The Effect of Pressure Injury Training for Nurses: A Systematic Review and Meta-analysis

Traditional Chinese-version reliability test of the Pieper-Zulkowski pressure ulcer knowledge: Psychometric and assessment

This study was to translate the Pieper-Zulkowski pressure ulcer knowledge test (PZ-PUKT) into Traditional Chinese and evaluate its psychometric properties as well as identify the predictors of knowledge on pressure injury. The PZ-PUKT was translated into Traditional Chinese (TC-PZ-PUKT), and its content validity was evaluated. A total of 296 nurses participated in this study and completed the 72-item TC-PZ-PUKT online. The reliability of the TC-PZ-PUKT was analysed by evaluating its internal consistency and test-retest reliability. Hierarchical regression was used to determine factors associated with TC-PZ-PUKT scores. Content validity was achieved with a score of 0.986. Internal consistency was observed to be reliable, with a Cronbach's alpha of 0.858. The mean knowledge score on the TC-PZ-PUKT was 72.5%, with a 1-week test-retest reliability of r = 0.849. Education level, certification as a wound specialist and self-learning through reading articles, books or guidelines on pressure injury were significantly associated with TC-PZ-PUKT scores. The TC-PZ-PUKT is a valid and reliable tool. Education level, certification as a wound specialist and self-learning regarding pressure injury are related to knowledge of pressure injury.

Nurses' experiences of hospital-acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.

The Effectiveness of Mobile Applications in Improving Nursing Students' Knowledge Related to Pressure Injury Prevention

The study's main goal was to compare the effects of a mobile application versus traditional methods of teaching on nursing students' acquisition of knowledge about pressure injury prevention. In addition, a secondary aim was to discover nursing students' viewpoints related to the advantages and disadvantages of using mobile applications as an educational method. A randomized controlled study design was implemented during November and December of 2023 in a nursing faculty with 60 undergraduate students in their second nursing year. A total of 30 students were assigned to the mobile application group, while the other 30 students were assigned to the traditional lecture group. The study was executed in three stages: pre-test, educational intervention, and post-test. The results of the study during the pre-test showed that there were no statistically significant differences in the mean scores of pressure injury themes between the two groups. However, the post-test scores for all PI themes were higher in the mobile application group compared to the traditional lecture group. Furthermore, five advantages of the mobile application were highlighted by students: "improvement of students' knowledge and skills", "self-confidence", "stress reduction", "enhancement of competence", and "stimulation of learning motivation". This study demonstrated the effectiveness of the mobile application method in enhancing nursing students' knowledge and prophylaxis of pressure injury. Therefore, the mobile application method is recommended as an innovative approach to teaching.

Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence

OBJECTIVE

To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs.

RESEARCH METHODOLOGY/DESIGN

A pre-post test intervention study without a control group.

SETTING

The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients).

MAIN OUTCOME MEASURES

The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E).

RESULTS

The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001).

CONCLUSION

The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings.

IMPLICATIONS FOR CLINICAL PRACTICE

Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

Effect of e-learning program for improving nurse knowledge and practice towards managing pressure injuries: A systematic review and meta-analysis

AIM

The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in managing pressure injuries patients.

DESIGN

Systematic review and meta-analysis.

METHODS

Systematic search was done in EMBASE, SCOPUS, Cochrane library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov databases until August 2022. Meta-analysis was carried out using random-effects model, and the results were reported as pooled standardized mean differences (SMD), or odds ratios (OR) with 95% confidence intervals (CIs).

RESULTS

Eight studies were included in the analysis. Most of the studies had higher risk of bias. The pooled SMD for knowledge score and for the classification skill were 1.40 (95%CI: 0.45-2.35; I2  = 93.1%) and 1.75 (95%CI: 0.94-3.24; I2  = 78.3%) respectively. The pooled OR for the classification skills was 1.75 (95%CI: 0.94-3.24; I2  = 78.3%).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nursing Students' Knowledge on Pressure Injuries Following a Blended-Learning Unit: A Quasi-experimental Study

OBJECTIVE

To assess first-year bachelor's degree in nursing students' knowledge about pressure injury (PI) etiology, classification, prevention, and management following blended learning and clinical practice.

METHODS

A quasi-experimental design was used. Nursing students' PI knowledge was measured using the French version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) at three time points: baseline (before a blended-learning unit, consisting of 2 hours of e-learning and 3 hours of practical workshop), after the blended-learning unit, and after clinical practice.

