Investigation of nursing students' knowledge levels and attitudes in incontinence-associated dermatitis management through game-based learning: a mixed methods study.

PURPOSE: This study aimed to assess nursing students' knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game. DESIGN: A mixed-method study. SUBJECTS AND SETTING: The sample size of the study was 32 students. METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach. RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game's contribution to a better understanding and classification of IAD. CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.

Exploring Nursing Students' First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study.

BACKGROUND: Undergraduate nursing students experience significant differences between practice with models, manikins, or simulation applications and real patients in a clinical setting. Students' experiences applying their theoretical knowledge to real patient-care practices are little understood. OBJECTIVE: To determine the experiences of nursing students in providing skin, chronic wound, and ostomy care to real patients for the first time in a clinical setting within the content of the Ostomy and Wound Care Nursing Track Program (OWCNTP) and to define factors affecting this program. METHODS: The research was conducted qualitatively using the individual critical incident technique, and 17 senior undergraduate nursing students enrolled in the Nursing OWCNTP were selected using a simple random sampling method. In the classroom setting, individual face-to-face interviews were conducted using the critical incident technique. Data were analyzed with inductive content analysis. RESULTS: The research found that students experience genuine caregiving in putting their experiences from the Track Program into practice with real patients in a clinical setting. Three main themes were identified: experiencing real patient care in a clinical setting, being a competent student, and being a novice student. CONCLUSIONS: The study found that nursing students enrolled in the OWCNTP could apply their theoretical knowledge to care for real patients in clinical settings. Therefore, it is recommended that these programs be integrated into nursing curricula.

Everyday Prevention: The Impact of Daily Comprehensive Skin Assessments on Pressure Injury Healing in the General ICU.

OBJECTIVE: To investigate the effect of daily versus weekly comprehensive skin assessments on wound healing status in patients with pressure injuries (PIs) treated in the general ICU. METHODS: This quasi-experimental study was conducted at a foundation hospital from November 15, 2022, to March 15, 2023. The sample consisted of 193 patients with PIs who met the inclusion criteria. The Braden Scale, Nutritional Risk Scale 2002 (NRS-2002), and Pressure Ulcer Scale for Healing (PUSH) were used. The intervention group (n = 98) underwent comprehensive skin assessment every day, whereas the control group (n = 95) followed routine procedures. The study findings were reported according to TREND (Transparent Reporting of Evaluations with Non-randomized Designs) guidelines. RESULTS: Patients were older adults, with a mean age of 70 ± 15.45 years in the intervention group and 71 ± 13.20 years in the control group. The mean NRS-2002 score was 3 ± 2.01 in the intervention group and 2 ± 1.38 in the control group. Medical device-related PI incidence was high in both groups (intervention: 36.8%, control: 24.5%). In the intervention (14.3%) and control (50%) groups, PIs developed mostly due to antiembolic stockings. Deep-tissue PIs were the most common (intervention: 56.8%, control: 62.2%). The last PUSH scores decreased in both groups. The difference between the PUSH scores of the intervention and control groups was statistically significant (P < .05). CONCLUSIONS: The findings of this study demonstrate the critical role of daily comprehensive skin assessment in the healing process of PIs. Especially in ICUs, the study provides compelling evidence for the need to prioritize and implement regular skin assessments to prevent PIs and support the healing process.

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.

Translation and validation of the ELPO for Turkish population: Risk assessment scale for the development of pressure injuries due to surgical positioning.

AIM OF THE STUDY: This study was conducted to translate the ELPO risk assessment scale for the development of pressure injuries due to surgical positioning to Turkish and to test its validity and reliability in the Turkish Population. MATERIALS AND METHODS: The data were collected using the patient identification form, the risk assessment scale for the prevention of injuries due to surgical positioning, and the Braden Scale. This scale consisted of a total of seven items, each of which contained five sub-items. It is rated between 1 and 5 in the Likert type. The total score of the scale ranges between 7 and 35. The risk of developing pressure injuries increases in patients as the score increases. RESULTS: A total of 184 patients were included in the study sample. The mean age of the group was 55.96 ± 17.90, and the content validity index was 0.944. The sensitivity of the test was 60%, the specificity was 66%, and the accuracy was 66%. There was a negative, weak, statistically significant correlation between the total scores of the risk assessment scale for the prevention of injuries due to surgical positioning and the Braden scale. The mean total score of the scale was 18.45 ± 2.96 (12-26) and 35.9% (n = 66) of the group were at high risk. CONCLUSIONS: The ELPO, which includes the risks specific to patients during surgery, can be used as an assessment scale for the development of pressure injury due to surgical positioning for Turkish population.

