Psychometric evaluation of the United States-adapted perceived perioperative competence scale-revised: A national survey.

Background: Nursing competence is integral to ensuring patient safety, especially in high-risk environments such as the operating room. Instruments which facilitate self-assessment of specialty specific nursing competence allow nurses to gain important insights into their practice to facilitate continuous growth in their professional practice. Currently, there are no psychometrically tested tools to assess perioperative competence applicable to the United States context. Objective: Test the psychometric properties of the Perceived Perioperative Competence Scale-Revised in the United States context. Methods: A cross-sectional survey design was used. Perioperative nurses were recruited via four professional associations and the survey was administered online. Construct validity of the six-dimensional Perceived Perioperative Competence Scale-Revised was tested using a multidimensional item response theory model known as the graded response model. Measurement invariance was assessed relative to years of perioperative experience. Internal consistency was estimated using McDonald's Omega and Cronbach's alpha reliability coefficients. Results: Responses from a total of 1,581 participants were analyzed in the psychometric analysis. The six-dimensional graded response model of the Perceived Perioperative Competence Scale-Revised displayed satisfactory model fit for the sample (Chi-square(df) = 5,699.09(725); root mean square error of approximation = 0.066, 90% confidence interval: 0.064, 0.067; comparative fit index = 0.955; Tucker-Lewis index = 0.952; standardized root mean squared residual = 0.045). Scalar invariance was established when assessing the psychometric equivalence of the scale across years of perioperative experience (<10 years, ≥ 10 years) (Chi-square(df) = 5,785.29(1,573); root mean square error of approximation = 0.058, 90% confidence interval: 0.057, 0.060; comparative fit index = 0.959; Tucker-Lewis index = 0.959). Reliability across the six subscales ranged from alpha = 0.87 - 0.94 and Omega = 0.93 - 0.97. Conclusions: Results suggest that the Perceived Perioperative Competence Scale-Revised is suitable to use with perioperative nurses practicing in clinical settings in the United States. Measurement invariance testing indicates the scale is measuring the same construct and is being interpreted in a conceptually similar manner across groups based on years of perioperative experience.

The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis.

BACKGROUND: Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE: To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES: The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA: Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS: Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023423058. TWEETABLE ABSTRACT: Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.

Inter-device agreement of sacral subepidermal oedema measurement in healthy adults during prolonged 60° head of bed elevation.

AIM: To investigate the level of agreement between the SEM 200 and Provisio® subepidermal moisture sacral delta measurements, which may indicate increased pressure injury risk, in healthy adults during 120 min of prolonged 60° head of bed elevation. This position, which requires the elevation of the patient's upper body at a 60° angle above the horizontal plane for an extended period, is used by clinicians to prevent or manage a patient's medical or surgical conditions. DESIGN: This prospective exploratory study recruited 20 healthy adults during October 2021 and collected sacral subepidermal moisture delta measurements using the SEM 200 and Provisio® devices. METHODS: Delta measurements were taken at 20-min intervals over 120 min resulting in seven data collection timepoints. Descriptive statistics and a Bland Altman plot analysis were conducted. RESULTS: A total of 280 sacral subepidermal moisture delta measurements were gathered or 140 per device. There were good levels of agreement between the two devices at baseline (T0) [mean 0.025; SD 0.137] and following 60- (T3) [mean 0.025; SD 0.111], 80- (T4) [mean -0.01; SD 0.177] and 100 min (T5) [mean 0.01; SD 0.129] of prolonged 60° head of bed elevation. Head of bed elevations can increase a patient's risk of sacral pressure injuries. In some countries, nurses have access to the SEM 200 and/or the Provisio® device, so our findings may increase nurses' confidence in the interchangeability of the device measurements, although further research is needed to confirm this. The SEM 200 and Provisio® subepidermal moisture scanners show promise in gathering similar objective pressure injury risk data which could prompt clinicians to implement prevention strategies. IMPACT: Current pressure injury risk assessment is largely subjective in nature. This quantitative study on healthy human sacral tissue found a good level of agreement in the SEM 200 and Provisio® subepidermal moisture scanners, which may increase nurses' confidence in the interchangeability of the devices in clinical practice.

The frequency and reasons for missed nursing care in Australian perioperative nurses: A national survey.

