Enhancing prone positioning and skin damage prevention education: A randomized controlled non-inferiority trial comparing a digital education hub (PRONEtect) and a traditional lecture on final-year nursing participants' confidence and knowledge.

INTRODUCTION: The incidence of pressure ulcers remains high in patients with moderate to severe acute respiratory distress syndrome, ventilated in the prone position. A digital platform, dedicated to prone positioning and skin/tissue damage education was developed. OBJECTIVE: To evaluate the impact of the PRONEtect Education Hub versus a traditional lecture on final-year nursing students' confidence levels and knowledge in a non-inferiority study. DESIGN: A multicenter, non-blinded, parallel-group, non-inferiority study with equal randomization (1:1 allocation) was conducted at two nursing schools in Belgium. CLINICALTRIALS: gov (NCT05575869). METHODS: Following baseline assessments, the control group received a 1-h classroom lecture, and the experimental group gained access to the PRONEtect website. Three weeks later, participants completed the knowledge, confidence, and visual knowledge assessment. RESULTS: At baseline, 67 of the 80 participants completed the assessments and post-intervention, 28 and 27 participants respectively completed the confidence, knowledge, and visual knowledge assessments (dropout rate of 66.25%). Confidence levels: a mean ratio of relative change from baseline = 0.96 (Control (C)/Experimental (E)); 97.5% confidence interval (CI): 0.74 to 1.26; p = 0.74. Knowledge assessment: a mean difference in change from baseline = 1.58 (C-E); 97.5% CI: -0.58 to 3.75; p = 0.1. Although confidence and knowledge scores increased in both groups, the study cannot conclude non-inferiority. CONCLUSIONS: The trade-off between the inability to conclude efficacy of the impact of the website and the benefit of having an accessible educational platform on prone positioning and skin damage prevention makes the PRONEtect Education Hub an acceptable adjunct to traditional lecturing.

Registered nurses' self-rated research utilization in relation to their work climate: Using cluster analysis to search for patterns.

AIM: To describe and study the association between registered nurses' self-rated research utilization and their perception of their work climate. BACKGROUND: Research utilization is an important part of evidence-based nursing, and registered nurses value a work climate that supports the possibility to work evidence-based. METHOD: This cross-sectional study was conducted using the Creative Climate Questionnaire together with three questions measuring instrumental, conceptual and persuasive research utilization. The analysis was done using variable- and pattern-oriented approaches. RESULTS: An association was found between research utilization and experience of dynamism/liveliness. Women reported higher use of conceptual research utilization. Regarding work climate, younger registered nurses and registered nurses with less work experience gave higher scores for playfulness/humour and conflicts. The results showed an association between having a Bachelor's or Master's degree and higher instrumental research utilization. DISCUSSION: Research utilization was higher in registered nurses with higher academic education. Low users of research tended to experience a lack of dynamism and liveliness, which indicates the importance of improving the work climate by creating a climate that allows opinions and initiate discussions. CONCLUSION: The findings support the importance of creating a work climate that encourages reflection and discussion among registered nurses, and to promote academic education for nurses plus an optimal work-place staffing-mix. SUMMARY STATEMENT: What is already known about this topic? Research utilization is an important part of evidence-based nursing. Registered nurses value a work climate that supports the possibility to work evidence-based. Little is known about the association between how nurses use research in clinical work and how they perceive their work climate. What this paper adds? Low research users tended to experience low dynamism and liveliness in their work climate, showing the importance of improving the work climate in health care organizations to support clinical nurses' ability to express opinions and initiate discussions. The association between work climate and the use of research among nurses needs further investigation. Our findings support previous research showing that a higher academic level is associated with increased research among registered nurses working clinically, and therefore benefits patient outcomes. The implications of this paper: The association between low research utilization and experience of low dynamism and liveliness indicates the importance of improving the work climate by creating an atmosphere where nurses can express their opinions and initiate discussions. There is a need to support clinical registered nurses to maintain their research utilization throughout their working career. The health care sector and the individual workplace should support registered nurses in furthering their academic level.

Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation.

BACKGROUND: In-hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in-hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR). High-quality CPR is essential for patient survival and good neurological outcome. AIMS AND OBJECTIVES: To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. DESIGN: Manikin-based single-blinded randomised controlled trial. METHODS: Nursing students (N = 70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2-minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference. RESULTS: The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P = .043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P = .004). CONCLUSIONS: CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable. Mattress type, body weight and hand positioning appear to be significant predictors for adequate chest compression depth. RELEVANCE TO CLINICAL PRACTICE: A firm surface under the patient is needed during CPR. Special attention must be paid to correct hand positioning during CPR.

Exploring the learning needs of clinicians in Belgium and Sweden regarding prone positioning and skin damage prevention: A qualitative study.

INTRODUCTION: During the coronavirus pandemic (COVID -19), the use of prone positioning in critically ill patients with acute respiratory distress syndrome (ARDS) increased substantially. As a result, clinicians had to (re)learn how to treat the patient in the prone position while preventing adverse events such as pressure ulcers, skin tears and moisture-associated skin damage. AIM: The purpose of the study was to determine participants' learning needs related to patients in the prone position and the prevention of skin damage, such as pressure ulcers, and what they perceived as a positive or negative learning experience. DESIGN: This study used a qualitative methodological framework and employed an exploratory design. PARTICIPANTS: A purposive sample of clinicians (n = 20) with direct or indirect work experience with prone ventilated patients was recruited in Belgium and Sweden. METHODS: Individual semi-structured interviews were conducted in Belgium and Sweden between February and August 2022. Data were analysed thematically using an inductive approach. The COREQ guideline was utilised to comprehensively report on the study. FINDINGS: Two themes were identified: 'Adapting to a crisis' and 'How to learn', with the latter having two subthemes: 'balancing theory and practice' and 'co-creating knowledge'. Unexpected circumstances necessitated a personal adaption, a change in learning methods and a pragmatic adaptation of protocols, equipment and working procedures. Participants recognised a multifaceted educational approach which would contribute to a positive learning experience regarding prone positioning and skin damage prevention. The importance of poising theoretical teaching with practical hands-on training was highlighted with an emphasis on interaction, discussion, and networking between peers. CONCLUSIONS: The study findings highlight learning approaches which may help inform the development of befitting educational resources for clinicians. Prone therapy for ARDS patients is not limited to the pandemic. Therefore, educational efforts should continue to ensure patient safety in this important area.

First line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing.

AIM: The aim was to explore first line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing. DESIGN: A qualitative study with a phenomenographical approach. METHOD: Data were collected through focus group interviews with 15 first line nurse managers' in four settings. RESULTS: The results are presented in four categories of description headed: Manage the everyday work vs. evidence-based nursing; Uncertainties about evidence-based nursing and nursing research; Time as a reality, as an approach; and Shaping awareness-towards an active approach to evidence-based nursing. The overarching category of description has been formulated as follows: The internal relation-how active leadership influences evidence-based nursing. The outcome space is presented as: The individual path-how to make vision and reality become a working entity around evidence-based nursing.