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Lee YN, Chang SO. How experienced wound care nurses conceptualize what to do in pressure injury management. BMC Nurs 2023; 22:189. [PMID: 37277750 DOI: 10.1186/s12912-023-01364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Conceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management. METHODS A qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants' experience of pressure injury management. RESULTS The analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: "comparison", "consideration", and "monitoring" in assessment, and "creation", "conversation" and "judgement" in intervention. CONCLUSIONS This study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses' pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.
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Affiliation(s)
- Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, 145, Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
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Kindie Abate H, Birhanu Yohanes Y, Hailu Gebrie M. Clinical decision making approaches and associated factors among nurses working in a tertiary teaching hospital. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lei YY, Zhu L, Sa YTR, Cui XS. Effects of high-fidelity simulation teaching on nursing students' knowledge, professional skills and clinical ability: A meta-analysis and systematic review. Nurse Educ Pract 2022; 60:103306. [PMID: 35202957 DOI: 10.1016/j.nepr.2022.103306] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This meta-analysis was designed to systematically determine the effect of high-fidelity simulation teaching on nursing students' knowledge level, professional skill level and clinical ability. BACKGROUND High-fidelity simulation is an increasingly popular pedagogical approach in nursing education. It provides students with opportunity to practice in a variety of simulations before entering clinical practice through a variety of real-life situational experiences and many institutions and educators have embraced this method for enhancing access to clinical skills. However, evidence for the effectiveness of the method in nursing teaching remains scarce. DESIGN A meta-analysis and systematic review. METHODS The following Chinese and English databases were searched for relevant articles: PubMed, Embase, Cochrane library, Web of Science, CNKI (China National Knowledge Infrastructure) and Wangfang. The search encompassed the establishment of these databases up until November 2021. Two reviewers separately entered the data into Review Manager Software 5.3. RESULTS A total of 15 studies were included in this study. High-fidelity simulation significantly increased nursing students' knowledge acquisition (SMD = 1. 37, 94%CI:0. 73-2. 00,P <0. 0001), enhanced nursing students'professional skills (SMD = 0. 90, 95%CI:0. 36-1. 44,P = 0. 0001). In terms of clinical practice ability outcomes, high-fidelity simulation significantly improved the levels of critical thinking ability (SMD = 0. 58, 95%CI:0. 09-1. 07,P <0. 00001), Clinical judgement ability (SMD = 1. 34, 95%CI:0. 38-2. 31,P=0. 006) and communication skills (SMD = 2. 62, 95%CI:1. 84-3. 40,P <0. 001) of nursing students. CONCLUSIONS We found that high-fidelity simulation have strong educational effects in nursing education, helping nursing students to increase knowledge acquisition, enhance professional skills and cultivate their clinical practice ability (critical thinking ability, communication skills and clinical judgement ability). These findings can provide guidance for nursing educators, indicating that the use of High-fidelity simulation teaching represents an effective solution for transitioning students from the learning environment to clinical practice.
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Affiliation(s)
- Yan-Yuan Lei
- School of Nursing, Yanbian University, 977 Park Road, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
| | - Li Zhu
- School of Nursing, Yanbian University, 977 Park Road, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
| | - Ya Tuo Ren Sa
- School of Nursing, Yanbian University, 977 Park Road, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
| | - Xiang-Shu Cui
- School of Nursing, Yanbian University, 977 Park Road, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
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Stan D, Tanase C, Avram M, Apetrei R, Mincu NB, Mateescu AL, Stan D. Wound healing applications of creams and "smart" hydrogels. Exp Dermatol 2021; 30:1218-1232. [PMID: 34009648 PMCID: PMC8453519 DOI: 10.1111/exd.14396] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/15/2021] [Indexed: 12/11/2022]
Abstract
Although superficial wounds are often easy to treat for healthy individuals, there are some more severe types of wounds (burns, ulcers, diabetic wounds, etc.) that are a challenge for clinicians. A good therapeutic result is based on the delivery of a treatment at the right time, for the right patient. Our goal was to sum up useful knowledge regarding wound healing and wound treatments, based on creams and hydrogels with various active ingredients. We concluded that both preparations have application in preventing infections and promoting healing, but their efficacy is clearly conditioned by the type, depth, severity of the wound and patient profile. However, due to their superior versatility and capability of maintaining the integrity and functionality of the active ingredient, as well as it is controlled release at site, hydrogels are more suited for incorporating different active ingredients. New wound healing devices can combine smart hydrogel dressings with physical therapies to deliver a more efficient treatment to patients if the indications are appropriate.
