Psychometric Properties of the Chinese Version of the Pieper-Zulkowski Pressure Ulcer Knowledge Test in Nursing Practice: A Cross-sectional Survey.

OBJECTIVE: To translate the Pieper-Zulkowski Pressure Ulcer Knowledge Test into Chinese and analyze the internal consistency of the adapted questionnaire. METHODS: The Pieper-Zulkowski Pressure Ulcer Knowledge Test was translated into Chinese, and the internal consistency and content validity of the translated test were assessed. Further, the authors conducted a cross-sectional survey using the test among 476 RNs in six hospitals in four cities of China. MAIN RESULTS: The Cronbach α was .93 for all items and .83, .82, and .84 for the prevention, staging, and wound description subscales, respectively. The validity of content was acceptable (content validity index = 0.83-1.00). The average correct scores were as follows: total, 69.37%; prevention, 73.38%; staging, 69.61%; and wound description, 64.87%. Nurses with more advanced professional titles or wound care certifications scored significantly higher than other test takers. Participants who had conducted internet research about pressure injuries or read the pressure injury guidelines also had significantly higher scores than those who had not. CONCLUSIONS: The translated instrument can effectively measure Chinese nurses' knowledge about pressure injuries.

Understanding Moisture-Associated Skin Damage, Medical Adhesive-Related Skin Injuries, and Skin Tears.

GENERAL PURPOSE: To provide information on superficial skin issues related to moisture-associated skin damage, medical adhesive-related skin injury, and skin tears. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Examine the anatomy of skin, including changes that occur from aging and chronic wounds.2. Identify issues related to moisture-associated skin damage, medical adhesive-related skin injury, and skin tears, including techniques for prevention. ABSTRACT: The purpose of this continuing education article is to examine the superficial skin issues related to moisture-associated damage, medical adhesive-related skin injury, and skin tears. Similarities, differences, prevention, and treatment will be described.

Educating Nurses in the United States about Pressure Injuries.

GENERAL PURPOSE: To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. ABSTRACT: Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.

Secondary analysis of office of inspector general's pressure ulcer data: incidence, avoidability, and level of harm.

PURPOSE: To provide information about a secondary analysis of pressure ulcer data regarding incidence, avoidability, and level of harm. TARGET AUDIENCE: This continuing activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Summarize the data provided in the Office of Inspector General (OIG) study regarding incidence of pressure ulcers (PrUs) found in hospitals and skilled nursing facilities (SNFs).2. Identify the classification systems used that designate levels of harm to patients and the avoidability of PrUs. OBJECTIVE: To investigate in greater detail the government data on pressure ulcer (PrU) incidence, avoidability, and level of harm. DESIGN: The authors performed a secondary analysis of PrU data published in 2 studies by the Office of Inspector General (OIG) on adverse events in hospitals and skilled nursing facilities (SNFs). SETTING: Acute care hospitals and Medicare-certified SNFs across the United States. PATIENTS: The hospital sample included 780 Medicare beneficiaries randomly selected from 999,645 discharges during October 2008. The SNF population included 653 Medicare beneficiaries randomly selected from 100,771 patients whose stay began within 1 day of hospital discharge, who had a length of stay of 35 days or less, and whose stay ended in August 2011. MAIN OUTCOME MEASURES: Pressure ulcer incidence with stage, location, avoidability, and level of harm using the Modified National Coordinating Council for Medication Errors Reporting and Prevention Index. MAIN RESULTS: The PrU incidence in hospitals was 2.9%, and the incidence in SNFs was 3.4%. Most PrUs were Stages I and II, with 78.3% in hospitals and 54.5% in SNFs. The avoidability of PrUs was similar in both locations, with 39.1% unavoidable in hospitals and 40.9% unavoidable in SNFs. All hospital-acquired PrUs and 90.9% of SNF-acquired PrUs were designated level E on the National Coordinating Council for Medication Errors Reporting and Prevention Index, indicating a temporary harm event. CONCLUSIONS: The OIG studies captured few Stage III PrUs and no Stage IV PrUs, and they underestimate the level of harm generated from PrUs in hospitals and SNFs. The studies offer a structured algorithm for avoidability determination, but lack measures of reliability and validity. Nonetheless, the high rate of unavoidable ulcers leads to questions on the reliability of PrUs as a quality indicator. There are several weaknesses in OIG methodology with regard to PrUs; however, its structured algorithm can be viewed as a starting point for future studies of PrU avoidability.

