Knowledge and practices of operating room nurses in the prevention of pressure injuries

Investigation of related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy

OBJECTIVE

The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy.

METHODS

A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument.

RESULTS

The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries.

CONCLUSIONS

While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.

Operating room nurse's awareness and implementation status of the prevention of patient's intraoperative acquired pressure injuries: design and validation of a questionnaire

Aim

To compile the awareness and implementation status of patients with intraoperative acquired pressure injuries prevention by operating room nurses and to test its reliability and validity.

Design

This is an equipment development research based on recommendations for developing a reliable and valid questionnaire.

Methods

The research was carried out in two phases from February to November 2022. Through a panel discussion, expert consultation, and literature review, the questionnaire for operating room nurses on the current status of awareness and implementation of the prevention of intraoperative acquired pressure injuries was preliminarily formulated. The formal questionnaire was developed through validity analysis, reliability analysis and item analysis, and reliability and validity tests were conducted. Moreover, according to the questionnaire survey results, confirmatory factor analysis was carried out to construct the structural equation model.

Results

The initial questionnaire consisted of five dimensions with 48 items, which was finalized to five dimensions with 38 items after reliability and validity testing and analysis. The five dimensions included implementation of intraoperative acquired pressure injuries prevention, intraoperative acquired pressure injuries preventing cognitive conditions, preoperative intraoperative acquired pressure injuries preventing cognitive conditions, basic knowledge of pressure injuries, and implementation of intraoperative acquired pressure injuries prevention in special patients. Cronbach's α of the overall questionnaire was 0.969 while that of each dimension was 0.846-0.959. The KMO value of structural validity was 0.945 (P < 0.001), and the contribution rate of cumulative variance was 70.694%. The fitting of confirmatory factor analysis was found to be generally ideal: χ2/df = 2.382, RMR = 0.027, TLI = 0.894, RMSEA = 0.072, IFI = 0.905, CFI = 0.904.

Conclusions

The study and design of the questionnaire for operating room nurses on the current status of awareness and implementation of the prevention of intraoperative acquired pressure injuries are scientific and rational, providing a scientific basis for the standardized reform of hospitals and the optimization of the intraoperative acquired pressure injuries management system of the operating room.

Assessment of the risk factors for intraoperative pressure injuries in patients

AIM

This study was conducted to assess the risk factors for pressure injuries in patients during surgery.

METHODS

In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS).

RESULTS

The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05).

CONCLUSIONS

According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

Thermal preconditioning can reduce the incidence of intraoperatively acquired pressure injuries

Intraoperatively acquired pressure injuries (IAPIs) occur frequently among patients who undergo surgical procedures that last longer than 3 h. Several studies indicated that heat shock proteins (HSPs) play an important role in the protection of stress-induced damages in skin tissues. Hence, the aim of this study was to investigate the potential preventive effect of thermal preconditioning (TPC) on IAPIs in surgical patients and rats and to identify the differentially expressed HSP genes in response to the above treatment. TPC was performed on one group of hairless rats before the model of pressure injuries was established. Subsequently, the size of skin lesions was measured and the expression levels of mRNA and protein of HSPs of the pressured skin were detected by real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into the TPC group (n = 59) and the control group (n = 59), respectively. The temperature and pressure of sacral skin, as well as the incidence of pressure injury (PI) were detected and compared. In animal studies, TPC significantly reduced both the size and incidence of PI in rats on the second, third and fourth days post treatment. In addition, the expression levels of both mRNA and protein of HSP27 were increased in the TPC group, compared with the control group. Immunohistochemical staining showed that HSP27 was distributed in various types of dermal cells and increased in basal cells. In human studies, a significant reduction (75%) of IAPIs was observed among the patients in the TPC group. TPC can reduce the incidence of PI in rats and humans, and the upregulation of HSP27 may play an important role in this biological progress. Further studies are warranted to explore the molecular mechanism of the preventive effect in PI mediated by HSP27.

Determining knowledge and attitudes related to pressure injury prevention among operating room nurses and associated factors

AIM

To determine attitudes and levels of knowledge related to pressure injury (PI) prevention among operating room nurses and identify associated factors.

