Overlooked Pain Assessment Records in Patients with Pressure Injuries During the COVID-19 Pandemic: A Retrospective Data Analysis.

BACKGROUND: During the COVID-19 pandemic, healthcare professionals focused on identifying the cause of hemodynamic instability in patients and may have neglected to assess pressure injury (PI)-related pain. Although pain is an early indicator of PI development, there has been no systematic evaluation of PI-related pain in patients. OBJECTIVE: To review nurses' records of PI-related pain in patients who developed PIs during the COVID-19 pandemic. METHODS: This retrospective, descriptive study included data from 510 patients at one hospital. Collected data included patient demographics (age, sex, diagnosis, and comorbidities), PI classification, and assessment of PI-related pain. Assessment data regarding PI-related pain included the characteristics of the pain, the type of analgesia (pharmacologic/nonpharmacologic) administered before and after PI management (debridement, dressing change, etc), the route of administration, and the frequency of pain assessment before and after analgesia. RESULTS: The mean age of the patients (60.4% men) was 28.96 (SD, 5.82) years, and the mean length of hospital stay was 26.15 (SD, 16.1) days. Overall, 43.1% of the patients were treated in the ICU, 68.0% were conscious, and 18.6% tested positive for COVID-19. Deep-tissue injuries occurred in 57.5% of patients, with 48.6% developing stage 2 PI. The sacral region was the most common area for PI development (44.8%). The mean duration of repositioning in patients with PI was 23.03 (SD, 5.4) hours. Only 0.40% of patients (n = 2) were evaluated for pain, and only one patient was assessed for pain before and after analgesia was administered. CONCLUSIONS: The findings suggest a lack of comprehensive evaluation and records concerning PI-related pain in patients with COVID-19.

Development and psychometric property testing of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool.

AIMS: We aimed to develop and test the psychometric properties of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool. BACKGROUND: Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device-related Pressure Injuries. DESIGN: This was an instrument development and testing study. METHODS: The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple-choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre-tested. The third phase examined item difficulty, discrimination index and distractor quality. The test-retest method was used for reliability. RESULTS: The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54. CONCLUSIONS: The tool is a suitable measurement instrument for use in nursing education, research and clinical settings.

Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countries.

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.

Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis.

BACKGROUND: A reduction in tissue tolerance promotes the development of pressure ulcers (PUs) and incontinence-associated dermatitis (IAD). AIMS: To determine the cost-effectiveness and efficacy of evidence-based (EB) nursing interventions on increasing tissue tolerance by maintaining tissue integrity. METHODS: The study involved 154 patients in two intensive care units (77 patients, control group; 77 patients, intervention group). Data were collected using the following: patient characteristics form, Braden PU risk assessment scale, tissue integrity monitoring form, PU identification form, IAD and severity scale, and a cost table of the interventions. Patients in the intervention group were cared for by nurses trained in the use of the data collection tools and in EB practices to improve tissue tolerance. Routine nursing care was given to the patients in the control group. The researcher observed all patients in terms of tissue integrity and recorded the care-related costs. RESULTS: Deterioration of tissue integrity was observed in 18.2% patients in the intervention group compared to 54.5% in the control group (p < .05). The average cost to increase tissue tolerance prevention in the intervention and control groups was X¯ = $204.34 ± 41.07 and X¯ = $138.90 ± 1.70, respectively. LINKING EVIDENCE TO ACTION: It is recommended that EB policies and procedures are developed to improve tissue tolerance by maintaining tissue integrity. CONCLUSIONS: Although the cost of EB preventive initiatives is relatively high compared to those that are not EB, the former provide a significant reduction in the prevalence of tissue integrity deterioration.

A Prospective, Descriptive Study to Assess Nursing Staff Perceptions of and Interventions to Prevent Medical Device-related Pressure Injury.

Nurses play an important role in identifying patients at risk for medical device-related (MDR) pressure injuries and preventing their occurrence. A prospective, descriptive study was conducted across 6 hospitals in Ankara, Turkey between December 2014 and June 2015 to assess nursing perceptions about and interventions used for the pre- vention of MDR pressure ulcers. A questionnaire was used to collect demographic information and data on experience with MDR pressure ulcers; in addition, participants completed a Nursing Interventions Form that included 10 statements regarding basic nursing interventions to prevent MDR pressure ulcers; answer options were I perform, I partly perform, I do not perform. Of the 1555 nurses invited, 606 (38%) participated. Nurses who chose to volunteer completed the study instruments independently at their convenience; their responses were entered directly into the statistical analysis system by the researchers. Demographic and interventions data were analyzed using frequency and percentage distributions. Participant mean age was 30.0 ± 6.83 years, most were women (86.9%), with a mean of 8.47 ± 6.70 years of experience. Most had a bachelor's degree (55.1%), 38.2% worked in intensive care units, 50.2% participated in a scienti c program regarding the prevention/treatment of pressure ulcers after their gradu- ation, and 87.9% provided care to patients with pressure ulcers. A great majority (80.1%) of the nurses believed the use of medical devices can lead to pressure ulcers and 59.2% had experience with MDR pressure ulcers, but almost 20% did not believe medical devices can cause a pressure ulcer. The nurses identi ed 18 medical devices that posed the highest risk of causing MDR pressure ulcers; the 3 most commonly identi ed devices were endotracheal tubes (59.7%), tracheostomy ties (58.9%), and blood pressure cuffs (58.4%). The most common interventions used by these nurses included ensuring correct device positioning (87.9%) and loosening devices at least once every shift (80%) when medical conditions allowed. These ndings suggest nurses may not be aware of the risk for pressure ul- cers associated with a number of medical devices, indicating a need for comprehensive inservice training programs and research to identify optimal measures and methods to prevent MDR pressure ulcers.

