Redesigning blood pressure measurement training in healthcare schools.

Blood pressure (BP) measurement is the most commonly performed procedure in clinical practice and requires mastering several skills. A prior study determined that medical school students failed to perform more than half of BP measurement skills correctly, demonstrating a need to redesign how BP measurement is taught. The American Medical Association set out to create and test a solution to address this BP measurement curricula gap. An eLearning series consisting of three modules was developed. The series was informed by evidence-based guidelines, includes content on self-measured blood pressure, is accessible to students at any time within their education journey, is interactive, and available to all healthcare schools at no cost. Prior to launch, a small pilot study was conducted with medical and nursing students to determine if these new eLearning modules address current gaps in BP measurement curricula. Students were instructed to complete an online assessment before and after viewing the main module within the series. Our results suggest that eLearning modules on BP measurement can help improve knowledge and ability to identify correct BP measurement skills. Pronounced improvements were observed in the topics of patient preparation, positioning, and cuff sizing and placement. Revisions were made to content areas where improvement was minimal. Overall, the findings revealed the importance of pilot testing a product prior to launch and while many skills may improve with an eLearning intervention, certain skills will still likely require additional in-person training with peers.

Comparing Human Amniotic Allograft and Standard Wound Care When Using Total Contact Casting in the Treatment of Patients with Diabetic Foot Ulcers.

OBJECTIVE: This prospective, randomized study compared two treatments for diabetic foot ulcers: total contact cast and a skin substitute versus total contact cast and standard wound care. PARTICIPANTS: Researchers screened 270 adult outpatients in a Midwestern wound care clinic for inclusion. Adults 18 years or older with type 1 or 2 diabetes and a diabetic foot ulcer located on the plantar surface larger than 0.5 cm in area were invited to participate if they had not demonstrated a 50% reduction in wound area following 4 weeks of standard treatment. Thirteen patients were randomized into two intervention groups. The majority of the participants had type 2 diabetes. INTERVENTIONS: Group A treatment: total contact cast and a skin substitute (human amniotic allograft); group B treatment: total contact cast and standard wound care. OUTCOME MEASURES: Mean ulcer surface area, time to closure, recurrence rates, satisfaction with total contact casting, infection, and hemoglobin A1c were measured. RESULTS: The majority of participants experienced wound closure during the course of the study (92.3%). Two participants did not achieve closure, both of whom had Charcot foot. Group A, which had a higher mean hemoglobin A1c at study outset, experienced a longer mean time to closure (29.50 days) compared with group B (26.20 days). The 90-day recurrence rates were different for the two groups, with only one recurrence for group A (14.29%) but five recurring ulcers in group B (83.33%). CONCLUSIONS: Although significance was not established because of sample size, there was a definite trend toward significance that merits further investigation with human amniotic allograft.

Use of Simulation to Develop Teamwork Skills in Prelicensure Nursing Students: An Integrative Review.

BACKGROUND: While use of simulation to improve teamwork skills has been established in a variety of clinical settings, it is unclear how teamwork skills of nursing students are developed using simulation. PURPOSE: The purpose of this review was to synthesize literature on how simulation is used to teach teamwork skills to prelicensure nursing students. METHODS: The integrative review of the literature was conducted using the Whittemore and Knafl 5-stage methodology and the TeamSTEPPS framework. RESULTS: Twenty-one articles were included in the review. Each of the articles reviewed used a component of TeamSTEPPS. The most common TeamSTEPPS concept addressed in the simulations was communication followed by mutual support. CONCLUSION: While simulation appears to be an appropriate methodology to teach teamwork skills to prelicensure nursing students, it is evident that some of those skills are not being taught using the TeamSTEPPS framework.

Observations of periwound skin protection in venous ulcers: a comparison of treatments.

OBJECTIVE: The objective of this study was to examine the effectiveness of 2 products on venous ulcer periwound skin. DESIGN: This was a descriptive comparative study. SETTING: An outpatient wound care clinic in a rural Midwestern area of the United States. PARTICIPANTS: Participants included a retrospective group of 50 patients and a prospective group of 28 patients. INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. MAIN RESULTS: For the periwound size, the estimated rates of change were as follows: 0.092 (SE, 0.021) cm/d and -0.026 (SE, 0.014) cm/d for products B and A groups, respectively. The decrease for the experimental group was significantly greater than the attenuated decrease for the retrospective cases (t297 = -2.57, P = .01), and the decrease for product B group was also significantly different from zero (t76 = -4.34, P < .0001). For the ulcer size model, the estimated rates of change were -0.272 (SE, 0.102) cm/d and -0.130 (SE, 0.067) cm/d for the experimental and retrospective groups, respectively. The rate for the experimental group was significantly less than zero (t76 = -2.67, P = .009), but there was no significant difference between prospective and retrospective cases in the rates of reduction in ulcer size (t308 = -1.16, P = .25). CONCLUSION: The results of this study illustrate how the integrity of the periwound skin may be an important determinant in decreasing periwound and ulcer size.

