulcers

BACKGROUND

Pressure ulcers (PU) remain a serious complication of immobile patients and a burden for healthcare professionals. The incidence and prevalence remain alarming. Knowledge and attitudes of nurses play a fundamental role in prevention. The aim of this study was to determine the knowledge and attitudes of nurses towards the prevention of PU in selected Slovak hospitals and find relationships and differences among selected variables.

METHODS

A quantitative exploratory cross-sectional design was chosen. Validated instruments were used. From the 460 randomly selected nurses, 225 (49%) participated in this research.

RESULTS

Results showed insufficient knowledge (45.5%) and attitudes (67.9%) of nurses towards PU prevention. There was a significant positive correlation found between the knowledge and attitudes (ρ = 0.300; p = 0.000). Nurses´ knowledge was significantly different within the level of education (p = 0.031) and work department (p = 0.048).

CONCLUSIONS

Results showed insufficiencies in the knowledge and attitudes of nurses towards PU prevention. Therefore, it is essential to focus on general education and continuing education and practice of nurses. Further development of educational programs and frequent measurement of these two parameters can lead to a significant improvement in the quality of care provided.

Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument

The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach's alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.

A systematic and psychometric review of tests measuring nurses' wound care knowledge

Wound care is an important realm of nurses' clinical responsibilities, and a broad knowledge and range of skills are needed to perform efficient and safe patient care. Nurses' knowledge on this matter can be measured using knowledge tests. This study aims to identify, define, and analyse the knowledge tests developed for the measurement of nurses' wound care knowledge, and to evaluate the psychometric properties of the tests. This study was a systematic literature review. A total of 52 studies and 18 instruments were found. Of the 18 instruments, only 5 had been used more than once and were successful in a psychometric evaluation. These five instruments were analysed on the basis of their psychometric properties by using Zwakhalen et al.'s (2006) psychometric testing framework. According to the analysis, the Pressure Ulcer Knowledge Test (PUKT) and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) were the most valid and reliable instruments for measuring nurses' wound care knowledge. Most of the instruments identified and analysed focused on pressure ulcers, indicating that future instruments could focus more on other types of wounds or on wound care in general in order to receive a broader understanding of nurses' wound care knowledge.

Determination of nurses' level of knowledge on the prevention of pressure ulcers: The case of Turkey

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.

Do we still need to assess nurses' attitudes towards pressure ulcer prevention? A systematic review

OBJECTIVE

To critically appraise and synthesise existing research literature pertaining to nurses' attitudes towards pressure ulcer (PU) prevention.

METHOD

Using systematic review methodology, published quantitative studies focusing on nurses' attitudes towards PU prevention measured by psychometric tests were included. The search was conducted in May 2019 using PubMed, CINAHL, Scopus, Cochrane and EMBASE databases, and returned 442 records, of which 21 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the checklist.

RESULTS

Of the included studies, 20 employed a cross-sectional design and one author employed a validation study. In measuring nurses' attitudes toward PU prevention two distinct instruments were used: the 'Moore and Price Attitude Scale' and the 'Attitude towards Pressure Ulcer Prevention Instrument'. The mean attitude score within the studies was 73% (standard deviation=9.2%). The lowest attitude score was 51%, while the highest score was 89%. The results obtained from the studies indicated that 86% (n=18) yielded positive attitude results.

CONCLUSION

The findings suggest that, overall, nurses are positively disposed towards PU prevention. However, it is important to highlight that the nurses have difficulties translating this positive attitude into actual PU prevention strategies.

The effect of educational intervention on the knowledge and attitude of intensive care nurses in the prevention of pressure ulcers

BACKGROUND

Pressure ulcers can cause disability, which can lead to a default in patients' safety and results in frequent complications for patients.

OBJECTIVES

This study aimed to determine the effect of educational intervention on nurses' knowledge and attitude in preventing pressure ulcers.

METHODS

In this study, 67 nurses of ICU wards at Ilam University of Medical Sciences were randomly assigned to the experimental or control group. Data collection tools included the demographic characteristics questionnaire, the Pieper Pressure Ulcer Knowledge test (PUKT) and the Attitude toward Pressure Ulcer tool (APuP). In the experimental group, the nurses were allocated into groups of four-five persons and for each group four face-to-face training sessions and two virtual training sessions by means of educational videos on bed sores were performed. Gathered data were analyzed using SPSS software version 16, and descriptive and analytical tests were performed.

RESULTS

PUKT questionnaire score in the experimental group improved from 15.68 (3.42) to 29.75 (12.33) (P = 0.000), while in the control group it was 16.40 (3.13) and 17.54 (6.62) before intervention, which was not significant (P > 0.05). Furthermore, the APUP questionnaire score in the experimental group improved from 27.12 (2.13) to 39.37 (3.21) (P = 0.000), while in the control group it was 27.65 (1.71) and 28.37 (5.00) before intervention, which was not significant (P > 0.05).

CONCLUSIONS

Since educational intervention improved the knowledge and attitude of nurses in preventing pressure ulcers, it is required to conduct appropriate educational interventions to improve their knowledge and attitude.