Finnish and Swedish prehospital emergency care providers' knowledge and attitudes towards pressure ulcer prevention

BACKGROUND

Despite the knowledge that transportation by emergency medical services may increase the risk of pressure ulcers (PU), there is still lack of knowledge about the possibility of prehospital emergency care providers to be a part of preventing and reducing the risk of PUs.

METHODS

A survey was carried out during 2017 in Finland and Sweden. Validated questionnaires were used.

RESULTS

A total of 179 (72.7%) Finnish and 188 (28.8%) Swedish prehospital emergency care providers participated in the study. The overall rate of correct answers and the mean total knowledge score was 58.8% (SD 21.8), 20/34, in the Finnish group and 70.5% (SD 15.7), 24/34, in the Swedish group (p < 0.000). The percent of the total and the mean attitude score was in the Finnish group 71.3% (SD 0.48), 37.1/52, and in the Swedish group 69.4% (SD 0.77), 36.1/52 (p < 0.813). Half of the Finnish and most of the Swedish participants felt they needed more education about PUs (Fin 50.2% & Swe: 76.0%).

CONCLUSIONS

Prehospital emergency care providers don't see themselves as responsible for PU prevention. Therefore, there is a need for increasing the level of knowledge on PU prevention and classification among prehospital emergency care providers. They could play a key role in developing methods to improve PU prevention and identifying patients in risk of developing PUs.

Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review

The effective approach on pressure ulcer (PU) prevention regarding patient safety in the hospital context was evaluated. Studies were identified from searches in EBSCO host, PubMed, and WebofScience databases from 2009 up to December 2018. Studies were selected if they were published in English, French, Portuguese, or Spanish; incidence of PUs was the primary outcome; participants were adults (≥18 years) admitted in hospital wards and/or units. The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on-screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs. Repositioning only was effective when supported by technological pressure-mapping feedback or by a patient positioning system. Risk-assessment tools are not effective in preventing PUs. PUs in the hospital context are still a worldwide issue related to patient safety. Multiple intervention programmes were more effective in decreasing PU occurrence than single interventions in isolation. Single interventions (prophylactic dressings, support surfaces, repositioning, preventive skin care, system reminders, and education for health care professionals) were effective in decreasing PUs, which was always in compliance with other preventive measures. These results provide an overview of effective approaches that should be considered when establishing evidence-based guidelines to hospital health care professionals and administrators for clinical practice effective in preventing PUs.

Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study

BACKGROUND

Inserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement.

OBJECTIVE

To determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence.

DESIGN

Cross-sectional.

SETTINGS

The study was carried out (March-September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna).

PARTICIPANTS

A convenience sample of NSs (n = 1056) was involved.

METHODS

We collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample.

RESULTS

Most participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%). In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores. "Infusionset removal after 24 h when lipids or blood products are administered" (75.4%).

CONCLUSIONS

NSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.

Pressure Ulcers Prevalence in the Acute Care Setting: A Systematic Review, 2000-2015

Little is known about the prevalence of pressure ulcer (PrU) in acute care settings. The aim of this study is to determine the prevalence rate of PrU in acute care settings and to assess the methodological quality of the reviewed publications. The Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, MEDLINE, and Cochrane Database of Systematic Reviews were searched using the keywords pressure ulcer or decubitus ulcer or bed sore or pressure sore or pressure injury, with prevalence and acute care, for studies published between January 2000 and December 2015. Nineteen publications met our criteria. These reported a prevalence range of between 7.8% and 54% for those using European Pressure Ulcer Advisory Panel methodology, 6% and 22% for those using National Pressure Ulcer Advisory Panel methodology, and 4.94% for the study that employed the Torrance system. The likely worldwide PrU prevalence rate range in acute care settings is between 6% and 18.5%. Prevalence rate varies between studies depending on the methodology of data collection. Moreover, the methodological quality of the included studies in the review was variable; therefore, it was difficult to compare the prevalence rate between the studies, settings, and countries.