Planning, conducting, and interpreting prevalence and incidence for the wound practitioner.

Prevalence is a 1-time "snapshot" of cases present on a specific date, and incidence measures the new cases of a disease or condition in a given period. This article discusses prevalence and incidence and gives practical tips for wound care practitioners who plan and conduct prevalence/incidence audits.

Incontinence and incontinence-associated dermatitis.

Incontinence is a prevalent problem and can lead to many complications. Both urinary and fecal incontinence can result in tissue breakdown, now commonly referred to as incontinence-associated dermatitis. This article addresses the types of incontinence, its etiology and pathophysiology, assessment, prevention and treatment, and the latest research.

Hyperbaric oxygen therapy for chronic wounds.

Hyperbaric oxygen therapy continues to be discussed as another adjunctive therapy in the continuum of wound care. There is a dearth of evidence from randomized clinical trials on HBO therapy. For evidence-based practice, more randomized, controlled studies need to be conducted with HBO therapy to determine its efficacy in treating other chronic wounds besides those of patients with diabetes.

The relationship between hemoglobin A(1c) values and healing time for lower extremity ulcers in individuals with diabetes.

PROBLEM: The diabetic population is at an increased risk, up to 15% over a lifetime, to develop leg and foot ulcers due to such factors as neuropathy, ischemia, and infection. The tight control of glucose levels as possible is necessary to prevent the diabetic complications by preventing microvascular changes that predispose the patient to neuropathy, ischemia, and infection. Although it is clear from the literature review that tight glucose control prevents complications, the relationship between HgbA1c values and healing times of ulcers is less well defined. This study explored the relationship between HgbA1c values and healing times of leg and foot ulcers. THEORETICAL/CONCEPTUAL FRAMEWORK: The theoretical framework used was Orem's self-care deficit theory of nursing, which focuses on self-care of patients and nursing intervention if self-care is inadequate. SUBJECTS: Forty-one male and 22 female patients having either type 1 or type 2 diabetes were considered in this study. Of these 63 patients, 9 had type 1 and 54 had type 2 diabetes. Ages ranged from 33 to 94 years (mean, 67.7 years [SD, 14.98 years]). Weight ranged from 122 to 402 lb (mean, 221.84 lb [SD, 58.79 lb]). METHODOLOGY: As part of a larger study, a retrospective chart review was performed on 63 patients with diabetes served by a Midwestern outpatient wound care clinic from July 2001 to July 2004. Approval for this study was granted through the local institutional review board. No data collected required the consent of the individual or included any identifying data, thus protecting the privacy of the individuals whose charts were reviewed. A tool was developed by the researchers through literature review to gather needed information. The data collection tool included demographics, medical diagnoses, wound size at presentation, and most recent wound size, as well as the HgbA1c results closest to admission and closest to time of wound closure. Statistics were generated using the SPSS program. RESULTS: Of the 63 ulcers, 36 healed, 26 did not heal, and it was not possible to determine if healing occurred for 1 ulcer. Admission HgbA1c values ranged from 4.5 to 15.4 (mean, 8.05 [SD, 2.29]). HgbA1c values closest to ulcer closure ranged from 5.3 to 12.3 (mean, 7.68 [SD, 1.81]). It was found that patients with higher HgbA1c levels did experience wound healing, but in a significantly longer period than those with lower HgbA1c. Individuals with type 1 diabetes had a higher healing rate (77.8%) than individuals with type 2 diabetes (53.7%), whereas 40% of all closed ulcers reopened. A significant correlation was also noted between a history of smoking and increased HgbA1c levels. IMPLICATIONS: Healing times were decreased in those individuals who had lower HgbA1c values. Decreased healing times result in lower cost for the patient, decreased chance of infection due to lack of portal of entry, and increased quality of life. Patient education may increase self-care practices in the diabetic population regarding better glucose control.

Heel pressure ulcers: stand guard.

PURPOSE: To present a comprehensive overview of current information on heel pressure ulcer (PrU) risk, development, prevention, and treatment. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Identify risk factors for heel PrUs. 2. Describe assessment findings and staging of a heel PrU. 3. Discuss current heel PrU prevention and treatment.