Practice implications for peristomal skin assessment and care from the 2014 world council of enterostomal therapists international ostomy guideline.

All persons with an ostomy are at risk for development of peristomal skin problems. This is true regardless of the person's nation of residence, type of stoma, or supplies available for stoma care. There are measures that can be taken to lessen the potential for peristomal skin problems. These measures include preoperative stoma site marking, preoperative education, appropriate pouch/barrier fitting, and pouch maintenance. The 2014 World Council of Enterostomal Therapists International Ostomy Guideline includes recommendations that can be implemented to prevent situations that may lead to peristomal skin complications.

The Pieper-Zulkowski pressure ulcer knowledge test.

OBJECTIVE: To describe the development and initial testing of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT). DESIGN: Cross-sectional, instrument testing. SETTING: Hospital association pressure ulcer educational program conference. METHODS: Pressure ulcer research and guidelines from the last 5 years were examined for test item content. The initial PZ-PUKT had 115 items; response options were "true," "false," and "don't know." Registered nurses (N = 108) were randomly divided into 2 groups to take either the 60 prevention/risk and staging items or the 55 wound description items. Analyses of these responses resulted in 72 items, which were administered in total to a second cohort of 98 nurses for reliability. RESULTS: Cronbach's α was .80 for the 72-item PZ-PUKT. Cronbach's α values for the subscales were as follows: staging, .67; wound description, .64; and prevention/risk, .56. The mean correct scores were as follows: total, 80%; prevention, 77%; staging, 86%; and wound description, 77%. Nurses with wound care certification scored significantly higher on the PZ-PUKT than did nurses with other clinical certifications or with nurses who lacked certification. CONCLUSIONS: The PZ-PUKT has updated content about pressure ulcer prevention/risk, staging, and wound description. Reliability values are highest for the total test. Further use of the instrument in diverse settings will add to reliability testing and may provide direction for determination of a passing cutoff score.

Skin bacteria: implications for wound care.

Skin is the body's physical barrier to the outside world. Its primary role is to protect the body from organisms or toxic substances, while maintaining fluid and electrolyte balance. Because skin interfaces with the outside world, it develops an ecosystem that may be colonized with bacteria, viruses, fungi, and mites.

Diagnosing and treating moisture-associated skin damage.

Certain types of moisture can cause debilitating damage to the skin. Terms such as perineal dermatitis, diaper rash, incontinence-associated dermatitis, or moisture-associated skin damage describe some of the conditions caused by moisture from wound drainage, fecal and/or urinary incontinence, and perspiration. It is important for clinicians to correctly diagnose and to locally treat the cause of skin damage, as well as promote appropriate cleaning techniques, to keep patients' skin healthy.

Comprehensive programs for preventing pressure ulcers: a review of the literature.

OBJECTIVE: The objective of this study was to examine the evidence supporting the combined use of interventions to prevent pressure ulcers (PrUs) in acute care and long-term-care facilities. DESIGN: A systematic review of the literature describing multifaceted PrU prevention programs was performed. Articles were included if they described an intervention implemented in acute care settings or long-term-care facilities, incorporated more than 1 intervention component, involved a multidisciplinary team, and included information about outcomes related to the intervention. MAIN RESULTS: Twenty-four studies were identified. Recurring components used in the development and implementation of PrU prevention programs included preparations prior to the start of a program, PrU prevention best practices, staff education, clinical monitoring and feedback, skin care champions, and cues to action. Ten studies reported PrU prevalence rates; 9 of them reported decreased prevalence rates at the end of their programs. Of the 6 studies reporting PrU incidence rates, 5 reported a decrease in incidence rates. Four studies measured care processes: 1 study reported an overall improvement; 2 studies reported improvement on some, but not all, measures; and 1 study reported no change. CONCLUSIONS: There is a growing literature describing multipronged, multidisciplinary interventions to prevent PrUs in acute care settings and long-term-care facilities. Outcomes reported in these studies suggest that such programs can be successful in reducing PrU prevalence or incidence rates. However, to strengthen the level of evidence, sites should be encouraged to rigorously evaluate their programs and to publish their results.

