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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Hillmann K, Blume-Peytavi U, Hahnel E, Sill J, Balzer K, Kottner J. Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial. Int J Nurs Stud 2024; 149:104627. [PMID: 37956524 DOI: 10.1016/j.ijnurstu.2023.104627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package. TRIAL DESIGN A two-arm cluster-randomised controlled trial was conducted. METHODS In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed. RESULTS A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial. CONCLUSIONS The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function. TRIAL REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hillmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Elisabeth Hahnel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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Ott CLB, Brinton CD, Yogaparan T, Dayal T, Vecchio A, Berall A. Skin Tear Management: A Multidisciplinary Education Project. Adv Skin Wound Care 2024; 37:48-55. [PMID: 38117171 DOI: 10.1097/asw.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To identify the number of skin tears present at the authors' facility and evaluate a multidisciplinary educational intervention to support treatment of skin tears. METHODS The authors determined the prevalence of skin tears from an analysis of a wound audit dataset at Baycrest Health Sciences and compared it with the literature to inform the aims of the educational intervention. They developed an educational module and presented it to physicians and students at separate in-person sessions and to clinical care staff at a virtual session. Participants completed an evaluation survey after the education sessions to assess their knowledge and confidence with skin tear management and obtain their feedback about the session. RESULTS The prevalence of skin tears at Baycrest hospital was 5.6%, which was low compared with the values reported in the literature. For the 10 studies reviewed, the median prevalence was 8.8% (range, 3.0%-22.1%). A total of 7 physicians, 12 students, and 7 clinical care staff completed the evaluation survey. All of the physicians (100%), 43% of students, and 57% of clinical care staff could classify an image of a skin tear; 86% of physicians, 33% of students, and 43% of clinical care staff identified the correct skin tear complications; and 71% of physicians, 0% of the students, and 29% of clinical care staff selected the appropriate dressing. Participants reported moderate to considerable increases in knowledge and confidence in skin tear management. CONCLUSIONS This method of multidisciplinary teaching on skin tears was well received and useful in enhancing knowledge and confidence in identifying and treating skin tears.
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Affiliation(s)
- Carol L B Ott
- Carol L. B. Ott, MD, FRCPC, is Geriatrician, Baycrest Health Sciences/Women's College Hospital, and Assistant Professor, University of Toronto, Ontario, Canada. Christopher D. Brinton, BSc, is Research Assistant, Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences and Medical Student at McMaster University, Hamilton, Ontario, Canada. Thirumagal Yogaparan, MD, FRCPC, is Geriatrician, Baycrest Health Sciences, Associate Professor, University of Toronto. Also at Baycrest Health Sciences, Taranvir Dayal, MN, is Advanced Practice Nurse Educator; Adrian Vecchio, MN, is Baycrest Innovation Partner; and Anna Berall, RN, is Project Coordinator, Kunin-Lunenfeld Centre for Applied Research and Evaluation. Acknowledgments: The authors acknowledge and thank Sandra Gardner, PhD, for providing the estimates of skin tear prevalence. This work was completed with a grant from the Academic Health Science Centre Alternative Funding Plan (Project BMS-19-003) to support the research staff in carrying out the study. The authors have disclosed no other financial relationships related to this article. This research was presented as a poster at the Post-Acute and Long-Term Care Conference, Baltimore, Maryland, USA, in March 2022. Submitted October 3, 2022; accepted in revised form February 17, 2023
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Vuorinen M, Ram F. Effectiveness of moisturiser for the prevention of skin tears in older adults residing in long-term care facilities: a clinical review. Br J Community Nurs 2023; 28:S14-S18. [PMID: 37643116 DOI: 10.12968/bjcn.2023.28.sup9.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
In long-term care facilities the treatment of skin tears often takes a lot of nursing time, is costly and can negatively impact the residents' quality of life. The purpose of this clinical review was to investigate whether the application of moisturising lotion is beneficial in skin tear reduction in older adults residing in long-term care facilities. A literature review of original studies investigating the effect of moisturising lotion on skin tears in older adults (65+ years) was conducted. Results indicate that a minimum of twice daily application of moisturising lotion with neutral pH can reduce skin tears by 50% compared to usual care. Therefore, routine skin moisturising is recommended as one component of a skin tear prevention programme for this demogrpahic.