AIM: To describe Australian perioperative nurses' reported frequency and reasons for missed nursing care in the operating room. DESIGN: Cross-sectional online survey conducted in March-April 2022. METHODS: A census of Australian perioperative nurses who were members of a national professional body were invited to complete a survey that focussed on their reported frequency of missed nursing care and the reasons for missed nursing care in the operating room using the MISSCare Survey OR. RESULTS: In all, 612 perioperative nurses completed the survey. The perioperative and intraoperative nursing care tasks reported as most frequently missed included time-intensive tasks and communication with multiple surgical team members present. The most frequently reported reasons for missed care were staffing-related (e.g. staff number, skill mix, fatigue and complacency) and affected teamwork. There were no significant differences in the frequency of missed care based on perioperative nurse roles. However, there were statistically significant differences between nurse management, circulating/instrument nurses and recovery room nurses in reasons for missed care. CONCLUSIONS: Much of the missed care that occurs in the operating room is related to communication practices and processes, which has implications for patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Understanding the types of nursing care tasks being missed and the reasons for this missed care in the operating room may offer nurse managers deeper insights into potential strategies to address this situation. REPORTING METHOD: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Prioritising patients for semi-urgent surgery: A scoping review.

BACKGROUND: Semi-urgent surgery where surgical intervention is required within 48 h of admission and the patient is medically stable is vulnerable to scheduling delays. Given the challenges in accessing health care, there is a need for a detailed understanding of the factors that impact decisions on scheduling semi-urgent surgeries. AIM: To identify and describe the organisational, departmental and contextual factors that determine healthcare professionals' prioritising patients for semi-urgent surgeries. METHODS: We used the Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist. Four online databases were used: EBSCO Academic Search Complete, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase and EBSCO Medline. Articles were eligible for inclusion if they published in English and focussed on the scheduling of patients for surgery were included. Data were extracted by one author and checked by another and analysed descriptively. Findings were synthesises using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. RESULTS: Twelve articles published between 1999 and 2022 were included. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework highlighted themes of emergency surgery scheduling and its impact on operating room utilisation. Gaps in the management of operating room utilisation and the incorporation of semi-urgent surgeries into operating schedules were also identified. Finally, the lack of consensus on the definition of semi-urgent surgery and the parameters used to assign surgical acuity to patients was evident. CONCLUSIONS: This scoping review identified patterns in the scheduling methods, and involvement of key decision makers. Yet there is limited evidence about how key decision makers reach consensus on prioritising patients for semi-urgent surgery and its impact on patient experience. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Risk factors predicting hospital-acquired pressure injury in adult patients: An overview of reviews.

BACKGROUND: Hospital-acquired pressure injuries remain a significant patient safety threat. Current well-known pressure injury risk assessment tools have many limitations and therefore do not accurately predict the risk of pressure injury development over diverse populations. A contemporary understanding of the risk factors predicting pressure injury in adult hospitalised patients will inform pressure injury prevention and future researchers considering risk assessment tool development may benefit from our summary and synthesis of risk factors. OBJECTIVE: To summarise and synthesise systematic reviews that identify risk factors for hospital-acquired pressure injury development in adult patients. DESIGN: An overview of systematic reviews. METHODS: Cochrane and the Joanna Briggs Institute methodologies guided this overview. The Cochrane library, CINAHL, MEDLINE, and Embase databases were searched for relevant articles published in English from January 2008 to September 2022. Two researchers independently screened articles against the predefined inclusion and exclusion criteria, extracted data and assessed the quality of the included reviews using "a measurement tool to assess systematic reviews" (AMSTAR version 2). Data were categorised using an inductive approach and synthesised according to the recent pressure injury conceptual frameworks. RESULTS: From 11 eligible reviews, 37 risk factors were categorised inductively into 14 groups of risk factors. From these, six groups were classified into two domains: four to mechanical boundary conditions and two to susceptibility and tolerance of the individual. The remaining eight groups were evident across both domains. Four main risk factors, including diabetes, length of surgery or intensive care unit stay, vasopressor use, and low haemoglobin level were synthesised. The overall quality of the included reviews was low in five studies (45 %) and critically low in six studies (55 %). CONCLUSIONS: Our findings highlighted the limitations in the methodological quality of the included reviews that may have influenced our results regarding risk factors. Current risk assessment tools and conceptual frameworks do not fully explain the complex and changing interactions amongst risk factors. This may warrant the need for more high-quality research, such as cohort studies, focussing on predicting hospital-acquired pressure injury in adult patients, to reconsider these risk factors we synthesised. REGISTRATION: This overview was registered with the PROSPERO (CRD42022362218) on 27 September 2022.

Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review.

AIMS: To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN: A scoping review. DATA SOURCES: Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS: Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION: The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT: Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD: Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: A health consumer interpreted the data and prepared the manuscript.

Medication management of COVID-19 patients during transition to virtual models of care: a qualitative study.