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Affiliation(s)
- Diana Stan
- DDS Diagnostic, Bucharest, Romania.,Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Cristiana Tanase
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania.,Biochemistry - Proteomics Department, Victor Babes National Institute of Pathology, Bucharest, Romania
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González-de la Torre H, Verdú-Soriano J, Quintana-Lorenzo ML, Berenguer-Pérez M, Lavín RS, Soldevilla-Ágreda J. Specialised wound care clinics in Spain: distribution and characteristics. J Wound Care 2020; 29:764-775. [PMID: 33320747 DOI: 10.12968/jowc.2020.29.12.764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. METHOD This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. RESULTS A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). CONCLUSION The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.
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Affiliation(s)
- Héctor González-de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - María L Quintana-Lorenzo
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - Raquel Sarabia Lavín
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Cantabria, Santander, Spain
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Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care. PLoS One 2018; 13:e0190045. [PMID: 29320522 PMCID: PMC5761849 DOI: 10.1371/journal.pone.0190045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients’ wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals. Methods We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence. Results The most common uncertainty type was ‘interventions’ 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence. Conclusions Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.
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Piaggesi A, Sambataro M, Nicoletti C, Goretti C, Lacopi E, Coppelli A. Safety and effectiveness of therapeutic magnetic resonance in diabetic foot ulcers: a prospective randomised controlled trial. J Wound Care 2017; 25:704-711. [PMID: 27974006 DOI: 10.12968/jowc.2016.25.12.704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To test the efficacy and safety of therapeutic magnetic resonance (TMR) in the management of diabetic foot ulcers (DFU), the authors designed a prospective randomised controlled trial in three highly specialised diabetic foot clinics. METHOD All the patients consecutively visited in a period of 18 months were screened according to the inclusion (presence of an ulcer >1 cm2 in the foot lasting at least 6 weeks; ABPI>0.6; consent to participate in the study) and exclusion (Charcot's foot; local or systemic infections; chronic renal failure; any wearable electrically-driven life-supporting device) criteria. Patients, who were treated according to international guideline protocols, were randomised into two groups: group A received for four weeks the sham application of TMR, while group B received the active TMR for the same period. People were followed-up to 10 weeks and healing rate (HR), healing time (HT), rate of granulation tissue on wound bed (% GT), reduction of the area of the lesion (∆AL) and a score (0-3) evaluating erythema, oedema, pain and tenderness, respectively, were measured. Adverse events (AE) were registered and monitored throughout the study. RESULTS No differences were observed in HR, HT and ∆AL between the two groups during follow-up, while % GT and the scores for erythema, oedema and pain at 10 weeks showed significant (p<0.05) improvements in group B compared with group A and versus baseline. When restricted to non-ischaemic patients (ABPI>0.8), ∆AL was significantly (p<0.05) more pronounced in group B than in group A. No difference in AE occurrence was observed between the two groups. CONCLUSION Our study, despite not being able to demonstrate the effectiveness of TMR on healing rate at 10 weeks, with 4 weeks of active treatment in neuro-ischaemic DFUs, shows positive effects on clinical aspects of the DFU and is associated with a significant increase of GT in the wound bed. DECLARATION OF INTEREST The study has been fully sponsored by Thereson S.p.A., manufacturer of TMR devices.
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Affiliation(s)
- A Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - M Sambataro
- Metabolism Disease and Clinical Nutrition Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - C Nicoletti
- Diabetic Foot Service, Casa di Cura Pederzoli, Peschiera del Garda, Italy
| | - C Goretti
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - E Lacopi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - A Coppelli
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
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Abdelrahman I, Moghazy A, Abbas A, Elmasry M, Adly O, Elbadawy M, Steinvall I, Sjoberg F. A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy. J Plast Reconstr Aesthet Surg 2016; 69:1121-7. [PMID: 27289482 DOI: 10.1016/j.bjps.2016.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/22/2016] [Accepted: 04/24/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects. PATIENTS AND METHODS Thirty consecutive adult (>15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff. RESULTS One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p < 0.001) and perioperative billed charges cost by 54% (779 USD) (p < 0.001), and shorter total hospital stay (36.5 days; p < 0.001), inpatient postsurgical care duration (6.4 days; p < 0.001), operating time (4.3 h; p < 0.001) and fewer scrub staff (2.2 persons; p < 0.001). CONCLUSION These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects.
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Affiliation(s)
- Islam Abdelrahman
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt; The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Amr Moghazy
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt
| | - Ashraf Abbas
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt
| | - Moustafa Elmasry
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt; The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Osama Adly
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt
| | - Mohamed Elbadawy
- Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt
| | - Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Burn Centre, Department of Hand, Plastic Surgery and Intensive Care, Linköping University, Linköping, Sweden
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