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Affiliation(s)
- Minna Vuorinen
- Clinical Nurse Educator, Oceania Healthcare, New Zealand
| | - Felix Ram
- Director, Center of Excellence for Person-Centered Aged Care, Oceania Healthcare, New Zealand
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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Sill J, Balzer K, Kottner J. Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study. Int J Nurs Stud 2023; 141:104472. [PMID: 36898269 DOI: 10.1016/j.ijnurstu.2023.104472] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time. OBJECTIVES Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents. DESIGN Analysis of baseline data of a cluster-RCT in long-term residential settings. SETTING The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany. PARTICIPANTS Care dependent nursing home residents being 65+ years. METHODS A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted. RESULTS Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo. CONCLUSIONS The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways. REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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Cilluffo S, Bassola B, Beeckman D, Lusignani M. Risk of skin tears associated with nursing interventions: A systematic review. J Tissue Viability 2023; 32:120-129. [PMID: 36577638 DOI: 10.1016/j.jtv.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/08/2022] [Accepted: 11/27/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions. OBJECTIVES To examine which nursing interventions increase the risk of skin tears. DESIGN Systematic review. DATA SOURCES The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022. PUBLICATION YEARS Publications included were from 2012 to 2022. RESULTS Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears. CONCLUSION Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.
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Affiliation(s)
- Silvia Cilluffo
- School of Nursing, University of Milan, ASST GOM Niguarda, Milan, Italy; Department Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy.
| | - Barbara Bassola
- School of Nursing, University of Milan, ASST GOM Niguarda, Milan, Italy
| | - Dimitri Beeckman
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research, Örebro University, Sweden; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium
| | - Maura Lusignani
- School of Nursing, University of Milan, ASST GOM Niguarda, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Feng L, Hu C, Li J, Ying Y, Chen L, Wei H, Liang H, Hu H. The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation. J Tissue Viability 2023; 32:107-113. [PMID: 36543636 DOI: 10.1016/j.jtv.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Skin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent. OBJECTIVE To culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context. METHODS The cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested. RESULTS The content validity index was 0.88-1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71-0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62. CONCLUSIONS The Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.
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Affiliation(s)
- Liuqun Feng
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chen Hu
- Nursing Department, School of Medicine, Zhejiang University, Hangzhou, China
| | - Juyun Li
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yuai Ying
- Nursing Department, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lanpeng Chen
- Kangda College of Nanjing Medical University, Lianyungang, China
| | - Huiyan Wei
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyan Liang
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyang Hu
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Miles SJ, Fulbrook P, Williams DM. Skin tear prevalence in an Australian acute care hospital: A 10-year analysis. Int Wound J 2022; 19:1418-1427. [PMID: 34951125 PMCID: PMC9493203 DOI: 10.1111/iwj.13735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
Hospital-acquired skin tear prevalence is under-reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10-year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital- or community-acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5-10.4) with an associated hospital-acquired pooled prevalence of 5.5% (95% CI 4.5-6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital-acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital-acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation.
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Affiliation(s)
- Sandra J. Miles
- School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health SciencesAustralian Catholic UniversityVirginiaQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health SciencesAustralian Catholic UniversityVirginiaQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Damian M. Williams
- Wound Management, Clinical Effectiveness ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
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9
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Bandeira MA, Schmidt FMQ, Nogueira PC, Rosa T, Felizardo RDM, Villela de Castro DL, Woo K, Santos VLCG. The prevalence of skin tears and associated factors in hospitalised patients with cancer. J Wound Care 2022; 31:579-584. [PMID: 35797254 DOI: 10.12968/jowc.2022.31.7.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Oncology patients are vulnerable to skin breakdown. The primary purpose of this study was to estimate the prevalence of skin tears (STs) in hospitalised patients with cancer and to explore related sociodemographic and clinical factors. METHOD This was an observational, epidemiological, cross-sectional study conducted in an oncology hospital in the city of São Paulo. All STs were classified using the STAR Classification adapted and validated for Brazil. RESULTS Of the 341 patients evaluated, 22 had STs, equating to a prevalence of 6.5%. A higher number of STs were noted on the lower limbs (26.9%) than on other body areas. The main factors associated with STs were the use of anticoagulants, the presence of ecchymosis and the use of incontinence briefs. CONCLUSION This study contributed to a better understanding of the epidemiology of STs in hospitalised patients with cancer, as well as its associated factors. Results may inform nursing professionals with regard to the need to develop prevention strategies and early interventions.
