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Anker-Hansen C, Grøndahl VA, Helgesen AK, Olsen LB, Rummelhoff G, Halvorsrud L, Bååth C. Pressure ulcer point prevalence, classification, locations, and preventive measures: Insights from a Norwegian nursing home survey. Scand J Caring Sci 2024; 38:409-416. [PMID: 38366680 DOI: 10.1111/scs.13245] [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: 08/22/2023] [Revised: 01/19/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To report data from a point pressure ulcer (PU) prevalence survey on prevalence, PU categories, locations and preventive interventions at one Norwegian nursing home. METHODS A cross-sectional research design was used. One nursing home in Norway participated in the prevalence survey in 2020. The data were collected on one selected day. A total of 74 out of 88 residents (84.1%) participated. Descriptive statistical analyses were run. RESULTS The overall prevalence of PUs was 27% amongst all participants in the nursing home, who together had a total of 57 PUs categorised as category I-III. One major finding was that the most common site of the PUs was on the residents' toes. Interestingly, the prevalence of PUs in the residents' sacrum was considerably low. The most frequently used PU preventive interventions were foam chair cushions, nutritional supplements and pressure-reducing heel protection. CONCLUSION This study identified a high prevalence of PUs, predominantly on residents' toes. Although preventive strategies were implemented, their application appeared limited. Implementing obligatory care packages and annual nationwide PU surveys might be worth considering in municipalities.
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Affiliation(s)
- Camilla Anker-Hansen
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Vigdis Abrahamsen Grøndahl
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Ann Karin Helgesen
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Liv Berit Olsen
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Guri Rummelhoff
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Liv Halvorsrud
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Carina Bååth
- Department of Nursing, Health, and Biomedical Engineering, Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
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Wall B, Kelly AM, White P, McCann M. Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S16-S28. [PMID: 38722011 DOI: 10.12968/bjon.2024.33.9.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. AIM To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. DESIGN Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. METHODS Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). RESULTS The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. CONCLUSIONS The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.
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Affiliation(s)
- Breda Wall
- Clinical Nurse Specialist in Wound Management and Tissue Viability, St Vincent's Hospital, Athy, Ireland
| | - Anne Marie Kelly
- Clinical Nurse Specialist - Continence Promotion and Management of Incontinence, Continence Promotion Service, Meath Campus, Dublin, Ireland
| | - Patricia White
- Project Officer, European Association for Palliative Care, previously Research Fellow at Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret McCann
- Assistant Professor and Postgraduate Specialist Educational Facilitator, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
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Jin Y, Back JS, Im SH, Oh JH, Lee SM. Data-driven approach to predicting the risk of pressure injury: A retrospective analysis based on changes in patient conditions. J Clin Nurs 2023; 32:7273-7283. [PMID: 37303250 DOI: 10.1111/jocn.16795] [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: 01/30/2023] [Revised: 04/03/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
AIMS To determine the risk of pressure injury development in the intensive care unit based on changes in patient conditions. DESIGN This retrospective study was based on secondary data analysis. METHODS Patient data from electronic health records were retrospectively obtained and we included 438 and 1752 patients with and without pressure injury, respectively, among those admitted to the medical and surgical intensive care units (ICUs) from January 2017-February 2020. Changes in patient conditions were analysed based on the first and last objective data values from the day of ICU admission to the day before the onset of pressure injury and categorised as follows: improved, maintained normal, exacerbated and unchanged. Logistic regression was performed to identify the significant predictors of pressure injury development based on 11 variables. RESULTS The 11 selected variables were age, body mass index, activity, acute physiology and chronic health evaluation II score, nursing severity level, pulse and albumin, haematocrit, C-reactive protein, total bilirubin and blood urea nitrogen levels. The risk for a pressure injury was high with exacerbation of or persistently abnormal levels of nursing severity, albumin, haematocrit, C-reactive protein, blood urea nitrogen and pulse >100 beat/min. CONCLUSION Periodic monitoring of haematological variables is important for preventing pressure injury in the intensive care unit. REPORTING METHOD The study followed STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION This study contributes to the utilisation of patient data from electronic health records. RELEVANCE TO CLINICAL PRACTICE In addition to other pressure injury risk assessment tools, ICU nurses can help prevent pressure injuries by assessing patients' blood test results, thereby promoting patient safety and enhancing the efficacy of nursing practice.
