A Survey of Australian Nurses' Knowledge of Pressure Injury/Pressure Ulcer Management

Medical and surgical nurses' approach to patient pressure injury prevention education: An integrative review

AIMS

Identify and synthesise the published literature on the approaches and practices nurses use during the delivery of pressure injury prevention (PIP) education to hospitalised medical and surgical patients.

DESIGN

An integrated review.

METHODS

Whitmore and Knaff's (2005) five-stage methodology guided this review: (1) research problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020) Statement was followed. The quality of included studies was assessed using the Mixed Method Appraisal Tool (2018). Extracted data were analysed using inductive content analysis.

DATA SOURCES

Journal publication dates from 1992 to 2022. Systematic searches of CINAHL (Cumulative Index of Nursing and Allied Health Literature) complete, Embase, PsycINFO (via Ovid) and Scopus databases were undertaken.

RESULTS

A total of 3892 articles were initially identified, four quantitative and two qualitative studies were included. Articles were published between 2013 and 2022.Two themes were identified: responsibility and workplace culture determine nurses' approach to PIP education delivery; and nurses tailor education strategies to address challenges and opportunities for PIP education delivery.

CONCLUSION

Nurses require resources to facilitate approaches to PIP education with medical and surgical patients. In the absence of clear instruction to support nurses' practice, PIP education for patients is at best delivered in an informal and ad hoc manner. Nurses require accessible education resources to enable them to tailor the content and frequency of PIP education to patients in med-surg settings.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The effect of knowledge levels of intensive care nurses about pressure injuries on their attitude toward preventing pressure injuries

AIM

The aim of this study was to determine the current knowledge levels of intensive care nurses about pressure injuries and their attitudes toward preventing pressure injuries, and to reveal the relationship between these variables.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted with 152 nurses, working in the Adult Intensive Care Units of a Training and Research Hospital. Data were collected between 10.08.2021 and 31.11.2021 with the Patient Information Form, Modified Pieper Pressure Ulcer Knowledge Test and Attitude toward Pressure Injury Prevention Scale. Frequency analysis, descriptive statistics, multiple logistic regression analysis and the structural equation modeling technique were used in the analysis of the study data.

RESULTS

The mean age of the nurses was 25.82 ± 3.42 years, 86.2% of them were female and 67.1% of them had a bachelor's degree. Total mean score of the Modified Pieper Pressure Ulcer Knowledge Test of the intensive care nurses was found to be 32.58 ± 6.58. The knowledge score of 113 out of 152 nurses was ≥60% or above. The total mean score of the Attitude toward Pressure Injury Prevention Scale was 42.00 ± 5.70 and a total of 76.97% (117 participants) of them were found to score 75% or above on the scale. The results of the regression analysis showed that educational degree, and status of having training about pressure injuries did not affect the total mean score of the Knowledge Test and the Attitude Scale. However, it revealed that the frequency of encountering a patient with pressure injuries in the unit where they work has affected the total mean score of the scales significantly (p < 0.05). As per the results of the structural equation model, the Modified Pieper Pressure Ulcer Knowledge Test scores of the nurses were found to have a statistically significant effect on the scores of the Attitude toward Pressure Injury Prevention Scale (p < 0.05).

CONCLUSION

This study revealed that intensive care unit nurses had a positive attitude toward Pressure Injury Prevention and their knowledge was sufficient and that as the Modified Pieper Pressure Ulcer Knowledge Test scores increase, their positive attitude toward Pressure Injury Prevention also increases.

Knowledge of intensive care unit nurses about medical device-related pressure injury and analysis of influencing factors

