Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses

Student nurses' knowledge levels and attitudes regarding pressure injury prevention

OBJECTIVE

The research was conducted to examine the relationship between student nurses' knowledge levels and attitudes regarding pressure ulcer prevention.

METHOD

The research was registered between 01.05.2022 and 01.12.2022, and the certification studies of the health sciences faculty of a state and a foundation university in Turkey are carried out on a multi-center basis. The lists of the research were created by 426 student pictures. "Nurse Introduction Form", "Pressure Sore Prevention Information Survey" and "Attitude Scale towards Preventing Pressure Ulcers" were used as data collection tools. Data was collected online via Google Forms and the SPPS 24.0 program was evaluated in detail.

RESULTS

It was determined that the PIPK total score of Student Certificates was 18.29 ± 5.98, and the total score of APUP was 33.96 + 4.66. The change analysis results revealed positive aspects and a low-level significant relationship between the average nutrition total knowledge scores and the pressure prevention attitude total scores (p < 0.05).

CONCLUSION

In our study results, it was determined that the pressure values of the certificates and the knowledge scores of the students were insufficient and the attitudes were positive. The values of knowledge and attitudes regarding the nurturing of the values of certificates, starting from student life, states where the necessary knowledge and skills must be acquired in educational programs.

Factors affecting repositioning policy compliance: an integrative review

Objective

To explore the factors affecting nurses’ compliance with repositioning policy.

Methods

An integrative review was conducted following the Whittemore and Knafl methodology to identify the problem related to repositioning policy compliance. We searched the following databases: Coherence Wounds Group Specialized Register (Jan 1997 to Jun 2019), Ovid MEDLINE (Jan 1997 to Jun 2019), EBSCO CINAHL (Jan 1997 to Jun 2019), and Clinical Key database (Jan 2014 to Oct 2018).

Results

The review revealed three factors that influence repositioning compliance: nurse-related factors, patient-related factors, and Environment-related factors.

Conclusions

These factors directly impact one another and, in turn, influence the compliance of nurses to the repositioning policy. However, there is no evidence currently available that explains the collective impact of these factors and how they interact to affect repositioning policy compliance. Nevertheless, all these factors are important and should be considered to enhance and further improve the quality of nursing care and adherence to the repositioning policy.

Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries

Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.

An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation

Background: Pressure ulcers (PUs) are a major burden to individuals, impacting their physical, mental and social wellbeing. While PU prevention is traditionally regarded as a nursing issue, an interprofessional approach has been promoted as best practice. However, little is known about current practice or the knowledge and attitudes of the wider interprofessional team (IPT). Purpose: Pre-designed questionnaires were used to explore knowledge and attitudes with healthcare staff in the community. Methods: Questionnaires were disseminated to all healthcare staff within a community healthcare Trust predominantly via an online tool. Data were analyzed using descriptive and inferential statistics. Results: The median values of all professional groups demonstrated satisfactory attitudes (>75%) and levels of knowledge (>60%) to PU prevention. However, there were differences within and between groups. Management staff demonstrated the most positive attitude to PU prevention (89%), followed by occupational therapists (OTs) and healthcare assistants (HCAs) (87%, IQR: 75%→89%). OTs demonstrated the highest scores for knowledge (69%, IQR: 62%→73%), while healthcare and rehabilitation assistants scored the lowest (58%, IQR: 58%-64%). Conclusion: This study has demonstrated that the majority of healthcare staff in a UK community setting have satisfactory levels of knowledge and attitudes in relation to PU prevention overall. Nevertheless, there were some differences between groups, albeit non-significant. There were also differences between sub-themes of the questionnaires, indicating a greater focus of pressure ulcer treatment over prevention. While PU prevention is widely regarded to be a nursing issue, these findings provide some indication of the potential for an interprofessional approach.

Strategies to support pressure injury best practices by the inter-professional team: A systematic review

Optimal pressure injury (ulcer) management by the inter-professional team requires appropriate health care system and organisational resources, infrastructure, and policies. A systematic review was conducted on pressure injury care-related education and health care system-/organisation-level strategies. A search for relevant articles published between January 2006 and October 2014 was applied to 8 databases. Ultimately, 22 articles pertaining to education and training and 12 articles pertaining to health care system and organisation supports for pressure injury care were included in the systematic review. A lack of pressure injury assessment and management knowledge by health care professionals was an overriding theme in the education literature. Some of the methods preferred for pressure injury education among nurses and physicians included information technology (eg, e-learning) with technology support and the use of high-quality wound pictures. Although the evidence is scarce, the literature did highlight specific system- and organisation-level barriers and enablers that influence practice change, including inter-professional communication and human resource investments. In conclusion, (1) the current evidence on the education and system-level enablers, barriers, and strategies to optimise pressure injury best practices requires further investigation, and (2) multi-faceted, up-stream, evidence-based approaches for pressure injury care are essential to improve health care and patient-related outcomes.

Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators

The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term "quality indicator" regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence-based and internationally comparable indicators to help improve patient care and safety worldwide.

Reduced pressure for fewer pressure ulcers: can real-time feedback of interface pressure optimise repositioning in bed?

The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.

Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument

The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden

The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.

Pressure ulcers: development and psychometric evaluation of the attitude towards pressure ulcer prevention instrument (APuP)

BACKGROUND

Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking.

AIMS AND OBJECTIVES

Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP).

DESIGN

Prospective psychometric instrument validation study.

METHODS

A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008.

RESULTS

A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent pressure ulcers (three items); (2) attitude towards the priority of pressure ulcer prevention (three items); (3) attitude towards the impact of pressure ulcers (three items); (4) attitude towards personal responsibility in pressure ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards pressure ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC=0.88 (95% CI=0.84-0.91, P<0.001)]. For the total instrument, the internal consistency (Cronbachs alpha) was 0.79.

CONCLUSION

The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards pressure ulcer prevention in patient care, education, and research. In further research, the association between attitude, knowledge and clinical performance should be explored.