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Affiliation(s)
- Yinji Jin
- School of Nursing, Yanbian University, Jilin, China
| | - Ji-Sun Back
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Ho Im
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hyo Oh
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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Sardo PMG, Teixeira JPF, Machado AMSF, Oliveira BF, Alves IM. A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services. J Tissue Viability 2023; 32:179-187. [PMID: 36792441 DOI: 10.1016/j.jtv.2023.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
AIM To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services. MATERIALS AND METHODS Systematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906). RESULTS The pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission. CONCLUSIONS The prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services' characteristics.
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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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Maldonado-Cabrera B, Sánchez-Machado DI, López-Cervantes J, Osuna-Chávez RF, Ibarra-Zazueta C, Robles-Zepeda RE. Efficacy of chitosan in the treatment of chronic skin lesions in a horse: A case report. Vet Anim Sci 2022; 17:100261. [PMID: 35856003 PMCID: PMC9287356 DOI: 10.1016/j.vas.2022.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 10/30/2022] Open
Abstract
A case of a Gypsy Vanner horse with chronic foreskin lesion is reported. Chronic skin lesions in horses are a diagnostic challenge. Topical application of chitosan favors healing in horses with chronic skin lesions. Chitosan prevents complications in chronic skin lesions in horses.
Consultation was requested for a 7-year-old Gypsy Vanner male horse with a 2-year history of foreskin injury. Upon revision, an ulcer, 153 cm2 in size, with yellowish granules was observed; a RESVECH 2.0 evaluation revealed a score of 32/35 points. Medical history confirmed multiple failed deworming, anti-inflammatory, and antibiotic treatments with different topical therapies and recurrence in summer. Laboratory results confirmed elevated total proteins (8.8 g/dL) and globulins (5.5 g/dL), negative bacterial and fungal cultures, as well as negative coproparasitoscopic findings, and finally, identification of stable fly larvae (Stomoxys calcitrans) in the feces. Microscopy showed disorganized collagen, thickened tissue, polymorphonuclear cells, and acanthosis without neoplastic tissue or parasite remains. Debridement was performed and systemic treatment with ivermectin, penicillin, and non-steroidal anti-inflammatory drugs (NSAIDs) continued. In addition, 2% chitosan gel and films were applied to the entire surface of the lesion for 72 hours on 30 occasions; vector control with nets and insecticides was performed. On day 94, there was a 6 cm2 surface with involvement of the dermal and epidermal layers, moist epithelial tissue, and diffuse edges, with a RESVECH 2.0 evaluation of 6/35 points. Microscopy showed an intact basement membrane, presence of hair follicles, sweat glands, aligned collagen, and angiogenesis. It was concluded that chronic skin lesions in horses represent a diagnostic challenge, and topical chitosan is an adequate treatment due to its biocompatibility and efficacy, in addition to the functional and cosmetic results in dermal regeneration.
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Furtado K, Lopes T, Afonso A, Infante P, Voorham J, Lopes M. Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey. J Clin Med 2022; 11:jcm11030583. [PMID: 35160035 PMCID: PMC8836429 DOI: 10.3390/jcm11030583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Improvement in pressure ulcer care depends both on the dissemination of knowledge and its implementation. This study aims to translate the Pressure Ulcer Knowledge Test into Portuguese from Portugal and evaluate the internal consistency of the questionnaire. The second aim is to assess nurses’ pressure ulcer knowledge level. (2) Methods: The Pressure Ulcer Knowledge Test was translated into Portuguese, and the translated test’s internal consistency and content validity were assessed. Further, the authors conducted a cross-sectional survey using the test among 221 nurses working in long-term care units. (3) Results: The Cronbach’s alpha internal coefficient of reliability recorded for the 47 items was 0.738, which is higher than the minimum acceptable level of 0.7. The Cronbach’s alpha for the subscales was 0.709 for prevention/risk and less than 0.5 for staging and wound description. Only two of the 221 nurses achieved a score of 90% correct answers or more. The nurses scored lower in questions related to prevention/risk (Me = 67.4%, IQR = 60.6–75.8% vs. staging: ME = 85.7%, IQR = 71.4–85.7%, description: ME = 85.7%, IQR = 71.4–85.7%, p < 0.001). (4) Conclusion: The internal consistency of the instrument was acceptable. The instrument can accurately measure Portuguese nurses’ knowledge of pressure ulcers, and its information can help improve education and implementation of best practices.