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Affiliation(s)
| | | | - Paula C Nogueira
- Medical-Surgical Nursing Department University of São Paulo, School of Nursing, São Paulo, SP, Brazil
| | - Talita Rosa
- University of São Paulo, School of Nursing, São Paulo, SP, Brazil
| | | | | | - Kevin Woo
- School of Nursing, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Bandeira da Silva CV, da Costa Silva RS, Serna González CV, Hevia Campos HM, Woo K, Nogueira PC, Gouveia Santos VLCD. Epidemiología de los desgarros de piel: revisión bibliográfica. J Wound Care 2022; 31:7-18. [PMID: 36789899 DOI: 10.12968/jowc.2022.31.latam_sup_6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. Método: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. Resultados: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). Conclusión: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. Conflicto de interés: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.
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Affiliation(s)
- Cinthia V Bandeira da Silva
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rayanne S da Costa Silva
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Heidi M Hevia Campos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Escuela de Enfermería, Universidad Andres Bello, Viña del Mar, Chile
| | - Kevin Woo
- Escuela de Enfermería, Universidad de Queens (Queen's University), Kingston, Ontario, Canadá
| | - Paula C Nogueira
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L Conceição de Gouveia Santos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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Bandeira da Silva CV, da Costa Silva RS, Serna González CV, Hevia Campos HM, Woo K, Nogueira PC, Gouveia Santos VLCD. Epidemiología de los desgarros de piel: revisión bibliográfica. J Wound Care 2022; 31:7-18. [PMID: 36787945 DOI: 10.12968/jowc.2022.31.latam_sup_6a.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. Método: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. Resultados: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). Conclusión: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. Conflicto de interés: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.
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Affiliation(s)
- Cinthia V Bandeira da Silva
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rayanne S da Costa Silva
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Heidi M Hevia Campos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Escuela de Enfermería, Universidad Andres Bello, Viña del Mar, Chile
| | - Kevin Woo
- Escuela de Enfermería, Universidad de Queens (Queen's University), Kingston, Ontario, Canadá
| | - Paula C Nogueira
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L Conceição de Gouveia Santos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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12
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Peres GRP, Bandeira da Silva CV, Strazzieri-Pulido KC, de Gouveia Santos VLC. Skin tears in older adult residents of long-term care facilities: prevalence and associated factors. J Wound Care 2022; 31:468-478. [PMID: 35678790 DOI: 10.12968/jowc.2022.31.6.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. METHOD This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. RESULTS A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. CONCLUSION The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.
