Reliability and validity of the Turkish version of pressure ulcer knowledge assessment tool-updated version (PUKAT 2.0)

ObjectiveThis study aimed to determine the reliability and validity of the Turkish version of the measurement tool developed and updated by Manderlier et al. to evaluate the nurses’ evidence-based knowledge about pressure ulcers.Materials and methodsA methodological study design was used. The instrument was translated to Turkish and back-translated to English. A group of faculty members, including physicians and nurses who are experts in the subject area, evaluated the content validity of the tool with the Lawshe technique. A group of 240 nurses who met the inclusion criteria were reached, and then a pilot study was conducted with 35 nurses by using the test-retest method to determine the invariance of the tool over time. The nurses in the pilot study were excluded from the overall sample, and the evaluations were performed with 205 nurses. Item difficulty index and discrimination index were used for the validity of the items since they were multiple-choice items; Kuder-Richardson 20 analysis was used to determine the internal consistency.ResultsThe translated and modified instrument demonstrated acceptable psychometric properties as follows: 1) overall content validity index was 0.90, 2) overall test-retest reliability was 0.83 (0.70–0.92 for the sub-themes), 3) item difficulty indexes were 35–75%, 4) discrimination indexes were 0.44–0.92, and 5) overall Cronbach's alfa for the internal consistency was 0.72.ConclusionsSimilar to the earlier version, the Turkish version of PUKAT 2.0 was demonstrated to be a valid and reliable tool to evaluate the nurses’ knowledge of evidence-based current information about pressure ulcers.     

Development and validation of the incontinence associated dermatitis knowledge,attitude and practice questionnaire

AimThis study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses.MethodsA psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability.ResultsThe instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69–0.96, p < 0.001).ConclusionThe KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses’ KAP and associations between IAD knowledge, attitudes and practices.     

Validity and reliability of Japanese version of the pressure ulcer knowledge assessment tool

AimTo develop Japanese version of the pressure ulcer knowledge assessment tool, a tool for measuring nurses’ pressure ulcer knowledge to effectively evaluate the efficacy of current educational programs, resulting in prevention and early treatment, and to verify its validity and reliability among Japanese nurses.Materials and methodsA total of 1716 nurses across three university hospitals participated in this study. All had been employed for at least one year. Managers, part-timers, and those in the operating room and the outpatient ward were excluded from the study as it is limited to bedside preventive care.The original tool was translated into Japanese using the Brislin's translation model. A cross-sectional study was used to examine the reliability and validity of the measure within a Japanese sample. Assessment of the multiple-choice test items included analysis of the validity (item difficulty and discriminating index), construct validity, internal consistency, and stability (test–retest reliability).ResultsThe item difficulty indices ranged from 0.17 to 0.95, whereas values for item discrimination ranged from 0.15 to 0.45. Known group validity of the scale was confirmed; therefore, the higher-expertize group consisting of wound, ostomy, and continence nurses significantly outperformed nurses certified in other fields. The overall internal consistency reliability was 0.86 with a two-week test–retest intraclass correlation of 0.60.ConclusionsThe instrument may be applied as a reliable and valid measure to assess nurses’ pressure ulcer knowledge in the fields of nursing education, research, and practice in Japan.     

Effects of education about prevention of pressure ulcer on knowledge and attitudes of nursing students

BackgroundPressure ulcer is a significant healthcare problem throughout the world. Nurse educators should take the responsibility for students’ improving knowledge, skills and attitudes regarding prevention of Pressure ulcer and allocate sufficient time to teach them by using various teaching methods. In this study we evaluate effects of education about prevention of pressure ulcer on knowledge and attitudes of nursing students.MethodsThis is a quasi-experimental study with a control group and a posttest. The study population comprised of 96 second-year nursing students at a university in Middle Anatolia Region of Turkey. The study sample included 84 second year nursing students, of whom 42 were assigned into an intervention group and 42 were assigned into a control group. The intervention group was offered education for two hours weekly for four weeks. Data collection between April and May in 2019. The statistics program SPSS 22 packaged software was used in the analyses of data.ResultsThere was not a significant difference in sociodemographic features between the intervention and control groups. The groups significantly differed in their total scores for attitudes to prevention of pressure ulcer (p < 0.05). The intervention group got a significantly higher mean score for knowledge about prevention of pressure ulcer (63.00 ± 16.71) than the control group (39.35 ± 9.77) (p < 0.05).ConclusionThe control group had lower scores for knowledge and attitudes about prevention, evaluation and management of pressure ulcer. Educators should revise the content of the national nursing curriculum about pressure ulcer and update their learning material and lectures in accordance with national and international guidelines.     

The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation

BackgroundSkin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent.ObjectiveTo culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context.MethodsThe cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested.ResultsThe content validity index was 0.88–1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71–0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62.ConclusionsThe Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.     

The prevalence and prevention of pressure ulcers: A multicenter study of nine nursing homes in eastern China

AimTo assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China.Materials and methodsIn this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019.ResultsOf the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes.ConclusionsThe prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.     

An extracellular matrix graft (Oasis® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial

Aim

The purpose of the study was to evaluate clinical safety and effectiveness of Oasis^® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care.

Development and preliminary validation of a tool measuring concordance and belief about performing pressure-relieving activities for pressure ulcer prevention in spinal cord injury

ObjectiveTo develop and examine the reliability, and validity of a questionnaire measuring concordance for performing pressure-relief for pressure ulcer (PrU) prevention in people with Spinal Cord Injury (SCI).MethodsPhase I included item development, content and face validity testing. In phase II, the questionnaire was evaluated for preliminary acceptability, reliability and validity among 48 wheelchair users with SCI.ResultsThirty-seven items were initially explored. Item and factor analysis resulted in a final 26-item questionnaire with four factors reflecting concordance, perceived benefits, perceived negative consequences, and personal practical barriers to performing pressure-relief activities. The internal consistency reliability for four domains were very good (Cronbach's α = 0.75-.89). Pearson correlation coefficient on a test-retest of the same subjects yielded significant correlations in concordance (r² = 0.91, p = .005), perceived benefit (r² = 0.71, p < .04), perceived negative consequences (r² = 0.98, p < .0001), personal barriers (r² = 0.93, p= .002). Participants with higher levels of concordance reported a greater amount of pressure-relieving performed. Individuals viewing PrU as a threatening illness were associated with higher scores of concordance and tended to report a greater amount of pressure-relieving performance which provides evidence of criterion related validity.ConclusionThe new questionnaire demonstrated good preliminary reliability and validity in people with SCI. Further evaluation is necessary to confirm these findings using larger samples with follow-up data for predictive validity. Such a questionnaire could be used by clinicians to identify high risk of patients and to design individualised education programme for PrU prevention.     

Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool

Background

Pressure ulcers have a high impact on patients and their families. Profound and up-to-date knowledge among nurses is important given the effect on attitudes and preventative behaviour. To gain insight into educational needs and priorities, regular knowledge assessments are needed.

Design and evaluation of a dynamic air cushion for pressure ulcers prevention

Wheelchair users have a higher risk of developing pressure ulcers due to prolonged seated pressure. Pressure ulcers can be painful, may require surgical intervention, and even become life-threatening if infection occurs. To prevent pressure ulcers from forming the patient must either offload themselves or rely on a caregiver to move them allowing pressure redistribution over the seated area. In this work, we designed a dynamic air cushion to relieve pressure on loaded areas using sequences of inflation and deflation of the air cushion cells. The purpose of these sequences is to offload pressure from high-risk areas. To evaluate the effect of the alternating sequences on seated pressure and blood perfusion, we recorded interface pressure, skin blood flow, superficial tissue oxygen saturation, blood concentrations of oxygenated hemoglobin, and deoxygenated hemoglobin from twenty-one healthy volunteers who were asked to sit on the air cushion for static mode recording (3 min) and during the inflation/deflation sequences (up to 22 min). The alternating sequences consisted of ten combined inflation and deflation steps. Results showed that, after applying the alternating sequences, interface pressure reduced significantly $(p=0.02)$ compared to the static mode. Moreover, the coefficient of variation of the seated pressure was higher ($p<0.001)$ during the alternation sequence compared to the static mode. However, interface pressure under the right and left ischial tuberosities increased ($p<0.001)$ during the alternation sequence compared to the static mode. In addition, during the alternating sequences, males had larger dispersion index values of both right and left ischial tuberosities pressure compared to females. Furthermore, the maximum value of oxygen saturation ($p=0.04$) and skin blood flow ($p=0.001$) increased during the pressure alternation sequences compared to the static mode. The study findings highlighted the positive effects of the designed dynamic air-cushion to relieve pressure on compressed areas and enhance blood perfusion similar to manual offloading approaches. The outcomes of this study are encouraging to evaluate the performance of the designed air cushion in studies involving wheelchair users.     