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Affiliation(s)
- Katia Furtado
- Out patient Department, Hospital of Portalegre, Unidade Local de Saúde do Norte Alentejano, 7300-312 Portalegre, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal;
- Correspondence:
| | - Teresa Lopes
- Emergency Department, University Hospitalar Center Cova da Beira, 6200-000 Covilhã, Portugal;
- Department of Nursing, Health School, Polyctechnic Institute of Guarda, 6300-000 Guarda, Portugal
| | - Anabela Afonso
- CIMA, IIFA, Universidade de Évora, 7000-671 Évora, Portugal; (A.A.); (P.I.)
- Departamento de Matemática, ECT, Universidade de Évora, 7000-671 Évora, Portugal
| | - Paulo Infante
- CIMA, IIFA, Universidade de Évora, 7000-671 Évora, Portugal; (A.A.); (P.I.)
- Departamento de Matemática, ECT, Universidade de Évora, 7000-671 Évora, Portugal
| | - Jaco Voorham
- DTIRS—Data to Insights Research Solutions, 1750-307 Lisboa, Portugal;
| | - Manuel Lopes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal;
- São João de Deus School of Nursing, Universidade de Évora, 7000-671 Évora, Portugal
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Machado AMSF, Oliveira BF, Alves IM, Teixeira JMB, Teixeira JPF, Silva NMTD, Sardo PMG. Prevalence and incidence of pressure ulcers/injuries in emergency services: A systematic review protocol. J Tissue Viability 2021; 31:58-61. [PMID: 34711418 DOI: 10.1016/j.jtv.2021.10.005] [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: 05/14/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
AIM To develop a systematic review protocol on the prevalence and/or the incidence of pressure ulcers/injuries in adult patients in emergency services. MATERIALS AND METHODS This protocol was developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Joanna Briggs Institute (JBI) methodology for systematic reviews of prevalence and incidence studies. The inclusion criteria will be based on the CoCoPop mnemonic. The main variables of interest will be the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in emergency services (Context), with participants aged 18 or more (Population). This Systematic Review Protocol was registered in PROSPERO (CDR42021252906). RESULTS If meta-analysis is not possible, the syntheses of quantitative data will be presented in a narrative form to address the scope and objectives of this systematic review. Tables, graphs and/or figures will be designed to present the results of the prevalence and the incidence of pressure ulcers/injuries, their body locations and the respective categories/stages. The Systematic Review is currently ongoing. CONCLUSIONS Prevalence and incidence systematic reviews are an emerging methodology in the field of evidence synthesis. We believe that the systematic review on prevalence and incidence of pressure ulcers/injuries in emergency services can provide useful information for healthcare professionals and policy makers about the dimension of this problem in a specific context. The standardized approach outlined in this systematic review protocol offers a rigorous and transparent method to conduct the review.
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Affiliation(s)
| | | | - Inês Martins Alves
- Nurse Student. School of Health Sciences. University of Aveiro, Portugal.
| | | | | | | | - Pedro Miguel Garcez Sardo
- Registered Nurse, Clinical Nurse Specialist, Master in Nursing Sciences, PhD in Nursing Sciences, School of Health Sciences. University of Aveiro (Portugal). Institute of Biomedicine (iBiMED). University of Aveiro, Portugal.
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