Challenges faced by doctors and nurses in wound care management during the COVID-19 pandemic in Turkey and their views on telehealth.

AIM: This study aimed to determine the problems faced by physicians and nurses dealing with chronic wound care during the COVID-19 pandemic and their views on telehealth. MATERIALS AND METHODS: A descriptive and cross-sectional design was used in this study. The sample comprised physicians (n = 74) and nurses (n = 271) interested in chronic wound care. Data were collected through a questionnaire form consisting of open- and closed-ended questions. RESULTS: Of the participants, 21.4% (n = 74) were physicians and 78.6% (n = 271) were nurses. Of the physicians, 45.9% (n = 34) were obliged to work in another unit during the COVID-19 period, while 43.2% continued their service related to chronic wound care, and only 17.0% (n = 18) in the wound care service before the pandemic. These rates are 51.3% (n = 139), 51.6% (n = 157) and 36.8% (n = 128) for nurses, respectively. 40.7% of the physicians (n = 33) and 34.9% of the nurses (n = 106) stated that their time had been reduced for chronic wound care. When the telehealth experiences were examined, 32.4% (n = 24) of the physicians utilized telehealth, 29.7% (n = 22) used e-visit, 77.0% (n = 57) stated that they thought telehealth was a good option, 47.3% (n = 35) utilized it for wound evaluation and treatment, and 31.9% (n = 59) used smart phones. These rates for nurses were 16.6% (n = 45), 14.0% (n = 38), 72.7% (n = 197), 33.9% (n = 92), and 27.0% (n = 182), respectively. CONCLUSIONS: The COVID-19 pandemic negatively affected the manner of delivery, duration, and quality of service regarding wound management. During this period, face-to-face contact times with patients were reduced, some diagnosis and treatment attempts were not performed, and wound care services were suspended temporarily or permanently. On the other hand, a positive result was achieved in that the physicians and nurses gave positive feedback for the telehealth experience.

Assessment of the risk of pressure ulcer during the perioperative period: Adaptation of the Munro scale to Turkish.

AIM OF THE STUDY: This study was conducted to adapt the Munro Pressure Ulcer Risk Assessment Scale (Munro Scale) to Turkish and to test its validity and reliability. MATERIALS AND METHODS: In the methodological study, the data were collected using the patient identification form, the Braden Scale, and the Munro Scale. A total of 188 patients were diagnosed for the risk of preoperative and intraoperative pressure ulcer, and then re-evaluated in the recovery room and in their bed. RESULTS: The study group consisted of 81 (43.1%) males and 107 (56.9%) females with a mean age of 51.98 ± 16.87. The Kaiser-Meyer-Olkin sampling adequacy test was 0.588 and the Bartlett's test was 430.471. The results of goodness of fit indices were not as expected value in the confirmatory factor analysis. In the exploratory factor analysis, it was determined that the factor loadings of the Munro Scale varied between 0.336 and 0.873 and explained 62% of the total variance. In the parallel-form method performed for the reliability of the scale, it was observed that there was a weak and negative correlation between the total scores of the Munro Scale and Braden Scales before the surgery and a negative and moderate correlation between the total scores after the surgery. The total Cronbach's alpha value was found to be 0.504. In the reliability analysis of the scale, interrater correlation coefficients were found to be 0.865-0.998. CONCLUSIONS: The Munro Scale can be used to assess the risk of pressure injuries in perioperative patients and may help nurses to identify high-risk patients.