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13
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Yüceler Kaçmaz H, Karadağ A, Kahraman H, Erat A, Ödek Ö, Akın S. The prevalence and factors associated with skin tears in hospitalized older adults: A point prevalence study. J Tissue Viability 2022; 31:387-394. [DOI: 10.1016/j.jtv.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
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Hickey T, Ayres J. Who should be the first responders for the management of skin tears? J Wound Care 2021; 30:332-336. [PMID: 33979222 DOI: 10.12968/jowc.2021.30.5.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tim Hickey
- Advanced Paramedic, Clinical Lead - Primary & Urgent Care, East of England Ambulance Service NHS Trust, UK
| | - Jason Ayres
- Advanced Paramedic in Urgent Care, Clinical Procurement Specialist, East of England Ambulance Service NHS Trust, UK
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15
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LeBlanc K, Woo K. A pragmatic randomised controlled clinical study to evaluate the use of silicone dressings for the treatment of skin tears. Int Wound J 2021; 19:125-134. [PMID: 33960667 PMCID: PMC8684852 DOI: 10.1111/iwj.13604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
One of the most common types of skin breakdown in ageing populations is skin tears. The International Skin Tear Advisory Panel advocates for special attention to be paid to dressing selection related to skin tear management. The panel recommends choosing dressings that will promote the maintenance of moisture balance, suit the local wound environment, protect peri‐wound skin, control or manage exudate and infection, and optimise caregiver time. It is paramount that dressings protect the fragile nature of the skin associated with those who at heightened risk for skin tear development. To compare the effectiveness of soft silicone dressings (a contact layer and/or foam) for the healing of skin tears with local practices that do not include soft silicone dressings. The study was a pragmatic randomised controlled prospective study. One hundred and twenty‐six individuals from two long‐term care facilities in Ontario Canada who presented with skin tears were randomised into the treatment group using either soft silicone dressings (a contact layer and/or foam) or the control group using non‐adhesive dressings. The current study demonstrated that 96.9% (n = 63) of skin tears in the treatment group healed over a 3‐week period compared with 34.4% (n = 21) in the control group. The proportion of wound healing experienced at week 2 was 89.2% (n = 58) in the treatment group compared with 27.9% (n = 17) in the control group. There was a significantly greater reduction in wound surface area relative to baseline in the treatment group (2.9 cm2) compared with the control group (0.6 cm2) (χ2 = 21.792 P < .0001) at week 1. Survival analysis data supported that skin tears healed 50% faster in the treatment group (11 days) compared with the control group (22 days) (χ2 = 59.677 P < .0001). The expected healing trajectory of acute wounds, including skin tears, if proper wound bed preparation is realised and infection is controlled, is 7 to 21 days. Results of this study suggest the use of silicone dressings support wound healing and aid in wound closure within the expected healing trajectory, with faster complete wound closure and mean healing times compared with non‐silicone dressing for the treatment of STs.
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Affiliation(s)
- Kimberly LeBlanc
- Wound, Ostomy and Continence Institute, Association of Nurses Specialized in Wound Ostomy Continence, Ottawa, Ontario, Canada.,Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kevin Woo
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
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16
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Risk scoring tool for forearm skin tears in Japanese older adults: A prospective cohort study. J Tissue Viability 2021; 30:155-160. [PMID: 33741206 DOI: 10.1016/j.jtv.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.
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Van Tiggelen H, Alves P, Ayello E, Bååth C, Baranoski S, Campbell K, Dunk AM, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Langemo D, LeBlanc K, Ousey K, Pokorná A, Romanelli M, Santos VLCDG, Smet S, Williams A, Woo K, Van Hecke A, Verhaeghe S, Beeckman D. Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countries. J Adv Nurs 2020; 77:1609-1623. [PMID: 33305504 DOI: 10.1111/jan.14713] [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] [Received: 07/25/2020] [Revised: 10/06/2020] [Accepted: 11/18/2020] [Indexed: 12/26/2022]
Abstract
AIM To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). DESIGN Prospective psychometric instrument validation study. METHOD The skin tear knowledge assessment instrument was developed based on a literature review and expert input (N = 19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. RESULTS A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI = 0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01-0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p < .001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.78-0.86) for the full instrument and varied between 0.72 (95% CI = 0.64-0.79) and 0.85 (95% CI = 0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. CONCLUSION The skin tear knowledge assessment instrument is supported by acceptable psychometric properties and can be applied in nursing education, research, and practice to assess knowledge of healthcare professionals about skin tears. IMPACT Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice, and research needs and priorities related to skin tears in clinical practice.