A knowledge test on pressure injury in adult intensive care patients: Development,validation, and item analysis

BackgroundPressure injuries are a major problem in critically ill patients, but both students' and intensive care nurses’ knowledge about these injuries leaves room for improvement. As no knowledge test is currently available that focuses on pressure injuries in adult intensive care patients, we aimed to develop such tool, establish the content validity, and perform item analysis using Classical test theory.MethodsTest development followed established multiple-choice question-writing guidelines. Content validation used a Delphi procedure including eight international experts. Item analysis (question difficulty and discrimination power, and quality of the distractors) was based on the test results of a convenience sample who completed the test online, based on ready knowledge.ResultsFour Delphi validation rounds resulted in a 24-item multiple-choice test within seven categories: Epidemiology, Aetiology, Prevention, Classification, Risk factors and risk assessment, Wound care, and Skin care. The content validity index was 0.96. The median score of 12 students and 38 qualified nurses was 12.5/24 (interquartile range 11–14.25; range 4–17; 52%). Least correct answers were in the categories Classification and Wound care. Item analysis revealed several knowledge gaps and misconceptions.ConclusionsThe test has excellent content validity. The sample's overall score was low. Item analysis identified various training needs. Future users are recommended to further validate the test and establish its reliability, and to tailor it to their individual context and evaluation requirements.     

Validity and reliability of the Turkish version of The Pressure Injury Prevention Knowledge Questionnaire(PIPK)

AimThis study aimed to evaluate the validity and reliability of the Turkish version of the Pressure Injury Prevention Knowledge Questionnaire (PIPK).MethodA methodological study design was used. The instrument was translated into Turkish and back-translated into English. After evaluating the language equivalence and content validity of the scale, test-retest reliability, internal consistency and construct validity were examined. The research was conducted with a total of 324 nurses working in a state hospital and two private hospitals who volunteered to participate in the research. Number, percentage distributions, intraclass correlation coefficient (ICC), Kappa coefficient test, Man Whitney U test and Rasch analysis were used to evaluate the data.ResultsContent validity was evaluated by 11 experts in wound care and the CVI(content validity index was found 0.90. The correlation coefficient between the groups was found to be ICC 0.979 in the Kappa coefficient test performed for the reliability analysis. When the in- and out-of-fit difficulty index values of the scale were examined, it was found that the averages of these values varied between “0.72” and “1.38” values.ConclusionsThe Pressure Injury Prevention Knowledge Questionnaire (PIPK) was found to be a valid and reliable tool for intercultural studies revealing the nursing knowledge of prevention on PIs. It is recommended to conduct studies that test the validity and reliability of the scale in different samples.     

Development and validity of a new model for assessing pressure redistribution properties of support surfaces

Pressure ulcers are a common problem, especially in older patients. In Japan, most institutionalized older people are malnourished and show extreme bony prominence (EBP). EBP is a significant factor in the development of pressure ulcers due to increased interface pressure concentrated at the skin surface over the EBP.The use of support surfaces is recommended for the prophylaxis of pressure ulcers. However, the present equivocal criteria for evaluating the pressure redistribution of support surfaces are inadequate. Since pressure redistribution is influenced by physique and posture, evaluations using human subjects are limited. For this reason, models that can substitute for humans are necessary. We developed a new EBP model based on the anthropometric measurements, including pelvic inclination, of 100 bedridden elderly people. A comparison between the pressure distribution charts of our model and bedridden elderly subjects demonstrated that maximum contact pressure values, buttock contact pressure values, and bone prominence rates corresponded closely. This indicates that the model provides a good approximation of the features of elderly people with EBP. We subsequently examined the validity of the model through quantitative assessment of pressure redistribution functions consisting of immersion, envelopment, and contact area change. The model was able to detect differences in the hardness of urethane foam, differences in the internal pressure of an air mattress, and sequential changes during the pressure switching mode. These results demonstrate the validity of our new buttock model in evaluating pressure redistribution for a variety of surfaces.     

Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019

Aim

The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the ‘Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline’ (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update.

护士性健康照护素养量表的编制与信效度检验

目的:编制评价我国护士性健康照护素养量表,并检验其信度与效度。方法:以简单随机抽样对258名护士进行问卷调查,并采用探索性因子分析与验证性因素以简单随机抽样分析对量表进行检验。结果:性健康照护素养量表共17个条目,经探索性因子分析产生3个公因子(因子1为性健康照护知识;因子2为性健康照护态度;因子3为性健康照护效能),累计贡献率为55.334%。各条目内容效度指数(ICVI)为0.896~0.922,量表内容效度指数(S-CVI)为0.920;而验证性因子分析表明(χ~2=163.218,df=115,P0.001,GFI=0.948,AGFI=0.988,NFI=0.916,NNFI=0.925,CFI=0.941,RFI=0.903)。总量表的Cronbach’sα系数为0.862,重测信度为0.888。结论:护士性健康照护素养量表具有较好的信、效度,可做为评价护士性健康照护素养的现状。     

The effect of pressure and shear on tissue viability of human skin in relation to the development of pressure ulcers: a systematic review

Pressure ulcers are a significant problem in health care, due to high costs and large impact on patients' life. In general, pressure ulcers develop as tissue viability decreases due to prolonged mechanical loading. The relation between load and tissue viability is highly influenced by individual characteristics. It is proposed that measurements of skin blood flow regulation could provide good assessment of the risk for pressure ulcer development, as skin blood flow is essential for tissue viability. . Therefore, the aim of this systematic review is to gain insight in the relation between mechanical load and the response of the skin and underlying tissue to this loading measured in-vivo with non-invasive techniques.A systematic literature search was performed to identify articles analysing the relation between mechanical load (pressure and/or shear) and tissue viability measured in-vivo. Two independent reviewers scored the methodological quality of the 22 included studies. Methodological information as well as tissue viability parameters during load application and after load removal were extracted from the included articles and used in a meta-analysis.Pressure results in a decrease in skin blood flow parameters, compared to baseline; showing a larger decrease with higher magnitudes of load. The steepness of the decrease is mostly dependent on the anatomical location. After load removal the magnitude of the post-reactive hyperaemic peak is related to the magnitude of pressure. Lastly, shear in addition to pressure, shows an additional negative effect, but the effect is less apparent than pressure on skin viability.     

Translation and cross-cultural adaptation of the Neonatal Skin Risk Assessment Scale (NSRAS) to Italian

PurposeThe Neonatal Skin Risk Assessment Scale is the only tool exclusively designed for neonatal populations and it is the most recommended for neonatal skin risk assessment. To date, the NSRAS has been validated in different languages, but an Italian version was lacking. Consequently, the purpose of this study was to translate and to provide a cross-cultural adaptation of the NSRAS into Italian.MethodThe translation and cross-cultural adaptation were conducted following an international instrument translation guideline across five steps: (1)translation, (2)forward translation review, (3)back translation, (4)back-translation review and (5)pre-test. Content validity was measured using the content validity index (CVI), calculating Aiken's coefficient, according to the opinion of an expert group.ResultsThe final version approved by the expert committee was well understood by all nurses who participated in the study and has obtained a good face validity and content validity. Expert evaluation provided a CVI-Total of 0.92 [0.85–0.96], with Aiken V values for each item analyzed ranging between 0.85 and 0.97.ConclusionThe i-NSRAS is a clear, simple, relevant, and unambiguous tool. It is also updated to current knowledge on PUs and evaluates the presence of clinical devices as a risk factor in neonatal population.     

Psychometric testing and evaluation of user acceptance of an automatic lateral turning device for the prevention of pressure ulcers

IntroductionRepositioning of patients with reduced or impaired mobility could lessen pressure ulcers (PU). Automated preventive devices can support nurses, but user acceptance must be determined with valid and reliable tools. This study measured user acceptance of an automatic lateral turning device, using a self-developed questionnaire.MethodThe study included 194 nurses in leadership positions from 75 institutions. A two-page user acceptance questionnaire was designed and tested for internal validity (exploratory factor analysis; EFA) and reliability (Cronbach's-α). A linear regression analysis was used to test the model's theoretical framework.ResultsThe overall response rate was 74.9%. The EFA revealed five exploratory factors (“pain/well-being”, “PU prevention”, “handling”, “nurse support”, and “obese patient support”) from the two outcomes (“general satisfaction” and “can replace manual repositioning”). The adjusted r² was 0.607 for “general satisfaction”, with the maximum standardized β for “PU prevention” (0.476), “pain/well-being” (β = 0.197) and “handling” (β = 0.145). The adjusted r² for “can replace manual positioning” was 0.458. The β for “nurse support” was 0.264, followed by “pain-wellbeing” (β = 0.224) and “obese patient support” (β = 0.218).ConclusionThe psychometric testing results were satisfactory. Overall user acceptance of the automatic lateral turning device was high. A positive evaluation of the system's functionality, regarding the prevention of PU, is essential for patient and staff satisfaction, as well as user recommendation.