To investigate ICU nurses' knowledge level with regard to device-related pressure injuries in northern, central, and southern China and analyse its influencing factors. A total of 261 ICU nurses participated in this cross-sectional survey A convenience sampling method was used to select ICU nurses as respondents from one hospital in each of the six cities of Taiyuan, Wuhan, Xianning, Guangzhou, Foshan, and Huizhou. Data were collected using the MDRPI Knowledge Questionnaire. The questionnaire was developed by the investigators based on a summary of evidence of MDRPI, which has been reviewed and validated by experts. The obtained data were analysed using SPSS software. The average rate of the correct response about MDRPI was 60.54% (15.74 ± 2.90). The lowest percentage of correct responses was on the "concept and staging" dimension rated 28% (0.56 ± 0.67). The "skin assessment" dimension rated 39.2% (1.57 ± 0.84). Multiple linear regression analysis showed that the factors influencing the MDRPI knowledge of ICU nurses included hospital grade, the highest educational attainment, whether or not they had wound care certification, when they last attended MDRPI training or lectures, and whether or not they had attended MDRPI training or lectures. The level of knowledge of nurses about MDRPI was insufficient. Training of ICU nurses on MDRPI should be emphasised at the institutional level. MDRPI training contents should be based on clinical evidence and updated timely. There is a need to focus on the training of wound care certification and education.

A knowledge test on pressure injury in adult intensive care patients: Development, validation, and item analysis

BACKGROUND

Pressure injuries are a major problem in critically ill patients, but both students' and intensive care nurses' knowledge about these injuries leaves room for improvement. As no knowledge test is currently available that focuses on pressure injuries in adult intensive care patients, we aimed to develop such tool, establish the content validity, and perform item analysis using Classical test theory.

METHODS

Test development followed established multiple-choice question-writing guidelines. Content validation used a Delphi procedure including eight international experts. Item analysis (question difficulty and discrimination power, and quality of the distractors) was based on the test results of a convenience sample who completed the test online, based on ready knowledge.

RESULTS

Four Delphi validation rounds resulted in a 24-item multiple-choice test within seven categories: Epidemiology, Aetiology, Prevention, Classification, Risk factors and risk assessment, Wound care, and Skin care. The content validity index was 0.96. The median score of 12 students and 38 qualified nurses was 12.5/24 (interquartile range 11-14.25; range 4-17; 52%). Least correct answers were in the categories Classification and Wound care. Item analysis revealed several knowledge gaps and misconceptions.

CONCLUSIONS

The test has excellent content validity. The sample's overall score was low. Item analysis identified various training needs. Future users are recommended to further validate the test and establish its reliability, and to tailor it to their individual context and evaluation requirements.

Determining the pressure injury and staging knowledge of nurses at a hospital in Turkey

AIM

The aim of this research is to examine the nurses's knowledge level regarding pressure injury and its staging.

MATERIALS AND METHODS

The research was conducted in descriptive type. The data were collected at a hospital in Konya between September 1 and November 30, 2021. The sample of the study consisted of 158 nurses working in internal clinics, surgical clinics and intensive care units. "Sociodemographic Questionnaire Form" and "Modified Pieper Pressure Wound Knowledge Test (PUKT)" were used to collect data. Percentage, frequency, arithmetic mean, independent sample t-test and ANOVA tests were used to analyze the data.

RESULTS

It was found that 77.2% of the nurses had encountered pressure injuries and 63.1%had received training on pressure injuries. It was determined that 55.1% of them received this training as in-service training in the hospital. 96.8% of the nurses stated that pressure injury could be prevented with nursing care. The mean PUKT score of the nurses was 30.70 ± 7.15; staging mean score was 4.79 ± 1.87, wound description mean score was 4.43 ± 1.88; prevention/risk assessment score mean was determined as 20.78 ± 3.93. The average score obtained with the correct response rates to the test was 62.67%. There was no significant difference between nurses' education levels, years of employment and PUKT, wound description, staging and prevention/risk scores (p > .05). There was a significant difference between the mean PUKT score and staging mean score between those who received training on pressure injury and those who didn't, and between the units where the nurses worked and the mean PUKT score, wound description, staging and prevention/risk scores (p < .05).

CONCLUSION

It was found that the nurses's knowledge level was below satisfactory. It's recommended for nurses to attend trainings on pressure injury, to check the effectiveness of their training, to participate in scientific meetings and to encourage nurses to make research.

Factors Associated with Nurses' Perceived Competence in Pressure Injury Care in a Tertiary Hospital in Yunnan, China

OBJECTIVE

To assess nurses' perceived competence in pressure injury (PI) care and explore the association between perceived competence and nurses' backgrounds, knowledge, attitudes, and self-efficacy in PI care.

METHODS

This study used a descriptive correlational design. During January and February 2021, the authors sent an online questionnaire to 117 nurses caring for patients with or at risk of PI at a tertiary level hospital in Kunming, Yunnan Province, China, to collect information regarding demographics, knowledge, attitude, self-efficacy, and perceived competence in PI care. Univariate and multiple regressions were performed to assess the associations.

RESULTS

A total of 111 completed questionnaires were obtained, a response rate of 94.9%. Nurses reported inadequate knowledge and relatively low self-efficacy in PI care. However, they had positive attitudes and acceptable levels of perceived competence in PI care. According to a univariate analysis, being a wound specialist, having read PI-related articles or practice guideline within the past year, and having knowledge and self-efficacy in PI care were associated with nurses' perceived competence.

CONCLUSIONS

Pressure injury-related knowledge, attitude, and self-efficacy are independently associated with nurses' perception of their competency in PI care.

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.

Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities

OBJECTIVE

To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland.

METHODS

A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument.

RESULTS

According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices.

CONCLUSIONS

Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study

The use of consistent and evidence‐based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence‐based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.

Pressure injury knowledge of Turkish internship nursing students

AIM

This study aimed to describe the pressure injury (PI) knowledge of Turkish internship nursing students (INSs).

MATERIALS AND METHODS

This descriptive study was performed using the Turkish version of the Modified Pieper Pressure Ulcer Knowledge Test. The study population consisted of INSs in a nursing program in the West Black Sea Region, Turkey. The sample of the study was 278 (74.1% of a total of 375 volunteer INSs).

RESULTS

The mean knowledge test score was 29.03 ± 7.15 (range 11-44). The prevention/risk score was higher; only 28.4% of the students had a satisfactory test score.

CONCLUSION

The results of this study indicated that the INSs had significant knowledge gaps regarding PI. Nursing students' knowledge deficiencies regarding PIs should be identified at undergraduate level, and the necessary educational measures should be taken.

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

BACKGROUND

Operating room (OR) nurses play an important role in preventing the pressure injuries (PIs) that may develop during the perioperative process. This study was conducted to determine OR nurses' level of knowledge about PIs, and how they manage them.

METHODS

This is a cross-sectional, quantitative and descriptive study. The sample of the study consisted of 234 OR nurses working in eight different public hospitals in Ankara. The questionnaire applied in this study was prepared in accordance with the guidelines. This questionnaire consisted of three sections: demographic profiling, common preventive practices, and the knowledge of OR nurses about intraoperative PI prevention.

FINDINGS

66.7% of the participants had received education about PIs during their basic nursing training, and 41.5% had received education after graduation. 97.4% of OR nurses did not follow international guidelines about PIs. The mean total score of the OR nurses for the questions about PIs was 52.0 ± 13.7 out of a possible score of 100. The lowest mean score was obtained for the topic of 'staging pressure injuries', and the highest score was obtained from 'interventions to prevent pressure injuries'. In addition, 81.5% of the OR nurses stated that they were not given information about patients with a high PI risk by clinical nurses. 97.9% of the OR nurses did not use a scale to assess intraoperative PI risks. Fewer than half of the nurses said that they assessed the risk of PIs during surgery. 90.8% the nurses did not record risk assessment and interventions to prevent PIs.

CONCLUSION

There is a need to incorporate basic operating room PI (ORPI) training into both the basic nursing and in-service training to improve the knowledge of OR nurses about how to prevent and manage ORPIs. In addition, measures to assess PI risk and prevent ORPI should be included in institutional policies and procedures.

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.

Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis

OBJECTIVE

The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries.

METHOD

A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables.

RESULTS

The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme.

CONCLUSIONS

The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%.

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.

Nurses' knowledge, attitudes, and behaviours related to pressure injury prevention: A large-scale cross-sectional survey in mainland China

AIMS AND OBJECTIVES

To determine the level of and factors in nurses' knowledge, attitudes and behaviours towards pressure injury (PI) prevention.

BACKGROUND

Although there has been a declining trend in global PI prevalence and hospital-acquired rates in recent years, this has not been the case in China. Evidence in the literature indicates the importance of nurses' knowledge, attitudes and behaviours for promoting PI prevention.

DESIGN

Cross-sectional study.