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Affiliation(s)
- Hanne Van Tiggelen
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Catholic University of Portugal, Porto, Portugal
| | - Elizabeth Ayello
- Advances in Skin & Wound Care, Philadelphia, Pennsylvania, USA.,Faculty Emeritus, School of Nursing, Excelsior College, Albany, New York, USA.,Ayello, Harris & Associates, Inc., Copake, New York, USA
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Fredrikstad, Norway
| | - Sharon Baranoski
- Nursing Advisory Board, Rasmussen College, Romeoville/Joliet, Illinois, USA
| | - Karen Campbell
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ann Marie Dunk
- Tissue Viability Unit, Canberra Health Services, Canberra Hospital, Canberra, ACT, Australia.,Synergy Nursing and Midwifery Research Centre, Faculty of Health, University of Canberra and ACT Health, Canberra, ACT, Australia
| | | | - Heidi Hevia
- Nursing School, Nursing Department, Andres Bello University, Santiago, Chile
| | - Samantha Holloway
- Centre for Medical Education, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Wales, UK
| | - Patricia Idensohn
- Centre for Medical Education, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Wales, UK.,CliniCare Medical Centre, Ballito, South Africa.,School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | | | - Diane Langemo
- College of Nursing, University of North Dakota, Grand Forks, North Dakota, USA.,Langemo and Associates, Grand Forks, North Dakota, USA
| | - Kimberly LeBlanc
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Wound Ostomy Continence Institute/Association of Nurses Specialized in Wound Ostomy Continence, Ottawa, ON, Canada.,Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrea Pokorná
- Department of Nursing, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Czech National Centre for Evidence Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marco Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vera Lucia Conceição de Gouveia Santos
- School of Nursing, Medical-Surgical Nursing Department, University of São Paulo, São Paulo, Brazil.,School of Nursing, Portuguese Catholic University, Porto, Portugal
| | - Steven Smet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Wound Care Center, Ghent University Hospital, Ghent, Belgium
| | - Ann Williams
- Wound Ostomy Continence Solutions, LLC, Falls Church, Virginia, USA
| | - Kevin Woo
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.,School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden.,Faculty of Health Sciences, Department of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark.,School of Nursing and Midwifery, Monash University, Clayton, VIC., Australia
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Van Tiggelen H, Kottner J, Campbell K, LeBlanc K, Woo K, Verhaeghe S, Van Hecke A, Beeckman D. Measurement properties of classifications for skin tears: A systematic review. Int J Nurs Stud 2020; 110:103694. [DOI: 10.1016/j.ijnurstu.2020.103694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
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19
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Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, Chang Y, Dunk A, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Koren E, Kottner J, Langemo D, Ousey K, Pokorná A, Romanelli M, Santos V, Smet S, Tariq G, Van den Bussche K, Van Hecke A, Verhaeghe S, Vuagnat H, Williams A, Beeckman D. Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries. Br J Dermatol 2020; 183:146-154. [PMID: 31605618 PMCID: PMC7384145 DOI: 10.1111/bjd.18604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.
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da Silva CVB, Campanili TCGF, Freitas NDO, LeBlanc K, Baranoski S, Santos VLCDG. ISTAP classification for skin tears: Validation for Brazilian Portuguese. Int Wound J 2020; 17:310-316. [PMID: 31755663 PMCID: PMC7948925 DOI: 10.1111/iwj.13271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to evaluate interobserver reliability and the concurrent criterion validity of the adapted version of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System to Brazilian Portuguese. For the evaluation of interobserver reliability using the photograph database, 36 nurses classified 30 skin tears (STs) into three groups, according to its definitions (adapted version). For the evaluation through clinical application, 23 nurses classified 12 STs present in 8 thoracic and cardiovascular postoperative patients at a tertiary hospital in Sao Paulo, Brazil. For the data collection of patients, an enterostomal therapist nurse classified the ST found by simultaneously using the adapted ISTAP version and the Skin Tear Audit Research (STAR) Classification System to test the concurrent criterion validity. The average of 17.83 correct answers (SD = 5.03) resulted from 1080 photograph observations, with Fleiss κ = 0.279 (reasonable concordance level). The interobserver reliability in the clinical application resulted in a global correct answer percentage of 76.7% in 85 observations. The concurrent criterion validity was attested by the total correlation (r = 1) between ISTAP and STAR. The ISTAP classification for ST is a reliable instrument and also valid in Brazil, making it another option to be used in clinical practice.