Pressure ulcer knowledge in medical residents: an opportunity for improvement.

With the aging population and increasing complexity of patients with pressure ulcers (PrUs), as well as regulatory requirements, PrUs have become an important concern for physicians. Although there are some studies that measure nurses' knowledge of PrUs, there is a paucity of literature about physician knowledge of PrUs. Given that the Centers for Medicare & Medicaid Services is holding physicians accountable for documenting PrU status on admission to hospitals and the increased need for collaboration with revisions to long-term-care documentation MDS 3.0: Skin Condition, physicians' knowledge regarding PrUs takes on new urgency. This study reports on PrU knowledge of physicians using 2 tools: the Pieper Pressure Ulcer Knowledge Tool and a wound photograph test. Physicians' mean scores of 69% on the Pieper Tool were well below average scores of nurses' 76%. Physicians had greatest difficulty identifying suspected deep tissue injury and unstageable ulcers. Pressure ulcer content, including prevention, identification, staging, and treatment, needs to be included in physician education.

Certification and education: do they affect pressure ulcer knowledge in nursing?

OBJECTIVE: To determine whether wound care certification and education affect nursing knowledge. This study examined pressure ulcer knowledge among registered nurses who were (1) certified in wound care, (2) certified in specialty areas other than wound care, or (3) not certified in any specialty area. DESIGN: A convenience sample of 460 nurses, located in both urban and rural areas, provided demographic information and completed a standardized pressure ulcer knowledge test using (Pieper Pressure Ulcer Knowledge Tool). RESULTS: The mean standardized test score for the total sample was 78%, with nurses certified in wound care scoring 89%, nurses certified in specialties other than wound care scoring 78%, and nurses receiving no certification scoring 76.5%. CONCLUSION: Wound care certification and education significantly affect nursing knowledge.

Certification and education: do they affect pressure ulcer knowledge in nursing?

OBJECTIVE: To determine whether wound care certification and education affect nursing knowledge. This study examined pressure ulcer knowledge among registered nurses who were (1) certified in wound care, (2) certified in specialty areas other than wound care, or (3) not certified in any specialty area. DESIGN: A convenience sample of 460 nurses, located in both urban and rural areas, provided demographic information and completed a standardized pressure ulcer knowledge test using (Pieper Pressure Ulcer Knowledge Tool). RESULTS: The mean standardized test score for the total sample was 78%, with nurses certified in wound care scoring 89%, nurses certified in specialties other than wound care scoring 78%, and nurses receiving no certification scoring 76.5%. CONCLUSION: Wound care certification and education significantly affect nursing knowledge.

Nutrition and aging: a transdisciplinary approach.

Numerous factors may predispose the elderly to decreased nutritional status. These include physical (illness, physiological changes related to aging, pain, and gastro-intestinal issues), psychological (depression), and socio-economic (income and decreased mobility that leads to isolation and loneliness). The latter may affect food insecurity and the ability to nourish and hydrate. When nutrition suffers, wellness and healing cannot be sustained. Healthcare providers should 1) be aware of the care implications associated with decreased nutritional status, 2) assess nutritional status, and 3) individualize treatment plans, providing and/or pursuing assistance for persons at risk for nutritional deficiency by interceding with commercially prepared products, medications, and supplements and securing consultations with dietitians. A transdisciplinary team approach (multidisciplinary across specialties and settings) can provide the needed care.

Patient perceptions and provider documentation of diabetes care in rural areas.

Measures of effective diabetes management usually include laboratory results and the provider's point of view, omitting the patient perspective. To address this oversight, a descriptive study was conducted to examine congruence between rural patient self-reported and provider-documented information on American Diabetes Association recommended guidelines. Provider medical record information and patient questionnaires were matched for 149 patients with a diagnosis of type 2 diabetes being treated at rural healthcare facilities. Chi-squared testing showed a significant difference (P < 0.05) between patient and provider information in answers to questions on blood pressure and cholesterol testing, eye examination, influenza and pneumovax rates, and diabetic and nutrition education. Patients' perception of diabetes and blood pressure control did not always match documented values. To achieve diabetes control, providers must implement clinical practice guidelines and patients must take an active role in their disease management. Both must communicate effectively. This does not seem to be the case in rural areas.