Uso de la metodología de paquete de cuidados (care bundle)aplicada a la prevención de lesiones por presión adquiridas en hospital en pacientes adultos: revisión exploratoria / The care bundle approach applied to the prevention of hospital acquired pressure injuries in adults: a scoping review

Objetivo: Explorar el estado del conocimiento sobre la metodología del paquete de cuidados (PCuid) en la prevención de lesiones por presión adquiridas en hospital en pacientes adultos. Metodología: Revisión exploratoria en 10 bases de datos bibliográficos. Se incluyeron las publicaciones relacionadas con pacientes adultos ingresados en unidades de hospitalización convencional. Se realizó una descripción narrativa sin análisis de la calidad metodológica. Resultados: Se seleccionaron 31 artículos de diferentes diseños de investigación, identificando 9 PCuid. Como resultados cuantitativos, se obtuvieron reducciones de la incidencia de lesiones por presión desde el 8 al 90%, en la prevalencia del 37 al 94%, o incrementos en el número de días sin lesiones por presión desde el 50 al 59%. Otros efectos fueron un aumento del 36% en la utilización de la escala de Braden para la valoración del riego de lesiones por presión, o la mejora de cumplimentación de los registros de lesiones por presión del 13%. Desde el punto de vista cualitativo, los profesionales consideraron la aplicación de un PCuid como factible y aceptable, destacando como beneficios el aumento de la comunicación, los conocimientos y la participación en la prevención de LPP. Los pacientes consideraron la aplicación del PCuid como aceptable al aumentar su participación en el cuidado, favorecer la interacción con el personal y proporcionar información fácil de entender. Conclusión:La metodología del PCuid mejora la prevención de LPP en adultos hospitalizados. Son necesarios más estudios y de mayor calidad para valorar su efectividad. Resultaría recomendable estandarizar el uso de un único indicador de resultados que permitiera la comparación entre PCuid con distintos contenidos, preferiblemente la incidencia o la prevalencia de lesiones por presión adquiridas en el hospital (AU)

Objective: To explore the state of knowledge regarding the care bundle (CB) approach in the prevention of hospital-acquired pressure injuries (PI) in hospital wards in adult patients. Methodology: Scoping review from 10 bibliographic databases. Publications related to adult patients admitted to conventional hospital wards were included. A narrative description was made without analysis of methodological quality. Results:31 articles were selected with different designs, identifying 9 CB. As quantitative results, reductions in the incidence of PI were obtained from 8% to 90%, in the prevalence from 37% to 94%, or increases in the number of days without PI from 50% to 59%. Other effects were a 36% increase in the use of the Braden scale for the assessment of PI risk, or a 13% improvement in the completion of PI records. From a qualitative point of view, the professionals considered the application of a CB as feasible and acceptable, highlighting the increased communication, knowledge and participation in the prevention of PI as benefits. Patients considered the application of CB as acceptable by increasing their participation in care, promoting interaction with staff and providing easy to-understand information. Conclusion: The CB methodology improves the prevention of PI in hospitalized adults. More and higher quality studies are needed to assess its effectiveness. It would be advisable to standardize the use of a unique indicator of results that would allow comparison between CB with different contents, preferably the incidence or prevalence of PI hospital acquired (AU)

