Wound Care Nursing Education in the Acute Care Setting.

OBJECTIVE: To assess the feasibility of a survey study exploring how nurses in acute care prefer to be educated, particularly regarding wound management in the acute care setting. METHODS: This pilot study utilized a cross-sectional survey design that included both open-ended and close-ended questions. Participants (N = 47) completed the Index of Learning Styles Questionnaire and provided information regarding their educational preferences related to wound management through use of an online survey. RESULTS: Participants described the importance of varying educational techniques by topic, ensuring an appropriate time of day for education, and preferring smaller educational sessions over time. Most participants preferred one-on-one bedside education, and the most commonly reported learning styles were active, sensing, visual, and a balanced approach to sequential and global learning. There were few correlations between learning styles and choice of education method, only one of which was expected. CONCLUSIONS: It would be beneficial to conduct this study on a larger scale to confirm results, improve understanding of the correlations, and determine further potential correlations between study variables.

Impact of prolonged PPE use on Canadian health professionals.

AIM: To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals. METHOD: A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals. RESULTS: There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods. CONCLUSION: These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.

Formal Caregiver Experiences of Caring for Individuals at Risk for or with a Pressure Injury: A Metasynthesis.

OBJECTIVE: To explore formal caregiver experiences caring for patients with a pressure injury (PI) or who are at risk of developing a PI. DATA SOURCES: In November 2019, the researchers searched CINAHL (Cumulative Index to Nursing and Allied Health Literature) and MEDLINE databases for articles related to caregivers and their experiences with PI prevention and care. STUDY SELECTION: Twenty-eight qualitative studies were included in this review. DATA EXTRACTION: Literature was graded and critiqued with regard to design and research quality and then synthesized utilizing a narrative approach. DATA SYNTHESIS: Four themes were found within the literature: knowledge and education, environment and resources, collaboration and role clarity, and risk assessment. CONCLUSIONS: Across healthcare settings, formal caregivers noted the importance of effective PI knowledge and education. Recognizing both barriers and facilitators to PI prevention and management within the healthcare environment can help decision-makers make informed choices to improve PI management within their settings. In addition, developing interprofessional team skills and relationships, rather than practicing in silos, may have an impact on PI management. Although there are many interventions that reduce PI risk and assist in the management of PIs, not every intervention is appropriate for every healthcare setting. Clinician education on PIs, along with new interventions, could significantly impact the effectiveness of patient care.

Pandemic Responsiveness in an Acute Care Setting: A Community Hospital's Utilization of Operational Resources During COVID-19.

Background: To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies utilized by a large community hospital located in Ontario, Canada. Methods: Guided by a qualitative descriptive approach, we performed a thematic analysis of all COVID-19-related documentation discussed by the hospital's emergency operation centre (EOC) during the pandemic's first wave. We then solicited operational strategies from a multidisciplinary group of hospital leaders to construct a narrative for each theme. Results: Seven recurrent themes critical to the hospital's pandemic response emerged: 1) Organizational structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational health and workplace safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human resources/workforce planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal protective equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate communication: a robust communication strategy provided timely and transparent access to rapidly evolving information. Conclusion: A community hospital's operational preparedness for COVID-19 was supported by inter-operability, leveraging internal and external expertise and partnerships, creative problem solving, and developing novel tools to support occupational health and community initiatives.

The Lived Experience of Patients with an Ostomy: A Pilot Study on the Effect of Ostomy Pouch Opacity.

OBJECTIVE: To explore the effects of ostomy pouch opacity on the lived experience of patients with ostomies in the postoperative period. METHODS: This qualitative, descriptive phenomenology study used purposive sampling to recruit seven participants who were inpatients in an acute care facility in Central Ontario, Canada, after their first ostomy surgery. Face-to-face, audio-recorded, semistructured interviews were used to collect data regarding patient experience with either a transparent or opaque ostomy pouch. Data were collected between August and November 2019. Audio tapes were transcribed verbatim and analyzed using a thematic analysis technique focused on describing patient lived experience. RESULTS: Five themes were discovered: "undercover," "fiscal consideration," "past medical experience," "self-esteem," and "functionality." Most participants focused on appliance functionality over pouch opacity in the immediate postoperative period. However, participants did describe difficulties adjusting to their new stoma and noted that an opaque pouch can improve postoperative comfort. Past exposure to medical devices, particularly in terms of their cost, may impact the decision to use a transparent or opaque pouching system. CONCLUSIONS: Pouching systems that are opaque while still allowing for assessment of the pouching contents and stoma are ideal. When this is not available, providers should consider the patient's wishes to alleviate any psychosocial effects the opacity of the pouching system may have.

The Value of Nurses Specialized in Wound, Ostomy, and Continence: A Systematic Review.