INTRODUCTION: Expansion of hospital service models was one of the strategies implemented to manage the COVID-19 pandemic through virtual models of care. COVID-19 patients were hospital inpatients transferred to virtual wards and managed outside the hospital. Pharmacists had to provide distance medication management and support services. Virtual care patient support incorporated telehealth consultations by doctors, pharmacists and nurses. This study explored hospital clinicians' experiences and perspectives on medication management and safety issues of the COVID-19 patients transferred from inpatient units (IPUs) to virtual models of care at the time of transfer. METHODS: Semi-structured qualitative interviews were conducted with purposively selected doctors, pharmacists and nurses involved in the management of COVID-19 patients in a virtual model of care (home or hotel). Clinicians were interviewed face-to-face or via MS Teams between March and May 2022. An interview schedule included 13 questions and prompts to explore perceptions of medication management and safety aspects. RESULTS: Twenty clinicians were interviewed: six doctors, seven pharmacists, and seven nurses. The average interview time was 26 min (SD: 4.7; range 21-39). Four major medication management and safety themes emerged from the data: (1) complexities involved in efficient handover between IPU and virtual models of care; (2) lack of clarity on roles and responsibilities between hospital and primary care clinicians; (3) communication challenges when pharmacists work remotely; and (4) proactive management of specific medication safety risks. A common thread throughout the themes was concerns for potential impact on patient safety. CONCLUSION: Overall, clinicians were supportive of the virtual models although patient safety issues were raised that need to be addressed in the development of future services. The results from this study may inform improvements in medication safety implementation of future virtual models of care.

COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit.

BACKGROUND: Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care. METHOD: A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out. RESULTS: One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period. CONCLUSION: Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.

Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis.

BACKGROUND: Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES: To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN: Systematic review and meta-analysis. SETTING(S): Nursing homes, aged care, or long-term care facilities. PARTICIPANTS: Older people, 60 years and older. METHODS: Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS: 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION: The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER: PROSPERO CRD42022328367. TWEETABLE ABSTRACT: Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.

Incidence of wound dehiscence in patients undergoing laparoscopy or laparotomy: a systematic review and meta-analysis.

Surgical wound dehiscence (SWD) is a serious complication-with a 40% estimated mortality rate-that occurs after surgical intervention. Since the implementation of advanced recovery protocols, the current global incidence of SWD is unknown. This systematic review and meta-analysis estimated the worldwide incidence of SWD and explored its associated factors in general surgical patients. Eligible full-text cross-sectional, cohort and observational studies in English, between 1 January 2010 to 23 April 2021, were retrieved from MEDLINE, CINAHL, EMBASE and the Cochrane Library. Data extraction and quality appraisal were undertaken independently by three reviewers. Random effects meta-analytic models were used in the presence of substantial inconsistency. Subgroup, meta-regression and sensitivity analyses were used to explore inconsistency. Publication bias was assessed using Hunter's plots and Egger's regression test. Of 2862 publications retrieved, 27 studies were included in the final analyses. Pooled data from 741,118 patients across 24 studies were meta-analysed. The 30-day cumulative incidence of SWD was 1% (95% Confidence Interval (CI): 1-1%). SWD incidence was highest in hepatobiliary surgery, at 3% (95% CI: 0-8%). Multivariable meta-regression showed SWD was significantly associated with duration of operation and reoperation (F=7.93 (2-10); p=0.009), explaining 58.2% of the variance. Most studies were retrospective, predated the agreed global definition for SWD and measured as a secondary outcome; thus, our results likely underestimate the scope of the problem. Wider uptake of the global definition will inform the SWD surveillance and improve the accuracy of reporting.

Nurse-delivered patient education on postoperative wound care: a prospective study.

OBJECTIVE: It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. METHOD: A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. RESULTS: In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (ß=-0.776, p=0.013); hospital site (ß=-0.702, p=0.025); and number of postoperative days (ß=-0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6-10.3% of variance in the postoperative wound care education patients received. CONCLUSION: Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.

Psychometric validation of the Perceived Perioperative Competence Scale-Revised Short Form.

AIM: To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale-Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. DESIGN: A longitudinal online survey was adopted. METHODS: A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. RESULTS: Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40-item revised scale was reduced to an 18-item measure, maintaining its six domains. Cronbach's alpha for the 18-item scale was .92 at time 1 and .90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self-efficacy, years of operating room experience, postgraduate education and recency of training. CONCLUSIONS: Results suggest the 18-item Perceived Perioperative Competence Scale-Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition-to-practice, orientation programs and yearly professional development reviews. IMPLICATIONS FOR THE PROFESSION: This short-form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. IMPACT: Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18-item measure of the previously validated 40-item Perceived Perioperative Competence Scale-Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. PATIENT OR PUBLIC CONTRIBUTION: Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study.

Medical and surgical nurses' approach to patient pressure injury prevention education: An integrative review.