RESULTS

A total of 21 students participated over the three time points. At baseline, the mean percentage of correct answers on the PUKAT was 45.8%. This score increased to 59.2% following the blended-learning unit and 65% after completing the clinical practice (F2,58 = 19.08; P = .00). Over the three time points, students scored highest on knowledge of risk assessment and lowest on knowledge of prevention.

CONCLUSIONS

Blended-learning units combining e-learning and practical workshops are valuable tools to increase students' knowledge about PIs. The PUKAT enables the evaluation of changes in students' knowledge following a teaching unit on PIs. However, more research is needed to assess the long-term evolution of knowledge and the impact of this teaching on clinical practice.

Effectiveness of an E-Book App on the Knowledge, Attitudes and Confidence of Nurses to Prevent and Care for Pressure Injury

AIMS

This study evaluates the effectiveness of an interactive E-book app training program in improving nurses' knowledge, attitudes, and confidence to prevent and care for pressure injury.

DESIGN

Randomized experimental study.

METHODS

Participants were recruited from a teaching hospital in Taiwan. The study was carried out between 20 March 2014 to 1 April 2016. In total, 164 participants were randomly assigned to a pressure injury E-book app training program (n = 86) or a conventional education program (n = 78) with a one-month follow-up. Outcome variables were levels of pressure injury knowledge, attitudes, and confidence of pressure injury care.

RESULTS

Participants answered 51.96% of the pressure injury knowledge questions correctly before the intervention and 75.5% after the intervention. The pressure injury attitude score was slightly positive, with moderate confidence in pressure injury care. The knowledge, attitudes, and confidence of pressure injury care of the two groups in the pretest and posttest groups increased significantly. Analysis of covariance indicated that nurses in the pressure injury E-book app group had significantly greater improvement in knowledge, attitudes, and pressure injury care confidence as compared with the control group.

CONCLUSION

The pressure injury E-book app interactive training program was effective in improving nurses' knowledge and attitudes toward pressure injury care and in enhancing their confidence in pressure injury care; therefore, this program has potential for nurses' in-service education in both Taiwan and worldwide.

IMPACT

E-book apps allow individuals to control the time and place of learning. Direct observation of procedural skills can provide feedback to trainees on techniques to ensure learning effectiveness and pressure injury care quality.

Effect of Educational Training on Nurses' Ability to Care for Patients with Pressure Injuries: A Meta-analysis

OBJECTIVE

To provide up-to-date, systematic pooled evidence on the effect of educational training on nurses' knowledge and classification skills related to pressure injuries.

DATA SOURCES

The authors searched the following databases: MEDLINE, EMBASE, ScienceDirect, Google Scholar, and Cochrane library.

STUDY SELECTION

Two investigators independently performed the primary screening (title, abstract, and keywords). Of the 903 articles identified, 99 studies met the eligibility criteria, and their full texts were reviewed. Of these, nine studies totaling 25,723 participants satisfied the inclusion criteria and were included in the review.

DATA EXTRACTION

Manual data extraction was performed by the primary investigator using a predefined, semistructured form and was checked for accuracy by secondary investigators.

DATA SYNTHESIS

The majority of the included studies (five out of nine) were low quality. For knowledge score, the pooled standardized mean difference was 1.60 (95% CI, 0.79-2.41), P < .001. For classification skills, the pooled risk ratio was 1.20 (95% CI, 1.12-1.28).

CONCLUSIONS

Educational training was relatively effective in improving nurses' pressure injury knowledge and classification skills, although the studies in this review exhibited significant heterogeneity.

ABCD before E-verything else-Intensive care nurses' knowledge and experience of pressure injury and moisture-associated skin damage

Patients in intensive care units are at high risk of developing pressure injuries and moisture-associated skin damages. Prevention and care rely much on intensive care nurses' competency and attitudes. This study explored intensive care nurses' experience, knowledge and bedside practice in prevention and care of pressure injuries and moisture-associated skin damages with a descriptive qualitative design. Six focus groups (n = 25) were carried out in three University hospitals, two in Norway and one inIceland. Interviews were guided by a questioning route, recorded and transcribed verbatim before an inductive content analysis. Three interconnected main categories related to nurses' experience, knowledge and bedside care were identified: (a) nursing; (b) context; and (c) patients. Intensive care nurses recognise patients' risk of developing pressure injuries, as well as their continuous need of personal hygiene because of leakage of body fluids. Nurses were therefore attentive to skin inspection and preventive care but felt insecure and in need of expert help in pressure injury wound care. It varied whether nurses had access to suitable beds and mattresses and experts in wound care. ABCD had to be before E-verything else, but the skin had higher priority in long-stay compared with short-stay patients.