OBJECTIVE: To critically appraise peer-reviewed evidence concerning the value, or implied sense of worth or benefit, of nurses specialized in wound, ostomy, and continence (WOC) care. DATA SOURCES: The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used to systematically review current literature in a single database from 2009 to the date of search (July 2019). STUDY SELECTION: The initial search retrieved 2,340 elements; 10 studies were retained following removal of duplicate records, title and abstract reviews, and application of the inclusion/exclusion criteria. DATA EXTRACTION: Literature was graded and critiqued with regard to design and research quality and then synthesized using a narrative approach. DATA SYNTHESIS: Nine values that WOC nurses demonstrate were identified: improved quality of life for patients, teaching and mentoring, cost reduction, improved efficiency, improved wound outcomes, improved incontinence outcomes, advanced treatments, research, and leadership. CONCLUSIONS: Although current studies suggest that there is value in the WOC nurse role, in all areas of the trispecialty, there is a need for high-quality literature with higher-level designs focused on bias reduction.

Algorithmic approaches to ostomy management: An integrative review.

OBJECTIVE: The aim of this review is to describe approaches to ostomy management utilizing algorithmic approaches found within the literature. DESIGN: An integrative review approach was used based on a modified Cooper's five-stage research review framework. DATA SOURCES: Systematic searches occurred using the CINAHL and MEDLINE databases searching for peer-reviewed, English publications. REVIEW METHODS: There were 640 articles identified through the review process, 608 of which were excluded based on title and abstract review. The remaining 12 articles were assessed in full text after which two studies were removed as duplicates and six studies were excluded based on inclusion/exclusion criteria. Four studies were included in this synthesis. Studies were critically analysed using a critical appraisal tool developed for both qualitative and quantitative study assessments. RESULTS: Utilizing inductive content analysis, included literature was presented within two categories: validation of ostomy algorithms and implementation of ostomy algorithms in practice. Four themes emerged from these categories including the following: algorithm validation, identifying underlying causes, focus on accessories and large-scale implementation. CONCLUSION: No currently available validated algorithms published in full were found during this literature review. Current literature demonstrates the potential benefit for ostomy management algorithms to standardize and improve ostomy patient care. IMPACT: This study sought to determine the availability and supporting research of ostomy management algorithms which may assist in standardizing and improving ostomy care. This review has demonstrated a lack of available ostomy management algorithms. Given the potential benefit of ostomy algorithms identified within the literature, further studies should be completed to develop, validate and test new ostomy management algorithms.

The Financial Impact of Living in Canada With an Ostomy: A Cross-sectional Survey.

PURPOSE: The aim of this study was to explore how living with an ostomy financially impacts Canadians. METHODS: A descriptive, pan-Canadian, cross-sectional online and paper-based survey was conducted using a convenience sample. RESULTS: Surveys were completed by 467 individuals. Seventy-six percent (n = 355) reported spending more than $1000 annually on ostomy supplies, with 58% (n = 271) paying partially out of pocket. Atlantic regions relied primarily on insurance (n = 81), and the central, prairies, and western regions used a combination of funding (provincial government funding and/or insurance) (n = 385) with no significant out-of-pocket funding differences between regions (χ = 18.267, P = .079). Fifteen percent (n = 70) reported frequent peristomal skin problems, and 19% (n = 89) indicated that having an ostomy negatively affected their ability to work. When experiencing ostomy-related problems, 60% (n = 280) sought assistance from a nurse specialized in wound, ostomy, and continence (NSWOC) and spent significantly less on ostomy supplies (χ = 231.267, P < .001). CONCLUSION: This study demonstrated that living with an ostomy may result in financial burden and that Canadian regional variations in funding and access to an NSWOC should be explored.

Wound management: Investigating the interprofessional decision-making process.

Our aim is to develop a robust socio-geographical transferable theory outlining the basic social process used by members of an interprofessional health care team when making decisions around wound care management. Using a qualitative multigrounded theory approach, three focus groups were held at the Royal Victoria Regional Health Centre in Barrie, Ontario, Canada, comprised of 13 clinicians who participate in wound care decision-making. Data were analysed using an approach developed for multigrounded theory. A Critical Realist theoretical lens was applied to data analysis in the development of conclusions. Ten categories were identified before thematic saturation. Category interactions developed a perceived basic social process outlining how interprofessional clinicians determine how they approach wound care decisions: patient factors, scope of practice, equipment and supplies, internal clinician factors, knowledge and education, interprofessional team, assessment, wound care specialist consultation, and care plan, as well as documentation and communication. Understanding how wound care decision-making is determined by interprofessional health care providers will assist clinical leaders and policy makers in creating a foundation for determining resource allocation, allowing clinicians to use evidence-based practice to improve patient and clinician satisfaction, wound healing time, decrease costs, and prevent wound recurrence.

Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting.

BACKGROUND: Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety. OBJECTIVE: The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting. METHODS: Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety. RESULTS: Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration. CONCLUSION: Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients.

Challenges to student learning in the clinical setting: a qualitative descriptive study.

Clinical education is used throughout nursing to promote competency. Although this experience can be rewarding, students may face a variety of challenges within this context. The purpose of this qualitative descriptive study is to explore senior nursing students' perceptions of challenges to learning within the clinical setting. Three interrelated themes emerged from the data: (a) internal reactions to external limitations; (b) barriers experienced within the clinical environment; and (c) ineffective programme organisation. Findings are meant to guide educators and policy makers during decision making. The goal is advancement towards making the clinical environment a superior form of nursing education.