Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities.

OBJECTIVE: To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland. METHODS: A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument. RESULTS: According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices. CONCLUSIONS: Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross-sectional study.

The aim of this correlational, cross-sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self-reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence-based pressure ulcer prevention practices should be promoted.

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study.

The use of consistent and evidence-based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence-based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.

Simulated Wound Care as a Competence Assessment Method for Student and Registered Nurses.

OBJECTIVE: To describe the development and use of a wound care simulation assessing RNs' and graduating student nurses' practical wound care competence and to describe observations of participants' wound care competence. METHODS: A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies. RESULTS: Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants' shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals' and students' practical wound care competence in a safe and standardized situation. CONCLUSIONS: This study provided new information about simulation as a method to assess student nurses' and RNs' wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals.

The development and testing of the C/WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists.

The purpose of this study was to describe the level of chronic wound-care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P < .0001), but the students showed a positive attitude towards chronic wound care. The instrument demonstrated preliminary validity and reliability, but this warrants further testing. This study provides new knowledge about student nurses' and student podiatrists' competence in chronic wound care, suggesting that their theoretical and practical competence is limited. In addition, it provides information on different methods of assessing competence and how they can be combined.

Physical, social, and symbolic environment related to physical activity of older individuals in long-term care: A mixed-method systematic review.

BACKGROUND: Being active in old age is vital for health and well-being. Inactivity decreases functional ability, mobility, and increases care dependence and risk of falling. Worryingly, older individuals in long-term care settings spend most of their waking day sitting or lying down. The environment should be of special interest considering active life in long-term care. This review aimed to synthesize evidence and provide a comprehensive understanding of the environmental aspects related to the physical activity of older individuals in long-term care settings. METHODS: A mixed-method systematic review, registered in PROSPERO (CRD42021251899; May 30th, 2021) was conducted using four international scientific databases (CINAHL, PubMed, Cochrane, PsychInfo). The searches were conducted from the earliest possible date till Dec 31st, 2020. All empirical peer-reviewed studies published in the English language in scientific journals were included if they had investigated environmental aspects (physical, social, and/or symbolic) in relation to the physical activity of older individuals in long-term care facilities providing full-time care. Critical appraisal was conducted using Joanna Briggs Institute's Critical Appraisal tools, and the Mixed Method Appraisal Tool. Abductive thematic analysis and a conceptual map were used to synthesize the evidence. RESULTS: Altogether 838 original articles were assessed for eligibility, resulting in 30 included studies. No studies were excluded based on quality. The mean age of residents was over 75 when reported. Their cognitive and physical functioning varied. The most frequent setting was nursing home. Three themes and corresponding descriptive themes were formulated, including 1) Physical environment: accessible and safe living environment, activating physical environment, 2) Social environment: supportive professionals, the role of other people, adequate activities to socialize and be active, and 3) Symbolic environment: policy at multiple levels, values of organizations and professionals. Different environmental aspects within and between the dimensions of the physical, social, and symbolic environment were related to each other. CONCLUSIONS: A comprehensive synthesis of current evidence was provided and may be used for the assessment and development of long-term care settings. However, some aspects may have been missed because they have been addressed with terminology not identified with the word environment or similar concepts. As increasing activity may require actions in multiple dimensions, experimental research should be conducted to develop and test the effects of widescale modifications to existing environments from the needs of residents and fitting for each context. The evidence should be used for the design of new facilities. TWEETABLE ABSTRACT: New mixed methods systematic review develops a concept map of environmental aspects influencing the physical activity of older individuals in long-term care.

Learning goals and content for wound care education in Finnish nursing education - A Delphi study.

BACKGROUND: Caring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content. OBJECTIVES: To create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts. DESIGN: A consensus-building approach using the Delphi technique. SETTINGS: A Delphi panel of wound care experts built on an online platform. PARTICIPANTS: The participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians. METHODS: Learning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis. RESULTS: Learning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and attitudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas. CONCLUSIONS: The basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education.

Reporting of Research Ethics in Studies Focusing on Foot Health in Patients with Rheumatoid Arthritis - A Systematic Review.

Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics.