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.     

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.     

Knowledge of pressure injury in medical and surgical nurses in a tertiary level hospital: A cross-sectional study

BackgroundNurses play a vital role in pressure injury prevention (PIP) but require foundational knowledge to ensure appropriate PIP strategies are enacted.AimsTo describe and compare medical and surgical nurses’ knowledge of pressure injury (PI) in a tertiary level hospital in China, and to identify predictors of PI knowledge among these groups.DesignA cross-sectional survey was conducted between June and December 2020.MethodsRegistered nurses from nine medical and fifteen surgical wards in a tertiary hospital were invited. The survey was composed of two parts; demographic and professional characteristics; and the Chinese translated version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) where the total score ranged from 0 to 25; higher scores imply more knowledge. Medical and surgical nurses' knowledge test scores were compared using independent t-test. Multiple linear regression analysis was used to determine factors predictive of nurses’ knowledge.ResultsIn total, 423 nurses from 24 wards participated the study and 404 nurses (95.5%) completed the knowledge test (Surgical n = 236, 58.4%; Medical n = 168, 41.6%). The PUKAT 2.0 mean score was 11.6 ± 3.0 (Surgical 12.2 ± 3.0; Medical 10.7 ± 2.8) with 335 (82.9%) nurses scoring <60%. Multiple linear regression showed working in surgical wards, nurse-in-charge position and previous PI training were significant predictors of knowledge scores.ConclusionKnowledge is a precursor to safe practice. Nurses demonstrated poor knowledge of PIP. Pressure injury related education may help improve nurses' knowledge but the extent to which it is used in place and impacts patients’ outcome requires more investigation.     

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.     

The validity and reliability of the Pressure Ulcer Quality of Life instrument: A methodological study

AimThis study aimed to adapt the Pressure Ulcer Quality of Life instrument to Turkish and to determine the validity and reliability by using the Rasch model.Materials and methodsThis methodological study used forward translation, expert opinion, back translation, pilot testing, and finalization for the language adaptation of the instrument. Prior to back translation, the instrument was assessed by five experts certified in wound care nursing. Then, the comprehensibility of the instrument was tested in the pilot study. The study was conducted between March 2017 and September 2019 at one private, one state, and four university hospitals in Turkey. Eligible participants were patients 18 years of age or older, having pressure injury, and fully conscious. Data were collected from a total of 250 patients by using a demographic and clinical history form, the Pressure Ulcer Quality of Life instrument, and the World Health Organization Quality of Life - Brief Form Turkish scale. The instrument's internal construct validity using the Rasch model, the external construct validity, internal consistency, and test-retest reliability were assessed.ResultsThe final Turkish version of the Pressure Ulcer Quality of Life self-report instrument differed from the original, comprising 74 items under the following ten subscales: three regarding symptoms, plus one itchiness item; four regarding physical functioning; two regarding psychological well-being, self-consciousness, and appearance; and one regarding social participation.ConclusionThe Turkish version of the PU-QOL is a valid, reliable, and widely available instrument for measuring quality of life for patients with pressure injury.     

Translation,cross-cultural adaptation and validation of the revised-Skin Management Needs Assessment Checklist questionnaire in Malay language

IntroductionPressure injury (PI) related knowledge can be used as an outcome indicator of a PI education program. In Malaysia, no scale has been translated and validated for measuring PI-related knowledge among patients with a PI.AimThe purpose of this study was to cross-culturally adapt, translate and determine the validity and reliability of the Malay version of the revised-Skin Management Need Assessment Checklist (revised-SMnac).MethodThe instrument was initially written in English and translated into the Malay language. The internal consistency, construct validity, and test-retest reliability were examined after the item and scale's cross-cultural equivalence and content validity were evaluated. Construct validity was determined through the administration of the instrument amongst 170 hospitalised patients with a PI. Content validity index (CVI) was further determined through validation by a panel of five wound care experts. The instrument's stability was determined by the test-retest model with a two-week interval.ResultsThe content validity of the item-CVI (I-CVI) was >79%, indicating that all 17-items were appropriate, while the scale-CVI (S-CVI) of >0.83 indicated an acceptable scale. The Cronbach's Alpha was .994 indicated good internal consistency. Test-retest showed a good intra-class correlation coefficient, ICC = 0.955 with 95% CI [0.992–0.996].ConclusionsThe Malay version of the revised-SMnac demonstrated to be a valid and reliable tool to measure PI-related knowledge among the Malay-speaking patient population in Malaysia. The tool is recommended for use to measure the effectiveness of education programs related to PI care in future studies.     