Disgust and Its Effect on Quality of Life and Adjustment to Stoma in Individuals with Ileostomy and Colostomy

AIM: This study aims to determine the effect of disgust sensitivity on the quality of life of patients with ileostomy and colostomy, and their adaptation to stoma. METHODS: This study has a cross-sectional and correlational design. The sample consists of 167 patients being treated in a state hospital and a private foundation hospital, who meet the research inclusion criteria. The Patient Information Form, Disgust Sensitivity Scale, Ostomy Adjustment Inventory, and Ostomy Quality of Life Scale (OQLS) are used for data collection. Descriptive statistics, oneway analysis of variance (ANOVA), t-test, and correlation analysis are used in data analysis. RESULTS: Of the 86% of the participants diagnosed with cancer, 60% had undergone ileostomy and 40% had undergone a colostomy; 46% of the patients declared that they were capable of handling their own stoma care and 53% stated that they felt self-efficient about care. Participants who were female (88.55 ± 23.17), single (88.40 ± 20.98), or university graduates (93.34 ± 22.92) had higher disgust sensitivity scores. The study found no significant correlation between disgust sensitivity, quality of life, and stoma adjustment scores (p > .05). CONCLUSION: The findings proved believe that recognizing the disgust sensitivity will help meet the physical and psychological needs of stoma patients and understand their quality of life and adjustment to stoma. This will help in guiding both patients and healthcare workers, and lead clinical studies.

Determination of nurses' level of knowledge on the prevention of pressure ulcers: The case of Turkey.

AIM OF THE STUDY: Pressure ulcers (PUs) constitute a health issue that has a high prevalence and incidence rate in acute and long-term care, requiring long-term nursing care for treatment and prevention. Therefore, nurses should have adequate knowledge of the interventions and practices used to prevent PUs. MATERIALS AND METHODS: This study employed a descriptive and cross-sectional design to assess the level of nurses' knowledge concerning preventive interventions for PUs. Based on data found in the literature, researchers developed a 16-question Participant Information Form (including age, gender, level of education, employed ward, and training on PUs) and used this form, along with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), to collect data. RESULTS: A group of 471 nurses working in two foundation hospitals in 2018 participated in the study by completing a questionnaire. Among the participants, 44.2% worked in surgery, 21.2% in internal medicine, and 34.6% in other wards (such as intensive care, pediatrics, and the operating theater). Most of the nurses(73.5%) held a bachelor's degree, and their average work experience was 7.27 ± 7.00 years. It was determined that 69.4% of the nurses had not received in-service training relating to PUs, 55.6% did not attend lectures/conferences or read articles on the prevention of PUs, and 59.7% rated themselves as "adequate" in interventions used to prevent PUs. Based on the use of PUPKAI-T, 17 individuals (3.6%) scored equal to or more than the 60% cut-off value, and 454 individuals (96.4%) scored less than 60%. The mean level of knowledge on PUs was calculated as 11.1 ± 2.659 (range: 1-18) out of 26 questions. CONCLUSIONS: Results of the study showed that the general level of knowledge of nurses in preventing PUs are extremely insufficient. Therefore, various strategies should be developed to increase nurses' level of knowledge on the etiology and development, classification and observation, and risk assessment of PUs, as well as on nutrition plans and preventive interventions.

Connectors as a risk factor for blood-associated infections (3-way stopcock and needleless connector): A randomized-experimental study.

BACKGROUND: Microorganisms causing catheter-related bloodstream infections colonize to intravenous catheters (IVC)-particularly to connectors mounted to catheters. The aim of this study was to examine the colonization in 3-way stopcock (TWS) connectors and needleless connectors (NCs) that integrated into central, port, and peripheral venous catheters. METHODS: This random, experimental study consisted of 180 connectors that were inserted into the IVCs of patients in general surgery, reanimation intensive care, and daily chemotherapy units. Cultures of the connectors were obtained at least 48 hours after connecting to IVCs. RESULTS: This study showed that gram-negative, gram-positive, and other pathogens reproduced, although their colonization level was not high enough to develop an infection. When the results of colonization for patients using TWS and NC were compared, the peripheral venous catheters (using a TWS) resulted in a significantly higher increase in reproduction than in patients using NC (P ≤ .01) and no significant difference in the level of colonization in other types of connectors or catheters (P ˃ .05). CONCLUSIONS: The study's results indicated no significant difference between NC and TWSs in terms of reproduction. It should also be noted that connectors integrated into IVC pose a risk in the development of catheter-related bloodstream infections.