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en adultos hospitalizados en España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of dependencerelated skin lesions in hospitalised adult population in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener indicadores epidemiológicos actualizados paralas lesiones cutáneas relacionadas con la dependencia en unidades dehospitalización de adultos de hospitales españoles, tanto globales comoajustados. Analizar las características demográficas y clínicas de laspersonas con lesiones cutáneas relacionadas con la dependencia, y de laslesiones. Metodología: Estudio observacional, transversal, tipo encuestaepidemiológica (6.º Estudio Nacional de Prevalencia), dirigido a todos loshospitales de España. Recogida de datos mediante formulario seguro online.Variables: características de los hospitales y de las unidades, pacientesingresados, pacientes con cada tipo de lesiones cutáneas relacionadascon la dependencia, clasificación de las lesiones. Se estimó la prevalenciacruda global y ajustada por hospitales y por tipo de unidades. Resultados:Participaron 470 unidades de hospitalización de adultos pertenecientesa 67 hospitales de todo el territorio nacional. La prevalencia global delesiones cutáneas relacionadas con la dependencia fue del 8,4%. Segúnel tipo de lesiones, las prevalencias fueron: lesiones por presión 7,7%;combinadas 0,9%; humedad 1,5%; por fricción 0,9%, y desgarros 0,8%.Los hospitales pequeños, de menos de 200 camas, son los que presentanprevalencias mayores. Las unidades con prevalencias más altas fueron:cuidados paliativos (24,2%), UCI (21,5%) y unidades posquirúrgicas y dereanimación (14,8%). La mayoría de las lesiones son de origen nosocomial(80%), producidas en el mismo o en otro hospital. Siguen faltando laimplementación de medidas preventivas en los centros y la dotación derecursos de prevención. Conclusiones: La prevalencia de lesiones cutáneasrelacionadas con la dependencia se mantiene en cifras similares a la deestudios anteriores en hospitales españoles, con gran variabilidad en función del tamaño del centro y las unidades en las que ingresa el paciente. (AU)

Objectives: To obtain updated epidemiological indicators fordependence-related skin lesions (DSRL) in adult inpatientunits of Spanish hospitals, both global and adjusted. Toanalyse the demographic and clinical characteristics of personswith DRSLs and lesions. Methodology: Observational,cross-sectional, epidemiological survey-type study (6thNational Prevalence Study), aimed at all hospitals in Spain.Data collection by means of a secure online form. Variables:characteristics of hospitals and units, patients admitted,patients with each type of DRSL, classification of lesions.Overall and adjusted crude prevalence was estimated byhospital and by type of unit. Results: A total of 470 adultinpatient units from 67 hospitals nationwide participated.The overall prevalence of DRSL was 8.4%. According totype of injury, the prevalences were: pressure injuries 7.7%;combined injuries 1.5%; moisture 1.4%; friction 0.9%; andtears 0.8%. Small hospitals with less than 200 beds haveshigher prevalence. The units with the highest prevalencewere: palliative care (24.2%), ICU (21.5%), and post-surgicaland resuscitation units (14.8%). Most of the injuries are ofnosocomial origin (80%), produced in this or other hospitals.The implementation of preventive measures in the centresand the provision of resources are still lacking. Conclusions:The prevalence of DRSL remains similar to that of previousstudies in Spanish hospitals, with great variability dependingon the size of the centre and the units to which the patient isadmitted. (AU)

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en centros de atención primaria de salud de España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of pressure injuries and other dependence-related skin lesions in primary healthcare centers in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener indicadores epidemiológicos actualizados para laslesiones cutáneas relacionadas con la dependencia en centros de atenciónprimaria de salud españoles, tanto globales como ajustados. Analizarlas características demográficas y clínicas de las personas con lesionescutáneas relacionadas con la dependencia y de las lesiones. Metodología:Estudio observacional, transversal, tipo encuesta epidemiológica (6.ºEstudio Nacional de Prevalencia), dirigido a todos los centros deatención primaria de salud en España. Recogida de datos medianteformulario seguro online. Variables: características de los centros deatención primaria, población total, población mayor de 65 años ypoblación en programas de atención domiciliaria, pacientes con cadatipo de lesiones cutáneas relacionadas con la dependencia, clasificaciónde las lesiones. Se estimó la prevalencia cruda global poblacional yajustada en mayores de 65 años y en personas en programas de atencióndomiciliaria. Resultados: Se han obtenido datos de una población de1.754.228 personas atendidas en 131 centros de atención primaria desalud españoles. La prevalencia de lesiones cutáneas relacionadas conla dependencia en las personas en pacientes atendidos en programasde atención domiciliaria (ATDOM) fue del 5,82%. Solo un 7,7% delos centros declararon no tener ninguna persona con lesiones cutáneasrelacionadas con la dependencia atendida en el momento de obtenerlos datos. La prevalencia casi se duplica en los centros rurales (7,1%)y mixtos (6,0%) respecto a los centros urbanos (3,9%). Las lesiones seoriginaron en el mismo domicilio del paciente en un 79,8% de los casos,y solo un 18,7% se originaron durante el ingreso del paciente en unainstitución. (AU)