Universal Pressure Ulcer Prevention Bundle With WOC Nurse Support

PURPOSE

This study examined the effectiveness of a universal pressure ulcer prevention bundle (UPUPB) applied to intensive care unit (ICU) patients combined with proactive, semiweekly WOC nurse rounds. The UPUBP was compared to a standard guideline with referral-based WOC nurse involvement measuring adherence to 5 evidence-based prevention interventions and incidence of pressure ulcers.

DESIGN

The study used a quasi-experimental, pre-, and postintervention design in which each phase included different subjects. Descriptive methods assisted in exploring the content of WOC nurse rounds.

SUBJECT AND SETTING

One hundred eighty-one pre- and 146 postintervention subjects who met inclusion criteria and were admitted to ICU for more than 24 hours participated in the study. The research setting was 3 ICUs located at North Memorial Medical Center in Minneapolis, Minnesota.

METHODS

Data collection included admission/discharge skin assessments, chart reviews for 5 evidence-based interventions and patient characteristics, and WOC nurse rounding logs. Study subjects with intact skin on admission identified with an initial skin assessment were enrolled in which prephase subjects received standard care and postphase subjects received the UPUPB. Skin assessments on ICU discharge and chart reviews throughout the stay determined the presence of unit-acquired pressure ulcers and skin care received. Analysis included description of WOC nurse rounds, t-tests for guideline adherence, and multivariate analysis for intervention effect on pressure ulcer incidence. Unit assignment, Braden Scale score, and ICU length of stay were covariates for a multivariate model based on bivariate logistic regression screening.

RESULTS

The incidence of unit-acquired pressure ulcers decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6 months, focusing primarily on early detection of pressure sources. Data analysis revealed significantly increased adherence to heel elevation (t = -3.905, df = 325, P < .001) and repositioning (t = -2.441, df = 325, P < .015). Multivariate logistic regression modeling showed a significant reduction in unit-acquired pressure ulcers (P < .001). The intervention increased the Nagelkerke R-Square value by 0.099 (P < .001) more than 0.297 (P < .001) when including only covariates, for a final model value of 0.396 (P < .001).

CONCLUSION

The UPUPB with WOC nurse rounds resulted in a statistically significant and clinically relevant reduction in the incidence of pressure ulcers.

Pressure Injury Prevention in a Saudi Arabian Intensive Care Unit: Registered Nurse Attitudes Toward Prevention Strategies and Perceived Facilitators and Barriers to Evidence Implementation

PURPOSE

The purpose of this study was to examine RNs' attitudes toward pressure injury (PI) prevention strategies. Barriers and facilitators perceived by RNs to potentially impact on the adoption and implementation of PI prevention interventions in the intensive care unit (ICU) were examined.

DESIGN

Descriptive cross-sectional survey.

SUBJECTS AND SETTING

The target population was RNs practicing in an intensive care unit (ICU) of a major tertiary hospital, King Abdul-Aziz, Mecca, in Saudi Arabia. Fifty-six of the available 60 ICU RNs participated in this study.

METHODS

Data were collected via survey using the Attitude towards Pressure injury Prevention instrument, which included 13 items rated with 4-point Likert scale, and the modified Barriers and Facilitators tool, which included 27 items. The survey was organized into 3 parts: demographic information, potential barriers to optimal skin care, and potential facilitators to skin care. The survey took 10 to 15 minutes to complete. Data were analyzed with descriptive-correlation statistics and multiple regression analysis. Thematic analysis was undertaken for qualitative data.

RESULTS

Participants demonstrated positive attitudes toward PI prevention (μ = 38.19/52; 73.44%). No significant differences were found between demographic characteristics of the participants with the RNs' Attitude subscale and perceived barriers and facilitators associated with implementing PI prevention in the critical care setting. Several barriers influenced the ability of RNs to implement PI prevention strategies including time demands (β = .388; P = .011), limitation of RNs' knowledge (β = -.632; P = .022), and current documentation format (β = .344; P = .046). Statistically significant facilitating factors that increased respondents ability to undertake PI prevention were ease of obtaining pressure-reduction surfaces (β = -.388; P = .007), collaboration with interdisciplinary teams (β = .37; P = .02), and availability of appropriate skin care products (β = .44; P = .015). Thematic analysis of open-ended questions highlighted workload as a barrier that impedes the implementation of care specific to PI prevention.

