COVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The ...benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non‐porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device‐related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.
At the April 2016 National Pressure Ulcer Advisory Panel (NPUAP) consensus conference, terminology and staging definitions were updated and two definitions were revised to describe pressure injuries ...(PIs) caused by medical devices or other items on the skin or mucosa. Here, the authors discuss the etiology and prevention of PIs resulting from medical and other devices, the frequency of such injuries, and the bodily sites at which they most often occur. They provide an overview of the current NPUAP guideline, highlight important risk factors, and explain why mucosal PIs cannot be staged.
ABSTRACTPediatric pressure injuries continue to be a worldwide healthcare problem. Studying pediatric pressure injury point prevalence may provide more insight into the problem and drive prevention ...strategies for at-risk pediatric patients, a truly vulnerable population. This article reports 10 years of longitudinal pediatric pressure injury prevalence data and demographics from around the world.
OBJECTIVETo assess pressure injury knowledge of Skin Care Council nursing members using the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), to design an educational intervention informed by ...the results of the baseline assessment, and to evaluate the effect of the intervention.
METHODSThis was a single-group pretest-posttest project conducted in an urban, academic, tertiary medical center from January to August 2017. Participants were measured on the pretest, received the intervention, and then were reevaluated on the posttest 3 months later. Pretest results informed the design of the intervention, which was a 1-day interactive, targeted educational program referred to as the “Skin Care Council Boot Camp.” Paired-samples t tests were conducted to examine differences between pretest and posttest scores on the PZ-PUKT overall and in each test section.
RESULTSSeventy-seven participants enrolled in the project and completed the pretest. Of those, 58 (75.3%) were retained through the intervention and the posttest evaluation. Participants had a mean pretest score of 78.9 and a mean posttest score of 85.3. There were significant mean differences among pretest and posttest PZ-PUKT scores6.4 (t = 9.419, P < .001) overall; 4.6 (t = 5.356, P < .001) in the Prevention/Risk category; 4.1 (t = 3.668, P < .001) in the Staging category; and 10.5 (t = 7.938, P < .001) in the Wound Description category.
CONCLUSIONSBy testing pressure injury knowledge before developing a program, investigators created a tailored, education program that addressed knowledge gaps. Posttest results provided insight into the program’s success and opportunities for future improvement.
Using their personal experience, the authors identify three key components to successfully completing a nursing doctoral program. The first component is asking the right questions to determine the ...doctoral degree best suited for the potential student. The second component is having a strategic plan that includes aspects such as financial considerations (research costs and potential financial support) and the development of a strong support system (specifically study pairs). The third component is the development of a systematic approach to completing the research, writing the dissertation, and completing the oral requirements. Addressing these areas will help students balance the many demands of doctoral study.
OBJECTIVE: To determine the pressure injury knowledge of health professionals before and after providing an interactive, educational intervention. DESIGN AND SETTING: The research design was a ...quasi-experimental study using a nonrandomized pretest/posttest methodology in Manila, Philippines. PATIENTS AND INTERVENTION: The population for this study was healthcare professionals who participated in a 2-day Basic WoundPedia course. There were 57 participants on day 1 and 55 participants on day 2. The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT, version 2), a standardized, validated instrument with 72 items, was used to measure 3 domains: prevention (28 items), staging (20 items), and wounds (24 items). The test was used to determine the baseline pressure injury knowledge of the students on day 1 before the course began and on day 2 after related content was completed. The intent of this approach was to document that knowledge deficits were met, especially for future courses. MAIN RESULTS: There was a statistically significant increase in pressure injury knowledge scores after healthcare professionals received an interactive, educational intervention. CONCLUSIONS: Measuring knowledge before and after educational intervention should be considered to determine whether knowledge deficits are corrected. This methodology reinforced the adult learning theory and to help participants realize their own knowledge deficits. The PZ-PUKT may prove a valuable nonthreatening instrument for adult learners to self-identify, self-learn, and self-correct knowledge according to the best new evidence as it becomes available. These findings documented that this interactive, educational intervention did improve the percentage of correct pressure injury knowledge concepts for this group in all 3 subscales. This study also added support for the newly revised PZ-PUKT.
OBJECTIVETo replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient ...population.
METHODSResearchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression modelʼs ability to predict HPI development.
RESULTSSeven variables were significant and independent predictors associated with HPIsdiabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model.
CONCLUSIONSBeyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.
To develop and validate a method of predicting whether patients will develop a heel pressure ulcer during their hospital stay.
This retrospective case-control study used 2 separate data sets, one for ...an initial analysis followed by a second data set for validation analysis.
From 2009 to 2011, medical records of discharged patients with a DRG code for heel pressure ulcers in our urban, tertiary medical center were retrospectively reviewed. Using age as the matching criterion, we then reviewed cases of patients without heel pressure ulcers. The initial analysis comprised 37 patients with hospital-acquired heel pressure ulcers and 300 without. The validation analysis included 12 patients with heel pressure ulcers and 68 without.
In order to develop this method of identifying patients with heel pressure ulcers, logistic regression modeling was used to select a set of patient characteristics and hospital conditions that, independently and in combination, predicted heel pressure ulcers. Logistic modeling produced adjusted and unadjusted odds ratios for each of the significant predictor variables. The validation analysis was employed to test the predictive accuracy of the final model.
Initial analysis revealed 4 significant and independent predictors for heel pressure ulcer formation during hospitalization: diabetes mellitus, vascular disease, immobility, and an admission Braden Scale score of 18 or less. These findings were also supported in the validation analysis.
Beyond a risk assessment scale, staff should consider other factors that can predispose a patient to heel pressure ulcer development during their hospital stay, such as comorbid conditions (diabetes mellitus and vascular disease) and immobility.
OBJECTIVE:To determine the pressure injury knowledge of health professionals before and after providing an interactive, educational intervention.
DESIGN AND SETTING:The research design was a ...quasi-experimental study using a nonrandomized pretest/posttest methodology in Manila, Philippines.
PATIENTS AND INTERVENTION:The population for this study was healthcare professionals who participated in a 2-day Basic WoundPedia course. There were 57 participants on day 1 and 55 participants on day 2. The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT, version 2), a standardized, validated instrument with 72 items, was used to measure 3 domainsprevention (28 items), staging (20 items), and wounds (24 items). The test was used to determine the baseline pressure injury knowledge of the students on day 1 before the course began and on day 2 after related content was completed. The intent of this approach was to document that knowledge deficits were met, especially for future courses.
MAIN RESULTS:There was a statistically significant increase in pressure injury knowledge scores after healthcare professionals received an interactive, educational intervention.
CONCLUSIONS:Measuring knowledge before and after educational intervention should be considered to determine whether knowledge deficits are corrected. This methodology reinforced the adult learning theory and to help participants realize their own knowledge deficits. The PZ-PUKT may prove a valuable nonthreatening instrument for adult learners to self-identify, self-learn, and self-correct knowledge according to the best new evidence as it becomes available. These findings documented that this interactive, educational intervention did improve the percentage of correct pressure injury knowledge concepts for this group in all 3 subscales. This study also added support for the newly revised PZ-PUKT.
Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin ...assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent.
To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones.
The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education.
This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
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