METHODS

This descriptive, cross-sectional study was conducted in Turkey with a sample of 112 operating room nurses recruited by the snowball method of convenience sampling. Data were collected online via Google Forms using a nurse data collection form, the Knowledge of Operating Room Nurses about Pressure Injuries Form, and the Attitude Towards Pressure Ulcer Prevention Instrument (APuP).

RESULTS

The operating room nurses' mean score for PI knowledge was 52.19 ± 17.01 out of 100, and their mean total APuP score was 42.28 ± 5.19 out of 52. Knowledge about PIs was negatively associated with being male (β = -0.287, p < 0.001) and positively associated with intervening to prevent PIs during surgery (β = 0.214, p = 0.008), using international PI guidelines as a reference in the operating room (β = -0.225, p = 0.005), and APuP score (β=.415, p < 0.001). Intervening to prevent PIs during surgery (β = 0.294, p = 0.003) was a significant predictor of attitude toward PI prevention.

CONCLUSION

Our results indicate that overall, operating room nurses have insufficient knowledge but positive attitudes about PI prevention. Female gender, using international PI reference guides in the operating room, and positive attitude toward PI prevention were identified as factors associated with higher PI knowledge level, while intervening to prevent PIs during surgery was positively associated with both knowledge level and attitude toward PI prevention.

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.

Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room

The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.

Evaluation of pressure ulcer risk and development in operating rooms

AIM

This study aimed to determine the risk and development of pressure ulcers in operating rooms.

MATERIALS AND METHODS

The sample of the study included a total of 250 patients. In the study, the risk of pressure ulcers was assessed before the operation, and the development of pressure ulcers was evaluated within 24 h after the operation.

RESULTS

The risk of pressure ulcers was low before the operation, and Stage I pressure ulcer developed in 12.8% of the patients within 24 h after the operation. The patients had pressure ulcers mostly in their sacrum. Their mean 3S Intraoperative Risk Assessment Scale of Pressure Sore score was 15.68 ± 4.84, suggesting that they were not at risk of developing pressure ulcers. Having a chronic disease (OR = 8.986; 95% CI = 3.697-21.845), undergoing general anesthesia (OR = 3.084; 95% CI = 1.323-7.194), and orthopedic surgery (OR = 10.172; 95% CI = 3.121-33.155) were statistically significant risk factors for pressure ulcers (p < 0.001). Additionally, moderately edematous skin (OR = 3.838; 95% CI = 1.024-14.386), overweight/underweight (OR = 16.333; 95% CI = 3.779-70.602), intraoperative bleeding greater than 800 ml (OR = 13.000; 95% CI = 3.451-48.969), operation time longer than 5 h (OR = 21.667; 95% CI = 2.122-221.223), moderate intraoperative stress (OR = 4.917; 95% CI = 0.425-56.916), body temperature higher than 38.3 °C or lower than 36.1 °C (OR = 5.462; 95% CI = 2.161-13.805), and intraoperative prone position (OR = 3.354; 95% CI = 1.386-8.115) were statistically significant risk factors for the development of pressure ulcers.

CONCLUSION

According to our preoperative pressure ulcer risk assessment, it is very important to take additional protective measures both during and after surgical operations to prevent pressure ulcers.

Study on the Effect of PDCA Circulation Method on Nursing Quality Management in the Day Operating Room

Objective

The main objective is to investigate the effect of PDCA circulation management on nursing quality in the day operation room.

Methods

A retrospective study was performed in 300 patients in the day surgery room. For the control group, 150 patients received routine nursing. For the observation group, 150 patients underwent PDCA circulation nursing management. The scores for nursing quality management, the hospital infection, the detection rate of pathogenic bacteria, the incidence rate of adverse events, the negative emotion of patients, and the satisfaction rate for the day surgery department were recorded and analyzed between two groups.

Results

Compared with the control group, the scores for nursing quality management and the satisfaction rate for the day surgery department were significantly increased (all P < 0.05), while the hospital infection, the detection rate of pathogenic bacteria, HAMA scores, HAMD scores, and the incidence rate of adverse events were obviously decreased (all P < 0.05). Significantly statistical differences were observed between the two groups.

Conclusion

PDCA circulation nursing management in the day operating room could optimize the nursing quality management, improve the satisfaction rate of the operating room, reduce the negative emotions of patients, and prevent adverse events in time, with lower hospital infections.