Objectives: To obtain updated epidemiological indicatorsfor dependence-related skin lesions (DRSL) in SpanishPrimary Health Care (PHC) centres, both global andadjusted. To analyse the demographic and clinicalcharacteristics of people with DRSL and lesions. and thelesions. Methodology: Observational, cross-sectional,epidemiological survey-type study (6th NationalPrevalence Study), aimed at all PHC centres in Spain. Datacollection by means of a secure on-line form. Variables:characteristics of primary care centres, total population,population over 65 years of age and population in homecare programmes, patients with each type of DRSL,classification of lesions. We estimated the overall crudeprevalence in the population and adjusted prevalence,in people over 65 years of age and in people in homecare programmes. Results: Data were obtained from apopulation of 1,754,228 people cared for in Spanish PHCcentres in 131 centres. The prevalence of DRSL in personsin patients attended in home care programmes (HCP) was5.82%. Only 7.7% of the centres reported not having anypersons with DRSL in care at the time of data collection.The prevalence almost doubles in rural (7.1%) and mixed(6.0%) centres compared to urban centres (3.9%). Injuriesoriginated in the patient’s own home in 79.8% of cases,and only 18.7% originated during the patient’s admissionto an institution. The profile is that of an 83-year-oldwoman with mixed incontinence and using a staticmattress surface. Conclusions: The prevalence of primary care DRSL in Spain remains similar to previous studies,with great variability depending on the location of thecentre. Four out of 5 lesions develop in the patient’shome. (AU)

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en residencias de mayores y centros sociosanitarios de España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of dependence-related skin lesions in nursing home in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener las cifras de prevalencia de las lesiones cutáneasrelacionadas con la dependencia en centros residenciales para mayores ycentros sociosanitarios españoles. Analizar las características demográficasy clínicas de las personas con lesiones cutáneas relacionadas con ladependencia y de las lesiones. Metodología: Estudio observacional,transversal, tipo encuesta epidemiológica (6.º Estudio Nacional dePrevalencia), dirigido a todas las residencias y centros sociosanitariosde España. Recogida de datos mediante formulario seguro online.Variables: características de los hospitales y de las unidades, pacientesingresados, pacientes con cada tipo de lesiones cutáneas relacionadascon la dependencia, clasificación de las lesiones. Se estimó la prevalenciacruda global y ajustada por hospitales y por tipo de unidades. Resultados:Se han obtenido datos de 74 centros sociosanitarios y residencias demayores. Solo un 9,5% de los centros declararon no tener ningunapersona con lesiones cutáneas relacionadas con la dependencia atendidaen el momento de obtener los datos. La prevalencia global de lesionescutáneas relacionadas con la dependencia fue del 9,28% (IC95%,5,45-6,71), un 3% más que en el anterior. Las cifras de prevalencia decada tipo de lesión fueron: presión, 6,05%; humedad, 2,35%; fricción,1,35%; desgarros cutáneos, 2,38%, y combinadas, 0,61%. Esto suponeun incremento en todas las lesiones menos las combinadas. La prevalenciade todas las lesiones cutáneas relacionadas con la dependencia fue mayoren los centros públicos que en los concertados y privados. En un 85,2%,las lesiones cutáneas relacionadas con la dependencia eran de origennosocomial (originadas en la residencia u otra institución residencial)y solo un 10,9% se originaron en los domicilios. (AU)