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.     

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.     

Factors related to knowledge,attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study

IntroductionAs one of the main members of the health team, nurses have an important role in pressure ulcer prevention in health care centers. The aim of this study was to investigate knowledge, attitude, and practice of nurses on the prevention of pressure ulcers and their related factors.MethodsThis cross-sectional study was carried out in 2018. The total number of ICU nurses employed in educational-health centers affiliated to Iran University of Medical Sciences were examined. Among a total of 328 nurses, 308 questionnaires were completed by the participants. Pressure Ulcer Knowledge Questionnaire, Attitude Toward Pressure Ulcer, and Practice of Pressure Ulcer Prevention questionnaires were used to collect data. SPSS software version 16 and independent t-test, Chi-square, Fisher exact, one-way Analysis of variance, and multiple linear regressions tests were used for data analysis.FindingsBased on the mean score of knowledge, attitude, and practice of the nurses about the pressure ulcer prevention were 63.47 ± 10.31, 39.10 ± 40.22, and 32.03 ± 6.17, respectively. There was a positive and significant relationship between these three variables. Findings revealed that knowledge was increased by 0.051 units, with a one-year increase in work experience of nurses in the ICU. Moreover, women's knowledge and their attitude were higher than those of men as 3.132 and 1.65 units, respectively. Based on the findings, attitude of nurses increased by 0.43 units for an hour of extra work per week. Nurses' attitude score in the General ICU and their practice were higher than scores of other nurses as 2.144 and 2.574 units, respectively. Moreover, practice of nurses increased by 0.162 unit with one-year increase of their age.ConclusionGiven the undesirable level of knowledge and attitude and relatively desirable practice of nurses in the field of pressure ulcer prevention and the importance of improving the safety of patients admitted to the ICU, it is suggested that appropriate educational planning be developed to raise the level of knowledge, attitude, and practice of health care providers, especially nurses, in the area of pressure ulcer prevention.     

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study

BackgroundPressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK.ObjectiveTo examine healthcare support workers’ knowledge and attitudes regarding pressure ulcer prevention.MethodsA cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool.ResultsA total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005).ConclusionWhile positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers’ pressure ulcer knowledge and to inform a national continuous education strategy.     

Examination of the psychometric properties of the Persian version of the attitude towards pressure ulcer prevention instrument in nurses

IntroductionPressure ulcer development is a known indicator of the quality of care. Negative attitudes towards the prevention of pressure ulcers can lead to preventive care with suboptimal quality. There is no valid and reliable instrument in Iran to assess clinicians’ attitudes towards pressure ulcer prevention; therefore, this study aimed to examine the psychometric properties of the Persian version of the Attitude towards Pressure ulcer Prevention instrument (APuP) in Nurses.MethodsIn this cross-sectional study, 250 nurses were selected using a convenience sampling method. Face, content, and construct validity were examined using exploratory factor analysis (EFA). Internal consistency was assessed using the McDonald's omega (ω), and reliability was assessed using the test-retest method.ResultsIn the EFA, five factors of Competence, Responsibility, Perceived Consequences of Pressure Ulcers on Patients, Priority, and Confidence in the Effectiveness of Prevention were extracted that together explained 50.26% of the total variance. A McDonald's ω of 0.891 demonstrated the internal consistency of the total scale, and internal consistencies ranging from 0.70 to 0.86 were found for different dimensions of the instrument. In addition, an intraclass correlation coefficient (ICC) of 0.876 was found that indicated the reliability (stability) of the total scale (95% Confidence Interval [CI]: 0.736–0.963).ConclusionThe Persian version of the Attitude towards Pressure ulcer Prevention instrument (APuP) has good validity and reliability in Iranian nurses and can be used in future clinical studies.     

