Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES: To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites. DATA SOURCES: MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries. DATA EXTRACTION: Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury. DATA SYNTHESIS: Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0-25.9% and 16.9-23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4-27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6-36.8% and 12.2-24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0-23.8% and 12.4-15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as follows: sacrum 26.9-48.0%, buttocks 4.1-46.4%, heel 18.5-38.9%, hips 10.9-15.7%, ears 4.3-19.7%, and shoulders 0.0-40.2%. CONCLUSIONS: Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.

Supporting culturally and linguistically diverse (CALD) undergraduate nursing students undertaking clinical placements in Australia: An exploratory qualitative study of clinical facilitator and CALD student perceptions.

BACKGROUND: Internationalisation of higher education has contributed to the increasing number of culturally and linguistically diverse students in higher education programs worldwide. While there is some literature on the experiences and needs of these students, there is little evidence on what resources can be used to support these students when learning in the clinical setting. AIM: This study aimed to evaluate the usefulness of an existing handbook developed for clinical facilitators to enhance culturally and linguistically diverse nursing students' learning, and to explore the facilitator and student perceptions of their clinical placement support needs. DESIGN: This exploratory qualitative study, involving culturally and linguistically diverse Bachelor of Nursing students and clinical educators, was conducted in a multi-campus School of Nursing and Midwifery at Griffith University, Australia, in collaboration with health services. Focus groups and individual interviews with clinical facilitators and culturally and linguistically diverse nursing students were conducted. Activity theory provided the conceptual framework for this study and the qualitative data analysis was informed by grounded theory. RESULTS: Clinical facilitator focus groups and interviews generated three themes: understanding culturally and linguistically diverse students' needs; supporting culturally and linguistically diverse students; and improving learning resources for facilitators and students. Student focus groups generated three themes: wanting to be more prepared for clinical placement; feeling supported by facilitators and interacting with others in a different context; and creating resources to support learning. CONCLUSIONS: Supportive clinical environments are key to the work-integrated learning success of culturally and linguistically diverse nursing students. The findings of this qualitative research study, involving clinical educators and culturally and linguistically diverse Bachelor of Nursing students identify the pressing need to develop readily accessible resources to support the clinical learning of culturally and linguistically diverse students and their educators. Resources development should be attentive to complexities at the intersection of workplace culture and students' developing understanding.