Objectives: To obtain the prevalence figures ofdependence-related skin lesions (DRSL) in Spanish nursinghomes and long term care centres (NH-LTCC). To analysethe demographic and clinical characteristics of peoplewith DRSL and lesions. Methodology: Observational,cross-sectional, epidemiological survey-type study (6thNational Prevalence Study), aimed at all NHC-LTCC inSpain. Data collection by means of a secure on-line form.Variables: characteristics of hospitals and units, patientsadmitted, patients with each type of DRSL, classificationof lesions. Overall and adjusted crude prevalence wasestimated by hospital and by type of unit. Results: Datawere obtained from 74 NHC-LTCC. Only 9.5% of thecentres reported not having any person with DRSL in theircare at the time of data collection. The overall prevalenceof DRSL was 9.28% (95%IC, 5.45-6.71); 3% higher thanin the previous study. The prevalence figures for each typeof injury were: pressure 6.05%, moisture 2.35%, friction1.35%, skin tears 2.38%. combined 0.61%. Thisrepresents an increase in all but combined injuries. Theprevalence of all DRSLs was higher in the public centresthan in the state and private centres. The 85.2% ofthe DRSLs were of nosocomial origin (originating in anursing home or other residential institution) and only10.9% originated at home. Conclusions: The prevalenceof DRSL in nursing homes is among the highest in thistype of centre in the historical series of studies carriedout in Spain by the GNEAUPP. This higher prevalencecould be explained by the situation in which many havebeen left after the COVID pandemic and a relaxation in the prevention programmes implemented. (AU)

Algorithm for the differential diagnosis between dependence-related skin injuries and severe life-threatening skin injuries.

AIM: To develop a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). METHOD: A nominal group technique was used. Six experts with extensive knowledge of these types of injuries were selected for the group. All were nurses with a PhD in wound research and had more than 15 years of experience in wound care. The experts were asked only one question: In your opinion, what are the basic and indispensable aspects to differentiate a dependence-related skin injury (DR-SI) from a severe life-threatening skin injury (SLT-SI)? RESULTS: The experts identified three basic elements to differentiate DL-SI and SLT-SI (clinical situation, provision of care, and clinical characteristics of the lesions). A diagnostic algorithm was developed to differentiate the two types of skin lesions using the three basic elements identified, a literature review, and what was published in the two articles that define DR-SI and STL-SI. CONCLUSION: We developed a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). The algorithm also facilitates the identification of the subtypes of these injuries, depending on its location and characteristics.

Skin injuries associated with severe life-threatening situations: A new conceptual framework.

PURPOSE: To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN: A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS: Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS: Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS: We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE: This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.

Nurses and ward managers' perceptions of leadership in the evidence-based practice: A qualitative study.

AIM: To describe nurses and ward managers' experiences with nursing leadership in the implementation of evidence-based practice. BACKGROUND: The implementation of evidence-based practice requires to identify the most suitable styles of nursing leadership for the successful application. DESIGN: A qualitative descriptive study. METHODS: The study was carried out with 57 nurses (clinical nurses and ward managers) in eight focus groups from five public hospitals. Template analysis, using the Promoting Action on Research Implementation in Health Services framework, was used. The Consolidated Criteria for Reporting Qualitative Research guide was followed in planning and reporting this research. RESULTS: Three types of nursing leadership were identified: traditional leadership, medium leadership and transformational leadership. Traditional leadership was the most frequent, with a predominance of bureaucratic tasks for ward managers, so implementation of evidence-based practice is difficult. CONCLUSION: Nurses do not feel empowered and they perceive the changes as an imposition. In the absence of strong leadership for evidence-based practice, a natural leader emerges. IMPLICATIONS FOR NURSING MANAGEMENT: Clinical nurses demand more empowerment for decision-making, and ward managers need clarity of roles. To create an environment favourable to evidence-based practice, it is necessary consider the role of the transformational leader.

Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process.

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.

Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study.