Pressure injury prevention: Knowledge and attitude and their predictors in Indonesian nurses working in hospital settings

AimNurses' knowledge and attitude are critical for pressure injury (PI) prevention. However, to date, there has been little research carried out on the knowledge and attitude of Indonesian nurses regarding PI prevention in hospital settings, and no study has investigated the predictors of knowledge and attitude of Indonesian nurses regarding PI prevention. This study therefore aims to investigate knowledge and attitude, and to identify the predictors of knowledge and attitude regarding PI prevention among Indonesian nurses in hospital settings.MethodsA cross-sectional study was conducted between 1st November 2021 and 5th March 2022. A total of 563 nurses from three general hospitals in Central Java Province participated. The Pressure Ulcer Knowledge Assessment Tool 2.0 and the Attitude Pressure Ulcer Prevention questionnaires were used. A multiple linear regression analysis was used to determine the predictors of nurses' knowledge and attitude regarding PI prevention.ResultsThe percentage of correct answers was 35.02%, indicating poor knowledge, while the percentage of nurses' attitudes was 75.46%, indicating a satisfactory attitude. The predictors of knowledge of PI prevention were found to be age (β = -0.127, p = 0.025), level of education (β = 0.153, p = 0.001) and income (β = 0.107, p = 0.021), while the predictors of attitude toward PI prevention were level of education (β = 0.101, p = 0.020) and professional position (β = 0.093, p = 0.033).ConclusionThis is the first study to identify the predictors of attitude and knowledge regarding PI prevention in Indonesian nurses in a hospital setting. The results indicate a need for appropriate educational training based on the predictors to be given to Indonesian nurses working in hospital settings to increase their knowledge of PI prevention.     

Translation and validation of the ELPO for Turkish population: Risk assessment scale for the development of pressure injuries due to surgical positioning

Aim of the studyThis study was conducted to translate the ELPO risk assessment scale for the development of pressure injuries due to surgical positioning to Turkish and to test its validity and reliability in the Turkish Population.Materials and methodsThe data were collected using the patient identification form, the risk assessment scale for the prevention of injuries due to surgical positioning, and the Braden Scale. This scale consisted of a total of seven items, each of which contained five sub-items. It is rated between 1 and 5 in the Likert type. The total score of the scale ranges between 7 and 35. The risk of developing pressure injuries increases in patients as the score increases.ResultsA total of 184 patients were included in the study sample. The mean age of the group was 55.96 ± 17.90, and the content validity index was 0.944. The sensitivity of the test was 60%, the specificity was 66%, and the accuracy was 66%. There was a negative, weak, statistically significant correlation between the total scores of the risk assessment scale for the prevention of injuries due to surgical positioning and the Braden scale. The mean total score of the scale was 18.45 ± 2.96 (12–26) and 35.9% (n = 66) of the group were at high risk.ConclusionsThe ELPO, which includes the risks specific to patients during surgery, can be used as an assessment scale for the development of pressure injury due to surgical positioning for Turkish population.     

Assessment of the risk of pressure ulcer during the perioperative period: Adaptation of the Munro scale to Turkish

Aim of the studyThis study was conducted to adapt the Munro Pressure Ulcer Risk Assessment Scale (Munro Scale) to Turkish and to test its validity and reliability.Materials and methodsIn the methodological study, the data were collected using the patient identification form, the Braden Scale, and the Munro Scale. A total of 188 patients were diagnosed for the risk of preoperative and intraoperative pressure ulcer, and then re-evaluated in the recovery room and in their bed.ResultsThe study group consisted of 81 (43.1%) males and 107 (56.9%) females with a mean age of 51.98 ± 16.87. The Kaiser-Meyer-Olkin sampling adequacy test was 0.588 and the Bartlett's test was 430.471. The results of goodness of fit indices were not as expected value in the confirmatory factor analysis. In the exploratory factor analysis, it was determined that the factor loadings of the Munro Scale varied between 0.336 and 0.873 and explained 62% of the total variance. In the parallel-form method performed for the reliability of the scale, it was observed that there was a weak and negative correlation between the total scores of the Munro Scale and Braden Scales before the surgery and a negative and moderate correlation between the total scores after the surgery. The total Cronbach's alpha value was found to be 0.504. In the reliability analysis of the scale, interrater correlation coefficients were found to be 0.865-0.998.ConclusionsThe Munro Scale can be used to assess the risk of pressure injuries in perioperative patients and may help nurses to identify high-risk patients.