Australian First-Year Nursing Student Knowledge and Attitudes on Pressure Injury Prevention: A Three-Year Educational Intervention Survey Study

Pressure injury prevention is a significant issue as pressure injuries are difficult to heal, painful, and create clinical complications for patients. The aim of this study was to investigate knowledge and attitudes of first-year nursing students to pressure injury prevention, and to explore whether additional educational interventions augmented learning. A previously validated online survey was administered to three cohorts of first-year nursing students in 2016, 2017 (after additional online education), and 2018 (after further simulation education), and a subsequent comparative analysis was undertaken. Overall, the knowledge of students about pressure injury was low with measures to prevent pressure injury or shear achieving the lowest score (<50%). Students aged over 25 years (p < 0.001) and men (p = 0.14) gained higher attitude scores. There were significant differences for mean knowledge scores between the 2016 and 2018 cohorts (p = 0.04), including age group (p = 0.013) and number of clinical training units undertaken (p = 0.23). The 2016 cohort scored consistently lower in the attitude survey than both other cohorts (p < 0.001). Online resources and simulation experiences marginally improved knowledge and improved attitudes towards prevention of pressure injury. Nursing curricula should include targeted education to ensure student nurses are adequately prepared to prevent pressure injury through understanding of aetiology and risk assessment.

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

(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.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis

Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.

International comparison of pressure ulcer measures in long-term care facilities: Assessing the methodological robustness of 4 approaches to point prevalence measurement

INTRODUCTION

Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities.

MATERIAL AND METHODS

A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements.

RESULTS

The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems.

CONCLUSIONS

Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning.

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

AIM

To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients.

BACKGROUND

Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings.

DESIGN

A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.

METHODS

Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis.

RESULTS

The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low.

CONCLUSIONS

Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries.

RELEVANCE TO CLINICAL PRACTICE

Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

Effect of training programmes on nurses' ability to care for subjects with pressure injuries: A meta-analysis

We performed a meta-analysis to evaluate the education effects on nurses' ability to care for subjects with pressure injuries. A systematic literature search up to April 2021 was carried out, and 29 studies included 5704 nurses at the start of the study; 3800 of them were experiment or post-training and 3804 were control or per-training. They were reporting relationships between the education effects on nurses' ability to care for subjects with pressure injuries. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the education effects on nurses' ability to care for subjects with pressure injuries using the dichotomous or continuous method with a random or fixed-effect model. Experiment or post-trained nurses had significantly higher knowledge score (MD, 10.00; 95% CI, 7.61-12.39, P < .001), number of nurses with proper knowledge (OR, 20.70; 95% CI, 10.80-39.67, P < .001), practice score (MD, 12.39; 95% CI, 5.37-19.42, P < .001), and number of nurses with proper practice (OR, 3.56; 95% CI, 1.75-7.25, P < .001), attitudes score (MD, 7.46; 95% CI, 2.94-11.99, P < .001) compared with control or pertained nurses. Training may have a beneficial effect on improving the nurses' ability to care for subjects with pressure injuries, which was obvious in improving knowledge, practice, and attitudes post-training. Further studies are required to validate these findings.

Medical device-related pressure injury prevention in critically ill patients: nursing care

OBJECTIVES

to know the care implemented by the nursing team to prevent medical device-related pressure injuries in critically ill patients.

METHODS

this is a qualitative research conducted with 15 nursing professionals from Intensive Care Unit. Sampling was carried out by theoretical saturation. For data analysis, the Discourse of the Collective Subject technique was used.

RESULTS

six speeches emerged, whose central ideas were interventions for medical device-related pressure injury prevention: care in fixation; frequent repositioning; protection and padding of body areas in contact; preferences for flexible materials, when available; attention of professionals so that they do not comer under patients; early assessment and removal, when clinically possible.

FINAL CONSIDERATIONS

nursing care was directed mainly to respiratory devices, catheters in general and monitoring equipment, indicating that professionals have the knowledge to provide safe assistance consistent with the literature.