CONCLUSION

Findings from this study highlighted that ICU RNs had a positive attitude toward PI prevention. This study also identified perceived factors influencing PI prevention in the ICU, both facilitators and barriers. Perceived facilitators included availability of pressure-relieving support surfaces and appropriate skin care products and collaboration with the healthcare professional team. However, perceived barriers included limited PI prevention knowledge of the nurse and RN workflow (time demands and documentation format). Findings from this study provide important information identifying context-specific factors that may influence the adoption and implementation of PI prevention interventions in the ICU.

Nursing students' knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study

BACKGROUND

Pressure ulcers still remain a significant problem in many healthcare settings. Poor knowledge and negative attitudes toward pressure ulcer prevention could undesirably affect preventive care strategies.

OBJECTIVE

To assess both knowledge and attitudes among nursing students on Pressure Ulcer Prevention Evidence-Based Guidelines.

DESIGN

A multicenter cross-sectional survey was carried out from December 2012 to August 2013.

SETTINGS

The study was carried out in seven Italian nursing schools.

PARTICIPANTS

We involved a convenience sample of nursing students (n=742) METHODS: Data were collected using two validated questionnaires to assess students' knowledge and attitudes on pressure ulcer prevention.

RESULTS

The overall Knowledge and Attitude scores were 51.1% (13.3/26) and 76.7% (39.9/52), respectively. We found a weak correlation between total Knowledge scores and total Attitude scores (rho=0.13, p<0.001). We also observed that nursing students' year of education, training experience and number of department frequented during their clinical placement were significantly related to both the Knowledge and the Attitude total scores (p<0.05).

CONCLUSIONS

Nursing students' knowledge on pressure ulcer prevention was relatively low. However, we observed an association between a high level of education/training experience and higher knowledge scores. Most of the participants showed high attitude scores. These results suggest that positive attitudes toward pressure ulcer prevention may contribute to the compliance with the guidelines in clinical practice.

What factors do senior community nurses (Grade 7) consider in the provision of effective pressure ulcer preventative care in older aged patients?

This research identifies the views of senior community nurses (Grade 7, often known as District Nurse Team Leaders) in relation to the different service descriptions of pressure ulcer preventative care for older people. The discrete choice experiment (DCE) approach was employed. Scenarios were developed based on: ease of treatment management, impact of treatment on patient lifestyle, affordability of treatment, strength of current evidence and speed for obtaining the equipment. These scenarios were identified from focus discussions and incorporated into a self-administered questionnaire. This questionnaire was posted to 124 nurses in Wales, UK and regression analysis was applied to 85 consistent responses. The results demonstrate that the most preferred treatments are affordable, evidence-based and manageable, and use readily obtainable equipment. The impact of treatment was not significant for this experiment. The usefulness of the DCE approach in the nursing context is discussed in relation to this study.

Pressure ulcer prevention knowledge among Jordanian nurses: a cross- sectional study

Background

Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses.

Methods

Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master’s level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention.

ANOVA and t-test analysis were used to test the differences in nurses’ knowledge according to participants’ characteristics. Means, standard deviation, and frequencies were used to describe nurses’ knowledge levels, knowledge sources, and barriers to pressure ulcer prevention.

Results

The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5–17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention.

Conclusions

This study highlights concerns about Jordanian nurses’ knowledge of pressure ulcer prevention. The results of the current study showed inadequate knowledge among Jordanian nurses about pressure ulcer prevention based on National Pressure Ulcer Advisory Panel guidelines. Also, the low level of nurses’ pressure ulcer knowledge suggests poor dissemination of pressure ulcer knowledge in Jordan, a suggestion supported by the lack of relationship between years of experience and pressure ulcer knowledge.

Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors

Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting. A mixed methods approach was used to describe nurses' perceptions of individual and organization-level factors influencing performance of PUP in two Veterans Health Administration (VHA) nursing homes prior to implementation of a national VHA initiative on Hospital Acquired Pressure Ulcers (HAPUs). Individual interviews of 16 nursing staff were conducted. Individual factors influencing practice were a personal sense of responsibility to Veterans and belief in the effectiveness and importance of preventive measures. Organizational factors were existence of cooperative practices between nursing assistants and licensed nurses in assessing risk; teamwork, communication, and a commitment to Veterans' well-being. Integration and reinforcement of such factors in the development and maintenance of customized plans of PUP initiatives is recommended.

Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands

Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework.

Translating research into practice in nursing homes: can we close the gap?

PURPOSE

A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model.

DESIGN AND METHODS

The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices.

RESULTS

A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature.

IMPLICATIONS

NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in Belgian hospitals

BACKGROUND

Evidence-based guidelines for pressure ulcer prevention have been developed and promoted by authoritative organizations. However, nonadherence to these guidelines is frequently reported. Negative attitudes and lack of knowledge may act as barriers to using guidelines in clinical practice.

AIMS

To study the knowledge and attitudes of nurses about pressure ulcer prevention in Belgian hospitals and to explore the correlation between knowledge, attitudes, and the application of adequate prevention.

METHODS

A cross-sectional multicenter study was performed in a random sample of 14 Belgian hospitals, representing 207 wards. Out of that group, 94 wards were randomly selected (2105 patients). Clinical observations were performed to assess the adequacy of pressure ulcer prevention and pressure ulcer prevalence. From each participating ward, a random selection of at least five nurses completed an extensively validated knowledge and attitude instrument. In total, 553 nurses participated. A logistic regression analysis was performed to evaluate the correlation between knowledge, attitudes, and the application of adequate prevention.

RESULTS

Pressure ulcer prevalence (Category I-IV) was 13.5% (284/2105). Approximately 30% (625/2105) of the patients were at risk (Bradenscore <17 and/or presence of pressure ulcer). Only 13.9% (87/625) of these patients received fully adequate prevention whilst in bed and when seated. The mean knowledge and attitude scores were 49.7% and 71.3%, respectively. The application of adequate prevention on a nursing ward was significantly correlated with the attitudes of the nurses (OR = 3.07, p = .05). No independent correlation was found between knowledge and the application of adequate prevention (OR = 0.75, p = .71).

CONCLUSIONS

Knowledge of nurses in Belgian hospitals about the prevention of pressure ulcers is inadequate. The attitudes of nurses toward pressure ulcers are significantly correlated with the application of adequate prevention. No correlation was found between knowledge and the application of adequate prevention.

Comparação de escalas de avaliação de risco para úlcera por pressão em pacientes em estado crítico

OBJETIVO: Comparar as escalas de risco para úlcera por pressão de Norton, Braden e Waterlow entre pacientes em estado crítico. MÉTODOS: Estudo exploratório e longitudial abrangendo 42 pacientesque foram avaliados, por 15 dias ou pelo menos 10 dias consecutivos, em três Unidades de Terapia Intensiva de Fortaleza-Brasil, no período de março a julho de 2009. Cada paciente foi avaliado, simultaneamente, por três enfermeiros, sendo cada um responsável pela aplicação de apenas uma das escalas. RESULTADOS: Houve uma incidência de 59,5% de lesões e um aumento na pontuação das escalas de Norton (p=0,028) e Braden (p=0,004), entre os 1º-15º dias, e de Waterlow (p=0,005) entre os 1º-10º. Quando comparadas a Norton e Braden, os escores de Waterlow aumentaram constantemente (p<0,001). Os pacientes com alto e altíssimo risco, 2% e 92%, respectivamente, desenvolveram lesões (p=0,005). CONCLUSÃO: A escala de Waterlow apresentou maiores escores na avaliação do risco para úlcera por pressão em relação às escalas de Norton e Braden.