Turkish Nurses' Opinions of the Braden and Waterlow Pressure Ulcer Risk Assessment Scales: A Descriptive Pilot Study.

Risk evaluation scales are used as part of prevention strategies for pressure ulcers (PUs). Two of the more used scales, the Braden and Waterlow Pressure Ulcer Risk Assessment Scales (B-PURAS and W-PURAS, respectively) are used in Turkey and worldwide, and their validity in terms of sensitivity, specificity, and predictive validity have been examined in various studies. To determine nurses' opinions of B-PURAS and W-PURAS in terms of administration time, practicality, clarity, and perceived ability to encompass PU risks and accurately predict PUs, a descriptive study was conducted from October 15, 2011 to November 20, 2011 at a university hospital among nurses who volunteered to participate. Demographic information collected and assessed included age, highest degree of education completed, and practice area. Participants were trained to use both scales by researchers during a 1-hour session and asked to use them for 2 weeks in their daily practice. The nurses then completed a paper-and-pencil, 12-item questionnaire measuring agreement with general questions about PURAS with options to provide comments. In addition, the questionnaire contained 3 openended questions on scale preference, 1 question to rate perceived scale accuracy in predicting PUs, and the opportunity to recommend changes to the scales. Data were analyzed using SPSS 20.0. Frequencies, percentages, and Spearman's rank correlations were calculated. Eighty-three (83) registered nurses (mean age 27.46 ± 3.73, mean nursing experience 6.53 ± 3.25 [range 0.5-16] years) participated; 18.1% of the nurses had prior experience using such scales, and none of the clinics in the study facility had used PU risk scales previously. Most participants (71, 85.5%) had a bachelor's degree, 62 (74.7%) worked in a facility that admitted patients at high risk for developing PU, but 66 (almost 80%) saw fewer than 4 ulcers per week. Each nurse performed an average of 22 assessments during the study for a total of 1,826 assessments. Participants generally found both scales practical and appropriate; almost 75% thought the B-PURAS was acceptable for use in all clinics, compared to 51% for the W-PURAS; only 20 participants questioned the scales' accuracy in predicting PUs. While 43% preferred the B-PURAS for precision, clarity, and practicability, 25% preferred the W-PURAS because it was more comprehensive. Also, the older the nurse, the more likely the preference for the B-PURAS (P less than 0.019). Some nurses (13%) suggested adding different risk factors such as serum albumin. Overall, 61.4% stated they would prefer to use the B-PURAS over the W-PURAS. Nurses' recommendations should be considered for practice and new scale development and testing, ideally in different patient populations.

Assessment of nurses' knowledge and practice in prevention and management of deep tissue injury and stage I pressure ulcer.

PURPOSE: The aim of this descriptive study was to determine nurses' knowledge and usual practice in prevention and management of deep tissue injury (DTI) and stage I pressure ulcers (PUs). SETTING AND SUBJECTS: The study was conducted in neurology, orthopedics, physiotherapy, rehabilitation, and intensive care units of 3 hospitals located in Ankara, Turkey. These units were selected because they care for patients at risk for developing PUs. The sample comprised 243 nurses. METHODS: A questionnaire was developed in consultation with wound care experts to measure nurses' knowledge and practice for preventing DTI and stage I PUs. The questionnaire form was provided to nurses who consented to participate in the study; the nurses completed the forms in the presence of the investigator. RESULTS: The mean score of correct answers was 48.85±11.99 of 100. Significant correlations were found between the percentage of correct answers and level of nursing education, previous experience with PU management, and participation in in-service training programs. CONCLUSION: The nurses in this study tended to lack sufficient knowledge regarding prevention and management of DTI and stage I PUs.

Prevention of pressure ulcers: a descriptive study in 3 intensive care units in Turkey.

PURPOSE: The aim of this descriptive study was to describe the level of preventive care provided to intensive care unit (ICU) patients at risk for development of pressure ulcers (PU). SETTING AND SUBJECTS: Our study population comprised 126 nurses working at coronary ICU, cardiovascular surgery ICU, or a gastroenterology ICU of State Hospital in the Republic of Turkey. The study sample consisted of 30 nurses selected from these units using a layered sampling method. INSTRUMENTS: Data were collected using the following 4 forms: (1) ICU evaluation form, (2) demographic questionnaire form, (3) Braden Scale, and (4) observation form. The observation form was developed by the investigator to record PU prevention interventions made by the study nurses. METHODS: Nurses were observed while giving care to patients at risk according to Braden Scale scores and each action of the nurses to prevent PU was recorded. Data were collected until 90 observations (3 observations with each of 30 nurses) were completed. RESULTS: Nurses did not consistently engage in interventions recommended for prevention of PU. Subjects did not consistently use the risk-evaluation scale, document position changes on the appropriate form, and train auxiliary personnel about PU prevention. The most frequently fulfilled behaviors for PU prevention were avoiding hot water when cleansing the skin, helping the patient eat, avoiding placing the patient directly on a trochanter, refraining from using improper support material, and use of pressure-redistribution surfaces. The least fulfilled behaviors were (1) application of a skin barrier or protectant on moist skin and (2) application of a moisturizer to dry or compromised skin, protecting the skin during patient transfer, repositioning, and documenting prevention interventions. CONCLUSION: This study demonstrates that critical care nurses do not consistently provide preventive care for PU.