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6-68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5-2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2-90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

Actitud hacia la prevención de lesiones por presión en estudiantes de enfermería: cuestionario APuP / Attitude towards pressure injury prevention in nursing students: the APuP questionnaire

OBJETIVOS: Conocer la actitud hacia la prevención de las lesiones por presión que tienen los estudiantes y las estudiantes del Grado en Enfermería. Objetivos secundarios: a) realizar la valoración psicométrica de la versión española del cuestionario Attitudes towards Pressure ulcer Prevention (APuP) (Actitudes hacia la prevención de las UPP) en población de estudiantes y b) identificar los factores formativos asociados con la actitud. MÉTODOS: Estudio observacional transversal, llevado a cabo en la Universidad de Jaén mediante un cuestionario online en estudiantes de los 4 cursos del Grado en Enfermería. Se utilizó el análisis de Rasch para establecer las propiedades psicométricas del cuestionario. Se calculó la puntuación de actitud y su asociación con variables formativas. Para estimar el tamaño del efecto se usó la diferencia estandarizada de medias (d de Cohen). RESULTADOS: Se analizaron un total de 188 cuestionarios válidos. La puntuación media obtenida en el cuestionario APuP fue 22,60 (44,23% del máximo). El cuestionario presenta una buena consistencia global (α = 0,74) y los índices de ajuste de los ítems fueron buenos. Se encontró una actitud menos positiva en estudiantes que habían realizado prácticas clínicas (p < 0,0001) y los de los cursos superiores (p < 0,0001). Existe una correlación inversa entre la puntuación de actitud y la puntuación de conocimientos (r = -0,46). CONCLUSIONES: El cuestionario APuP (versión española) es un instrumento válido y fiable para su uso en estudiantes de enfermería. La actitud hacia la prevención no es positiva en estos estudiantes y se evidencia un posible efecto de la realización de prácticas clínicas y el aumento de conocimientos en una actitud menos favorable

OBJECTIVES: To explore the attitude towards pressure injury prevention of nursing students. Secondary objectives: a) To establish the psychometric properties of the questionnaire of Attitudes towards the prevention of pressure ulcer (APuP) -Spanish version- in student population, and b) To identify the educational factors associated with the attitude. METHODS: A cross-sectional observational and validation study was carried out with students of the four years of the Bachelor in Nursing in the University of Jaén (Spain) using an online survey. Rasch analysis was used to establish the psychometric properties of the questionnaire. Also, the score of attitude and its association with educational variables were analysed. The standardised median difference (Cohen's d) was used to estimate the effect size. RESULTS: A total of 188 valid questionnaires were analysed. The average score obtained in the APuP questionnaire was 22.60 (44.23% of the maximum). The questionnaire has a good overall internal consistency (α=0.74) and the item fit indices were good. It was found a less positive attitude in students who had done clinical placements (p < 0.0001) and those in higher years (p < 0.0001). There is an inverse correlation between the attitude score and the knowledge score (r= -0.46). CONCLUSIONS: The questionnaire of attitudes towards prevention of pressure ulcers (APuP) Spanish version is a valid and reliable instrument to use in nursing students. The attitude towards prevention is not positive in these students and there is some evidence for a possible effect of clinical placements and increased knowledge over a less favourable attitude

Development and validation of the Pressure Injury Prevention Barriers questionnaire in hospital nurses in Spain.

OBJECTIVE: To develop and validate a new questionnaire to measure the nurses' perceptions of the barriers towards the prevention of pressure injuries (PIs) at hospitals. DESIGN: Validation study with mixed methods. SETTING: Four university hospitals in southern Spain. PARTICIPANTS: The questionnaire was developed based on a literature review. A panel of 14 wound care experts rated the content validity. A sample of 438 nurses (registered nurses and assistant nurses) participated in the survey. MAIN OUTCOME MEASURES: The psychometric properties of the Pressure Injury Prevention Barriers (PIPB) questionnaire evaluated were: content validity, internal consistency reliability and construct validity. RESULTS: The final version of the questionnaire has 25 items grouped into four factors (management and organisation, motivation and priority, knowledge, and staff and collaboration). The confirmatory factor analysis showed good fit and error indices for the model (Comparative Fit Index=0.92, root mean square error of approximation=0.074). Cronbach's alpha was 0.90 (overall), and 0.89 (factor 1), 0.75 (factor 2), 0.72 (factor 3) and 0.45 (factor 4). Construct validity was good, demonstrated by the expected association with the scores on patient safety culture and on considering PIs as an adverse effect of hospital stay, but not with attitude score. CONCLUSION: The PIPB questionnaire is an instrument useful for measuring nurses' perceptions of the barriers to PIs prevention. The initial evidence shows that the questionnaire has good content validity, internal consistency and adequate construct validity. Relevance and comprehensiveness need to be assessed in further studies. It can be used both in research and in the evaluation of clinical settings to implementation of PIs preventive programmes in hospitals.