METHODS

A total of 1,806 nurses from 10 tertiary general hospitals in Hunan Province, China, participated in this study. Nurses' knowledge and attitudes were assessed using Pieper's Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, and behaviours were measured using a researcher self-designed questionnaire. Multiple logistic regression analysis determined factors affecting the nurses' PI-prevention knowledge, attitudes and behaviours. A STROBE checklist was used to report findings.

RESULTS

Among all nurses involved in this study, 41.7% had insufficient PI-prevention knowledge, 46.6% had negative PI-prevention attitudes, and 21.8% had poor PI-prevention behaviour. Nurses with a bachelor's degree or above were more likely to have adequate PI-prevention knowledge. Increased PI-prevention training frequency increased the nurses' positive attitude scores for PI prevention; longer years of service and a higher number of PI-prevention trainings attended predicted better PI-prevention behaviours.

CONCLUSION

Chinese nurses' PI-prevention knowledge and attitudes in this study were unsatisfactory, while their PI-prevention behaviour was acceptable. Increasing PI-prevention training frequency can help improve Chinese nurses' PI-prevention attitudes and further behaviour. Having a minimum of a bachelor degree may be beneficial to Chinese nurses' PI-prevention knowledge, but more evidence is needed.

RELEVANCE TO CLINICAL PRACTICE

Chinese nurses have insufficient knowledge about PI-repositioning, inadequate practices in PI nutrition assessment, and low confidence in their personal competence regarding PI-prevention. The key solution for the above issues is to promote ongoing education and training based on strong clinical leadership.

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.

Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis

Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.

Effects of pressure ulcer prevention training among nurses in long-term care hospitals

BACKGROUND

Nurses caring for elderly patients with a high risk of pressure ulcer at long-term care hospitals require the necessary knowledge, behaviors, and attitudes regarding preventing pressure ulcers.

OBJECTIVES

To identify the effects of pressure ulcer prevention training on nurses' knowledge, behaviors, and attitudes regarding pressure ulcer prevention.

DESIGN

A comparison group pretest-posttest design.

SETTINGS

Long-term care hospitals in a metropolitan area of the Republic of Korea.

PARTICIPANTS

Participants were conveniently assigned to team-based learning (n = 30) or lecture-based learning (n = 30) groups.

METHODS

We examined pre-post differences in the scores for pressure ulcer prevention knowledge, behaviors, and attitudes in each group using the paired t-test. Additionally, pre-post difference scores were compared between the two groups using the independent samples t-test.

RESULTS

Both groups exhibited significant increases in scores for pressure ulcer prevention knowledge, behaviors, and attitudes after the intervention as compared before it. However, we found no significant differences in the pre-post difference scores for any of the variables between the two groups.

CONCLUSIONS

Pressure ulcer prevention training, regardless of whether it utilizes team-based or lecture-based learning, is useful for enhancing nurses' pressure ulcer prevention knowledge, behaviors, and attitudes. Further study is needed to verify the longitudinal effects of pressure ulcer prevention training on nurses' actual performance and the incidence of pressure ulcers among patients.

Australian Nurses' Knowledge of Pressure Injury Prevention and Management: A Cross-sectional Survey

PURPOSE:

The aim of this study was to assess nurses' knowledge of pressure injuries in order to gather benchmark data, identify knowledge gaps, and based on results, implement educational strategies to improve practice.

DESIGN:

Cross-sectional survey.

SUBJECTS AND SETTING:

The study setting was a large Australian tertiary general hospital employing approximately 2500 nurses in both full-time and part-time roles. A proportional sample (25%) stratified by experience, preparation, and facility-generated categories (nursing grade) was generated. The sample included nursing students and nursing assistants. Three hundred six participants completing the survey.

INSTRUMENT:

The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZPUKT) version 2, comprising 72 statements, with 3 subscales (prevention/risk, staging, and wound description) was used to measure pressure injury knowledge. Item responses are “True,” “False,” and “Don't know.” For the purpose of analyses, correct responses were scored 1, and incorrect or “don't know” responses were scored 0. Generally accepted ranges of scoring for the original PZPUKT specify less than 70% as unsatisfactory, 70% to 79.9% as satisfactory, 80% to 89.9% as good, and 90% and greater as very good knowledge of pressure injury prevention.

