The development and testing of the C/WoundComp instrument for assessing chronic wound‐care competence in student nurses and podiatrists

The purpose of this study was to describe the level of chronic wound‐care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P < .0001), but the students showed a positive attitude towards chronic wound care. The instrument demonstrated preliminary validity and reliability, but this warrants further testing. This study provides new knowledge about student nurses' and student podiatrists' competence in chronic wound care, suggesting that their theoretical and practical competence is limited. In addition, it provides information on different methods of assessing competence and how they can be combined.     

International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive‐care‐specific risk‐assessment‐scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2‐hours of admission; 8‐hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate‐ and high‐risk patients should receive: a reactive mattress support surface and a heel off‐loading device. High‐risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure‐redistributing cushion for sitting. Repositioning is required at least 4‐hourly for low‐risk, and 2‐hourly for moderate‐ and high‐risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.     

Disorder‐ and Treatment‐Specific Therapeutic Competence Scales for Posttraumatic Stress Disorder Intervention: Development and Psychometric Properties

Although the assessment of therapeutic competence in psychotherapy research is essential for examining its possible associations with treatment outcomes, it is often neglected due to high costs and a lack of valid instruments. This study aimed to develop two therapeutic competence scales that assess disorder‐specific and treatment‐specific therapeutic competence, and to examine these scales’ psychometric properties along with those of the already established Cognitive Therapy Scale (CTS) in a posttraumatic stress disorder (PTSD) sample. Using an inductive procedure, two rating scales for assessing disorder‐specific and treatment‐specific competence were constructed. The psychometric properties of these scales and those of the CTS were assessed in a sample of 30 videotaped sessions of eight patients from a multicenter study in which PTSD related to child abuse was treated using cognitive processing therapy. Two raters assessed therapeutic competence in 30 videotaped psychotherapy sessions. Interrater reliability, internal consistency, and content validity were determined. The scales (all items and total scores) demonstrated good to excellent interrater reliability, intraclass correlation coefficients (ICCs) = .67 to .97, and internal consistency, Cronbach's α = .73 to .92. The PTSD experts’ ratings confirmed good internal validity. We found statistically significant associations with therapeutic adherence, r = .62 to .85; p < .001; and therapeutic alliance, r = .47, p < .001. These preliminary data imply that the two newly developed competence scales and the CTS can be reliably used to assess different types of therapeutic competence in PTSD samples and may be useful as possible predictors of treatment outcomes.     

术中获得性压力性损伤预防专家共识

目的 形成《术中获得性压力性损伤预防专家共识》,为预防手术患者术中获得性压力性损伤提供实践指导。 方法 通过文献检索,提取术中压力性损伤预防相关的证据和专家推荐意见,形成初稿,通过2轮专家咨询和4次线上会议进行修改和完善。 结果 术中获得性压力性损伤预防专家共识内容包括术中获得性压力性损伤风险因素与护理评估、评估工具选择、评估时机选择、风险界定与分级、分级预防措施和管理6个方面。 结论 该共识基于证据与指南,通过循证方法构建,操作性、实用性强,可为手术患者术中获得性压力性损伤预防和手术室护理管理提供理论依据和实践指导。     

Deployment Risk and Resilience Inventory‐2 (DRRI‐2): An Updated Tool for Assessing Psychosocial Risk and Resilience Factors Among Service Members and Veterans

The Deployment Risk and Resilience Inventory (DRRI) is a widely used instrument for assessing deployment‐related risk and resilience factors among war veterans. A revision of this instrument was recently undertaken to enhance the DRRI's applicability across a variety of deployment‐related circumstances and military subgroups. The resulting suite of 17 distinct DRRI‐2 scales is the product of a multiyear psychometric endeavor that involved (a) focus groups with Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to inform an assessment of the content validity of original DRRI measures, (b) examination of item and scale characteristics of revised scales in a national sample of 469 OEF/OIF veterans, and (c) administration of refined scales to a second national sample of 1,046 OEF/OIF veterans to confirm their psychometric quality. Both classical test theory and item response theory analytical strategies were applied to inform major revisions, which included updating the coverage of warfare‐related stressors, expanding the assessment of family factors throughout the deployment cycle, and shortening scales. Finalized DRRI‐2 scales demonstrated strong internal consistency reliability and criterion‐related validity. The DRRI‐2 can be applied to examine the role that psychosocial factors play in postdeployment health and inform interventions aimed at reducing risk and enhancing resilience among war veterans.     

Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback

BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). METHODS: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. RESULTS: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. CONCLUSIONS: Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.     

Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9‐year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual‐care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital‐acquired pressure ulcers decreased following implementation of an evidence‐based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual‐care nurses under‐estimated patients' risk of pressure ulcer development and under‐utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital‐acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.     

建构主义学习理论在手术室护理教学中的应用

目的探讨建构主义学习理论在手术室护理教学中的应用方法及效果。方法将2014级护理大专4个班护生根据班级随机分为研究组116人和对照组115人。对照组手术室护理教学采用传统教学方法,研究组采用建构主义学习理论指导进行情境模拟教学、协作、会话和意义建构。比较两组理论和操作成绩及评判性思维能力和自主学习能力。结果研究组的理论成绩、操作成绩、自主学习能力和评判性思维能力显著高于对照组(P0.05,P0.01)。结论手术室护理教学采用建构主义学习理论能够提高护生的学习成绩、自主学习能力和评判性思维能力。     

Validation of the Dutch translation of the Cardiff wound impact schedule for evaluation of the health‐related quality of life of patients with chronic wounds