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument.

The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach's alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.

Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses.

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.

Knowledge about the Care of People with Alzheimer's Disease of the Nursing Staff of Nursing Homes in Spain.

People with Alzheimer's disease often live in nursing homes. Updated knowledge among the nursing staff has led to better quality of care. The aim of this study was to measure the knowledge about the care of people with Alzheimer's disease of the nursing staff of nursing homes in Spain. A cross-sectional study was conducted in 24 nursing homes in the province of Jaén (Spain) with a sample of 361 members of staff, i.e., registered nurses (RNs), assistant nurses (ANs), and eldercare workers (EWs). The University of Jaén UJA-Alzheimer's Care Scale was used to measure the knowledge. The knowledge was higher among the RNs (83.3% of the maximum) than among the ANs and EWs (71.6%). Work experience and updated training were associated with the knowledge score in RNs, but only the updated training in ANs and EWs. Nursing homes with less experienced nursing staff and with a small proportion of staff receiving training on dementia have a low knowledge score. The nursing staff of nursing homes in Jaén have medium to high knowledge about Alzheimer's care. There is a wide range of variation in the knowledge score among the nursing homes. Up-to-date staff training in dementia care is the factor with the strongest association with knowledge.

Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en residencias de mayores y centros sociosanitarios de España en 2017 / Prevalence of pressure injuries and other dependence-related skin lesions in nursing homes and residential care centers in Spain in 2017

Objetivos: Obtener las cifras de prevalencia de las lesiones por presión (LPP) y otros tipos de lesiones cutáneas relacionadas con la dependencia (LCRD) en centros residenciales para mayores y centros sociosanitarios (CSS) españoles. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia), dirigido a residencias de mayores y CSS en España. Recogida de datos entre noviembre y diciembre de 2017 mediante formulario seguro on-line. Variables: características de los centros, número de pacientes con cada tipo de LCRD, medidas de prevención, clasificación de cada lesión, tamaño y tiempo de evolución. Se calculó la prevalencia cruda y su intervalo de confianza del 95%. Resultados: Se han obtenido datos de 43 CSS y residencias de mayores de 6 comunidades autónomas españolas. Solo un 7% de los centros declararon no tener ninguna persona con LCRD atendida en el momento de obtener los datos. La prevalencia global de LCRD fue del 6,24% (IC 95% 5,51-7,07%), y la de cada tipo de lesión: presión, 4,03%; humedad, 2,19%; fricción, 0,80%; combinadas, 1,01%, y desgarros cutáneos, 1,31%. Para las LPP, la prevalencia fue mayor en centros concertados (8,12%) y privados (4,40%) que en los centros públicos (2,96%). No hay diferencias entre tipos de centros para las otras lesiones. Las LCRD eran de origen nosocomial (originadas en instituciones residenciales u hospitales) en el 92,4% de los casos y solo un 7,6% se originaron en los domicilios. Conclusiones: La prevalencia de LCRD en residencias de mayores y CSS es la más baja en este tipo de centros en la serie histórica de estudios realizado en España por el GNEAUPP. Debido a la menor participación de centros en el estudio, esta menor prevalencia podría explicarse por mayor representación de centros más motivados en la prevención de LCRD, pero también por una mejora en los programas de prevención implementados. Hay diferencias estadísticamente significativas entre la prevalencia de LCRD en función de la titularidad de los centros, siendo las más bajas en los públicos y las más elevadas en los concertados. El perfil, los tipos de lesiones, severidad y localización de las LCRD son similares a las descritas en atención primaria de salud y hospitales