METHODS:

The survey was advertised throughout the hospital by strategically placed posters, computer screen savers within the hospital, and e-mails. Respondents completed paper-based questionnaires and data were manually entered online. Data were collected between September 2015 and October 2016. Descriptive and nonparametric inferential statistical tests (Mann-Whitney U, Kruskal-Wallis H) were used to analyze within sample differences in scores.

RESULTS:

The overall mean knowledge score was 65%; approximately two-thirds of the sample (68%) scored 60% and greater, reflecting an unsatisfactory knowledge level of pressure injury prevention according to the original PZPUKT scores. The lowest mean scores were found in the “wound description” subscale. Participants who sought pressure injury information via the Internet or had read pressure injury guidelines scored significantly higher than those who did not (P = .001 and P < .001, respectively). Seventeen items were answered incorrectly by over half of participants, identifying important knowledge deficits, particularly within the wound description subscale.

CONCLUSIONS:

When compared with results from studies using the PZPUKT, we contend that a cutoff score of 60% and greater (instead of ≥70%) should be used to indicate an overall satisfactory score. Our results identified deficits in pressure injury knowledge related to seating support and seated individuals and wound dressings as areas where nurses would benefit from focused education strategies.

Efficacy of pressure ulcer prevention interventions in adult intensive care units: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Pressure ulcers (PUs) are associated with substantial health burden. Patients in intensive care units (ICUs) are at high risk for developing PU. In the absence of large randomised controlled trials (RCTs) that compare commonly known interventions for preventing PU in ICUs, uncertainty remains around the best practice strategy for PU management in adult ICUs. This study, therefore, aims to identify the most effective interventions and combinations of interventions that prevent PU in adult ICU using systematic review and network meta-analysis (NMA).

METHODS AND ANALYSIS

We will search for all published and unpublished RCTs evaluating interventions to prevent PU compared with other PU prevention measures or with usual care in adult ICU. The primary outcomes are the incidence of PUs and PU severity in critically ill patients in ICU. The secondary outcomes include number of PUs per patient and intervention-related harms caused by the prevention intervention or intervention-related harms. All data extraction will be performed by at least two independent reviewers on the basis of a priori developed extraction form. We will evaluate the risk of bias of the included RCTs in accordance with the Cochrane Collaboration's risk of bias tool, and assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. A standard pairwise meta-analysis and a Bayesian NMA will be conducted to compare the efficacy of different PU prevention interventions. A surface under the cumulative ranking curve will be used to rank the probabilities of each prevention intervention for various outcomes.

ETHICS AND DISSEMINATION

This study will not require the ethics approval as it is a review based on published studies. The findings of this study will be submitted to a peer-reviewed journal for publication. We anticipate that the results of the study will provide the evidence to inform clinicians and guideline developers on determining the best interventions for the prevention of PU in ICU patients.

PROSPERO REGISTRATION NUMBER

CRD42018085562.

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

Introduction

Inadequate knowledge on pressure injury (PI) can have a detrimental effect on preventive care strategies. The aim of this study was to assess the overall knowledge of nurses on PI prevention based on their scores on the Pressure Ulcer Knowledge Assessment Tool (PUKAT) and its subscales in different settings.

Methods

In this systematic review and meta-analysis, databases including Web of Science, Science Direct, Google Scholar, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, knowledge, and their possible combinations. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All of the analyses were performed using STATA v.12 software.

Results

In all three groups (nurses, assistant nurses, and nursing students), the lowest knowledge scores were for prevention measures to reduce the amount of pressure/shear. Nurses' knowledge (55.4%, 95% CI: 42.4-68.4) was higher than that of nursing students (52.7%, 95% CI: 3-49.56) and assistant nurses (42.2%, 95% CI: 16.4-68).

Conclusion

The overall knowledge of nurses on PI prevention was lower than the recommended level (60%). Regular training courses and review of PI prevention guidelines can be useful in updating the knowledge of nurses, especially assistant nurses and nursing students on PI prevention.

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study

AIMS AND OBJECTIVES

To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications.

BACKGROUND

Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking.

DESIGN

Cross-sectional study.

METHODS

A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models.

RESULTS

Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia.