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Affiliation(s)
- Cinthia V. B. da Silva
- Heart Institute ‐ HCFMUSPSão PauloSPBrazil
- School of Nursing, Medical‐Surgical Nursing DepartmentUniversity of São PauloSão PauloSPBrazil
| | | | | | - Kimberly LeBlanc
- School of Physical Therapy, Advanced Health Care Practice ProgramWestern UniversityOntarioCanada
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21
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Dermoscopic Evaluation of Skin Frailty. J Wound Ostomy Continence Nurs 2019; 46:547-549. [PMID: 31738309 DOI: 10.1097/won.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Feng H, Wu Y, Su C, Li G, Xu C, Ju C. Skin injury prevalence and incidence in China: a multicentre investigation. J Wound Care 2019; 27:S4-S9. [PMID: 30307811 DOI: 10.12968/jowc.2018.27.sup10.s4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: To quantify the prevalence and incidence of different skin injuries, pressure ulcers (PU), skin tears (ST) and incontinence-associated dermatitis (IAD) in China, and to identify their causes to aid prevention and control. METHOD: A cross-sectional observational study was conducted across nine tertiary hospitals. Registered nurses were trained on a standard approach to injury assessment and examination. The study was carried out at the same time on the same day across the participating centres. Participating patients were examined for PU, ST or IAD. RESULTS: A total of 13,176 inpatients were assessed and 233 PU were identified, of which 126 occurred in hospitals, 99 cases at home and eight cases within community hospitals. In addition, there were 141 skin tears and 97 IADs. CONCLUSION: This study involved the largest number of hospitals, to date (in China). Therefore, the prevalence and rate of incidence of skin injury obtained in this study may represent a regional baseline in China.
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Affiliation(s)
- Haixia Feng
- Director Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Yanping Wu
- Head Nurse; Geriatric Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Chang Su
- Professor; Statistical Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Guohong Li
- Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Cuirong Xu
- Deputy Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Changping Ju
- Chief Nurse; Lishui Country People's Hospital, The Group Hospital, Zhongda Hospital, School of Medicine, Southeast University, China
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LeBlanc K, Langemo D, Woo K, Campos HMH, Santos V, Holloway S. Skin tears: prevention and management. Br J Community Nurs 2019; 24:S12-S18. [PMID: 31479335 DOI: 10.12968/bjcn.2019.24.sup9.s12] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Skin tears commonly occur at the extremes of age and are associated with skin changes in ageing skin. They are considered to be acute wounds caused by mechanical forces, such as blunt trauma. While the true prevalence and incidence of skin tears is unknown, the available evidence suggests that these wounds occur in all healthcare settings. Importantly, skin tears are preventable with the implementation of a risk-reduction programme, which includes twice-daily skin moisturisation. Where these injuries do occur, it is important to categorise the extent of damage as well as to choose the most appropriate dressing to avoid adding any risks for further trauma.
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Affiliation(s)
- Kim LeBlanc
- Chair Wound, Ostomy and Continence Institute, Canada
| | | | - Kevin Woo
- Associate Professor, Schools of Nursing and Rehabilitation Therapy, Queen's University, Kingston, Canada; Advanced Wound Consultant, West Park Health Center, Toronto, Canada
| | - Heidi Marie Hevia Campos
- Stoma Therapy Nurse Specialist, Assistant Professor, Universidad Andrés Bello, Viña del Mar, Chile
| | - Vera Santos
- Certified Stoma Therapy Nurse (TiSOBEST Emerit); Full Professor in School of Nursing, University of São Paulo, Brazil
| | - Samantha Holloway
- Reader, Programme Director MSc in Wound Healing and Tissue Repair, Cardiff University School of Medicine, UK
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24
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The prevalence and associated factors of skin tears in Belgian nursing homes: A cross-sectional observational study. J Tissue Viability 2019; 28:100-106. [DOI: 10.1016/j.jtv.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/29/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
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25
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Porter M. No tears for skin tears. Br J Community Nurs 2018; 23:478-480. [PMID: 30290727 DOI: 10.12968/bjcn.2018.23.10.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Michelle Porter
- Tissue viability clinical nurse specialist, Lincolnshire Community Health Services
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26
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Chaplain V, Labrecque C, Woo KY, LeBlanc K. French Canadian translation and the validity and inter-rater reliability of the ISTAP Skin Tear Classification System. J Wound Care 2018; 27:S15-S20. [DOI: 10.12968/jowc.2018.27.sup9.s15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Kevin, Y. Woo
- School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario
| | - Kimberly LeBlanc
- Chair, Wound Ostomy Continence Institute, Association of Nurses Specialised in Wound Ostomy Continence, Ottawa
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