Aims: To obtain figures on the prevalence of pressure injuries (PI) and other types of dependence-related skin lesions (DRSL) in Spanish nursing homes and residential care centres. To analyse the demographic and clinical characteristics of people with DRSL and the characteristics of the lesions. Methods: Observational, cross-sectional, epidemiological study through a survey (5th National Prevalence Study), aimed at nursing homes and residential centres in Spain. Data collection between November and December 2017 using a secure on-line form. Variables: characteristics of the centres, number of patients with each type of DRSL, prevention measures, classification of each lesion, size and time of evolution. The crude prevalence and its 95% confidence interval were calculated. Results: 43 nursing home and residential care centres participated, from 6 Spanish autonomous communities. Only 7% of the centres stated that they did not have any person with DRSL attended at the time of collecting the data. The overall prevalence of LCRD was 6.24% (95%CI: 5.51 7.07%) and that of each type of lesion: pressure 4.03%, humidity 2.19%, friction 0.80%, combined 1.01% and skin tears 1.31%. For PI, the prevalence was higher in subsidised (8.12%) and private (4.40%) centres than in public (2.96%) ones. There are no differences between types of centres for the other injuries. DRSL were of nosocomial origin (originating in residential institutions or hospitals) in 92.4% of cases and only 7.6% originated at home. Conclusions: The prevalence of DRSL in nursing homes and residential centres is the lowest in this type of settings in the historical series of studies carried out in Spain by GNEAUPP. Due to the fact that the participation of centres has been much lower than that of previous studies, this lower prevalence could be explained by a higher representation in the sample of those centres more motivated toward DRSL prevention; but also by an improvement in preventive programmes. There are statistically significant differences between the prevalence of SLRD according to the funding of the centres, with the lowest in the public centres and the highest in the subsidised centres. The profile, types of injuries, severity and location of the DRSL are similar to those described in primary care or hospitals

Effectiveness and safety of olive oil preparation for topical use in pressure ulcer prevention: Multicentre, controlled, randomised, and double-blinded clinical trial.

This non-inferiority, multicentre, randomised, controlled, and double-blinded clinical trial compared the therapeutic effectiveness of the topical application of an olive oil solution with that of a hyperoxygenated fatty acid compound for the prevention of pressure ulcers in at-risk nursing home residents. The study population comprised 571 residents of 23 nursing homes with pressure ulcer risk, randomly assigned to a hyperoxygenated fatty acid group (n = 288) or olive oil solution group (n = 283). Both solutions were applied on at-risk skin areas every 12 hours for 30 days or until pressure ulcer onset. The main outcome variable was the pressure ulcer incidence. The absolute risk difference was estimated (with 95% CI) using Kaplan-Meier survival and Cox regression curves. The groups did not significantly differ in any study variable at baseline. The pressure ulcer incidence was 4.18% in the olive oil group vs 6.57% in the control group, with an incidence difference of -2.39% (95% CI = -6.40 to 1.56%), which is within the pre-established non-inferiority margin of ±7%, thus supporting the study hypothesis. We present the first evidence of the effectiveness and safety of the topical application of olive oil to prevent pressure ulcers in the institutionalised elderly.

Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en centros de atención primaria de salud de España en 2017 / Prevalence of pressure injuries and other dependence-related skin lesions in primary healthcare centres in Spain in 2017

Objetivos: Obtener indicadores epidemiológicos actualizados para las lesiones por presión (LPP) y otras lesiones cutáneas relacionadas con la dependencia (LCRD) en centros de Atención Primaria de Salud (APS) españoles, tanto globales como ajustados. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia) (ENP), dirigido a centros de APS. Recogida de datos mediante formulario en línea seguro. Variables: características de los centros, número de pacientes con cada tipo de LCRD, clasificación de cada lesión, tamaño y tiempo de evolución. Se calcularon tres valores de prevalencia: prevalencia cruda poblacional, en mayores de 65 años y en personas en programas de atención domiciliaria. Resultados: Se han obtenido datos de una población de casi 763.000 personas atendidas en 98 centros de APS españoles. Un 14,3% de los centros declararon no tener ninguna persona con LCRD atendida en el momento de obtener los datos. En el grupo de personas en programas de atención domiciliaria (ATDOM), la prevalencia de LCRD fue del 6,11%. Según tipo de lesiones fueron: presión, 4,79%; humedad, 1,39%; fricción, 1,81%; combinadas, 1,05%, y desgarros cutáneos, 1,05%. Las lesiones se originaron en el mismo domicilio del paciente en un 83,3% de los casos, y solo un 16,7% eran de origen nosocomial. Conclusiones: La prevalencia de LCRD en pacientes atendidos en programas de ATDOM fue del 6,11%, siendo las LPP las lesiones más frecuentes, con un 4,79% de prevalencia (cifras similares a las del 3er ENP y suponen un ligero descenso sobre las encontradas en el 4º ENP). Tanto las LPP como el resto de LCRD son mayoritariamente producidas en el domicilio, a diferencia de la situación en hospitales en los que predominan las de origen nosocomial. La prevención de las LCRD en personas atendidas en ATDOM debe ser una prioridad

Aims: To obtain updated, global and adjusted epidemiological indicators for pressure injuries (PI) and others dependence-related skin lesions (DRSL) in Spanish primary healthcare (PHC) centres. To describe the clinical features of both people with DRSL and the lesions. Methods: Observational, cross-sectional study through a survey (5th National Prevalence Study), aimed to PHC in Spain. Data collected through a secure on-line form. Variables: characteristics of the centres, number of patients with each type of DRSL, classification of each lesion, size and time of evolution. Three prevalence values were calculated: crude population prevalence; in people over 65 years of age; and in people in home care programs (HCP). Results: Data have been obtained for a population of almost 763,000 people attended at Spanish PHC in 98 centers. 14.3% of the centres stated that they did not have any person with DRSL attended at the time of obtaining the data. In the group of persons in home care programmes, the prevalence of DRSL was 6.11%. According to the type of lesions: pressure 4.79%, moistureassociated lesions (MAL) 1.39%, friction 1.81%, combined 1.05% and skin tears 1.05%. The lesions originated in the patient's own home in 83.3% of cases, and only 16.7% were of nosocomial origin. Conclusions: The prevalence of DRSL in patients treated in was 6.11%, with PI being the most frequent lesion. Prevalence value is similar to that found in 2009 and slightly lesser than that of 2014. Both the PI and others DRSL are mostly developed in the home, unlike the situation in hospitals, where hospital-acquired injuries are predominant. So, prevention of DRSL in people in home care programmes should be a priority

Knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students: A survey at three universities in Colombia, Chile and Spain.

Teaching nursing students about the model of evidence-based practice is a challenge for university faculty. The aim of this study was to measure knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students, as well as associated factors. The study involved a cross-sectional design using a survey of all students enrolled in a Bachelor of Nursing programme (1st to 4th year) in three nursing faculties of universities in Chile, Colombia and Spain. The Spanish version of the Evidence-Based Competence Questionnaire was used to measure knowledge, skills, attitudes and overall competency. In total, 875 students completed the questionnaire. The overall score of competency in evidence-based practice was similar in all three universities (range 1-5) (3.63 in Chile, 3.58 in Colombia and 3.68 in Spain). The score of self-rated attitudes was strongly correlated with the overall competency measured. More hours of training in research methods and reading nursing journals articles in the last month were the factors associated with higher scores in evidence-based practice competency. The undergraduate nursing students at the three universities surveyed obtained a high score in overall competency in evidence-based practice. No differences were found among them, despite the different approaches used in educational programmes.