CONCLUSION

Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Knowledge and Attitudes of Nurses Toward Pressure Injury Prevention: A Cross-Sectional Multisite Study

PURPOSE

The purpose of the study was to examine the knowledge and attitudes of nurses on pressure injury prevention and determine if there was a relationship between knowledge, attitude, and years of experience following an unexplained increase in reported hospital-acquired pressure injuries across 1 health district in Sydney, Australia.

DESIGN

Multisite cross-sectional study.

SUBJECTS AND SETTING

Registered and enrolled nurses working in acute, medical, and rehabilitation units in 4 hospitals and 5 community health centers across a local health district.

METHODS

Using a modified version of the Pressure Ulcer Knowledge Test and the Staff Attitude Scale, nurses were invited to complete the survey online or on paper.

RESULTS

A total of 3123 surveys were distributed and 998 were returned yielding a response rate of 32%. Approximately one-third of nurse respondents who participated in the survey had been practicing for 5 to 10 years. Almost 80% of participants scored 33/47 or more (70% or more correct) on the knowledge survey; the mean score was 35.21. The mean score for the attitudes test was 44.43 ± 4.77, out of 55 (80.7%), indicating a positive attitude toward pressure injury prevention. There was a significant positive correlation between nurses' years of experience and attitudes, but there was no correlation between years of experience and knowledge. Knowledge and attitudes were also significantly positively correlated.

CONCLUSIONS

Nurses had sound knowledge and held positive attitudes toward pressure injury prevention. Positive attitudes were associated with greater time spent in the workforce. Additional research is required to examine relationships between knowledge of and attitude toward pressure injury prevention and clinical practice. Further research is also needed to determine if improving knowledge and attitudes results in a sustained reduction of hospital-acquired pressure injuries.

Prevention of heel pressure ulcers among adult patients in orthopaedic wards: an evidence-based implementation project

BACKGROUND

Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.

AIMS

The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel pressure ulcers.

METHODS

The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and involved a sample consisting of 30 adult patients.

RESULTS

Nurses' compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project resulted in more than 50% reduction in stage one heel pressure ulcers.

CONCLUSION

The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.

Prescription of pressure injury preventative interventions following risk assessment: An exploratory, descriptive study

This exploratory, descriptive study aimed to identify and describe the pressure injury preventative interventions prescribed by nurses following the assessment of a patient's pressure injury risk and to compare the prescribed interventions relative to the assessed risk level. A total of 200 inpatients in a tertiary Australian hospital were included. Patients' charts were audited within 24 hours of admission. Data collected included patient characteristics, pressure injury risk assessment score and level, and preventative interventions prescribed. Most patients were assessed as not being at risk, with the largest group of at-risk patients assessed as being at high risk. Some not-at-risk patients were prescribed interventions intended for those at risk, while prescription rates of preventative interventions recommended for those at any level of risk were variable (6%-64%). Significant associations were found between assessed pressure injury risk and preventative intervention prescription. Preventative intervention prescription was inadequate, potentially exposing some patients to pressure injury. However, the association between intervention prescription and risk level suggests that nurses are prescribing interventions relative to risk. A more structured approach to intervention prescription according to risk level, such as a care bundle, may help to improve nurses' preventative intervention prescription and ensure that all at-risk patients receive appropriate preventative interventions.

Development and psychometric validation of PUKAT 2·0, a knowledge assessment tool for pressure ulcer prevention

The aim of this study was to develop a tool to measure the knowledge of nurses on pressure ulcer prevention. PUKAT 2·0 is a revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) developed in 2010 at Ghent University, Belgium. The updated version was developed using state-of-the-art techniques to establish evidence concerning validity and reliability. Face and content validity were determined through a Delphi procedure including both experts from the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) (n = 15). A subsequent psychometric evaluation of 342 nurses and nursing students evaluated the item difficulty, discriminating power and quality of the response alternatives. Furthermore, construct validity was established through a test-retest procedure and the known-groups technique. The content validity was good and the difficulty level moderate. The discernment was found to be excellent: all groups with a (theoretically expected) higher level of expertise had a significantly higher score than the groups with a (theoretically expected) lower level of expertise. The stability of the tool is sufficient (Intraclass Correlation Coefficient = 0·69). The PUKAT 2·0 demonstrated good psychometric properties and can be used and disseminated internationally to assess knowledge about pressure ulcer prevention.