The aim of this study was to validate a Dutch translation of the Cardiff wound impact schedule (CWIS), a disease‐specific instrument to measure the health‐related quality of life (HRQoL) in patients with chronic leg ulcers. To achieve this, the original instrument was translated. A total of 83 patients with chronic lower leg ulcers were included and completed the translated instrument and SF36 at baseline after assessment of their wound severity. Follow‐up was performed 1 week after inclusion. The psychometric properties of the instrument were assessed. Construct validity was positively evaluated by an expert panel. Face validity was positively evaluated in a cognitive debriefing of a pilot group. Discriminant validity was assessed by correlating 1‐year amputation risk according to the Wound, Ischaemia, foot Infection classification system with the instrument scores. Significant correlation could not be proven. Criterion validity was assessed by correlating domain scores of the instrument with domain scores of the gold standard: SF36. Moderate to high correlation was calculated for most domains of the instrument. Test‐retest reliability and internal consistency were evaluated as acceptable. In conclusion, the Dutch translation of the CWIS is a valid and reliable disease‐specific instrument to assess the HRQoL in patients with chronic lower leg ulcers.     

《新入职护士规范化培训大纲》的践行与效果评价

目的贯彻落实国家卫生与计划生育委员会颁布的《新入职护士规范化培训大纲(试行)》,探索肿瘤专科医院新入职护士规范化培训与管理方法,提高肿瘤专科护士岗位胜任能力。方法根据《新入职护士规范化培训大纲(试行)》要求,结合肿瘤专科医院特点制定新入职护士培训方案。对37名新护士采用全脱产集中理论授课培训、模拟病房和临床路径的操作培训方案,考核方法采用微信推送题目考核、个案考核、临床实践能力考核。结果新护士培训后理论知识考核(87.08±6.64)分,操作技能(93.59±0.75)分;科室对新入职护士各方面表现的过程考核10名优秀,22名良好,5名合格;对新入职护士晚夜班能力考核26名优秀,11名良好。结论新护士规范化培训使其临床护理能力得到全面提高。专科医院应以《新入职护士规范化培训大纲(试行)》为蓝本,制定适合自己医院的新入职护士培训大纲,以提高临床护士岗位能力。     

Value of Debriefing during Simulated Crisis Management: Oral versus Video-assisted Oral Feedback

Background: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing).

Methods: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system.

Results: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups.     

Independent risk factors for pressure ulcer development in a high‐risk nursing home population receiving evidence‐based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium

The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high‐risk nursing home population receiving evidence‐based PU prevention. This study was part of a randomised controlled trial examining the (cost‐)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non‐blanchable erythema, Braden score ≤ 12 or Braden subscale “mobility” ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II‐IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III‐IV). PUs (category II‐IV) were significantly associated with non‐blanchable erythema, a lower Braden score, and pressure area‐related pain in high‐risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high‐risk individuals.     

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross‐sectional study

The use of consistent and evidence‐based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants'' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals'' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence‐based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.     

Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings

The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e‐learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital‐acquired pressure injuries and the percentages of each stage of pressure of injury 1–4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure‐relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice     

Development and psychometric validation of PUKAT 2·0, a knowledge assessment tool for pressure ulcer prevention

The aim of this study was to develop a tool to measure the knowledge of nurses on pressure ulcer prevention. PUKAT 2·0 is a revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) developed in 2010 at Ghent University, Belgium. The updated version was developed using state‐of‐the‐art techniques to establish evidence concerning validity and reliability. Face and content validity were determined through a Delphi procedure including both experts from the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) (n = 15). A subsequent psychometric evaluation of 342 nurses and nursing students evaluated the item difficulty, discriminating power and quality of the response alternatives. Furthermore, construct validity was established through a test–retest procedure and the known‐groups technique. The content validity was good and the difficulty level moderate. The discernment was found to be excellent: all groups with a (theoretically expected) higher level of expertise had a significantly higher score than the groups with a (theoretically expected) lower level of expertise. The stability of the tool is sufficient (Intraclass Correlation Coefficient = 0·69). The PUKAT 2·0 demonstrated good psychometric properties and can be used and disseminated internationally to assess knowledge about pressure ulcer prevention.     

Association of Pressure injury with body care activities in nursing homes

Frequent repositioning and skin examinations are the cornerstone of many pressure injury prevention programs. This study explores the hypothesis that frequent skin‐exposing body care activities are protective against pressure injuries in residents of long‐term care facilities. We designed a cross‐sectional observational cohort study of 381 residents from 13 such facilities. Data were collected on resident characteristics and nursing care activities for each resident. We analyzed those data, looking for an association between skin‐exposing body care and the presence of a pressure injury of stage 1 or greater. Body‐exposing care activities were divided into high‐ and low‐frequency groups. A logistic regression model was developed to include confounding variables. The odds ratio associated with body care and pressure injury was calculated. Fifteen percent of the residents in our study had pressure injuries. Confounders were activities of daily living score, heart failure, recent hospitalization, and stool incontinence. The adjusted odds ratio for body care as a risk factor was 4.9 (95% CI, 2.4, 10.4), indicating that residents with more than five body care needs are approximately five times more likely to have a pressure injury. Our results fail to support our hypothesis that frequent skin‐exposing body care activities protect against pressure injury. Further exploration is needed to understand the resident characteristics and co‐morbid conditions associated with the persistent risk for pressure injury despite frequent skin examinations.     

Debriefing with good judgment: combining rigorous feedback with genuine inquiry

Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, we develop a model of "debriefing with good judgment." The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors' own experience using this approach in approximately 2000 debriefings, it was found that the "debriefing with good judgment" approach often sparks self-reflection and behavior change in trainees.