AIMS: Identify and synthesise the published literature on the approaches and practices nurses use during the delivery of pressure injury prevention (PIP) education to hospitalised medical and surgical patients. DESIGN: An integrated review. METHODS: Whitmore and Knaff's (2005) five-stage methodology guided this review: (1) research problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020) Statement was followed. The quality of included studies was assessed using the Mixed Method Appraisal Tool (2018). Extracted data were analysed using inductive content analysis. DATA SOURCES: Journal publication dates from 1992 to 2022. Systematic searches of CINAHL (Cumulative Index of Nursing and Allied Health Literature) complete, Embase, PsycINFO (via Ovid) and Scopus databases were undertaken. RESULTS: A total of 3892 articles were initially identified, four quantitative and two qualitative studies were included. Articles were published between 2013 and 2022.Two themes were identified: responsibility and workplace culture determine nurses' approach to PIP education delivery; and nurses tailor education strategies to address challenges and opportunities for PIP education delivery. CONCLUSION: Nurses require resources to facilitate approaches to PIP education with medical and surgical patients. In the absence of clear instruction to support nurses' practice, PIP education for patients is at best delivered in an informal and ad hoc manner. Nurses require accessible education resources to enable them to tailor the content and frequency of PIP education to patients in med-surg settings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Variations in sacral sub-epidermal moisture measurements in hospitalized medical and surgical patients: A longitudinal observational sub-study.

BACKGROUND: Pressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema. AIMS: To assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements. METHODS: As part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement. RESULTS: A total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days. CONCLUSION: If only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach. TWEETABLE ABSTRACT: Sub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.

Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review.

AIM: The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. BACKGROUND: The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. DESIGN: Scoping review. METHODS: Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five-step scoping review methodology was used. RESULTS: Fifty-three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low-level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub-optimally; and current knowledge gaps include capacity assessment, decision-making and pre-procedural consent checks. CONCLUSION: Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision-making, pre-procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. RELEVANCE TO CLINICAL PRACTICE: This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. NO PATIENT OR PUBLIC CONTRIBUTION: The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.

Development and validation of a survey designed to measure patient experience of and preference for surgical wound care discharge education: A pilot study.

AIM OF THE STUDY: To develop and undertake validation testing of a survey designed to measure patients' experiences of and preferences for surgical wound care discharge education. MATERIALS AND METHODS: A literature review and content analysis was undertaken on patients' experiences of and preferences for surgical wound care discharge education. Four themes were uncovered in the literature (wound care discharge education, preferences for discharge education delivery, participation in wound care decisions and patient ability to manage their surgical wound to prevent wound complications), which guided item generation. Three types of validity testing occurred including: 1) face validity testing by the research team; 2) content validity testing (using Delphi study) with an international panel of experts including patients, clinicians and researchers; and 3) content validity (using pilot-testing) of the survey with seven patients from the target population. RESULTS: Initially 106 items were generated from the literature, and of these, 55 items were subjected to content validity testing by an international panel of 41 experts. After two Delphi rounds, 18 items were retained. Most patients provided limited and very minor feedback during pilot-testing. However, pilot-testing resulted in a revised survey administration plan to deliver the survey via telephone, including adding prompts and preambles to items. CONCLUSION: An 18-item survey comprised of three groups of items and an individual item was rigorously developed. The survey requires further testing among a larger sample of patients to confirm the items reflect important aspects of patients' experiences of and preferences for surgical wound care discharge education.

Cost-effectiveness of closed incision negative pressure wound therapy in preventing surgical site infection among obese women giving birth by caesarean section: An economic evaluation (DRESSING trial).

BACKGROUND: There is growing evidence regarding the potential of closed incision negative pressure wound therapy (ci-NPWT) to prevent surgical site infections (SSIs) in healing wounds by primary closure following a caesarean section (CS). AIM: To assess the cost-effectiveness of ci-NPWT compared to standard dressings for prevention of SSI in obese women giving birth by CS. MATERIALS AND METHODS: Cost-effectiveness and cost-utility analyses from a health service perspective were undertaken alongside a multicentre pragmatic randomised controlled trial, which recruited women with a pre-pregnancy body mass index ≥30 kg/m2 giving birth by elective/semi-urgent CS who received ci-NPWT (n = 1017) or standard dressings (n = 1018). Resource use and health-related quality of life (SF-12v2) collected during admission and for four weeks post-discharge were used to derive costs and quality-adjusted life years (QALYs). RESULTS: ci-NPWT was associated with AUD$162 (95%CI -$170 to $494) higher cost per person and an additional $12 849 (95%CI -$62 138 to $133 378) per SSI avoided. There was no detectable difference in QALYs between groups; however, there are high levels of uncertainty around both cost and QALY estimates. There is a 20% likelihood that ci-NPWT would be considered cost-effective at a willingness-to-pay threshold of $50 000 per QALY. Per protocol and complete case analyses gave similar results, suggesting that findings are robust to protocol deviators and adjustments for missing data. CONCLUSIONS: ci-NPWT for the prevention of SSI in obese women undergoing CS is unlikely to be cost-effective in terms of health service resources and is currently unjustified for routine use for this purpose.

The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study.

Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point-of-care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120-min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20-min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one-way repeated measures analysis of variance and an independent t-test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.